Mortality from major causes and lifestyles by proportions of public assistance recipients among 47 prefectures in Japan: Ecological panel data analysis from 1999 to 2016.

Objective: Comprehensive investigations of correlations between subnational socioeconomic factors and trends in mortality and lifestyle are important for addressing public health problems. Methods: Forty-seven prefectures in Japan were divided into quartiles based on the proportion of public assistance recipients (PPAR). Age-standardized mortality from all causes, cancer, heart disease, and stroke in each prefecture were averaged for these quartiles in 2000, 2005, 2010, and 2015. Data from the National Health and Nutrition Survey were obtained for the following periods: 1999-2001, 2003-2005, 2007-2009, 2012, and 2016. Body mass index (BMI), intake of total energy, vegetable and salt, step count, and prevalence of current smoking and drinking for individuals aged 40-69 years age range were standardized for each prefecture and averaged by quartile. A two-way analysis of variance was used to assess differences in mortality and lifestyle across different years or periods, and quartiles. Results: Mortality rates decreased, with the first (lowest) quartile showing the lowest rates, across all causes, cancer and heart diseases in both sexes. BMI exhibited an increase in men, whereas, BMI in women and other lifestyle factors in both sexes, excluding smoking and drinking in women, exhibited a decrease. BMI, vegetable and salt intake, total energy intake in men, and smoking in women varied across quartiles. Lower quartiles exhibited lower BMI and smoking prevalence but higher energy, vegetables, and salt intake. Conclusions: PPAR exhibited favorable trends and significant differences in mortality related to all causes, cancer and heart disease across both sexes, along with BMI among women.

Trends in mortality from major causes and lifestyle factors by per capita prefectural income: Ecological panel data analysis from 1995 to 2016 in Japan.

In Japan, trends in mortality and lifestyle have not been fully investigated according to subnational socioeconomic factors. Forty-seven prefectures (subnational units) were divided into quartiles by annual per capita prefectural income. Age-standardized mortality from all causes, cancer, heart disease, and stroke was averaged by quartile in 1995, 2000, 2005, 2010, and 2015. Data from the National Health and Nutrition Survey were obtained for periods 1 (1995-1997), 2 (1999-2001), 3 (2003-2005), 4 (2007-2009), 5 (2012), and 6 (2016). Body mass index (BMI), the intake of vegetables and salt, the number of steps, and the prevalence of current smoking and drinking for the 40-69-year age range were standardized by 10-year age groups in the 2010 Japanese population and were averaged by quartile. Differences in mortality and lifestyle by year and period, and quartile were tested using a two-way analysis of variance. Mortality decreased in both sexes and mortality in men from all causes, cancer, and stroke differed by quartile, with mortality highest in the first (lowest) quartile. BMI in men and smoking prevalence in women increased, whereas remaining lifestyle factors except for the prevalence of drinking decreased in women. BMI and the number of steps in both sexes and current smoking prevalence in women differed by quartile, with lower quartiles showing a higher BMI and fewer step counts. In conclusion, favorable trends and significant differences in mortality from all causes, cancer, and stroke in men and BMI in women were observed by per capita prefectural income level.

Oral function and cumulative long-term care costs among older Japanese adults: a prospective 6-year follow-up study of long care receipt data.

OBJECTIVES: This study evaluated the relationship between status of oral function and related long-term care service costs. DESIGN: This was a prospective 6-year follow-up study of previous survey data. SETTING: The data were obtained from the Japan Gerontological Evaluation Study conducted between 2010 and 2011. PARTICIPANTS: The participants were functionally independent older adults in 12 municipalities across Japan. INTERVENTIONS: Care service benefit costs were tracked over 6 years using publicly available claims records (n=46 616) to monitor respondents' cumulative care costs. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome variable was the cumulative cost of long-term care insurance services during the follow-up period. We adjusted for the presence or absence of oral function problems, age, sex, physical function and socioeconomic and lifestyle background at the time of the baseline survey. RESULTS: Tobit analysis revealed that, compared with those with no oral function problems, cumulative long-term care service benefit costs for those with one, two or three oral function problems were approximately US$4020, US$4775 and US$82 92, respectively, over 6 years. Compared with those with maintained oral function, there was a maximum difference of approximately US$8292 in long-term care service costs for those with oral function problems. With increase in number of oral function problems, there was a concomitant elevation in the cost of long-term care. CONCLUSIONS: Oral function in older people was associated with cumulative long-term care insurance costs. The oral function of older people should be maintained to reduce future accumulated long-term care insurance costs. Compared with those with maintained oral function, there was a maximum difference of approximately US$8292 in long-term care service costs for those with oral function problems. The cost of long-term care was amplified as oral problems increased.

Pre-Operative Four Dimensional Flow Sensitive Magnetic Resonance Imaging Assessment of Aortic Side Branches as a Method to Predict Risk of Type II Endoleak Resulting in Sac Enlargement After EVAR.

OBJECTIVE: To predict sac enlargement with type II endoleak (ELII) before endovascular aneurysm repair (EVAR) using four dimensional flow sensitive magnetic resonance imaging (4D flow MRI). METHODS: A single centre retrospective analysis of prospectively collected data was conducted. Patients with an abdominal aortic aneurysm (AAA) who underwent EVAR between 2013 and 2019 were included. Aortic branches occluded pre-EVAR, and patients with endoleaks other than ELII were excluded. The aortic branch diameter, peak flow velocity (PFVe), and amplitude of the dynamics of flow volume (AFV) were measured in each aortic branch pre-EVAR. Total flow volume per minute (TFV/min), defined as the sum of AFV/min, was calculated in each case. According to computed tomography findings one year post-EVAR, the aortic branches and patients were divided into patent vessel and occluded vessel groups and sac expanding and non-expanding groups. PFVe, AFV/min, and TFV/min were analysed via receiver operating characteristic curve analysis. RESULTS: The patent aortic branches pre-EVAR (69 inferior mesenteric arteries [IMAs]; 249 lumbar arteries [LAs]) of 100 patients were included. Patent IMAs (n = 14) and occluded IMAs (n = 55), patent LAs (n = 23) and occluded LAs (n = 226), and expanding (n = 9) and non-expanding (n = 91) groups were compared, respectively. No statistically significant difference was observed in branch diameters (IMA; patent, 2.5 ± 0.8 mm, occluded, 2.5 ± 0.8 mm, p < .78 and LA; patent, 1.5 ± 0.3 mm, occluded, 1.5 ± 0.4 mm, p < .35). PFVe (IMA; patent, 262.6 mm2/sec, occluded, 183.4 mm2/sec and LA; patent, 142.6 mm2/sec, occluded, 47.7 mm2/sec) and AFV/min (IMA; patent, 8.4 mL, occluded, 5.2 mL and LA; patent, 4.2 mL, occluded, 1.4 mL) were higher in the patent vessel group (p < .050). TFV/min was statistically significantly higher in the expanding group (24.1 mL/min) than in the non-expanding group (7.0 mL/min) (p < .010). CONCLUSION: Pre-EVAR haemodynamic analyses using 4D flow MRI were useful to detect aortic branches responsible for ELII and to predict AAA cases with sac enlargement. This analysis suggests a new strategy for pre-EVAR aortic branch embolisation.

The relationships between social participation before the COVID-19 pandemic and preventive and health-promoting behaviors during the pandemic: the JAGES 2019-2020 longitudinal study.

BACKGROUND: People's preventive behavior is crucial for reducing the infection and transmission of a novel coronavirus, especially in aging societies. Moreover, since behavioral restrictions may lead to high risks of secondary health impacts among older people, health-promoting behaviors, including proper nutrition intake and regular exercise, should also be encouraged. Although various studies have reported the positive association between social participation and health among older people, whether their social participation relates to preventive and health-promoting behaviors during the COVID-19 pandemic was uncertain. This study examined the relationships between social participation before the COVID-19 pandemic and preventive and health-promoting behaviors during the pandemic among older people in Japan. METHODS: We obtained longitudinal data from the Japan Gerontological Evaluation Study (JAGES), which conducted baseline and follow-up surveys from November 2019 to January 2020 (pre-pandemic) and from November 2020 to February 2021 (during the pandemic) in ten municipalities. In total, 10,523 responses were analyzed. Preventive and health-promoting behaviors were measured by nine actions (e.g., wash/disinfect hands, wear masks, do exercise), and the total of these actions was divided into two (highly implemented ≥7 or not highly implemented <7). Social participation was assessed by nine activities (e.g., participating in volunteering, sports clubs, had paid work). Adjusted for covariates, we examined the relationships between each social participation and preventive and health-promoting behavior by the logistic regression analysis or the Poisson regression analysis. RESULTS: Older people who participated in social activities pre-pandemic showed a tendency to implement preventive and health-promoting behaviors during the pandemic. Especially, participations in "sports" and "Kayoi-no-ba" were positively related to "do exercise." Only "had paid work" was negatively related to highly implemented preventive and health-promoting behaviors. CONCLUSIONS: There were the positive relationships between social participation and preventive and health-promoting behavior. This study also indicated that older people who did not participate in social activities or had paid work before the COVID-19 pandemic may have higher risks of infection and secondary health impacts. Taking into account such old people's lifestyles as well as their workplace conditions, promoting appropriate behaviors need to be considered.

Frequency of Change in Assessment from Bony Union to Nonunion after Lumbar Interbody Fusion: A Multicenter Study.

INTRODUCTION: Assessments of early postoperative bony union after posterior lumbar interbody fusion via computed tomography (CT) have revealed cases in which interbody fixation by bony union resulted in nonfusion due to bone absorption. The apparent bone union state reverted to a nonunion state several months later, exhibiting a so-called "fake union" phenomenon. Additionally, few reports have evaluated the effect of teriparatide on bony union. The present study aimed to evaluate the frequency of change in assessment from fusion to nonfusion in the postoperative follow-up of lumbar interbody fusion, compare the late postoperative bony union rates in groups with or without early postoperative fusion, and examine the effect of postoperative teriparatide in those groups. METHODS: Sixty-nine subjects enrolled from multiple hospitals were prospectively evaluated following single-level lumbar interbody fusion. The patients were randomly allocated into treatment with or without weekly postoperative teriparatide. The subjects were then classified as having bony union or nonfusion at 2 months postoperatively, and fusion rates at 6 months were compared. For the evaluation of bony union, blinded radiological examinations were performed via CT. Additional comparisons were made according to teriparatide use. RESULTS: The rate of nonunion at 6 months postoperatively in patients with fusion at 2 months postoperatively was 27.8%. Among subjects with bony union at 2 months postoperatively, the fusion rate at 6 months in those who received teriparatide was 93.3% (p=0.027) versus 57.1% in those who did not. CONCLUSIONS: The rate of nonunion at 6 months postoperatively in patients exhibiting union at 2 months after surgery was 27.8%. Postoperative weekly teriparatide treatment significantly reduced the rate of fake union.

Spatial statistical analysis of regional disparities in suicide among policy units in Japan: Using the Bayesian hierarchical model.

Suicide prevention is a crucial policy issue in Japan to be addressed nationally. Nevertheless, if there are regional differences in suicide, even in adjacent sub-regions, measures may need to be taken at the sub-regional level. Previous studies have not compared regional differences in suicide based on the size of policy units, such as prefectures, secondary medical areas, and municipalities. This study used the number of suicides from open data for 10 years from 2009 to 2018 to obtain shrinkage estimates of the standardized mortality ratio (SMR) using the Bayesian hierarchical model. We visualized and compared the regional disparities in suicide for each policy unit. For each gender and policy unit, adjacent regions had similar clusters of SMRs and positive spatial autocorrelation of global Moran's I (p < 0.001 for each). Comparisons between each policy unit showed that even if the SMR was low for the prefectural units, there were regions with high SMRs in municipalities and secondary medical areas, and vice versa. It was found that assessing suicide solely on a prefecture-by-prefecture basis may overlook regional disparities in suicide. This research emphasizes the need to establish suicide indicators at the secondary medical or municipal level and execute individual suicide prevention interventions in neighboring communities. Prefectures can also play a role in developing collaborative cooperation between neighboring regions by acting as actors.

[Does participation in community gatherings suppress aggravation of functional decline risk among older people? A study based on 2013-2016 data from the Japan Gerontological Evaluation Study].

Objective　Through the amendment of the Long-Term Care Insurance Law in 2014, Japan's Ministry of Health, Labour and Welfare established a general long-term care and prevention project centered on "Kayoinoba" to promote participation in social and physical activities for older people, which included environmental approaches for individual health and well-being through community-building. However, reports show that the effectiveness of long-term care and prevention in Kayoinoba across multiple municipalities is limited. The purpose of this study was to verify the effect of participation in Kayoinoba in reducing the risk of functional decline among older people, using data from 24 municipalities of 10 prefectures nationwide.Methods　This study examined self-administered mail survey data from the Japan Gerontological Evaluation Study. The participants were older people aged ≥65 years who lived in 24 municipalities of 10 prefectures, in 2013 and 2016. The dependent variable was an increase in total score of ≥5 points on a risk assessment scale predicting incident functional disability ("incident functional disability risk score")(Tsuji et al., 2018), and the explanatory variable was existence of participation in a Kayoinoba program. Nine variables were used as the covariates: educational attainment, equivalent income, depression, smoking, drinking, instrumental activities of daily living, incident functional disability risk score in 2013 (including sex and age), living status (whether the person lived alone), and employment status in 2013. We conducted Poisson regression analysis with stratification of the participants into two groups according to age: young older people and old older people. Sensitivity analysis of the possible increase of ≥3 or 7 points in the incident functional disability risk score was also conducted.Results　Of the 3,760 participants in the study, 472 (316 young older people and 156 old older people)[12.6% (11.8%, 14.5%)] participated in Kayoinoba. Compared with those who did not participate in Kayoinoba, the incidence rate ratio (IRR) of increase in risk assessment score was 0.88 (95% confidence interval: 0.65-1.18) for all who did participate, 1.13 (0.80-1.60) in the young older people and 0.54 (0.30-0.96) in the old older people, and was significant in the latter. In addition, similar results were obtained in the sensitivity analysis with the dependent variable as an increase in total score of ≥3 or 7 points on the risk assessment scale predicting incident functional disability.Conclusions　Compared with those who did not participate in Kayoinoba, functional decline risk was suppressed in those who did participate. The IRR was suppressed 46% in old older people. Promoting participation in Kayoinoba may effectively prevent the need for long-term care in old older people.

[Accumulated long-term care benefits by risk assessment scales for incident functional disability: A six-year follow-up study of long-term care receipt data].

Objectives　This study aims to evaluate the differences in the cumulative benefit costs of public long-term care [LTC] insurance services, using a risk assessment scale score, which predicts incident functional disability among older people.Methods　A baseline survey was conducted in 2010 involving individuals aged 65 and above from 12 municipalities in Japan who were not eligible for public LTC insurance benefits (response rate: 64.7%). Using public LTC claim records, we followed LTC service costs among 46,616 individuals over a period of about six years (up to 76 months). We used risk assessment scales to assess incident functional disability (0-48). We adopted a classical linear regression model, Tobit regression model, and linear regression with multiple imputation for missing values.Results　Overall, 7,348 (15.8%) of the participants had used LTC services during the follow-up period. The risk assessment score for incident functional disability was positively associated with the cumulative costs of LTC services per person, length of usage period of LTC services, and proportion of people certified for long-term care/support need and for over long-term care level 2. After adjusting for confounding variables, the six-year cumulative costs of LTC services were around JPY 31.6 thousand higher per point of risk score (95% confidence interval [CI]: 28.3 to 35.0). The costs were around JPY 8.9 thousand (95%CI: 6.5 to 11.3)higher in the low score group (risk score ≤ 16), and JPY 75.3 thousand (95%CI: 67.4 to 83.1) higher in the high score group (risk score ≥ 17). When we adopted other estimated models, the major results and trends were not largely different.Conclusions　In this study, the risk assessment scale score could estimate subsequent LTC benefit costs. Community interventions to improve and maintain variable aspects of risk assessment scores may help contribute to a reduction in public LTC benefits within municipalities.

Physical Activity and Cumulative Long-Term Care Cost among Older Japanese Adults: A Prospective Study in JAGES.

This study aimed to determine the impact of physical activity on the cumulative cost of long-term care insurance (LTCI) services in a cohort of community-dwelling people (65 years and older) in Japan. Using cohort data from the Japan Gerontological Evaluation Study (JAGES) on those who were functionally independent as of 2010/11, we examined differences in the cumulative cost of LTCI services by physical activity. We followed 38,875 participants with LTCI service costs for 59 months. Physical activity was assessed by the frequency of going out and time spent walking. We adopted a generalized linear model with gamma distribution and log-link function, and a classical linear regression with multiple imputation. The cumulative LTCI costs significantly decreased with the frequency of going out and the time spent walking after adjustment for baseline covariates. LTCI's cumulative cost for those who went out once a week or less was USD 600 higher than those who went out almost daily. Furthermore, costs for those who walked for less than 30 min were USD 900 higher than those who walked for more than 60 min. Physical activity among older individuals can reduce LTCI costs, which could provide a rationale for expenditure intervention programs that promote physical activity.

Differences in Cumulative Long-Term Care Costs by Community Activities and Employment: A Prospective Follow-Up Study of Older Japanese Adults.

We evaluated differences in the cumulative benefit costs of public long-term care (LTC) insurance services by employment status and frequency of community activities. A baseline survey was conducted on functionally independent older people from 12 municipalities as a nationwide survey from 2010 to 2011. Employment status was dichotomized, and community activity was assessed based on the frequency of participation in hobbies, sports clubs, or volunteering. We followed the respondents' LTC service costs over a period of 6 years using public LTC claim records (n = 46,616). We adopted a classical linear regression analysis and an inverse probability weighting estimation with multiple imputation for missing values. Compared with non-participation in each community activity, the cumulative LTC costs among individuals who participated in hobbies or sports group activities at least twice a week were 1.23 (95% confidence interval: 0.73-1.72) to 1.18 (0.68-1.67) thousand USD lower per person over the 6-year period (28.7% to 30.1% lower, respectively). Similarly, the costs for employed persons were 0.55 (0.20-0.90) to 0.64 (0.29-0.99) thousand USD per person lower than among retirees (14.5% to 16.9% lower). Promoting employment opportunities and frequent participation in community activities among older adults may help reduce future LTC costs by around 20% as a result of extending healthy longevity.

Comparison of frailty associated factors between older adult patients with rheumatoid arthritis and community dwellers.

PURPOSE: To determine whether frailty associated factors differ between community dwellers and older adult patients with rheumatoid arthritis (RA). METHODS: We used the cross-sectional data for patients with RA from the RA epidemiological quality-of-life study (n = 210, mean age 71.8 ± 3.7 years) and community dwellers from the Japan Gerontological Evaluation Study (n = 53,255, mean age 71.7 ± 4.0 years). Frailty status was assessed using the Kihon Checklist (KCL), and the primary outcome was frailty (KCL score ≥8 points). Information on predictor variables, including age, sex, marital status, educational level, body mass index (BMI), drinking and smoking status and social participation were obtained from a standardized questionnaire. We employed Poisson regression to calculate the prevalence ratio (PR) of frailty according to its predictors. RESULTS: We found frailty in 37.6% of the patients with RA and 15.7% of the community dwellers. In the multivariate models, BMI and social participation were independently associated with frailty in patients with RA (BMI <18.5: PR, 1.62; 95% confidence interval [CI] 1.09-2.41. BMI ≥25.0: PR, 1.81; 95% CI 1.20-2.71. Active social participation: PR, 0.61; 95% CI 0.42-0.87) and community dwellers (BMI <18.5: PR, 1.77; 95% CI 1.67-1.88. BMI ≥25.0: PR, 1.27; 95% CI 1.22-1.33. Active social participation: PR, 0.46; 95% CI 0.44-0.48). All other predictors were significantly associated with frailty in the community dwellers. CONCLUSION: Maintaining appropriate body weight and participating in social activities are important for preventing frailty in patients with RA as well as community dwellers.

Association between the 25-question Geriatric Locomotive Function Scale score and the incidence of certified need of care in the long-term care insurance system: The TOEI study.

BACKGROUND: The Geriatric Locomotive Function Scale is a screening tool to identify the risk of locomotive syndrome in the elderly. We aimed to clarify the association of Geriatric Locomotive Function Scale scores with the incidence of certified need of care in the long-term care insurance system in a prospective longitudinal observational study (the TOEI Study). METHODS: Participants were individuals aged ≥50 years from a mountainous area who had undergone medical check-ups by the National Health Insurance in Toei. The Geriatric Locomotive Function Scale questionnaire, physical performance tests, and radiographs were completed by participants. The primary endpoint was the incidence of certified need of care in the long-term care insurance system. The secondary endpoint was the incidence of either one of the following events: certified need of care or death. RESULTS: We enrolled 681 subjects (271 men and 410 women). The mean age was 72.9 (range, 50-92) years. The incidences of certified need of care and either one of the two events were 104 and 130, respectively, during the average 4.9-year follow-up. The cumulative incidence rates of certified need of care by groups of the Geriatric Locomotive Function Scale, namely, Group 0 (score 0-6), Group 1 (score 7-15), and Group 2 (score 16-) were 7.5%, 14%, and 35%, respectively. The cumulative incidence rates of either one of the two events by group were 11%, 18%, and 39%, respectively. There was a significant association between higher Geriatric Locomotive Function Scale scores and survival rates (not achieved at each endpoint) for the primary and secondary endpoints. CONCLUSIONS: Higher Geriatric Locomotive Function Scale score was associated with greater incidence of certified need of care in the long-term care insurance system as well as either one of the two aforementioned events. This scale might enable prediction of prognosis among elderly patients.

Associations Between Healthcare Resources and Healthy Life Expectancy: A Descriptive Study across Secondary Medical Areas in Japan.

Japan has the highest life expectancy in the world. However, this does not guarantee an improved quality of life. There is a gap between life expectancy and healthy life expectancy. This study aimed to reveal the features of healthy life expectancy across all secondary medical areas (n = 344) in Japan and examine the relationship among healthcare resources, life expectancy, and healthy life expectancy at birth. Data were collected from Japan's population registry and long-term insurance records. Differences in healthy life expectancy by gender were calculated using the Sullivan method. Maps of healthy life expectancy were drawn up. Descriptive statistics and correlation analysis were used for analysis. The findings revealed significant regional disparities. The number of doctors and therapists, support clinics for home healthcare facilities and home-visit treatments, and dentistry expenditure per capita were positively correlated with life expectancy and healthy life expectancy (correlation coefficients > 0.2). They also revealed gender differences. Despite controlling for population density, inequalities in healthy life expectancy were observed, highlighting the need to promote social policies to reduce regional disparities. Japanese policymakers should consider optimal levels of health resources to improve life expectancy and healthy life expectancy. The geographical distribution of healthcare resources should also be reconstituted.

Does the Association between Guardians' Sense of Coherence and their Children's Untreated Caries Differ According to Socioeconomic Status?

Untreated caries is the most prevalent disease in the world. A sense of coherence (SOC) is believed to contribute to oral health. We aimed to clarify the association between guardians' SOC and their children's caries based on socioeconomic status (SES) in Japan. This study's subjects were Japanese public junior high schoolers (N = 1730), aged 12-15, and their guardians in Kosai City. We administered a questionnaire survey among guardians in 2016 to assess their SOC and family environment. With their students' consent, public junior high schools shared the results of the dental examinations that were part of their school physicals. Multivariate logistic regression was conducted to clarify the association between guardians' SOC and their children's untreated decayed permanent teeth. We also conducted a stratified analysis according to a relative poverty line. We observed in the multivariate regression a significant inverse association between children's untreated decay and their guardians' SOC (OR 0.93, 95%CI 0.87-1.00). The association of SOC was stronger in the low economic group (OR 0.64, 95%CI 0.43-0.95). Guardians with higher SOC were associated with children having fewer caries. Guardians' SOC is a factor for the prevalence of caries and access to dental care, especially among children with low economic status.

Social participation and the combination of future needs for long-term care and mortality among older Japanese people: a prospective cohort study from the Aichi Gerontological Evaluation Study (AGES).

OBJECTIVES: Our study aimed to examine the longitudinal association between social participation and both mortality and the need for long-term care (LTC) simultaneously. DESIGN: A prospective cohort study with 9.4 years of follow-up. SETTING: Six Japanese municipalities. PARTICIPANTS: The participants were 15 313 people who did not qualify to receive LTC insurance at a baseline based on the data from the Aichi Gerontological Evaluation Study (AGES, 2003-2013). They received a questionnaire to measure social participation and other potential confounders. Social participation was defined as participating in at least one organisation from eight categories. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcomes were classified into three categories at the end of the 9.4 years observational period: living without the need for LTC, living with the need for LTC and death. We estimated the adjusted OR (AOR) using multinomial logistic regression analyses with adjustment for possible confounders. RESULTS: The primary analysis included 9741 participants. Multinomial logistic regression analysis revealed that social participation was associated with a significantly lower risk of the need for LTC (AOR 0.82, 95% CI 0.69 to 0.97) or death (AOR 0.78, 95% CI 0.70 to 0.88). CONCLUSIONS: Social participation may be associated with a decreased risk of the need for LTC and mortality among elderly patients.

Correlations between Forgetfulness and Social Participation: Community Diagnosing Indicators.

We analyzed the relationships between forgetfulness and social participation, social contact, and social support by municipality to develop community diagnosing indicators. The analysis subjects included 105 municipalities that agreed to provide data for the 2013 Survey of Needs in Spheres of Daily Life in Japan (n = 338,659 people). Forgetfulness as a risk factor for dementia was used as the dependent variable. The variables of social environment factors were (1) social participation, (2) social contact, and (3) social support. The ratio of people responding that they experienced forgetfulness differed among municipalities, with a mean of 19.0% (7.1-35.6%). Higher levels of social participation, social contact, and social support were associated with lower levels of forgetfulness, even after adjusting for age and regional variables. The results of the present study suggest that it is appropriate to use forgetfulness and social participation at least a few times a year in any social activity as community diagnosing indicators. Municipalities could encourage their inhabitants to participate by developing and providing engaging social activities.

[Association between time-appropriate vaccinations in early childhood and individual and community-level factors in Japan].

Objective　Recently, in Japan, the compulsory vaccinations administered during early childhood have been becoming increasingly varied. As a result, the vaccination schedule has become complicated. In this study, we aimed to identify the association of time-appropriate vaccination during early childhood (dependent variable) with individual-level factors including socioeconomic status and having a family doctor. We also studied the association of time-appropriate vaccination with community-level factors including the number of pediatricians in a community.Methods　Multilevel logistic regression models were used for analysis. Time-appropriate BCG, DPT, and measles vaccinations were the dependent variables. Individual-level data were obtained through a survey of parents of 18-month-old children as part of the final evaluation of "Healthy Parents and Children 21"; community-level data were obtained through a survey of municipalities as part of the aforementioned final evaluation as well as through a national survey. There were 23,583 parents in 430 municipalities who were eligible for analysis.Results　Time-appropriate vaccination of infants was carried out by 88.3% of parents. The results of the multilevel logistic regression showed that time-appropriate vaccination was significantly lower for those who did not have a family doctor (adjusted odds ratio [AOR], 0.45; 95% confidence interval [CI], 0.36-0.55), the fourth or later birth order (0.23; 0.19-0.28), mothers aged less than 19 years at childbirth (0.17; 0.13-0.24), full-time working mothers (0.52; 0.47-0.58), and those under very difficult economic conditions (0.66; 0.57-0.77). Among community-level factors, only use of vaccination data by a municipality had a significantly negative association with the dependent variable.Conclusion　Not having a family doctor, the mother's young age, late birth order, poor economic status, and full-time working mothers were risk factors associated with delayed vaccinations. It is necessary to improve environments that promote infants having a family doctor as well as to promote special approaches toward families at risk for delayed vaccinations.