"What Did You Do in the War, Daddy?": Paternal Military Conscription During WWII, Economic Hardship and Family Violence in Childhood, and Health in Late Life in Japan.

Childhood adversity is a risk factor for poor health in late life and includes economic hardship and family violence, whose prevalence is high among offspring of military conscripted father. We assessed the association between paternal military conscription (PMC) and paternal war death (PWD) during Second World War and self-rated health (SRH) among older adults in Japan. Data were obtained from a population-based cohort of functionally independent people aged 65 years or older from 39 municipalities across Japan in 2016. Information on PMC and SRH was obtained through a self-report questionnaire. A total of 20,286 participants were analyzed with multivariate logistic regression to investigate the association between PMC, PWD, and poor health. Causal mediation analysis was performed to see whether childhood economic hardship and family violence mediated the association. Among participants, 19.7% reported PMC (including 3.3% PWD). In the age- and sex-adjusted model, older people with PMC showed higher risk of poor health (odds ratio [OR]: 1.16, 95% confidence interval [CI] [1.06, 1.28]), while those with PWD were not associated (OR: 0.96, 95% CI [0.77, 1.20]). Causal mediation showed a mediation effect of childhood family violence exposure on the association between PMC and poor health (proportion mediated: 6.9%). Economic hardship did not mediate the association. PMC, but not PWD, increased the risk of poor health in older age, which was partially explained by the exposure to family violence in childhood. There appears to be a transgenerational health impact of war which continues to affect the health of offspring as they age.

Association of Nursery School-Level Promotion of Vegetable Eating with Caregiver-Reported Vegetable Consumption Behaviours among Preschool Children: A Multilevel Analysis of Japanese Children.

Nursery schools can play an important role in children developing healthy eating behaviours, including vegetable consumption. However, the effect of school-level vegetable promotion on vegetable consumption and body mass index (BMI) remains unclear. This study examined the associations of nursery school-level promotion of eating vegetables first at meals with Japanese children's vegetable consumption behaviours and BMI. We used cross-sectional data collected in 2015, 2016, and 2017 on 7402 children in classes of 3-5-year-olds in all 133 licensed nursery schools in Adachi, Tokyo, Japan. Caregivers were surveyed on their children's eating behaviours (frequency of eating vegetables, willingness to eat vegetables and number of kinds of vegetables eaten), height and weight. Nursery school-level promotion of eating vegetables first at meals was assessed using individual responses, with the percentage of caregivers reporting that their children ate vegetables first at meals as a proxy for the school-level penetration of the promotion of vegetable eating. Multilevel analyses were conducted to investigate the associations of school-level vegetable-eating promotion with vegetable consumption behaviours and BMI. Children in schools that were 1 interquartile range higher on vegetable promotion ate vegetable dishes more often (ß = 0.04; 95% CI: 0.004-0.07), and were more often willing to eat vegetables (adjusted odds ratio = 1.17; 95% CI: 1.07-1.28), as well as to eat more kinds of vegetables (adjusted odds ratio = 1.19 times; 95% CI: 1.06-1.34). School-level vegetable-eating promotion was not associated with BMI. The school-level health strategy of eating vegetables first may be effective in increasing children's vegetable intake but not in preventing being overweight.

Social participation patterns and the incidence of functional disability: The Japan Gerontological Evaluation Study.

AIM: To examine whether patterns of social participation vary in their associations with functional disability. METHODS: Data from 44 978 participants (22 750 men and 22 228 women) who participated in the 2010 Japan Gerontological Evaluation Study were analyzed; a study of those aged ≥65 years from 23 municipalities in eight prefectures. Social participation information was obtained at baseline with an eight-item questionnaire. Incidence of functional disability from 2010 to 2013 was defined as a new certification of eligibility for municipal public long-term care insurance. Social participation patterns were analyzed using exploratory factor analysis and participants were classified into quartiles of factor scores of social participation patterns. A competing risk model was used to calculate the hazard ratios and 95% confidence intervals for the incidence of functional disability in 3 years of follow-up. RESULTS: Two social patterns were identified: sports groups/clubs and hobby groups, and political groups/organizations and industry/trade associations. For both patterns, compared with participants in the lowest quartile, participants in the highest quartile were more likely to be male, college educated, high-income and current drinkers. Both patterns were associated with reduced incidence of functional disability (adjusted hazard ratios for top quartile of sports and hobby pattern: 0.66, 95% confidence interval: 0.59, 0.74; for political and industry/trade pattern: 0.81, 95% confidence interval: 0.72, 0.90; P for trend <0.001 for both). CONCLUSIONS: Those whose social participation patterns were characterized by frequent participation in sports groups/clubs and hobby groups or political groups/organizations and industry/trade associations were less likely to develop a functional disability. Geriatr Gerontol Int 2020; 20: 765-772.

Gender Difference in the Association Between Subjective Socioeconomic Mobility Across Life Course and Mortality at Older Ages: Results From the JAGES Longitudinal Study.

BACKGROUND: Socioeconomic mobility affects health throughout the life course. However, it is not known whether there are gender differences in the association between life-course subjective socioeconomic status (SSS) mobility and mortality at older ages. METHODS: Participants were 16,690 community-dwelling adults aged 65-100 years in the Japan Gerontological Evaluation Study (JAGES). Baseline information including demographic characteristics, depression, and lifestyle factors were collected in 2010. Participants' vital status was confirmed in 2013 via linkage to death records. We categorized life-course socioeconomic mobility into the following categories: 'persistently high', 'downward mobility', 'upward mobility', and 'persistently low'. Cox proportional hazard modeling was used to estimate hazard ratios (HR) for all-cause mortality. RESULTS: Mortality HRs for the 'downward' group were 1.37 (95% confidence interval [CI], 1.08-1.74) among men and 1.27 (95% CI, 0.94-1.71) among women in comparison with the 'persistently high' group. Compared to the 'persistently low' group, the HRs for the 'upward' group were 0.54 (95% CI, 0.35-0.83) among women and 0.91 (95% CI, 0.73-1.24) among men. Associations were not changed after adjusting for objective socioeconomic status but were attenuated by depression. CONCLUSIONS: 'Downward' mobility was associated with mortality among men, but not among women. Depression appeared to mediate the association. A protective effect of upward mobility was observed among women but not among men.

Association between Food Store Availability and the Incidence of Functional Disability among Community-Dwelling Older Adults: Results from the Japanese Gerontological Evaluation Cohort Study.

This study sought to clarify the association between food store availability and the incidence of disability in older adults. This study utilized a population-based cohort study of independent Japanese adults aged ≥65 years, which was a 6 year follow-up of participants in the Japan Gerontological Evaluation Study. A total of 31,273 respondents were extracted. Food store availability was evaluated based on the existence of food stores within 500/1000 m of the home. We utilized participant-reported subjective measurement as well as geographic information system-based objective measurement for the evaluation. The incidence of disability was determined using municipal data on eligibility for long-term care insurance benefits. There were 7643 (24.4%) community-dwelling participants with low subjective food store availability and 5673 (18.1%) with low objective food store availability. During the follow-up period of 6 years, the cumulative incidence of disability was 20.9%, with a significant association between low subjective food store availability and increased disability. Participants who reported low subjective food store availability had a significantly higher likelihood of developing disability (hazard ratio = 1.18, 95% confidence interval: 1.11-1.25) than those who reported high subjective food store availability after adjusting for age, sex, sociodemographic status, environmental status, walking and going out, dietary food intake, body mass index, and comorbidities. Low subjective food store availability was associated with early onset of disability. Accessibility of food stores might contribute to maintaining a disability-free life.

Socioeconomic status and improvement in functional ability among older adults in Japan: a longitudinal study.

BACKGROUND: Recovery from functionally disabled status is an important target of public health measures for older adults. This study aimed to examine socioeconomic inequalities in the improvement of functional ability among older adults stratified by the level of disability at baseline. METHODS: In the Japan Gerontological Evaluation Study, we conducted a mail survey of community-dwelling older adults (1937 men and 2212 women) who developed functional impairment during 2010-2014. The survey data were individually linked to the longitudinal records of changes in the levels of functional disability based on the Public Long-Term Care Insurance System. RESULTS: The mean (standard deviation) follow-up period was 316 (269) days. During follow-up, 811 participants (19.5%) showed improved functional ability. Among those with severe disabilities at baseline, men with 13 or more years of education were more likely to improve functional ability than men with 9 or fewer years of education (hazard ratio: 1.97, 95% confidence interval: 1.12-3.45). A similar association was observed among women (hazard ratio: 2.16, 95% confidence interval: 1.03-4.53). Neither income nor occupation was statistically associated with improved functional ability. CONCLUSIONS: There are education-related inequalities in the improvement of functional ability, especially among older adults with severe disabilities. Health policy makers and practitioners should consider the educational background of individuals with reduced functionality in formulating strategies to improve their functional ability.

Socioeconomic Disparity in the Prevalence of Objectively Evaluated Diabetes Among Older Japanese Adults: JAGES Cross-Sectional Data in 2010.

BACKGROUND: Studies on sex-specific socioeconomic gradients in objectively evaluated diabetes among older adults are scarce. METHODS: We used cross-sectional data of 9,893 adults aged 65 years and older in Aichi Prefecture without long-term care insurance from the Japan Gerontological Evaluation Study (JAGES) in 2010 (Response rate: 66.3%). We collected demographic, socioeconomic (income, years of education, and longest occupation) and behavioral information using a mail-in self-reported survey. Blood samples for the objectively evaluated diabetes and self-reported medical history were collected at annual municipal health checkups. Poisson regression analysis stratified by sex with multiple imputations was conducted to calculate prevalence ratio and 95% confidence interval. RESULTS: A clear income gradient in diabetes prevalence was observed among women, from 11.7% in the lowest income quartile (Q1) to 7.8% in the highest (Q4). Among men, the findings were 17.6% in Q1 to 15.1% in Q4. The prevalence ratios for diabetes with incomes Q1 to Q4 were 1.43 (95% confidence interval [CI], 1.07-1.90) for women and 1.16 (95% CI, 0.90-1.50) for men after adjusting for age and other socioeconomic factors. Even after adjusting for marital status, body mass index, other metabolic risk factors, and lifestyle factors, the income-based gradient remained among women. Education and occupation were not significantly associated with diabetes in the study population. CONCLUSIONS: Only women showed an income-based gradient in diabetes. Monitoring income gradient in diabetes is important in public health actions, even in older populations. Future longitudinal and intervention studies should evaluate the causal link of income to diabetes onset, determine the mechanisms of the potential sex differences in the income/diabetes association, and identify ways to mitigate the income-based inequality.

Long-term Impact of Childhood Disadvantage on Late-Life Functional Decline Among Older Japanese: Results From the JAGES Prospective Cohort Study.

Background: Increasing evidence suggests an impact of childhood disadvantage on late-life functional impairment in Western countries. However, the processes by which childhood disadvantage affects functional capacity are influenced by several factors unique to particular societies. We examined the impact of childhood disadvantage on functional decline among older Japanese, using a large-scale prospective cohort study. Methods: Data came from surveys conducted in 2010 and 2013 as part of the Japan Gerontological Evaluation Study (JAGES), a nationwide cohort study targeting community-dwelling people aged 65 years and over. Childhood disadvantage included subjective childhood socioeconomic status (SES), body height, and educational level. The sample was stratified by age at baseline (65-69, 70-74, 75-79, and ≥ 80 years). Results: A total of 11,601 respondents were analyzed. In the 65-69-year group, lower childhood SES was associated with functional decline but this association was mediated by adult SES. In contrast, childhood SES was independently associated with functional decline in the older cohort. In the 75-79-year group, lower childhood SES was associated with functional decline. However, in the ≥ 80-year group, people with higher childhood SES were more likely to experience functional decline. Shorter height was associated with functional decline in the 70-74-year group. Higher education was related to functional decline in all age groups except the ≥ 80-year group. Conclusions: These findings suggest that childhood disadvantage affects functional decline but its effect varies by age cohort. The mechanisms underlying the association between childhood disadvantage and functional decline may be influenced by social and historical context.

Community Social Capital, Built Environment, and Income-Based Inequality in Depressive Symptoms Among Older People in Japan: An Ecological Study From the JAGES Project.

BACKGROUND: Although reducing socioeconomic inequalities in depression is necessary, their associated factors have rarely been studied. This study aimed to screen the potential contextual factors associated with income-based inequality in older adults' depression. METHODS: Using data from the Japan Gerontological Evaluation Study (JAGES) of 2013, we conducted an ecological study covering 77 communities in Japan. Our measures of socioeconomic inequalities in depression were the slope index of inequalities (SII) and the relative index of inequalities (RII) of the prevalence of depressive symptoms across three income levels. We categorized available community-level factors, including socio-demographic factors, social participation, social relationships, subjective changes in the residential area, and the built environment. These indicators were aggregated from individual responses of 51,962 and 52,958 physically independent men and women, respectively, aged 65 years or more. We performed multiple linear regression analyses to explore factors with statistical significance of a two-tailed P-value less than 0.05. RESULTS: Factors associated with shallower gradients in depression for men included higher participation in local activities and reception or provision of social support, which did not show significant association among women. Perceived increases in unemployment and economic inequalities were positively associated with larger inequalities in both genders (P < 0.05). The built environment did not indicate any significant association. CONCLUSIONS: A community environment fostering social activities and relationships might be associated with smaller income-based inequalities in depression. There is a need for more deterministic studies for planning of effective community interventions to address socioeconomic inequalities in depression.

Adverse Childhood Experiences and Higher-Level Functional Limitations Among Older Japanese People: Results From the JAGES Study.

Background: A life-course perspective is essential in understanding the determinants of higher-level functional limitations. We examine the impact of adverse childhood experiences (ACEs) on higher-level functional limitations in older people. Methods: Data were from the Japan Gerontological Evaluation Study 2013, a population-based cohort of independent people aged 65 years or older across Japan (n = 19,220). ACEs before the age of 18 were assessed in terms of seven adversities: parental death, parental divorce, parental mental illness, family violence, physical abuse, psychological neglect, and psychological abuse. Associations between the cumulative number of ACEs and higher-level functional limitations were investigated by multivariate Poisson regression with robust error variances, adjusted for age, gender, childhood disadvantage, adult sociodemographics, adult health behaviors, and health status. Results: Of the older people, 36.3% reported at least one ACE. Older people who had experienced two or more ACEs showed significantly greater higher-level functional limitations than those with no ACE in a crude model (prevalence ratio, PR = 1.61, 95% confidence interval, CI = 1.51-1.71). After adjusting the covariates, this association remained (PR = 1.19, 95% CI = 1.12-1.27). Conclusions: ACEs showed robust independent effects on higher-level functional limitations among older Japanese without disabilities, even after adjusting for potential covariates in childhood and adulthood. The current findings may help in understanding the impact of the latent effects of ACEs on functional limitations in older people.

Childhood socioeconomic disadvantage is associated with lower mortality in older Japanese men: the JAGES cohort study.

BACKGROUND: Childhood socioeconomic disadvantage has been previously linked to increased mortality risk in adulthood. However, most previous studies have focused on middle-aged adults in Western contexts. Here, we sought to examine the association between childhood socioeconomic status (SES) and mortality among healthy older Japanese adults. METHODS: We conducted a 3-year follow-up of participants in the Japan Gerontological Evaluation Study (JAGES), a population-based cohort of 65- to 103-year-old Japanese adults. Childhood SES was assessed by survey at baseline. Mortality from 2010 to 2013 was analysed for 15 449 respondents (7143 men and 8306 women). Cox regression models were used to estimate hazard ratios (HR) for risk of death. RESULTS: A total of 754 deaths occurred during the 3-year follow-up. Lower childhood SES was significantly associated with lower mortality in men, but not in women. Compared with men growing up in more advantaged childhood socioeconomic circumstances, the age-adjusted HR for men from low childhood SES backgrounds was 0.75 [95% confidence interval (CI): 0.56-1.00]. The association remained significant after adjustment for height, education, adult SES, municipalities of residence, health behaviours, disease status and current social relationships (HR = 0.64; 95% CI 0.47-0.87). This association was stronger among men aged 75 years or older, HR = 0.67 (95% CI: 0.47-0.95), compared with men aged 65-74 years, HR = 0.90 (95% CI: 0.54-1.51). CONCLUSIONS: Childhood socioeconomic disadvantage is associated with lower mortality among men aged 75 years or older, which may be due to selective survival, or alternatively to childhood physical training or postwar calorie restriction in this generation of Japanese males.

Eating alone and depression in older men and women by cohabitation status: The JAGES longitudinal survey.

BACKGROUND: Eating by oneself may be a risk factor for mental illness among older adults, but may be influenced by cohabitation status. We examined the association between eating alone and depression in the context of cohabitation status in older adults in Japan. DESIGN: A longitudinal, population-based study. SETTING: Data from the Japan Gerontological Evaluation Study. SUBJECTS: We analysed 17,612 men and 19,581 women aged ≥65 without depression (Geriatric Depression Scale <5) at baseline in 2010. METHODS: Eating status was classified into two categories: eating with others and eating alone. The risk of depression onset by 2013 was estimated using Poisson regression. RESULTS: After adjusting for socioeconomic status, physical health, nutritional status, social support, social participation, frequency of meet friends, employment status and marital status, the adjusted rate ratio (ARR) for depression onset in men who ate alone compared with those who ate with others was 2.36 (95% confidence intervals [CI]: 1.18-4.71) for those living alone and 1.03 (95% CI: 0.81-1.32) for those living with others. Among women, the ARR for depression for those who ate alone compared with those who ate with others was 1.31 (95% CI: 1.00-1.72) for those living alone and 1.21 (95% CI: 1.01-1.44) for those living with others. CONCLUSIONS: Eating alone may be a risk factor for depression. Among men, the effect of eating alone on depression may be reinforced by living alone, but appears to be broadly comparable in women living alone and women living with others.