Associating Liver Enzymes and Their Interactions with Metabolic Syndrome Prevalence in a Japanese Working Population.

Background: Serum gamma-glutamyltransferase (γ-GT), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels often increase in metabolic diseases. Objective: This study was conducted to determine which liver enzymes are strongly associated with metabolic syndrome (MetS), how they interact to produce different probability estimates, and what cutoff levels should be used to guide clinical decision-making. Methods: The researchers examined the insurance-based medical checkup data of 293,610 employees ≥35 years years of age, who underwent medical checkups between April 1, 2016, and March 31, 2017. Liver enzyme levels were grouped into quartiles. The association and interaction of liver enzymes with MetS were examined using logistic regression, and receiver operating characteristic (ROC) analyses were used to determine the optimal cutoff values for each liver enzyme in detecting the prevalence of MetS. Results: High levels of γ-GT and ALT were more strongly associated with MetS than AST. At various levels, the tested liver enzymes were found interactive, and associated with the likelihood of MetS prevalence. ROC analysis underscored the significance of all liver enzymes in predicting the development of MetS. The cutoff values for each liver enzyme were determined. Conclusion: This findings of this study directly support the identification of MetS risks within the population, prioritize prevention strategies, and potentially inform policy formulation.

Effect of the national lifestyle guidance intervention for metabolic syndrome among middle-aged people in Japan.

Background: Japan has implemented a national lifestyle guidance intervention programme for potential metabolic syndrome among adults aged 40-74 years; however, there is limited evidence regarding the causal impact of this intervention. The study aims to determine the causal effect of this intervention on health outcomes and health care utilisation. Methods: We performed a regression discontinuity design study. A total of 46 975 adults with ≥1 cardiovascular risk factor in 2015 were included in the study. A two-stage evaluation process (stage 1: waist circumference ≥85 cm for men or ≥90 cm for women and ≥1 cardiovascular risk factor; stage 2: body mass index (BMI)≥25 kg/m2 and ≥2 cardiovascular risk factors) was applied. Changes in obesity, cardiovascular outcomes, and health care utilisation were evaluated in a one-year follow-up in the fiscal year 2016. Results: Participants who received lifestyle guidance intervention based on the waist circumference had a statistically significant reduction in obesity outcomes (Δ weight: -0.30 kg, 95% CI = -0.46 to -0.11; Δ waist circumference: -0.26 cm, 95% CI = -0.53 to -0.02; Δ BMI = -0.09 kg/m2, 95% CI = -0.17 to -0.04) but not in other cardiovascular risk factors and health care utilisation. Analyses based on BMI and results according to demographic subgroups did not reveal significant findings. Conclusions: The provision of this intervention had a limited effect on health improvement and a decrease in health care costs, health care visits, and length of stay. A more intensive intervention delivery could potentially improve the efficacy of this intervention programme.

The Impact of Continuous Use of Home Health Care Resources on End-of-Life Care at Home in Older Patients with Cancer: A Retrospective Cohort Study in Fukuoka, Japan.

This study aimed at examining the effect of continued use of home health care resources on end-of-life care at home in older patients with cancer. This retrospective cohort study was conducted using medical and long-term care claims data of 6435 older patients with cancer who died between April 2016 and March 2019 in Fukuoka Prefecture. The main explanatory variables were enhanced home care support clinics and hospitals (HCSCs), enhanced HCSCs with beds, conventional HCSCs, other HCSCs, and home visit nursing care. The covariates were sex, age, required level of care, and the Charlson Comorbidity Index. A logistic regression model was used. The results of the multilevel logistic regression analysis showed that the following were significantly associated with end-of-life care at home: use of enhanced HCSCs with beds (odds ratio, OR: 8.66; 95% confidence interval, CI: [4.31-17.40]), conventional HCSCs (OR: 5.78; 95% CI: [1.86-17.94]), enhanced HCSCs (OR: 4.44; 95% CI: [1.47-13.42]), home-visit nursing care (OR: 1.86; 95% CI: [1.42-2.44]), and a severe need for care (OR: 3.89; 95% CI: [2.92-5.18]). The results suggest that the continued use of home health care resources in older patients with cancer who require out-of-hospital care may lead to increased end-of-life care at home. Particularly, use of enhanced HCSCs with beds is most strongly associated with end-of-life care at home.

Impact of fee-revision policy for gastrostomy on its implementation among older adults with dementia in Japan.

OBJECTIVES: This study aimed to evaluate the impact of the policy to reduce the reimbursement fee for percutaneous endoscopic gastrostomy (PEG) on the number of PEG procedures performed among older adults with dementia. STUDY DESIGN: Interrupted time series (ITS). METHODS: We used the monthly aggregated data of the number of PEG procedures in older adults with dementia (both broad and narrow definitions), between 2012 and 2018, from the claims data in Fukuoka Prefecture, Japan. A single ITS design was used to estimate changes in the outcome following each intervention (i.e., first, second, and third interventions performed in 2014, 2015, and 2016, respectively). A controlled ITS design was applied to estimate the effects after the sequence of interventions (pre-intervention: 2012-2014; post-intervention: 2016-2018). The control group comprised patients with malignant head and neck tumors who underwent PEG procedures outside the scope of this policy restriction. RESULTS: The number of PEG procedures decreased significantly only in the month wherein the third intervention was introduced (broad definition: IRR = 0.11, CI = 0.03-0.49; narrow definition: IRR = 0.15, CI = 0.03-0.75). No significant difference was observed between the treatment and control groups during the post-intervention phase. CONCLUSIONS: The impact of fee-revision policy for PEG on the decrease in PEG procedures among older adults with dementia is remarkably minimal. It is difficult to reduce unnecessary PEG procedures by relying on this financial incentive alone. Policy decision-makers should consider methods to prevent inappropriate use of artificial nutrition for older adults at their end-of-life stage by reforming the health delivery system.

Hypnotics and injuries among older adults with Parkinson's disease: a nested case-control design.

BACKGROUND: Patients with Parkinson's disease often experience sleep disorders. Hypnotics increase the risk of adverse events, such as injuries due to falls. In this study, we evaluated the association between hypnotics and injuries among older adults with Parkinson's disease. METHODS: The study used a nested case-control design. The participants were 5009 patients with Parkinson's disease aged ≥ 75 years based on claims data between April 2016 and March 2019 without prescription hypnotics 1 year before the study started. Hypnotics prescribed as oral medications included benzodiazepines, non-benzodiazepines, orexin receptor antagonists, and melatonin receptor agonists. The incidences of outcomes, including injuries, fractures, and femoral fractures, were determined. Each case had four matched controls. Conditional logistic regression analyses were performed to calculate the odds ratios and 95% confidence intervals for the number of hypnotics taken per day for each type of hypnotic. RESULTS: The proportion of participants taking at least one type of hypnotic was 18.6%, with benzodiazepines being the most common. The incidence of injuries, fractures, and femoral fractures was 66.7%, 37.8%, and 10.2%, respectively. Benzodiazepines significantly increased the risk of injuries (odds ratio: 1.12; 95% confidence interval: 1.03-1.22), and melatonin receptor agonists significantly increased the risk of femoral fractures (odds ratio: 2.84; 95% confidence interval: 1.19-6.77). CONCLUSIONS: Benzodiazepines and non-benzodiazepines, which are not recommended according to current guidelines, were the most prevalent among older adults with Parkinson's disease. Benzodiazepines significantly increased the risk of injuries, and melatonin receptor agonists significantly increased the risk of femoral fractures.

Risk heterogeneity of bullous pemphigoid among dipeptidyl peptidase-4 inhibitors: A population-based cohort study using Japanese Latter-Stage Elderly Healthcare Database.

AIMS/INTRODUCTION: Although the association between dipeptidyl peptidase-4 (DPP-4) inhibitors and bullous pemphigoid (BP) has begun to be established, some studies have suggested there are risk differences among DPP-4 inhibitors. We conducted a population-based cohort study to examine the risk differences. MATERIALS AND METHODS: Using the claims databases of the Fukuoka Prefecture Wide-Area Association of Latter-Stage Elderly Healthcare between April 1, 2013 and March 31, 2017, we conducted a retrospective cohort study to compare patients receiving one DPP-4 inhibitor with those who were prescribed another antidiabetic drug. The primary outcome was an adjusted hazard ratio (HR) of the development of bullous pemphigoid during a 3-year follow-up. The secondary outcome was the development of BP requiring systemic steroids immediately after the diagnosis. These were estimated using Cox proportional hazards regression models. RESULTS: The study comprised 33,241 patients, of which 0.26% (n = 88) developed bullous pemphigoid during follow-up. The percentages of patients with bullous pemphigoid who required immediate systemic steroid treatment was 0.11% (n = 37). We analyzed four DPP-4 inhibitors: sitagliptin, vildagliptin, alogliptin, and linagliptin. Vildagliptin and linagliptin raised the risk of BP significantly (primary outcome, vildagliptin, HR 2.411 [95% confidence interval (CI) 1.325-4.387], linagliptin, HR 2.550 [95% CI 1.266-5.136], secondary outcome, vildagliptin HR 3.616 [95% CI 1.495-8.745], linagliptin HR 3.556 [95% CI 1.262-10.024]). A statistically significant risk elevation was not observed with sitagliptin and alogliptin (primary outcome, sitagliptin, HR 0.911 [95% CI 0.508-1.635], alogliptin, HR 1.600 [95% CI 0.714-3.584], secondary outcome, sitagliptin, HR 1.192 [95% CI 0.475-2.992], alogliptin, HR 2.007 [95% CI 0.571-7.053]). CONCLUSIONS: Not all the DPP-4 inhibitors could induce bullous pemphigoid significantly. Therefore, the association warrants further investigations before generalization.

The impact of lifestyle guidance intervention on health outcomes among Japanese middle-aged population with metabolic syndrome: A regression discontinuity study.

Metabolic syndrome (MetS) prevalence has increased globally with considerable morbidity and economic burden at both individual and national levels. Japan is the first and only country that has introduced a nationwide lifestyle guidance intervention program to manage and control MetS. We conducted a quasi-experiment approach-regression discontinuity design-to evaluate the impact of this intervention on health outcomes at the population level. We retrospectively collected data of adults aged ≥35 years who participated in health checkups in 2015. Age in 2015 was used as the assignment variable, and an age of 40 years old was the threshold because those with MetS aged ≥40 were required to receive lifestyle guidance intervention. Among 26,772 MetS adults, those who received the intervention had significant reductions in obesity measurements (bodyweight, waist circumference, and body mass index [BMI]) after 1 year of this intervention. Blood pressure was also significantly reduced in men after 1 year of undertaking the intervention. The results were similar when including demographic, socioeconomic, and behavioral covariates and using alternative functional forms to estimate the impact, or when bandwidths around intervention thresholds were changed. Our results showed that lifestyle guidance intervention for MetS has an important impact on weight loss and blood pressure reduction at the population level. This intervention could address the high burden of obesity and cardiovascular diseases in Japan and other countries with an unmet need for MetS prevention and management.

Impact of Income Disparity on Utilization of Home-Based Care Services Among Older Adults in Japan: A Retrospective Cohort Study.

This study aimed to determine whether there are disparities in the utilization of home-based care services according to income level among people aged 75 years or older in Japan. The research team used administrative claims data from April 2014 to March 2018 for people aged 75 years or older in Fukuoka Prefecture. Subjects were categorized according to income level using medical insurance claim data. Associations between income level and usage days of inpatient care, outpatient care, home medical care, and usage number of home-based long-term care (LTC) services were evaluated. Furthermore, medical and LTC costs were evaluated and adjusted for gender, age, and level of LTC needs. The team used generalized linear models (GLMs) to estimate medical and LTC services utilization, as well as the potential influence of gender, age, care needs level, and death as risk factors. The study analyzed 31,322 subjects, among whom 17,288 were in low-, 12,755 were in middle-, and 1399 were in high-income groups. The results of GLMs showed the number of home medical care days was 59.45, 62.24, and 69.66 days for users from low-, middle-, and high-income groups, respectively. Correspondingly, the number of home-based LTC services used was 668.84, 709.59, and 833.14 times. This study suggests that older adults with lower incomes had relatively low utilizations of home-based care services and high utilizations of nonhome-based LTC services. Policymakers should implement policies focused on people who need care to tackle socioeconomic inequalities in home-based care.

Association between care rehabilitation and the risk of fracture hospitalization in people with Parkinson's disease.

AIM: This study examined whether there is an association between continuous care rehabilitation (CR) and the risk of fracture hospitalization among people with Parkinson's disease (PwP) aged >75 years with mild-to-moderate care needs level. METHODS: A retrospective study design based on the merging of medical claims and long-term care insurance claims data was used. Before propensity score matching, of the 2177 participants, 222 received continuous CR, whereas 1955 did not. After matching using a 1:4 ratio, we identified 222 patients in the CR group and 888 patients in the non-CR groups. We carried out a survival analysis to clarify the association between CR and the risk of fracture hospitalization. RESULTS: After matching, there was a significant difference between the CR and non-CR groups in 3 years (stratified log-rank test by age P = 0.036) and in 4 years (stratified log-rank test by age P = 0.011). The CR group was significantly associated with delays of hospital admission due to fracture within 3 years (hazard ratio 0.54; 95% confidence interval 0.29-0.99; P = 0.047) and within 4 years (hazard ratio 0.52; 95% confidence interval 0.30-0.88; P = 0.010). CONCLUSIONS: Our study showed that older people with Parkinson's disease who continuously received CR had a lower risk of fracture hospitalization in 3 and 4 years than those who did not receive CR or received interrupted CR. Considering our participants with a mild-to-moderate care needs level, a sustainable CR service might benefit people with Parkinson's disease from an early time when their activities of daily living are still intact and cognitive function has not deteriorated. Geriatr Gerontol Int 2022; 22: 628-634.

Impact of Income and Industry on New-Onset Diabetes among Employees: A Retrospective Cohort Study.

The purpose of this study was to investigate the impact of income and industry type on the risk of developing diabetes among Japanese workers, including how this impact is affected by sex. A total of 24,516 employees at small- and medium-sized enterprises in Japan aged 40-74 years who underwent health examinations in fiscal years 2010-2015 were included in this retrospective cohort study. Generalized linear regression models were used to assess the association between new-onset diabetes and income and industry. In men, the cumulative incidence rate was significantly higher in the low-income group; it was highest in the transportation and postal service industries. Although income and industry were independent risk factors for developing diabetes in men, an interaction was found between income and industry, which was affected by participants' sex: in specific industries (i.e., lifestyle-related, personal services, and entertainment services), men had a significantly higher risk of developing diabetes in the high-income group, and women had a significantly higher risk of developing diabetes in the low-income group. These findings highlight important factors to consider in assessing diabetes risk and suggest that efficient primary and secondary prevention should be encouraged in industries where workers have a high risk of diabetes.

Cost-Sharing Effects on Hospital Service Utilization Among Older People in Fukuoka Prefecture, Japan.

BACKGROUND: The cost-sharing impact on hospital service utilization of different services is a critical issue that has not been well addressed worldwide. This study aimed to investigate the cost-sharing effects based on income status on hospital service utilization of different services among elderly people in Japan and provide a comprehensive examination and discussion for the reasonability of a cost-sharing system. METHODS: The data were extracted from the Latter-Stage Elderly Healthcare Insurance database in the fiscal year 2016. A total of 610 182 insured people aged ≥75 years old, with 155 773 hospitalization patients, were identified. Hospitalization rate, length of stay (LOS), and total hospitalization cost were used to test the statistical significance among patients categorized by income levels. Generalized linear models for total hospitalization cost were constructed based on bed types to further assess different hospital service utilization. RESULTS: For medical chronic care and psychiatric beds, which both required long-term care treatment, much higher hospitalization rates were observed in the patients with low- and middle-income levels than patients with high-income level. The LOS and total hospitalization cost of the patients with low- and middle-income levels were significantly higher than the patients with high-income level treated in medical chronic care and psychiatric beds. For psychiatric beds, the total hospitalization cost for patients with low-income level was significantly higher than that for patients with highincome level. CONCLUSION: The cost-sharing policy in Japan, especially the cap for out-of-pocket needs further determination. The importance of community-based care services needs to be emphasized, and the collaboration between hospitals and community-based care facilities should be enhanced.

Cost-effectiveness analysis of treatment with varenicline for nicotine dependence compared with smoking cessation without pharmacotherapy in the real world.

PURPOSE: Smoking is an important public health issue. Although measures to support smoking cessation have been implemented worldwide, smokers often fail to quit smoking after receiving pharmacotherapies for nicotine dependence. The present study evaluated the cost-effectiveness of varenicline for smoking cessation compared with no pharmacotherapy using actual paid medical cost data in Japan. METHODS: This was a retrospective cohort study of 3657 subjects who had quit smoking with varenicline or no pharmacotherapy. We extracted health examination and medical claim data from a health insurer database for the period 2012-2015. We calculated the incremental cost-effective ratio (ICER) of varenicline using actual paid medical costs for nicotine dependence and the number needed to treat to maintain smoking cessation compared with no pharmacotherapy, considering sex, age, income, and occupation. RESULTS: The 1- and 2-year smoking cessation maintenance rates were 69.7% and 62.4%, respectively. We found that 8.8% of subjects who quit smoking used varenicline for nicotine dependence and the cost per person was Japanese Yen (JPY) 52 177 (U.S. dollars [USD] 474; USD 1 = JPY 110). The ICER of varenicline was dominant when comparing 2-year cessation with 1-year cessation. Male, age <40 years, low income, and manufacturing workers were the most cost-effective variables. CONCLUSIONS: The cost-effective variables of varenicline in the real world were investigated. The results of this study strengthen the evidence regarding which type of people should be targeted for measures to support smoking cessation using varenicline.

Health Inequality Among Older Adults with Percutaneous Coronary Intervention and Universal Health Coverage in Japan.

This study aimed to comprehensively evaluate whether income affects long-term health outcomes for older patients who underwent percutaneous coronary intervention (PCI) provided by a universal health coverage system. Data were from the Latter Stage Elderly Healthcare Insurance database in Fukuoka Prefecture, Japan. A total of 5625 individuals aged ≥65 years who underwent PCI in 2014-2016 were included. Cox proportional hazards models were used to assess the association between income status and the incidence of health outcomes. With a median follow-up of 1095 days, 554 acute myocardial infarction (AMI) cases, 1075 stroke cases, 1690 repeat revascularization cases, and 1094 deaths were observed. Risk of all-cause mortality decreased significantly with increasing income level in both unadjusted and adjusted Cox regression models. Patients in the low-income level had a significantly higher rate of AMI (log-rank P = 0.003), stroke (log-rank P = 0.039), and all-cause mortality (log-rank P = 0.001) compared with patients in the high-income level. Observed rates for repeat revascularization also were high in the first year after PCI. In the Japanese universal health setting, low-income patients had a comparatively higher mortality risk after PCI. Poor long-term outcomes might be attributed to patients' baseline characteristics rather than treatment processes.

Effects of physician visit frequency for Parkinson's disease treatment on mortality, hospitalization, and costs: a retrospective cohort study.

BACKGROUND: The number of patients with Parkinson's disease among older adults is rapidly increasing. Such patients mostly take medication and require regular physician visits. However, the effect of physician visit frequency for the treatment for Parkinson's disease has not been evaluated. This study aimed to evaluate the impact of physician visit frequency for Parkinson's disease treatment on mortality, healthcare days, and healthcare and long-term care costs among older adults. METHODS: This study employed a retrospective cohort design utilizing claims data from the Fukuoka Prefecture Wide-Area Association of Latter-Stage Elderly Healthcare Insurance and Long-Term Care Insurance. Patients aged ≥75 years who were newly diagnosed with Parkinson's disease in 2014 were included in this study, following the onset of Parkinson's disease to March 31, 2019. We calculated the restricted mean survival time to evaluate mortality, focusing on the frequency of physician visits for Parkinson's disease treatment. Inpatient days, outpatient days, and healthcare and long-term care costs per month were calculated using a generalized linear model. RESULTS: There were 2224 participants, with 46.5% mortality among those with a higher frequency of physician visits and 56.4% among those with a lower frequency of physician visits. A higher frequency of physician visits was associated with a significant increase in survival time (1.57 months at 24 months and 5.00 months at 60 months) after the onset of Parkinson's disease and a decrease in inpatient days and healthcare costs compared to a lower frequency of physician visits. CONCLUSIONS: A higher frequency of physician visits was significantly associated with longer survival time, fewer inpatient days, and lower healthcare costs. Caregivers should support patients with Parkinson's disease to visit physicians regularly for their treatment.

Effect of body mass index on vertebral and hip fractures in older people and differences according to sex: a retrospective Japanese cohort study.

OBJECTIVES: The purpose of this study was to investigate the incidence of vertebral and hip fractures in the older people and to clarify the relationship between these fractures and body mass index (BMI) along with the impact of sex differences.DesignThis was a retrospective cohort study.SettingWe used administrative claims data between April 2010 and March 2018. PARTICIPANTS: Older people aged ≥75 years who underwent health examinations in 2010 and were living in the Fukuoka Prefecture, Japan were included in the study. A total of 24 691 participants were included; the mean age was 79.4±4.3 years, 10 853 males and 13 838 females, and an the mean duration of observation was 6.9±1.6 years. PRIMARY AND SECONDARY OUTCOME MEASURES: We estimated the incidence of vertebral and hip fractures by BMI category (underweight: <18.5 kg/m2, normal weight: 18.5-24.9 kg/m2, overweight and obese: ≥25.0 kg/m2) using a Kaplan-Meier curve in males and females and determined fracture risk by sex using Cox proportional hazards regression analyses. RESULTS: The incidence of vertebral and hip fractures was 16.8% and 6.5%, respectively. The cumulative incidence of vertebral and hip fracture at the last observation (8 years) in each BMI groups (underweight/normal weight/overweight and obese) estimated using the Kaplan-Meier curve was 14.7%/10.4%/9.0% in males and 24.9%/23.0%/21.9% in females, and 6.3%/2.9%/2.4% in males and 14.1%/9.0%/8.1% in females, respectively, and both fractures were significantly higher in underweight groups regardless of sex. Multivariable Cox proportional hazards models showed that underweight was a significant risk factor only in males for vertebral fractures and in both males and females for hip fractures. CONCLUSION: Underweight was associated with fractures in the ageing population, but there was a sex difference in the effect for vertebral fractures.

Impact of income and eating speed on new-onset diabetes among men: a retrospective cohort study.

OBJECTIVE: To examine the impact of income and eating speed on new-onset diabetes among men. DESIGN: This was a retrospective cohort study. SETTING: We used the administrative claims and health check-up data for fiscal years 2010-2015 obtained from the Fukuoka branch of the Japan Health Insurance Association. PARTICIPANTS: Participants were 15 474 non-diabetic male employees, aged between 40 and 74 years. They were categorised based on their eating speeds (ie, fast, normal and non-fast). PRIMARY AND SECONDARY OUTCOME MEASURES: To calculate the OR of the development of diabetes, we created generalised linear regression models with diabetes onset as the dependent variable and eating speed and income as covariates and calculated corresponding 95% CI values. The analyses were performed after adjusting the data for age, obesity and comorbidities. RESULTS: Of the total participants, 620 developed diabetes during the 5-year study period. A univariate analysis using the generalised linear regression model revealed that eating fast (OR: 1.35, 95% CI 1.17 to 1.55) and having a low income wereincome (OR: 1.47, 95% CI 1.24 to 1.74) were significantly associated with the onset of diabetes. After adjusting for age, obesity and comorbidities, both eating fast (OR: 1.17, 95% CI 1.02 to 1.35) and having a low income (OR: 1.24, 95% CI 1.03 to 1.50) were recognised as independent risk factors for diabetes onset. CONCLUSIONS: The study revealed that eating fast and having a low income were independent risk factors, leading to the development of diabetes. While it is difficult to address income differences, it may be possible to address the factors that contribute to income differences to manage diabetes appropriately and at low healthcare costs. However, eating speed can be controlled. Hence, the provision of education and coaching on dietary habits, including eating speed, may be effective in preventing diabetes onset.

Population-Based Multilevel Models to Estimate the Management Strategies for Acute Myocardial Infarction in Older Adults with Dementia.

BACKGROUND: Acute myocardial infarction (AMI) management strategies, involving treatment and post-care, are much more difficult for patients with dementia. This study investigated the factors influencing the use of invasive procedures and long-term care in the management strategies for AMI patients with dementia and the factors associated with these patients' survival. METHODS: This multilevel study combined information from two databases, namely later-stage elderly healthcare insurance and long-term care insurance claims, from 2013 to 2019. Of 214,963 individuals with dementia, we identified 13,593 patients with AMI. The primary outcomes were the use of invasive procedures for treatment and long-term care for post-care management. Survival outcomes were also measured over a 6-year period, adjusting for individual- and regional-level characteristics in multilevel models. RESULTS: A total of 1954 (14.38%) individuals received an invasive procedure during treatment, and 7850 (87.18%) used long-term care for post-care management after AMI. After multivariate adjustment, patients aged ≥ 85 years and women were less likely to receive invasive procedures and more likely to use long-term care. Patients undergoing invasive procedures had a lower use of long-term care. Better survival outcome was significantly associated with invasive management and long-term care, regardless of the type of care. CONCLUSION: Age and sex determine the use of invasive procedures and long-term care after AMI among patients with dementia. AMI patients with dementia receiving invasive procedures and long-term care had better survival outcomes.

Impact of the 2014 coinsurance rate revision for the elderly on healthcare resource utilization in Japan.

BACKGROUND: Cost sharing, including copayment and coinsurance, is often used to contain medical expenditure by decreasing unnecessary or excessive use of healthcare resources. Previous studies in Japan have reported the effects of a coinsurance rate reduction for healthcare from 30 to 10% on the demand for healthcare among 70-74-year-old individuals. However, the coinsurance rate for this age group has recently increased from 10 to 20%. This study aimed to estimate the economic impact of coinsurance rate revision on healthcare resource utilization. METHODS: We collected claims data from beneficiaries of the municipality National Health Insurance and the Japanese Health Insurance Association in Fukuoka Prefecture. We categorized subjects born between March 2, 1944 and April 1, 1944 into the 20% coinsurance rate reduction group and those born between April 2, 1944 and May 1, 1944 into the 10% reduction group. An interrupted time-series analysis for multiple groups was employed to compare healthcare resource utilization trends before and after coinsurance rate reduction at 70 years. RESULTS: The 10% coinsurance rate reduction led to a significant increase in healthcare expenditure for outpatient care. The 20% reduction group showed a significantly sharper increase in healthcare expenditure for outpatient care than the 10% reduction group. Similarly, the 10% coinsurance group significantly increased in the number of ambulatory visits. The 20% coinsurance rate reduction group had more frequent ambulatory care visits than the 10% reduction group. CONCLUSIONS: These results suggest that increasing the coinsurance rate among the elderly would reduce outpatient healthcare resource utilization; however, it would not necessarily reduce overall healthcare resource utilization.

Quantifying Regional and Health Care Variations to Identify Ways to Improve Hemodialysis Service Quality and Survival Outcomes.

The authors examined variations in hemodialysis care and quantified the effect of these variations on all-cause mortality. Insurance claims data from April 1, 2017 to March 30, 2018 were reviewed. In total, 2895 hospital patients were identified, among whom 398 died from various causes. Controlling effects of the facility and secondary medical care areas, all-cause mortality was associated with older age, heart failure, malignancy, cerebral stroke, severe comorbidity, and the first and ninth centile of physician density. Multilevel analyses indicated a significant variation at facility level (σ22 0.27, 95% confidence interval: 0.09-0.49). Inclusion of all covariates in the final model significantly reduced facility-level variance. Physician density emerged as an important factor affecting survival outcome; thus, a review of workforce and resource allocation policies is needed. Better clinical management and standardized work processes are necessary to attenuate differences in hospital practice patterns.