Pneumococcal vaccination, but not influenza vaccination, is negatively associated with incident dementia among Japanese older adults: The JAGES 2013-2022 prospective cohort study.

BACKGROUND: It is unclear whether inactivated influenza vaccination (IIV) or pneumococcal vaccination are associated with the risk of dementia; however, both types of vaccination are recommended for older adults. Studies have shown that the IIV is negatively associated with incident dementia; however, the uptake of pneumococcal vaccinations has not been considered. We investigated the independent associations of IIV and 23-valent pneumococcal polysaccharide vaccine (PPSV23) with incident dementia in older adults. METHODS: Health-related information on older Japanese adults was obtained through a baseline survey conducted in 2013 (baseline survey). The uptake of IIV and PPSV23 was determined in a second survey conducted in 2016 (second wave). Both surveys were conducted among independent Japanese older adults aged ≥ 65 years at the two surveys and who had not been certified as needing long-term care (LTC). In the second wave, 9,865 participants were followed up for 3.5 years (short-term follow-up), and 6,995 participants were followed up for six years and five months (long-term follow-up) until they required LTC due to dementia onset (incident dementia). A competing risk model with stabilized inverse probability weighting (SIPW) was constructed to calculate the hazard ratios (HRs) and 95 % confidence intervals (CIs) of incident dementia. RESULTS: PPSV23 uptake was negatively associated with incident dementia among participants in both the short- and long-term follow-up periods after SIPW (short-term follow-up: HR: 0.77, 95 % CI: 0.63 - 0.95; long-term follow-up: HR: 0.83, 95 % CI: 0.70 - 0.97). Conversely, IIV uptake was not associated with incident dementia among participants in either follow-up group (short-term follow-up: HR: 0.86, 95 % CI: 0.63-1.16; long-term follow-up: HR: 0.99, 95 % CI: 0.76-1.29). The PPSV23 uptake was negatively associated with incident dementia in participants without the IIV uptake (short-term follow-up: HR: 0.44, 95 % CI: 0.24 - 0.81; long-term follow-up: HR: 0.47, 95 % CI: 0.29 - 0.76). Conversely, the IIV uptake was not associated with incident dementia regardless of the PPSV23 status (short-term follow-up: HR: 0.87, 95 % CI: 0.62 - 1.23; long-term follow-up: HR: 1.00, 95 % CI: 0.74 - 1.35). CONCLUSION: Our results suggest that the PPSV23 uptake was independently associated with the incidence of dementia. However, the IIV uptake was not associated with the incidence of dementia.

Sedentary behavior and the combination of physical activity associated with dementia, functional disability, and mortality: A cohort study of 90,471 older adults in Japan.

OBJECTIVE: To examine the associations of sedentary behavior (SB) and the combination of moderate-to-vigorous intensity physical activity (MVPA) with dementia, functional disability, and mortality in older adults, and the heterogeneity in different subpopulations. METHODS: Nation-wide cohort with 90,471 individuals aged ≥65 years in Japan. SB (<3, 3-<8, and ≥ 8 h per day [h/d]) and MVPA (0, 0 < MVPA<1, and ≥ 1 h/d) were measured in 2016. Long-term care registry-based incidence of outcomes was ascertained through 2021. Cox proportional hazard models were performed. RESULTS: Compared with SB < 3 h/d group, SB ≥ 8 h/d was associated with higher risks of dementia, functional disability, and mortality with hazard ratios (95% confidence interval) of 1.36 (1.22-1.52), 1.32 (1.19-1.48), and 1.31 (1.18-1.45). The combination of MVPA and SB demonstrated a dose-respond trend of increasing risks of dementia, functional disability, and mortality with increased SB and decreased MVPA, where participants who spent no MVPA with SB ≥ 8 h/d had the highest risks. High MVPA attenuated but didn't eliminate the risks. Participants who spent MVPA≥1 h/d with SB ≥ 8 h/d had comparable risks to those who spent no MVPA with SB < 3 h/d. No heterogeneity was found by MVPA levels, sex, education, comorbidity, and depression conditions. CONCLUSIONS: Prolonged daily SB was associated with higher risks of dementia, functional disability, and mortality in older adults, regardless of MVPA, sex, education, and chronic conditions. Individuals with high MVPA also face considerable risks when engaging in high SB. High MVPA with high SB revealed a comparable risk to no MVPA with low SB.

Machine Learning-Based Prediction of Functional Disability: a Cohort Study of Japanese Older Adults in 2013-2019.

BACKGROUND: It is important to identify older adults at high risk of functional disability and to take preventive measures for them at an early stage. To our knowledge, there are no studies that predict functional disability among community-dwelling older adults using machine learning algorithms. OBJECTIVE: To construct a model that can predict functional disability over 5 years using basic machine learning algorithms. DESIGN: A cohort study with a mean follow-up of 5.4 years. PARTICIPANTS: We used data from the Japan Gerontological Evaluation Study, which involved 73,262 people aged ≥ 65 years who were not certified as requiring long-term care. The baseline survey was conducted in 2013 in 19 municipalities. MAIN MEASURES: We defined the onset of functional disability as the new certification of needing long-term care that was ascertained by linking participants to public registries of long-term care insurance. All 183 candidate predictors were measured by self-report questionnaires. KEY RESULTS: During the study period, 16,361 (22.3%) participants experienced the onset of functional disability. Among machine learning-based models, ridge regression (C statistic = 0.818) and gradient boosting (0.817) effectively predicted functional disability. In both models, we identified age, self-rated health, variables related to falls and posture stabilization, and diagnoses of Parkinson's disease and dementia as important features. Additionally, the ridge regression model identified the household characteristics such as the number of members, income, and receiving public assistance as important predictors, while the gradient boosting model selected moderate physical activity and driving. Based on the ridge regression model, we developed a simplified risk score for functional disability, and it also indicated good performance at the cut-off of 6/7 points. CONCLUSIONS: Machine learning-based models showed effective performance prediction over 5 years. Our findings suggest that measuring and adding the variables identified as important features can improve the prediction of functional disability.

Trends in Cardiovascular Risk Factors by Income Among Japanese Adults Aged 30-49 Years From 2017 to 2020: A Nationwide Longitudinal Cohort Study.

OBJECTIVE: Income is a major social determinant of cardiovascular health. However, individual-level evidence regarding the trends in cardiovascular risk factors by income level among young working-age adults is limited. We thus aimed to examine the trends in cardiovascular risk factors among men and women aged 30-49 years by their income levels. METHODS: This nationwide longitudinal study included Japanese adults aged 30-49 years, who annually participated in the national health screening program from 2017 to 2020. Modified Poisson regression models were used to investigate trends in the prevalence of cardiovascular risk factors (obesity, hypertension, diabetes, and dyslipidemia) according to tertiles of individuals' annual income, adjusting for potential confounders. RESULTS: Among 58 814 adults, 50 024 (85%) were men; the mean (SD) age was 42.1 (5.4) years. Over the study period, the low-income group consistently showed a higher prevalence of obesity, hypertension, and diabetes than the high-income group. The difference in the prevalence of these diseases, particularly hypertension, across income groups increased from 2017 to 2020 among both men (low-income vs high-income: +5.73% [95% CI, 4.72-6.73] in 2017 and +8.26% [95% CI, 7.11-9.41] in 2020) and women (low-income vs high-income: +2.53% [95% CI, 0.99-4.06] in 2017 and +3.83% [95% CI, 1.93-5.73] in 2020). CONCLUSION: Among adults aged 30-49 years in Japan, a country with a universal healthcare coverage system, we found an increase in the gap of cardiovascular risk factors by income levels over the last 4 years. Careful monitoring of the increasing social disparities is needed to achieve cardiovascular health equity at this life stage.

Association of frailty with influenza and hospitalization due to influenza among independent older adults: a longitudinal study of Japan Gerontological Evaluation Study (JAGES).

BACKGROUND: It is unknown that whether frailty is a risk factor of influenza and the hospitalization among older adults, although it has been shown that frailty was associated with poor recovery from the hospitalization among those. We examined the association of frailty with influenza and the hospitalization and the effect by sex among independent older adults. METHODS: We used the longitudinal data from the Japan Gerontological Evaluation Study (JAGES), performed in 2016 and 2019 and conducted in 28 municipalities in Japan. The target population comprised 77,103 persons aged ≥ 65 years who did not need assistance from the public long-term care insurance. Primary outcome measures were influenza and hospitalization due to influenza. Frailty was evaluated with the Kihon check list. We estimated the risk of influenza, the hospitalization, those risks by sex, and the interaction for frailty and sex using Poisson regression adjusting for covariates. RESULTS: Frailty was associated with both influenza and the hospitalization among the older adults compared with nonfrail individuals after adjusting for covariates (influenza, frail: risk ratio {RR}: 1.36, 95% confidence interval {95% CI}: 1.20 - 1.53, and prefrail: RR: 1.16, 95% CI: 1.09 - 1.23; the hospitalization, frail: RR: 3.18, 95% CI: 1.84 - 5.57, and prefrail: RR: 2.13, 95% CI: 1.44 - 3.16). Male was associated with the hospitalization, but not associated with influenza compared to female (the hospitalization: RR: 1.70, 95% CI: 1.15 - 2.52 and influenza: RR: 1.01, 95% CI: 0.95 - 1.08). The interaction for frailty and sex was significant neither in influenza nor in the hospitalization. CONCLUSION: These results suggest that frailty is a risk of influenza and the hospitalization, that risks of the hospitalization are different by sex, but that the sex difference does not cause the effect heterogeneity of frailty on the susceptibility and severity among independent older adults.

Does disaster-related relocation impact mental health via changes in group participation among older adults? Causal mediation analysis of a pre-post disaster study of the 2016 Kumamoto earthquake.

BACKGROUND: Disaster-related relocation is associated with depression and post-traumatic stress disorder, especially in older adults. Disaster-related relocation often deprives survivors of opportunities for social group participation, potentially deteriorating their mental health. On the contrary, the relocation could also be an opportunity for optimizing social relationships, ending/reducing unwanted participation. This study examined the potential mediation effects of changing participation for the link of disaster-related relocation to mental health. METHODS: We analyzed a pre-post disaster dataset of functionally independent older adults from the Japan Gerontological Evaluation Study. Following the 2013 survey, a follow-up survey was conducted seven months after the 2016 Kumamoto earthquake (n = 828). RESULTS: The causal mediation analyses indicated that compared to no relocation, the relative risk for experiencing major depressive episodes among those relocating to temporary housing was 3.79 [95% confidence interval: 1.70-6.64] (natural direct effect). By contrast, the relative risk for those renewing (either ceased or started) group participation was 0.60 [95% CI: 0.34-0.94] (natural indirect effect). CONCLUSIONS: Optimization of social ties according to a renewal of group participation status might have protected older adults in temporary housing against depression.

A novel behavioral science-based health checkup program and subsequent metabolic risk reductions in a workplace: Checkup championship.

The effectiveness of general health checkups and lifestyle counseling has been questioned. This study examined whether a workplace health promotion program implemented during a health checkup was associated with metabolic syndrome-related indicators. Hakuhodo DY group, one of Japan's largest advertising agencies, implemented a behavioral science-based program called "Checkup Championship" (Kenshin-sen in Japanese) in 2019, in which all employees could voluntarily participate. We studied 3697 employees (2818 men and 879 women, mean age: 40.7 years), consisting of 1509 program participants and 2188 non-participants. The characteristics of participants and non-participants were balanced using inverse probability weighting. We used their data from the health checkups in 2018 and 2019 together with other covariates and performed a difference-in-differences analysis using a linear mixed model. After program implementation, greater reductions were observed among participants compared with non-participants in weight (-0.66 kg, 95% confidence interval: -0.84 to -0.47), body mass index (-0.23 kg/m2, -0.29 to -0.16), waist circumference (-0.67 cm, -0.91 to -0.43), systolic blood pressure (-1.13 mmHg, -2.10 to -0.16), and diastolic blood pressure (-0.84 mmHg, -1.53 to -0.15). In addition, we observed greater reductions in weight, body mass index, waist circumference, and low-density lipoprotein cholesterol among participants who were with two or more risk factors for metabolic syndrome than other participants. We found that participation in a health checkup program based on behavioral science was associated with reduced metabolic syndrome-related indicators. There may be room for improvement in the effectiveness of general health checkups.

Association of Pneumococcal and Influenza Vaccination With Patient-Physician Communication in Older Adults: A Nationwide Cross-sectional Study From the JAGES 2016.

BACKGROUND: Increasing the coverage of vaccinations recommended by the World Health Organization in the older adult population is an urgent issue, especially in the context of avoiding co-epidemics during the current coronavirus disease 2019 crisis. The aim of this study was to examine factors associated with the quality of perceived patient-physician communication and whether this variable was associated with increased odds of vaccination. METHODS: We used cross-sectional data from the Japan Gerontological Evaluation Study conducted from October 2016 to January 2017. The participants were 22,253 physically and cognitively independent individuals aged 65 or older living in 39 municipalities in Japan. Multilevel logit models were used to estimate the odds of vaccination. RESULTS: Among the participants, 40.0% and 58.8% had received pneumococcal and influenza vaccinations as per the recommended schedule, respectively. People with low educational levels were more likely to have a family physician but rate their experience in asking questions lower than those with higher educational levels. Having a family physician and high rating for physicians' listening attitude were positively associated with increased odds of pneumococcal and influenza vaccinations. High rating for patients' questioning attitude and shared decision-making, compared to an ambiguous attitude toward medical decision-making, were positively associated with increased odds of pneumococcal vaccination. CONCLUSION: The results suggest that promotion of having a family physician, better patient-physician communication, and shared decision-making may encourage older adults to undergo recommended vaccinations.

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.

Potential causal effect of physical activity on reducing the risk of dementia: a 6-year cohort study from the Japan Gerontological Evaluation Study.

BACKGROUND: The causal effect of physical activity on reducing dementia risk has been questioned due to the possibility of reverse causation. This study examined the potential causal effects of physical activity on reducing dementia risk using residency in a snowy area as an instrumental variable (IV) representing the physical activity of older adults. METHODS: We used cohort data from the Japan Gerontological Evaluation Study, a longitudinal cohort enrolling people aged 65 or older who were physically and cognitively independent in 2013; study participants were followed for an average of 5.7 years. Participants in the present study included 73,260 individuals living in 19 municipalities in Japan. Physical activity was measured by self-report questionnaires and the incidence of dementia was ascertained by linking participants to the public registries of long-term care insurance. IV estimation was obtained from a piecewise Cox proportional hazard model using a two-stage regression procedure. RESULTS: During the study period, we ascertained 8714 cases (11.9%) of dementia onset. In the IV analysis, we found that the frequency of physical activity per week was negatively associated with dementia risk, though the association weakened over time (Year 1: hazard ratio = 0.53, 95% confidence interval: 0.39-0.74; Year 4: 0.69, 0.53-0.90; Year 6: 0.85, 0.66-1.10). CONCLUSIONS: Our IV analysis indicated a potential causal effect of physical activity on reducing dementia risk that persisted for at least 4 years of follow-up. Thus, we conclude that physical activity should be recommended for older adults to reduce dementia risk.

Changes in work and life patterns associated with depressive symptoms during the COVID-19 pandemic: an observational study of health app (CALO mama) users.

BACKGROUND: During the COVID-19 pandemic, many people refrained from going out, started working from home (WFH), and suspended work or lost their jobs. This study examines how such pandemic-related changes in work and life patterns were associated with depressive symptoms. METHODS: An online survey among participants who use a health app called CALO mama was conducted from 30 April to 8 May 2020 in Japan. Participants consisted of 2846 users (1150 men (mean age=50.3) and 1696 women (mean age=43.0)) who were working prior to the government declaration of a state of emergency (7 April 2020). Their daily steps from 1 January to 13 May 2020 recorded by an accelerometer in their mobile devices were linked to their responses. Depressive symptoms were assessed using the Two-Question Screen. RESULTS: On average, participants took 1143.8 (95% CI -1557.3 to -730.2) fewer weekday steps during the declaration period (from 7 April to 13 May). Depressive symptoms were positively associated with female gender (OR=1.58, 95% CI 1.34 to 1.87), decreased weekday steps (OR=1.22, 95% CI 1.03 to 1.45) and increased working hours (OR=1.73, 95% CI 1.32 to 2.26). Conversely, starting WFH was negatively associated with depressive symptoms (OR=0.83, 95% CI 0.69 to 0.99). CONCLUSIONS: Decreased weekday steps during the declaration period were associated with increased odds of depressive symptoms, but WFH may mitigate the risk in the short term. Further studies on the longitudinal effects of WFH on health are needed.

Working from home and dietary changes during the COVID-19 pandemic: A longitudinal study of health app (CALO mama) users.

It is plausible that the coronavirus disease pandemic and related changes in work and life patterns affected dietary patterns, but existing studies have limitations owing to a cross-sectional design. Using longitudinal data, we examined dietary changes in people due to the pandemic and work and life patterns. We conducted an online survey on changes in work and life patterns during the pandemic from April 30, 2020, to May 8, 2020, among users of a health app called CALO mama provided in Japan. We retrieved and linked the dietary data for 5929 participants from January 1, 2020, to May 13, 2020. Generalized linear mixed models were used to estimate the frequencies of food intake associated with the pandemic and work and life patterns. During the state of emergency, the frequency of intake of vegetables, beans, seaweeds, fish, meats, dairy products, and snacks increased, whereas alcohol intake decreased. Working from home was associated with increased intake of vegetables, fruits, dairy products, and snacks but decreased intake of seaweeds, meats, and alcohol. Time spent on childcare was associated with decreased intake of vegetables and fruits but increased intake of meats. Probable depressive symptoms were negatively associated with the frequency of food intake other than snacks and alcohol. We conclude that diet quality improved during the pandemic in general, but attention must be paid to overconsumption of snacks and negative factors such as increased burden of childcare and depression for healthy eating.

Postdisaster Changes in Social Capital and Mental Health: A Natural Experiment From the 2016 Kumamoto Earthquake.

Levels of social capital can change after a natural disaster; thus far, no study has examined how changes in social capital affect the mental health of disaster victims. In this study, we examined how predisaster social capital and its changes after a disaster were associated with the onset of mental disorders. In October 2013, we mailed a questionnaire to participants in the Japan Gerontological Evaluation Study living in Mifune, a town in Kumamoto Prefecture, Japan, and measured predisaster social capital. In April 2016, the Kumamoto earthquake struck the region. Three years after the baseline survey, postdisaster social capital and symptoms of mental disorders were measured using the Screening Questionnaire for Disaster Mental Health (n = 828). Multiple Poisson regression indicated that a 1-standard-deviation change in predisaster social cohesion at the community level reduced the risk of depression among women (relative risk = 0.44, 95% confidence interval: 0.24, 0.78); a decline in social capital after the disaster elevated the risk (relative risk = 2.44, 95% confidence interval: 1.33, 4.47). In contrast to social cohesion, high levels of social participation at the community level were positively associated with the risk of depression among women. Policy-makers should pay attention to sex differences and types of social capital when leveraging social capital for recovery from disasters.

Spillover benefit of improved access to healthcare on reducing worry about housing and meal affordability.

BACKGROUND: The Affordable Care Act Medicaid expansion improved access to health insurance among low-income populations. We sought to examine the spillover benefits of the ACA Medicaid expansion on ability to afford rent/mortgage and purchase of nutritious meals. METHODS: Using data from the Behavioral Risk Factor Surveillance System (BRFSS) we analyzed individuals aged 18-64 years residing in 12 U.S. states (including five ACA Medicaid expansion states) in 2015. Our treatment of interest was access to health insurance, instrumented by the ACA Medicaid expansion. Our outcome variables were: worry or stress about having sufficient money to pay the rent or mortgage and to purchase nutritious meals. We conducted a two-stage least squares instrumental variables regression. RESULTS: A 10%-point increase in the proportion of those who obtained health insurance following the ACA Medicaid expansion reduced the probability of being worried and stressed related to purchasing nutritious meals by 7.2% points (95% CI: 1.3-13.2) as well as paying the rent or mortgage by 8.6% points (95% CI: 2.5-14.7) among people living below 138% of the federal poverty level (FPL). The ACA Medicaid expansion was not associated with access to health insurance among those living over 138% of FPL, and obtaining health insurance did not influence stress or worry in relation to affording rent/mortgage or meals in this income group. CONCLUSIONS: Improved access to health insurance contributed to reducing worry and stress associated with paying rent/mortgage or purchasing meals among low-income people. Expanding health insurance access may have contributed to increasing the disposable income of low income groups.

Estimating the joint association of adverse childhood experiences and asthma with subsequent depressive symptoms: a marginal structural modelling approach.

BACKGROUND: The relationship between adverse childhood experiences (ACEs) and depression risk has been well documented. However, it remains unclear whether stress-related chronic conditions associated with ACEs, such as asthma, increase the long-term mental health burden of ACEs. OBJECTIVE: To investigate the joint association of ACEs and asthma with subsequent depressive symptoms among US adults. METHODS: This study used data from the Behavioural Risk Factor Surveillance System 2010, including 21 544 participants over 18 years old from four states where participants were questioned about ACEs. We used logistic regression models to calculate the adjusted OR (aOR) for elevated depressive symptoms evaluated by Patient Health Questionnaire-8 according to ACEs and asthma, along with marginal structural models (MSM) to consider ACE-related confounders between asthma and depression. We evaluated the additive interaction between ACEs and asthma on depressive symptoms with the relative excess risk due to interaction (RERI). FINDINGS: Of the 21 544 participants (mean age: 56, women: 59.5%), 52.3% reported ≥1 ACEs, 14.9% reported a history of asthma and 4.0% had depressive symptoms. ACEs and asthma were independently associated with elevated depressive symptoms (aORs (95% CI) were 2.85 (2.30 to 3.55) and 2.24 (1.50 to 3.27), respectively). Furthermore, our MSM revealed an additive interaction between ACEs and asthma for depressive symptoms (RERI (95% CI)=+1.63 (0.54 to 2.71)). CONCLUSIONS: These findings suggest that asthma amplifies the risk of depressive symptoms associated with ACEs. CLINICAL IMPLICATIONS: Prevention and treatment of asthma, along with establishing preventive environments and services against ACEs, are effective in mitigating the potential burden of ACEs on mental health.

Association Between the COVID-19 Pandemic and Early Childhood Development.

Importance: Although a growing number of studies have reported negative associations of the COVID-19 pandemic with academic performance among school-aged children, less is known about the pandemic's association with early childhood development. Objective: To examine the association between the COVID-19 pandemic and early childhood development. Design, Setting, and Participants: In this cohort study conducted in all accredited nursery centers in a Japanese municipality, baseline surveys of children aged 1 and 3 years (1000 and 922, respectively) were conducted between 2017 and 2019, and participants were followed up for 2 years. Exposure: Children's development was compared at age 3 or 5 years between cohorts that were exposed to the pandemic during the follow-up and a cohort that was not. Main Outcome and Measure: Children's developmental age was measured by nursery teachers using the Kinder Infant Development Scale (KIDS). Data were analyzed between December 8, 2022, and May 6, 2023. Results: A total of 447 children (201 girls [45.0%] and 246 boys [55.0%]) aged 1 year at baseline were followed up to age 3 years, and 440 children (200 girls [45.5%] and 240 boys [54.5%]) aged 3 years at baseline were followed up to age 5 years. During the follow-up, the cohorts that were exposed to the pandemic were 4.39 months behind in development at age 5 compared with the cohort that was not (coefficient, -4.39; 95% credible interval, -7.66 to -1.27). Such a negative association was not observed in development at age 3 years (coefficient, 1.32; 95% credible interval, -0.44 to 3.01). Variations in development were greater during the pandemic than before the pandemic regardless of age. Additionally, the quality of care at nursery centers was positively associated with development at age 3 years during the pandemic (coefficient, 2.01; 95% credible interval, 0.58-3.44), while parental depression appeared to amplify the association between the pandemic and delayed development at age 5 (coefficient of interaction, -2.62; 95% credible interval, -4.80 to -0.49; P = .009). Conclusions and Relevance: The findings of this study showed an association between exposure to the pandemic and delayed childhood development at age 5 years. Variations in development widened during the pandemic regardless of age. It is important to identify children with developmental delays associated with the pandemic and provide them with support for learning, socialization, physical and mental health, and family support.

Associations of influenza and pneumococcal vaccinations with burdens of older family caregivers: The Japan Gerontological Evaluation study (JAGES) cross-sectional study.

BACKGROUND: Influenza and pneumonia tend to be severe in older adults; thus, vaccination is necessary to prevent these illnesses. Vaccination is especially important for older family caregivers (OFCs) not only to prevent them from becoming ill, but also to prevent secondary infections in the family care receivers (FCRs), who are mostly frail older adults and have a higher risk of severe illness. Thus, we investigated whether caregiving burdens were associated with the vaccinations among older adults. METHODS: We used cross-sectional data from the Japan Gerontological Evaluation Study (JAGES), which was conducted in 64 Japanese municipalities from November 2019 to January 2020. The target population consisted of 26,177 individuals aged 65 years or older who were independent and did not need public long-term care. The primary outcome was the uptakes of either or both influenza and pneumococcal vaccinations. Multinomial logistic regressions were performed, setting those who underwent neither vaccinations as the reference group. RESULTS: Among the participants, 23.3 %, 25.8 %, 9.4 %, or 41.5 % underwent neither, only influenza, only pneumococcal, or the both vaccinations, respectively. The caregiving frequency, time length in a day, or dementia of FCR were negatively associated with influenza vaccination (caregiving almost every day: relative risk ratio {RRR}: 0.39, 95 % confident interval {95 % CI} [0.24-0.63]; caregiving almost all day: 0.44, 95 % CI: 0.23-0.85; caregiving for FCR: RRR:0.55, 95 % CI: 0.34-0.91). On the other hand, those caregiving burdens were not associated with pneumococcal only or the both vaccinations. Having a family physician mitigated all the negative effect of the caregiving burdens on the vaccinations. CONCLUSION: Our results suggest that the caregiving burden is a barrier to influenza vaccination but not to pneumococcal vaccination and that having a physician mitigates the negative effect regardless of the burden kind.

Retirement and cardiovascular disease: a longitudinal study in 35 countries.

BACKGROUND: Many countries have been increasing their state pension age (SPA); nonetheless, there is little consensus on whether retirement affects the risk of cardiovascular disease (CVD). This study examined the associations of retirement with CVD and risk factors. METHODS: We used harmonized longitudinal datasets from the Health and Retirement Study and its sister surveys in 35 countries. Data comprised 396 904 observations from 106 927 unique individuals aged 50-70 years, with a mean follow-up period of 6.7 years. Fixed-effects instrumental variable regressions were performed using the SPA as an instrument. RESULTS: We found a 2.2%-point decrease in the risk of heart disease [coefficient = -0.022 (95% confidence interval: -0.031 to -0.012)] and a 3.0%-point decrease in physical inactivity [-0.030 (-0.049 to -0.010)] among retirees, compared with workers. In both sexes, retirement was associated with a decreased heart disease risk, whereas decreased smoking was observed only among women. People with high educational levels showed associations between retirement and decreased risks of stroke, obesity and physical inactivity. People who retired from non-physical labour exhibited reduced risks of heart disease, obesity and physical inactivity, whereas those who retired from physical labour indicated an increased risk of obesity. CONCLUSIONS: Retirement was associated with a reduced risk of heart disease on average. Some associations of retirement with CVD and risk factors appeared heterogeneous by individual characteristics.

Family Pharmacy and Medication Adherence Among Older Adults in Japan: A Cross-Sectional Study of JAGES 2019.

OBJECTIVES: Poor medication adherence among older adults is a global concern as it causes adverse drug interactions and inappropriate dosing. This study aimed to assess the association between family pharmacy and medication adherence among older adults. METHODS: The Japan Gerontological Evaluation Study was a cross-sectional study of 18,792 people aged ≥65 years living in 61 municipalities in 25 prefectures who participated in a survey conducted in 2019 and did not require long-term care. Self-reported questionnaires were administered to evaluate whether the participants "always received medicines from the same pharmacy" and whether they had unused medicines. Modified Poisson regression was used to examine the association after adjusting for confounders. RESULTS: Unused medicines were present in 89.9% of the "have group" (individuals who always received their medicines from the same pharmacy). This group had a lower prevalence of unused medicines (prevalence ratio [PR] = 0.87, 95% confidence interval [CI]: 0.82-0.92) than the "none group" (individuals who did not always receive their medicines from the same pharmacy). In the stratified analysis by education level, the prevalence of unused medicines was lower among those with low levels of education (≤9 years: PR = 0.82, 95% CI: 0.71-0.96; 10-12 years: PR = 0.81, 95% CI: 0.74-0.88). DISCUSSION: Older adults who "always received medicines from the same pharmacy" had a lower prevalence of unused medicines, especially those with low levels of education. Thus, "always receiving medicines from the same pharmacy" may be effective in reducing the proportion of unused medicines and improving medication adherence.

Pre-pandemic individual- and community-level social capital and depressive symptoms during COVID-19: A longitudinal study of Japanese older adults in 2019-21.

During a pandemic, it is important to know whether social capital can mitigate the risk of mental disorders, given the restrictions on social interactions. However, evidence using longitudinal data is scarce. This study examined the association between pre-pandemic social capital and depressive symptoms during COVID-19 among older adults. We used longitudinal data from the Japan Gerontological Evaluation Study (JAGES), including 8291 participants aged 65 or older who were physically and cognitively independent and not depressed at baseline. We conducted baseline and follow-up mail surveys in ten municipalities in Japan from November 2019 to January 2020 (pre-pandemic period) and from November 2020 to February 2021 (pandemic period), respectively. We measured depressive symptoms using the 15-item Geriatric Depression Scale. Social capital was measured with three validated subscales, namely, civic participation, social cohesion, and reciprocity. We performed a multilevel logistic regression analysis to examine the association. A total of 1089 (13.1%) participants newly developed depressive symptoms during the pandemic. The logistic regression showed that pre-pandemic individual-level social cohesion (odds ratio = 0.79, 95% confidence interval: 0.73 to 0.86) and reciprocity (0.89, 0.82 to 0.96) and community-level reciprocity (0.93, 0.88 to 0.98) were negatively associated with the odds of depressive symptoms. Even after adjusting for declines in social capital during the pandemic, the observed associations of pre-pandemic social capital remained. Fostering social cohesion and reciprocity may increase resilience to mental disorders during a pandemic of infectious disease.