Prevalence and Associated Factors of Psychological Distress Among Single Fathers in Japan.

BACKGROUND: In Japan, ten percent of single-parent households are led by fathers. Taking care of children as a single father is very stressful and could put a strain on their health. It is very important to prevent and identify psychological distress among fathers for both their own health and to avoid negative impacts on children. This study aims to determine the prevalence of and factors associated with psychological distress among single fathers and understand how it is different from partnered fathers. METHODS: We used data from the Comprehensive Survey of Living Conditions 2016. Psychological distress, assessed using the K6 scale, was analyzed among 868 single and 43,880 partnered fathers. Logistic regression analysis was performed to assess the risk factors for psychological distress, such as employment type, sleep hours, and smoking and drinking habits. RESULTS: Single fathers had a higher proportion (8.5%) of psychological distress compared to partnered fathers (5.0%). A larger percentage of single fathers had a lower educational level and were more likely to be non-regular workers, self-employed, or unemployed than partnered fathers. Among single fathers, the crude and adjusted odds ratio for employment type and sleep hours were significantly associated with psychological distress. CONCLUSION: As single parents who are self-employed or directors are likely to have significantly reduced psychological distress than those with regular jobs, measures are needed to improve the work-family balance for non-self-employed fathers. There is a need to provide greater financial assistance and other social welfare support to single parents to ensure their and their children's good health.

Trajectories of fathers' childcare involvement and child behavioral outcomes.

BACKGROUND: Father's closeness and playful behavior influence a child's emotional and cognitive development. In this study, we aimed to assess the long-term association of paternal involvement in childcare at 1-3 years of life on subsequent behavioral outcomes at 8 years of age. METHODS: Data were obtained from the 2010 cohort of the Longitudinal Survey of Newborns in the 21st century in Japan. We used group-based trajectory modeling to predict the trajectory of total childcare scores in surveys 1, 2 and 3 to determine the overall involvement of fathers in childcare during early childhood. The level of fathers' involvement in childcare was categorized as "low", "medium" and "high". Responses from the eighth survey were used to assess child behavioral outcomes using five indicators when the child was 8 years old. Crude and adjusted logistic regression analysis was conducted to estimate the odds ratio (OR) separately for each of the behavioral outcomes of the child. RESULTS: Among the 17,027 father-child dyads included in this study, two-thirds of the fathers were of the age group 30-39 years. Compared to low involvement, children of fathers with high involvement in childcare during the early childhood years were less likely to not want to go to school even after adjusting for covariates (adjusted OR, 0.46; 95% CI: 0.32-0.66). CONCLUSIONS: Children benefit from their fathers' involvement in early childcare activities. To improve a child's well-being, fathers should be encouraged by providing them with a suitable working environment with flexible arrangements and the opportunity to involve in childcare.

Changes in cause-specific mortality trends across occupations in working-age Japanese women from 1980 to 2015: a cross-sectional analysis.

BACKGROUND: Reducing health inequalities is an important public health challenge. Many studies have examined the widening health gap by occupational class among men, but few among women. We therefore estimated variation in absolute and relative mortality by occupational category across four leading causes of mortality-cancer, ischaemic heart disease, cerebrovascular disease, and suicide-to explore how occupational class is associated with health among working women aged 25-64 in Japan. METHODS: We conducted a repeated cross-sectional study using Poisson regression analysis on each five-yearly mortality data from 1980 to 2015, obtained from the National Vital Statistics and the Japanese Population Census. RESULTS: There was a decreasing trend in mortality from all cancers, ischaemic heart disease, cerebrovascular disease, and suicide among women in all occupational groups from 1980 to 2015. Agriculture workers had higher risk of mortality than professional workers for all four causes of death. The absolute difference in mortality rates for all cancers and cerebrovascular disease was higher in 2000-2015 than 1980-1995. The mortality trend among clerks and sales workers decreased after 2000, except for suicide. CONCLUSIONS: Mortality rates from all four causes are higher among agriculture workers compared to professional workers, and attention is needed to reduce this mortality gap. Continuous monitoring of ongoing mortality trends is essential to ensure better health and wellbeing in Japan.

Occupation- and industry-specific cancer mortality among Japanese women from 1980 to 2015.

BACKGROUND: The number of women in Japan who continue working after childbirth is on the rise. Over the past few years, Japan's cancer mortality rate has increased. About 50% of all cancer deaths among Japanese women aged 25-64 are caused by lung, gastric, pancreatic and colorectal cancers. This study aims to examine the difference in mortality risk for key cancers among women and explore the effect of the economic crisis in the mid-1990s separately for occupational and industrial categories. METHODS: Data from 1980 to 2015 were gathered from the Japanese Population Census and National Vital Statistics conducted in the same year. A Poisson regression analysis was used to estimate mortality risk and mortality trends for lung, gastric, pancreatic and colorectal cancer among Japanese working women aged 25-64 years. RESULTS: Across most industrial and occupational groups, the trends in age-standardised cancer mortality rate for women have declined. Workers in management, security and transportation have a higher cancer mortality risk than sales workers. The risk of death from all four cancers is higher for workers in the mining and electricity industries than for wholesale and retail workers. CONCLUSION: To improve the health and well-being of employed Japanese women, it is crucial to monitor cancer mortality trends. Using these population-level quantitative risk estimates, industry- and occupation-specific prevention programmes can be developed to target women at higher cancer risk and enable the early detection and treatment of cancer.

Trends and correlates of cesarean section rates over two decades in Nepal.

BACKGROUND: Cesarean section (CS) is a major component of emergency obstetric care. There has been a substantial rise in the rate of CS in private institutions in Nepal which might reflect the successful implementation of delivery schemes introduced by the government extended to the private organizations alternatively, it may also reflect the need for more public health care facilities to provide maternal and child health care services. Hence, the objective of this study was to examine the trends in institutional-based CS rates in Nepal along with its correlates over time. METHODS: We used the National Demographic and Health Survey (NDHS) data collected every 5 years, from 1996 to 2016. The trend in CS rates based on five waves of NDHS data along with its correlates were examined using multivariable logistic regression models after adjusting for socio-demographics and pregnancy-related variables. RESULTS: We included 20,824 reproductive-aged women who had a history of delivery within the past 5 years. The population-based CS rate increased from 0.9% in 1996 [95% CI: (0.6-1.2) %] to 10.2% in 2016 [95% CI: (8.9-11.6) %, p < 0.01] whereas the institutional-based CS rate increased from 10.4% in 1996 [95% CI: (8.3-12.9) %] to 16.4% in 2016 [95% CI: (14.5-18.5) %, p < 0.01]. Private institutions had a nearly 3-fold increase in CS rate (8.9% in 1996 [95% CI: (4.8-16.0) %] vs. 26.3% in 2016[95% CI: (21.9-31.3) %]. This was also evident in the trend analysis where the odds of having CS was 3.58 times higher [95% CI: (1.83-7.00), p < 0.01] in 2016 than in 1996 in the private sectors, while there was no evidence of an increase in public hospitals (10.9% in 1996 to 12.9% in 2016; p for trend > 0.05). Education of women, residence, wealth index, parity and place of delivery were significantly associated with the CS rate. CONCLUSION: Nepal has observed a substantial increase in cesarean delivery over the 20 years, which might indicate a successful implementation of the safe motherhood program in addressing the Millennium Development Goals and Universal Health Care agenda on maternal and child health. However, the Nepal government should examine existing disparities in accessibility of emergency obstetric care services, such as differences in CS between public and private sectors, and promote equity in maternal and child health care services accessibility and utilization.

Japanese fathers' work-related factors associated with involvement in childcare.

OBJECTIVES: Existing studies of fathers' involvement in childcare have focused on its impact on children's psychosocial development and the facilitation of family functions, like marital relationships. In this study, we investigated the factors that determine paternal childcare in Japan, particularly focusing on work-related hours and environment, separately, according to mothers' employment status. METHODS: We used data from the Longitudinal Survey of Newborns in the 21st Century (2010 cohort) conducted in Japan. We restricted the sample to 27 783 participants with working fathers and analyzed how paternal work-related factors affect fathers' childcare involvement by mothers' employment status using an ordered logistic regression model. RESULTS: In the model adjusting for all covariates, the odds ratio (OR) of spending less time with children on weekdays was higher: for fathers who worked 50 and more hours per week compared with those who worked 40-49 hours per week (OR = 1.95, 95% CI: 1.72-2.20 for 50-59 hours), for fathers whose commuting hours were longer than those commuting less than 0.5 hours per day (OR = 2.93, 95% CI: 2.34-3.69 for 1.5 or more hours), for larger workplace employee sizes than for 5-99 employee sizes (OR = 1.56, 95% CI: 1.38-1.77 for 500 or more employees). The associations between these paternal work-related variables and paternal hours spent with the children on weekdays were almost the same if the mothers were working or not working. CONCLUSIONS: Regardless of whether the mother is working, fathers' work environment factors, such as working hours, play a key role in their involvement in childcare.

Suicide Interventions in Spain and Japan: A Comparative Systematic Review.

(1) Background: This systematic review presents an overview of psychological interventions in suicide published between 2013 and 2023 in Spain and Japan, sparked by Spain's alarming recent increase in suicide rates and the potential exemplar of Japan's reduction efforts. (2) Methods: Following the PRISMA checklist, the databases Web of Science, Scopus, PubMed, and PsycInfo were searched using the terms [("suicide" OR "suicidal behavior" OR "suicidal attempt" OR "suicidal thought" OR "suicidal intention") AND ("prevention" OR "intervention" OR "psychosocial treatment" OR "Dialectical Behavior Therapy" OR "Cognitive Therapy" OR "psychotherap*")] AND [("Spain" OR "Spanish") OR ("Japan" OR "Japanese")]. We included articles published in peer-reviewed academic journals, written in English, Spanish, and Japanese between 2013 and 2023 that presented, designed, implemented, or assessed psychological interventions focused on suicidal behavior. (3) Results: 46 studies were included, concerning prevention, treatment, and training interventions. The risk of bias was low in both Spanish and Japanese studies, despite the lack of randomization of the samples. We identified common characteristics, such as psychoeducation and coping skills. Assertive case management was only highlighted in Japan, making an emphasis on active patient involvement in his/her care plan. (4) Conclusions: The findings will help professionals to incorporate into their interventions broader, more comprehensive approaches to consider more interpersonal components.

Trends in Participation in Rubella Antibody Testing among Working-Aged Men during Annual Health Check-Ups from 2019 to 2022 in Japan.

In 2019, the Japanese government established a scheme for rubella antibody testing of men born between 1962 and 1978 during workplace health check-ups. However, the use of vouchers for rubella antibody testing was limited. Health check-up data analyses are needed to determine the reason why rubella antibody testing is not widely used. In this study, we aimed to describe changes in rubella antibody test-taking behavior during health check-ups during the first 3 years of the rubella catch-up campaign in Japan. In 2019, 2020, and 2021 (2020 in some areas) vouchers were sent to men born during the fiscal years 1972-1978, 1966-1971, and 1962-1965, respectively. We calculated the prevalence in men born between 1962 and 1978 who underwent rubella antibody testing during mandatory health check-ups under the Industrial Health and Safety Act. Rubella antibody testing uptake was relatively high (approximately 15%) in all three age groups soon after the distribution of the vouchers and then declined to below 2% during the second and third years. Further population-based approaches with continuous public engagement are required in workplaces to effectively promote and expand the rubella vaccination program in Japan.

Characteristics of needlestick and sharps injuries of the hands in the operating room among orthopedic surgeons in Japan.

Among the reports on needlestick and sharps injuries (NSIs), many are orthopedic-related due to the frequent use of sharp devices such as pins and wires. This study aimed to identify high-risk instruments, the most common injury sites for each instrument, and the circumstances of NSIs of the hand during orthopedic surgeries in Japan. Incidents of exposure to blood or bodily fluids among physicians during orthopedic surgeries reported to the Japan-EPINet between 2000 and 2015 were included in this study. The four most common devices were identified and the associations among years of experience, equipment users, and injured sites were analyzed. We identified 666 cases of NSIs affecting orthopedic surgeons in the operating room. The instrument most frequently responsible for NSIs was suture needles, which were involved in 265 cases (39.7%). The second most common instrument was pins/wires, which was involved in 111 cases (16.6%). NSIs of the hands of orthopedic surgeons were frequently caused by suture needles used in all surgeries, but relatively often caused by orthopedic devices. Orthopedic surgeons must be aware that they are at risk of NSIs and must take appropriate measures and always be cautious when performing surgery, regardless of their years of experience.

Association of paternal factors with mothers' employment postchildbirth.

OBJECTIVES: The demand on Japanese women to fulfill their dual roles as mothers and labor force participants leads to a subsequent reduction of their employment hours, switching of occupations, or quitting the labor force. This study aims to examine paternal factors associated with mothers' employment status 18 months after childbirth. METHODS: We used data from the 2010 cohort of the Longitudinal Survey of Newborns conducted in Japan. We restricted our analysis to 10 712 mothers who had full-time employment 1 year before childbirth. A logistic regression analysis was conducted to assess paternal factors associated with mothers' employment after childbirth. RESULTS: One-third of the mothers with full-time employment before childbirth were not working full-time 18 months after delivery. We found that high childcare involvement (score 13-18) of fathers (OR, 1.20; 95% CI, 1.01-1.43) and fathers with part-time employment (OR, 1.59; 95% CI, 1.12-2.26) were associated with higher odds of mothers' full-time employment. Fathers' weekly work of ≥60 h (OR, 0.79; 95% CI, 0.71-0.88) and higher annual income decreased the odds ratios by over 20%. CONCLUSIONS: Fathers' work arrangements and involvement in childcare play a key role in helping mothers resume employment postchildbirth.

The long-term association between paternal involvement in infant care and children's psychological well-being at age 16 years: An analysis of the Japanese Longitudinal Survey of Newborns in the 21st Century 2001 cohort.

BACKGROUND: Some studies conducted in the United Kingdom have shown long-term associations between paternal involvement in childcare and adolescents' mental health issues. However, findings were inconsistent, and similar epidemiologic studies have not been conducted in other countries in Europe or Asia. Thus, we aimed to examine this association using Japanese population-based cohort study data. METHODS: The Japanese Longitudinal Survey of Newborns in the 21st Century commenced in 2001. Data from 18,568 16-year-olds enrolled in the survey were analyzed. Poor psychological well-being was assessed using the WHO-5 Well-being Index. Paternal involvement in childcare-in tasks such as changing diapers-was assessed at the children's 6 months of age. We created four groups from least involvement to most active involvement based on the frequency of fathers' performing the tasks. RESULTS: The risk of poor psychological well-being was lower among more active involvement groups compared with the least involvement group, after adjusting for potential confounders (risk ratios = 0.90 [95 % confidence intervals: 0.85, 0.95] for the most active group). LIMITATIONS: Due to 16 years of follow-up, loss to follow-up may have caused a selection bias. CONCLUSIONS: Our study is the first in Asian countries to show that fathers' active involvement in childcare is associated with poor psychological well-being in adolescence. Encouraging fathers' involvement in childcare may ameliorate prevalent issues of school refusals and withdrawals in the long term in Japan.

Evolving trends in drug overdose mortality in the USA from 2000 to 2020: an age-period-cohort analysis.

Background: Drug overdose deaths in the USA have increased rapidly in the past 20 years, and understanding patterns and trends in mortality is essential to develop policy responses. This study aimed to determine whether cohort patterns in mortality due to drug overdose have changed in the past two decades and assess these patterns by race and sex. Methods: The national records of accidental drug overdose death were extracted from Centers for Disease Control and Prevention, National Center for Health Statistics Mortality Data for 2000-2020. Age-period-cohort analysis was performed to examine independent effects of age, period and birth cohort on accidental drug overdose mortality. Findings: The number of accidental drug overdose deaths increased by 622% between 2000 and 2020, and age-standardized mortality rates increased nearly four-fold in both men and women. Age-period-cohort decomposition found rapid increases in mortality since 2012 in men and women, with higher mortality risk in cohorts born after 1990. The fastest increase occurred in Black Americans since 2012, and Americans of all races born after 1975 had significantly higher mortality risk, with mortality risk increasing rapidly in more recent cohorts. The peak of mortality has shifted from the 40-59 age group to the 30-40 year age group in the past decade. Interpretation: The burden of drug overdose mortality has shifted to younger Americans, and a new generation of Americans are at significantly higher and rapidly increasing risk of overdose death. Urgent action is needed to prevent an entire generation of young people being consigned to decades of preventable mortality. Funding: None.

Socioeconomic and education-based inequality in suspected developmental delays among Nepalese children: a subnational level assessment.

Failure to meet early childhood developmental milestones leads to difficulty in schooling and social functioning. Evidence on the inequality in the burden of developmental delays across population groups, and identification of potential risk factors for suspected developmental delays (SDD) among younger children, are essential for designing appropriate policies and programs. This study explored the level of socioeconomic and maternal education-based inequality in the prevalence of SDD among Nepalese children at subnational level and identified potential risk factors. Individual-level data from the 2019 Nepal Multiple Indicator Cluster Survey was used to estimate the prevalence of SDD among children aged 3-4 years. Regression-based slope index of inequality (SII) and relative index of inequality were used to measure the magnitude of inequality, in terms of household socioeconomic status (SES) and mother's education, in the prevalence of SDD. In addition, a multilevel logistic regression model was used to identify potential risk factors for SDD. The national prevalence of SDD was found to be 34.8%, with relatively higher prevalence among children from rural areas (40.0%) and those from Karnali Province (45.0%) followed by Madhesh province (44.2%), and Sudhurpashchim Province (40.1%). The prevalence of SDD was 32 percentage points higher (SII: -0.32) among children from the poorest households compared to their rich counterparts at the national level. At the subnational level, such inequality was found to be highest in Lumbini Province (SII = -0.47) followed by Karnali Province (SII = -0.37), and Bagmati Province (SII = -0.37). The prevalence of SDD was 36 percentage points higher (SII: -0.36) among children whose mother had no formal education compared to children of higher educated mothers. The magnitude of education-based absolute inequality in SDD was highest in Lumbini Province (SII = -0.44). Multilevel logistic regression model identified lower levels of mother's education, disadvantaged SES and childhood stunting as significant risk factors for SDD. One in each three children in Nepal may experience SDD, with relatively higher prevalence among children from rural areas. Subnational level variation in prevalence, and socioeconomic and education-based inequality in SDD highlight the urgent need for province-specific tailored interventions to promote early childhood development in Nepal.

Time to update the Japanese standard population for comparing mortality rates.

For the last three decades, Japan has been using the population of 1985 for age standardisation to compare mortality rates over time. With the population of Japan declining and ageing rapidly every year, there is a need to update the standard population to make the comparison representative of the current scenario. This is particularly relevant owing to declining mortality rates among the super-ageing Japanese elderly population and more data availability for older age groups. The choice of one population as standard over another is arbitrary because it does not make much difference to the trends in rates. The proportion of elderly in Japan is increasing rapidly and is expected to be one-third of the total population by 2030, in contrast to the proportion of 10% in the 1980s. Using a standard population with a lower proportion of elderly may weight the rates disproportionately for this age group. It is typically suitable to change the standard population every 25 to 30 years. It is advisable to choose the population of 2015 as the new standard population as suggested by the working group of the Ministry of Health, Labour and Welfare of Japan for revising the standard population. However, it should be noted that the newly calculated age-standardised mortality rates will no longer be comparable to those calculated using the older standard populations. Updating the standard population will produce age-standardised rates for recent years closer to the crude rates and would thus reduce the extent of misinterpreting decreased mortality risks using age-standardised rates that do not closely resemble the crude rates.

Effectiveness of Workplace Interventions for Improving Working Conditions on the Health and Wellbeing of Fathers or Parents: A Systematic Review.

Evidence on the effectiveness of workplace interventions for improving working conditions on the health and wellbeing of fathers is scarce. We reviewed studies on the effectiveness of various workplace interventions designed to improve working conditions for the health and wellbeing of employed fathers and their families. Randomized controlled trials (RCTs) and quasi-randomized controlled trials of workplace interventions applied to employees with the aim of improving working conditions of employed parents, compared with no intervention, other active arms, placebo, wait list, or usual practice were included. Studies involving only women were excluded. An electronic search of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, ERIC and SSCI was done for eligible studies. Studies were screened against predetermined criteria and assessment of risk of bias done using the Cochrane Handbook for Systematic Reviews of Interventions for RCTs and the Risk of Bias Assessment tool for Non-randomized Studies for non-RCTs. Of the 8229 records identified, 19 reports were included in this review: 14 reports from five RCTs and five reports from two quasi-RCT studies. The studies were conducted in four different countries among working populations from various sectors. Studies addressing issues related to improving working conditions of fathers alone were lacking. All included studies assessed intervention effects on various health-related outcomes, the most common being sleep disturbances and mental health outcomes. Interventions administered yielded positive effects on various health outcomes across all seven studies. All included studies had methodological limitations, while study designs and methodologies lacked comparability. Consequently, a narrative synthesis of evidence is provided. Based on our findings, providing workplace interventions for improving working conditions may improve some aspects of the health and wellbeing of employed parents, including fathers.

Difference in Mortality Rates by Occupation in Japanese Male Workers Aged 25 to 64 Years from 1980 to 2015.

This study examines the trends in mortality among Japanese working men, across various occupational categories, from 1980 to 2015. A Poisson model of trend, occupational category, and step variable was analysed for eight occupational categories separately, by cause, to explore the trends in mortality. This study found a sharp increase in mortality in the late 1990s, especially among professionals and managers. The overall trends in cancer, ischemic heart disease (IHD), cerebrovascular disease (CVD), and suicide mortality decreased across almost all occupational categories from 1980 to 2015, although there was an increasing trend in cancer of 0.5% among managers. Clerical workers had the greatest relative decrease in mortality rates from cancer (-82.9%), IHD (-81.7%), and CVD (-89.1%). Japan continues to make gains in lowering mortality and extending life expectancy, but its workplace culture must improve to ensure that those working at the heart of the Japanese corporate world can also benefit from Japan's progress in health. Mortality rates in working-aged Japanese men have been declining. However, similar declines are not evident among managers, for whom the mortality rate is remaining stable or slightly increasing. There is a need to address the needs of managers and improve workplace environments for these workers.

Method-specific suicide trends from 1979 to 2016 among Japanese adolescents.

BACKGROUND: In 2015 the Japanese government set a target of a 30% reduction in the total suicide rate by 2025, but deaths among adolescents have been rising since. In 2018 the overall suicide rate increased by 33% among Japanese students, as a part of a continued trend of rising suicide among adolescents. This study analysed the trends in method-specific suicide among Japanese adolescents from 1979 to 2016. METHODS: We conducted a cross-sectional study using data obtained from the vital statistics registration of the Ministry of Health, Labour and Welfare Japan. Poisson regression analysis was performed among 10-20-year-olds separately by sex, with year, age category, suicide method and a 1998 step variable as covariates. RESULTS: There was a sharp increase in suicide rates among boys (Incidence Rate Ratio (IRR), 1.68; 95% CI, 1.58-1.77) and girls (IRR, 1.69; 95% CI, 1.56-1.84) aged 10-20 years in 1998 when the overall suicide rate in Japan was at its peak. The commonly used method of suicide, hanging, has increased rapidly among high school and university-level aged adolescents since 1998. LIMITATIONS: The computed mortality rates may have been affected by the shift in mortality coding from ICD-9 to ICD-10 in 1995. CONCLUSIONS: Suicide among adolescents has been rising since the early 1990s. Several cultural factors such as notoriety of internet suicide and detergent suicide could have influenced the increase in suicide among adolescents. There is an urgent need to address suicide by hanging and gas among high school and university-aged adolescents.

Reliability of Early Estimates of the Basic Reproduction Number of COVID-19: A Systematic Review and Meta-Analysis.

OBJECTIVE: This systematic review estimated the pooled R0 for early COVID-19 outbreaks and identified the impact of study-related factors such as methods, study location and study period on the estimated R0. METHODS: We searched electronic databases for human studies published in English between 1 December 2019 and 30 September 2020 with no restriction on country/region. Two investigators independently performed the data extraction of the studies selected for inclusion during full-text screening. The primary outcome, R0, was analysed by random-effects meta-analysis using the restricted maximum likelihood method. RESULTS: We identified 26,425 studies through our search and included 151 articles in the systematic review, among which 81 were included in the meta-analysis. The estimates of R0 from studies included in the meta-analysis ranged from 0.4 to 12.58. The pooled R0 for COVID-19 was estimated to be 2.66 (95% CI, 2.41-2.94). The results showed heterogeneity among studies and strong evidence of a small-study effect. CONCLUSIONS: The high heterogeneity in studies makes the use of the R0 for basic epidemic planning difficult and presents a huge problem for risk assessment and data synthesis. Consensus on the use of R0 for outbreak assessment is needed, and its use for assessing epidemic risk is not recommended.

Mortality risks among blue- and white-collar workers: A time series study among Japanese men aged 25-64 years from 1980 to 2015.

OBJECTIVE: We aimed to analyse age-standardised mortality trends in Japan among blue- and white-collar male workers aged 25-64 years, by major causes of mortality from 1980 to 2015. METHODS: Five-yearly mortality data were extracted from occupation-specific vital statistics maintained by the Japanese Ministry of Health, Labour and Welfare. A time series study was conducted among employed men aged 25-64 years. Age-standardised mortality trends by occupational category were calculated separately for all cancers, ischaemic heart disease, cerebrovascular disease and suicide. Poisson regression analysis was performed to analyse mortality trends by occupational category for each cause. RESULTS: Mortality rates for all cancers and ischaemic heart disease were higher among white-collar workers than blue-collar workers throughout the 35-year study period. The gap in the mortality rates for all four causes of death among blue- and white-collar workers widened in 2000 after Japan's economic bubble burst in the late 1990s. Simultaneously, suicide mortality rates among white-collar workers increased sharply and have remained higher than among blue-collar workers. CONCLUSIONS: White-collar male workers in Japan have a higher risk of mortality than male blue-collar workers. However, despite substantial differences, significant progress has been made in recent years in reducing mortality across all occupations in Japan.