Relationship between occupational stress and presenteeism status among workers in small and medium-sized enterprises.

This study aimed to identify characteristics of workers experiencing health problems without a decline in labor productivity to address presenteeism. A cross-sectional analysis was conducted on 554 workers in Japan, with a median age of 43 years. Participants reported any health problems in the past month, along with job stressors, stress responses, social support, and job and life satisfaction using the Brief Job Stress Questionnaire. They were categorized into three groups: "no symptoms," "pre-presenteeism" (health problems without work impact), and "presenteeism" (health problems with work impact). Results showed that 30.1% were in "prepresenteeism" and 52.0% in "presenteeism." Stress responses and social support were linked to both "pre-presenteeism" and "presenteeism," while job stressors and job and life satisfaction were only associated with "presenteeism." These findings offer insights for preventing presenteeism.

Combined associations of regular exercise and work-related moderate-to-vigorous physical activity with occupational stress responses: a cross-sectional study.

Objective: The association between work-related moderate-to-vigorous physical activity (MVPA) and higher levels of stress response is recognized, but whether this association is moderated by regular exercise remains unclear. This cross-sectional study investigated whether exercise-based physical activity (PA) associates with lower levels of stress responses moderated by work-related MVPA. Methods: The study participants comprised 863 workers from 35 small and medium-sized enterprises in Shimane prefecture, Japan, collected through convenient sampling from April 2021 to August 2022. The Brief Job Stress Questionnaire was used to assess stress responses. Work-related MVPA and exercise-based PA were measured using questionnaires. Multiple linear regression was used to analyze the combined variables of work-related MVPA and exercise-based PA. The reference group had no weekly exercise-based PA and >60 min of work-related MVPA. Results: When work-related MVPA exceeded 60 min/day, flexibility activity or walking for ≥5 days/week (B = -3.53, 95% CI = -5.96, -1.11; B = -2.53, 95% CI = -4.90, -0.16) and muscle-strengthening activity 1-3 times/week (B = -3.52, 95% CI = -6.91, -0.12) were significantly associated with lower psychological stress response. Flexibility activity (B = -1.74, 95% CI = -3.01, -0.46) showed a similar link with physical stress response. When work-related MVPA was below 60 min/day, flexibility activity (B = -3.23, 95% CI = -6.01, -0.44; B = -3.29, 95% CI = -5.94, -0.63) or walking (B = -4.03, 95% CI = -6.62, -1.45; B = -3.10, 95% CI = -5.76, -0.44) practice 1-4 times/week and ≥5 times/week was significantly associated with lower psychological stress response. Conclusion: Exercise-based PA greatly and consistently associates with a lower level of stress responses moderated by work-related MVPA.

Association between different types of physical activity and occupational stress in Japanese workers: a cross-sectional study.

This cross-sectional study investigated the association between different types of physical activity (PA) and occupational psychological and physical stress responses among workers in Japan. Stress responses were assessed using the Brief Job Stress Questionnaire. Work-related PA (time spent sitting, sitting bouts, standing, walking, engaging in heavy labor, and moderate-to-vigorous PA [MVPA]) and exercise-based PA (frequencies [times/wk] of flexibility and muscle-strengthening activity, and walking) were measured using a questionnaire. Multiple linear regression was performed to examine the association between each type of PA and stress responses. Participants who engaged in >108 min/d of work-related MVPA exhibited a statistically significant association with higher psychological stress responses when compared to those who engaged in 0-42 min/d of work-related MVPA. For exercise-based PA, participants who engaged in flexibility activity or walking five or more times/wk, or muscle-strengthening activity one to three times/wk, demonstrated significantly lower psychological stress responses compared to those who did not exercise. Participants who engaged in flexibility activity five or more times/wok demonstrated significantly lower physical stress responses compared to those who did not exercise. This study suggests that work-related MVPA is associated with higher psychological stress responses, while exercise-based PA is associated with lower psychological or physical stress responses.

Neighbourhood socioeconomic status and pain among older adults-A cross-sectional study.

BACKGROUND: Pain is associated with falls, disability and a poor quality of life among older adults. It is highly prevalent in many societies, and studies have shown that pain could be preventable or managed more effectively at the population level. However, few studies have investigated who is at higher risk of pain in the general population, which is important for development of effective interventions. The purpose of this study was to investigate, by using nationally representative samples in Sweden, whether neighbourhood socioeconomic status (SES) is associated with pain among older adults after considering other important risk factors. METHODS: The study used the Statistics on Income and Living Conditions (EU-SILC), which is a nationwide annual survey of the living conditions of residents in Sweden. We used the data of individuals who were over 65 years of age between 2008 and 2013. Multivariable logistic regression was conducted to investigate the association between neighbourhood SES and severe pain. RESULTS: Those who resided in low SES neighbourhoods had a 30% higher odds of having severe pain than those who resided in high SES neighbourhoods after controlling for individual risk factors, such as the sex, age, individual SES, smoking, exercise habits and body mass index. Exercise was protective against severe pain. CONCLUSION: Given the high prevalence of pain across populations, interventions targeting geographic areas (such as those in the current study) in combination with individual risk factors could be effective to reduce the burden of pain at the population level. SIGNIFICANCE: Those who reside in neighbourhoods with low SES may have higher risks of pain due to a lack of health-promoting resources as well as psychological stress. Further studies identifying the specific mechanisms behind the association between neighbourhood SES and pain would be useful in order to develop effective interventions.

Associations between dairy consumption and the physical function in Japanese community-dwelling older adults: The Shimane CoHRE study.

OBJECTIVES: We investigated sex differences in the associations between dairy consumption and the physical function among community-dwelling older adults. METHODS: Six hundred and fifty-six older adults (75.6 ± 6.4 years old) participated in this study. Dairy consumption (5-item Likert score) and the physical function (gait speed, handgrip strength, and skeletal muscle mass) were measured. The linear and quadratic associations between dairy consumption and the physical function measures were examined by a multiple linear regression analysis adjusted for covariates. RESULTS: Among women, an increased dairy consumption was significantly linearly associated with greater hand-grip strength and faster gait speed (both p<0.05) after adjusting for covariates. Among men, dairy consumption was not associated with the physical function measures. Dairy consumption was not associated with the muscle mass in either sex. CONCLUSIONS: Increased dairy consumption was associated with a superior physical function in older women.

Association between flexibility activity and blood-pressure change among older adults in Japan: A 5-year longitudinal study.

This longitudinal study examined the relationship between flexibility-activity and blood-pressure (BP) change among older adults in Japan. Our study included 452 older adults who took part in our survey in both 2012/2013 and 2017/2018. The seated systolic blood pressure (SBP) and diastolic BP (DBP) were measured both at baseline and at the 5 years follow-up. The frequencies of the different physical activities at baseline were assessed using a questionnaire. A generalized linear mixed model was used to estimate the non-standardized coefficient (B) of BP change associated with flexibility activity, after adjustments for sex, age, body mass index, smoking status, alcohol consumption, antihypertensive medication use, history of heart disease, walking time, and muscle-strengthening activity as a fixed-effect, and area of residence as a random-effect. Higher flexibility-activity frequency was significantly associated with reduced SBP (B = -0.77 [95% confidence intervals = -1.36, -0.18], p for linear trend = 0.01, p for quadratic trend = 0.85) and DBP (-0.33 [-0.71, 0.05], p for linear trend = 0.09, p for quadratic trend = 0.04). Engaging in flexibility activity for 3 days per week was significantly associated with a reduction in DBP (B = -4.16, 95% CI [-7.53, -0.79], p = 0.02) compared with that in the reference group (0 days per week). Interaction tests were not significant between basic variables (sex, age, BMI, and antihypertensive medication) and flexibility. In conclusion, higher flexibility activity frequency was associated with a reduction in BP in older adults. Future longitudinal and interventional studies should examine the effects of flexibility activity on cardiovascular disease prevention.

Neighborhood deprivation and coronary heart disease in patients with bipolar disorder.

The aim was to study the potential effect of neighborhood deprivation on incident and fatal coronary heart disease (CHD) in patients with bipolar disorder. This was a nationwide cohort study which included all adults aged 30 years or older with bipolar disorder (n = 61,114) in Sweden (1997-2017). The association between neighborhood deprivation and the outcomes was explored using Cox regression analysis, with hazard ratios (HRs) and 95% confidence intervals (CIs). Patients with bipolar disorder living in neighborhoods with high or moderate levels of deprivation were compared with those living in neighborhoods with low deprivation scores. There was an association between level of neighborhood deprivation and incident and fatal CHD among patients with bipolar disorder. The HRs were 1.24 (95% CI 1.07-1.44) for men and 1.31 (1.13-1.51) for women for incident CHD among patients with bipolar disorder living in high deprivation neighborhoods compared to those from low deprivation neighborhoods, after adjustments for potential confounders. The corresponding HR for fatal CHD were 1.35 (1.22-1.49) in men and 1.30 (1.19-1.41) in women living in high deprivation neighborhoods. Increased incident and fatal CHD among patients with bipolar disorder living in deprived neighborhoods raises important clinical and public health concerns.

Associations between physical frailty and living arrangements in Japanese older adults living in a rural remote island: The Shimane CoHRE study.

Background: Living arrangements have been known to be associated with physical frailty. However, the prevalence of frailty and its risk factors in remote islands is not understood. We examined the association between living arrangements and objectively measured frailty among older adults living in a remote island of Japan. Methods: Among older people living in Okinoshima, 656 older adults (75.6 ± 6.4 years) were analyzed. Physical frailty (robust, prefrailty, or frailty) was assessed using the 5-item frailty phenotype (unintentional weight loss, self-reported exhaustion, weakness, slow walking speed, and low physical activity). Physical functions (muscle mass, gait speed, and grip strength) were measured objectively. Results: The prevalence of frailty and prefrailty was 6.6% and 43.8%, respectively. Living with a spouse resulted in a significantly lower prevalence of frailty (p < 0.001) compared with other living arrangements. All objectively measured physical functions among those who lived with a spouse were significantly superior to those who lived with family or alone (p < 0.001). Multinomial logistic regression showed that living alone was significantly associated with frailty (odds ratio [OR] 2.36, 95% confidence interval [CI] 1.07-5.24) and prefrailty (OR 1.75, 95% CI 1.14-2.69) after adjusting for all covariates. Conclusion: The prevalence of frailty on remote islands seemed similar to that in urban areas. Older people living in remote islands might be able to maintain their physical health. Furthermore, living alone may correlate with increased risks of frailty and prefrailty. Among elderly individuals on remote islands, living with a spouse might be desirable to prevent (pre)frailty.

Changes in the Urinary Sodium-to-Potassium Ratio Are Associated with Blood Pressure Change in Older Japanese Adults: A 7-Year Longitudinal Study.

Studies on the association between sodium-to-potassium (Na/K) ratio changes and blood pressure (BP) changes among older adults are limited. This 7-year longitudinal study examined the association between Na/K ratio changes (evaluated using spot urine tests) and BP changes among older Japanese adults. Data were collected from 432 participants (mean age: 70.3±4.4; range: 65−84 years) in 2012 and 2019. Changes in BP and the Na/K ratio over 7 years were calculated by subtracting baseline values from values noted during a follow-up survey. The median systolic and diastolic BP (SBP) and (DBP) changes after 7 years were 4 (IQR, −7, 14) and −1 (IQR, −9, 5) mmHg, respectively. The median Na/K ratio was changed during the follow-up period by −0.2 (IQR, −1.3, 0.7). A generalized linear model indicated that Na/K ratio changes were positively associated with SBP (B = 2.03, p < 0.001) and DBP (B = 0.62, p = 0.021) changes. In the non-antihypertensive medication-using group, urinary Na/K ratio changes were associated with SBP and DBP changes (B = 2.39, p = 0.001; B = 0.99, p = 0.033). In the antihypertensive medication user group, urinary Na/K ratio changes were associated with SBP changes (B = 1.62, p = 0.015). We confirmed the association between changes in the Na/K ratio and changes in BP.

Relationship Between Neighborhood Food Environment and Diet Variety in Japanese Rural Community-dwelling Elderly: A Cross-sectional Study.

BACKGROUND: Food access is an important aspect of health promotion for the elderly. The aim of this study was to investigate the relationship between distance to the nearest food store and diet variety in rural community-dwelling elderly Japanese. METHODS: This cross-sectional study analyzed data from 1,103 elderly participants surveyed by mail in rural areas of Japan. Diversity of food intake was assessed using the diet variety score (DVS). Street network distance from home to food store was calculated and categorized by quartile using a geographic information system and analyzed in relation to diet using multivariable regression with the primary outcome as low DVS. Sub-analysis of the association with DVS was conducted for each food store category (convenience store, supermarket, and small food store). The association between intake frequency of each food group and distance was also analyzed. RESULTS: Participants in the fourth quartile of distance to food store had significantly higher prevalence ratio (1.15; 95% CI, 1.01-1.32) for low DVS than those in the first quartile. There was a significant tendency between greater distance to food store and lower DVS (P for trend = 0.033). Supermarkets and convenience stores, in particular, showed significant associations. Greater distance was significantly associated with lower frequency of meat and fruit intake. CONCLUSION: There was significant association between distance to nearest food store and diet variety in rural Japanese elderly. These findings suggest the importance of interventions for areas at high risk of low diet variety, such as places far away from food stores.

Association of energy availability with resting metabolic rates in competitive female teenage runners: a cross-sectional study.

BACKGROUND: Resting metabolic rate (RMR) has been examined as a proxy for low energy availability (EA). Previous studies have been limited to adult athletes, despite the serious health consequences of low EA, particularly during adolescence. This study aimed to explore the relationship between RMR and EA in competitive teenage girl runners. METHODS: Eighteen girl runners (mean ± standard-deviation; age, 16.8 ± 0.9 years; body mass, 45.6 ± 5.2 kg, %fat, 13.5 ± 4.2 %) in the same competitive high-school team were evaluated. Each runner was asked to report dietary records with photos and training logs for seven days. Energy intake (EI) was assessed by Registered Dietitian Nutritionists. The runners were evaluated on a treadmill with an indirect calorimeter to yield individual prediction equations for oxygen consumption using running velocity and heart rate (HR). Exercise energy expenditure (EEE) was calculated by the equations based on training logs and HR. Daily EA was calculated by subtracting EEE from EI. The daily means of these variables were calculated. RMR was measured early in the morning by whole-room calorimetry after overnight sleep on concluding the final day of the seven-day assessment. The ratio of measured RMR to predicted RMR (RMR ratio) was calculated by race, age, sex-specific formulae, and Cunningham's equation. Body composition was measured using dual-energy X-ray absorptiometry. Bivariate correlation analyses were used to examine the relationship between variables. RESULTS: RMR, EI, EEE, and EA were 26.9 ± 2.4, 56.8 ± 15.2, 21.7 ± 5.9, and 35.0 ± 15.0 kcal⋅kg-1 FFM⋅d-1, respectively. RMR reduced linearly with statistical significance, while EA decreased to a threshold level (30 kcal⋅kg-1 FFM⋅d-1) (r= 0.58, p= 0.048). Further reduction in RMR was not observed when EA fell below the threshold. There was no significant correlation between RMR ratios and EA, irrespective of the prediction formulae used. CONCLUSIONS: These results suggest that RMR does not reduce with a decrease in EA among highly competitive and lean teenage girl runners. RMR remains disproportionally higher than expected in low EA states. Free-living teenage girl runners with low EA should be cautiously identified using RMR as a proxy for EA change.

Association between a hilly neighborhood environment and falls among rural older adults: a cross-sectional study.

Objective: Falls in older adults are a major public health issue, and it is unclear whether the neighborhood environment is associated with falls among this group. This cross-sectional study investigated whether hilly neighborhood environmental factors were associated with fall status (falls or fear of falling) in rural Japanese older adults. Materials and Methods: Data obtained from 965 participants aged 65 years and older living in Unnan City, Shimane Prefecture, Japan, in 2017 were analyzed. Fall status was assessed based on the 1-year fall incidence (yes/no) for the past year and fear of falling (yes/no) using a self-report questionnaire. For hilly neighborhood environmental factors, the mean elevation and land slope were assessed using a geographic information system. The logistic regression model examined the odds ratios (OR) and 95% confidence intervals (CIs) of fall status in quartiles for elevation and land slope, respectively, and was adjusted for confounders. Results: Falls and fear of falling were observed in 16.8% and 43.2% of participants, respectively. Falls were associated with elevation (OR 1.99, 95% CI 1.17-3.37 for Q2 vs. Q1; OR 2.02, 95% CI 1.19-3.44 for Q3 vs. Q1) and land slope (OR 1.74, 95% CI 1.04-2.93 for Q3 vs. Q1; OR 1.74, 95% CI 1.04-2.93 for Q4 vs. Q1). Fear of falling was associated with elevation (OR 1.78, 95% CI 1.19-2.65 for Q3 vs. Q1) and land slope (OR 1.51, 95% CI 1.01-2.25 for Q4 vs. Q1). Conclusion: Our study found that elevation and land slope as hilly neighborhood environment factors were positively associated with falls or fear of falling among older adults living in rural Japan. Prospective observational studies that investigate the effects of region-specific environmental factors on falls among older adults should be conducted.

Association between hilliness and walking speed in community-dwelling older Japanese adults: A cross-sectional study.

PURPOSE: This cross-sectional study investigated the association between hilliness and walking speed in community-dwelling older adults, and whether it varied according to their car-driving status. METHODS: Data were collected from 590 participants aged 65 and older living in Okinoshima Town, Shimane prefecture, Japan, in 2018. Comfortable walking speed (m/s) was objectively assessed. Hilliness was measured by the mean land slope (degree) within a 500-m or 1000-m network buffer around each participant's home using a geographic information system. A multiple linear regression examined whether the land slope was associated with walking speed, adjusted for sex, age, body mass index, smoking habits, alcohol consumption habits, exercise habits, chronic disease, and living arrangements. A stratified analysis by car-driving status was also conducted. RESULTS: After adjusting for all confounders, the land slope within the 500-m or 1000-m network buffer was negatively associated with walking speed (B = -0.007, 95% CI [-0.011, -0.002]; B = -0.007, 95% CI [-0.011, -0.003], respectively). The stratified analysis by car-driving status showed that living in a hilly area was negatively associated with walking speed among non-drivers in the 500-m or 1000-m network buffer (B = -0.011, 95% CI [-0.017, -0.004]; B = -0.012, 95% CI [-0.019, -0.006]), though there were no associations among drivers. CONCLUSIONS: A hilly environment is positively associated with slow walking speed in community-dwelling older adults in Japan. Moreover, car-driving status potentially modifies the relationship between living in a hilly environment and slow walking speed.

Effect of Multimorbidity on Fragility Fractures in Community-Dwelling Older Adults: Shimane CoHRE Study.

Fragility fractures (FFxs), which are a common musculoskeletal injury in older adults, is associated with an increased frequency of falls. Both FFxs and falls may result from drugs, habits, and co-occurring diseases. We aimed to evaluate the effects of various diseases on the risk of FFx. This retrospective study included 1420 individuals aged ≥60 years. We evaluated the history of clinical FFx and diseases using a detailed questionnaire and a health examination. The risk of comorbidities was assessed using the Age-Adjusted Charlson Comorbidity (AAC) Index. We performed binary logistic regression analysis to determine the risk of FFx and falls after adjusting for covariates. In elderly men, the incidence of FFx positively correlated with rheumatoid arthritis and parent's hip fracture. For elderly women, the incidence of FFx positively correlated with rheumatoid arthritis and antihypertensive drugs but was inversely associated with dyslipidemia and antilipidemic drugs. The FFX risk of older adults with an AAC Index ≥6 was higher than those with an AAC Index of 1-3. In addition, the AAC Index and falls were independently and strongly associated with a higher risk of FFx. Taken together, multimorbidity increases the risk of clinical FFx independent of falls in the community-dwelling elderly population.

Environmental Factors Affecting Cognitive Function among Community-Dwelling Older Adults: A Longitudinal Study.

Although neighborhood environmental factors have been found to be associated with cognitive decline, few longitudinal studies have focused on their effect on older adults living in rural areas. This longitudinal study aimed to investigate the role of neighborhood environmental factors in cognitive decline among rural older adults. The data of 485 older adults aged ≥60 years who were living in Unnan City in Japan and had participated in two surveys conducted between 2014 and 2018 were analyzed. Cognitive function was assessed using the Cognitive Assessment for Dementia, iPad version 2. Elevation, hilliness, residential density, and proximity to a community center were determined using geographic information system. We applied a generalized estimating equation with odds ratios (OR) and 95% confidence intervals (CIs) of cognitive decline in the quartiles of neighborhood environmental factors. A total of 56 (11.6%) participants demonstrated a decrease in cognitive function at follow up. Elevation (adjusted OR 2.58, 95% CI (1.39, 4.77) for Q4 vs. Q1) and hilliness (adjusted OR 1.93, 95% CI (1.03, 3.63) for Q4 vs. Q1) were associated with a higher likelihood of cognitive decline. The second quartiles of residential density showed significantly lower likelihoods of cognitive decline compared with the first quartiles (adjusted OR 0.36, 95% CI (0.19, 0.71) for Q2 vs. Q1). Thus, an elevated hilly environment and residential density predicted cognitive decline among rural older adults.

Number of teeth and masticatory function are associated with sarcopenia and diabetes mellitus status among community-dwelling older adults: A Shimane CoHRE study.

OBJECTIVES: We aimed to examine the number of teeth and masticatory function as oral health indices and clarify their roles in the pathogenesis of sarcopenia and diabetes mellitus in community-dwelling older adults. SUBJECTS AND METHODS: This cross-sectional study was conducted with 635 older adults in Ohnan, Shimane Prefecture, in rural Japan. The number of teeth and masticatory function (measured by the number of gummy jelly pieces collected after chewing) were evaluated by dental hygienists. Sarcopenia status was assessed using handgrip strength, skeletal muscle index, calf circumference, and a possible sarcopenia diagnosis based on the Asian Working Group for Sarcopenia 2019. Diabetes mellitus status was defined as a hemoglobin A1c level ≥6.5% or self-reported diabetes. A multivariable logistic regression model was used to analyze the association between oral health, sarcopenia, and diabetes mellitus after adjusting for confounders. RESULTS: After adjusting for all confounders, logistic regression analysis showed that the number of remaining teeth was negatively associated with a low level of handgrip strength (odds ratio [OR], 0.961; 95% confidence interval [CI], 0.932-0.992) and possible sarcopenia (OR, 0.949; 95% CI, 0.907-0.992). Higher levels of masticatory function were also negatively associated with a low level of handgrip strength (OR, 0.965; 95% CI, 0.941-0.990) and possible sarcopenia (OR, 0.941; 95% CI, 0.904-0.979). Logistic regression analysis showed that the number of remaining teeth and a higher level of masticatory function were negatively associated with diabetes mellitus (OR, 0.978; 95% CI, 0.957-0.999; OR, 0.976; 95% CI, 0.960-0.992, respectively). CONCLUSION: Our findings suggest that improvement in oral health, including the maintenance of masticatory function and remaining teeth, may contribute to the prevention of sarcopenia and diabetes mellitus in older adults.

Assessing the Impact of a Hilly Environment on Depressive Symptoms among Community-Dwelling Older Adults in Japan: A Cross-Sectional Study.

Although some neighborhood environmental factors have been found to affect depressive symptoms, few studies have focused on the impact of living in a hilly environment, i.e., land slope, on depressive symptoms among rural older adults. This cross-sectional study aimed to investigate whether a land slope is associated with depressive symptoms among older adults living in rural areas. Data were collected from 935 participants, aged 65 years and older, who lived in Shimane prefecture, Japan. Depressive symptoms were assessed using the Zung Self-Rating Depression Scale (SDS) and defined on the basis of an SDS score ≥ 40. Land slopes within a 400 m network buffer were assessed using geographic information systems. Odds ratios (ORs) with 95% confidence intervals (CIs) of depressive symptoms were estimated using logistic regression. A total of 215 (23.0%) participants reported depressive symptoms. The land slope was positively associated with depressive symptoms (OR = 1.04; 95% CI = 1.01-1.08) after adjusting for all confounders. In a rural setting, living in a hillier environment was associated with depressive symptoms among community-dwelling older adults in Japan.

Inconvenience of Living Place Affects Individual HbA1c Level in a Rural Area in Japan: Shimane CoHRE Study.

BACKGROUND: It has been shown that the socio-geographical environment of residential areas, such as altitude, affects the health status and health-maintenance behavior of residents. Here, we examined a hypothesis that altitude of residence would influence glycemic control in a general elderly population living in a rural area. METHODS: A thousand and sixteen participants living in a mountainous region in Japan were recruited at health examinations. Hemoglobin A1c (HbA1c) was measured in serum as a parameter of glycemic control. The altitude of residence, distance to grocery stores and to medical facilities were estimated using a geographic information system. RESULTS: Linear regression analysis confirmed a significant effect of the altitude on log HbA1c even after adjustment of other demographic and biochemical factors. When the distance to grocery stores or medical facilities were used instead of the altitude in a linear regression analysis, distance to secondary medical facilities alone showed a significant effect on HbA1c. CONCLUSIONS: We found a positive correlation between HbA1c level and residential altitude in a rural area of Japan. The altitude seemed to be a parameter substituting the inconvenicence of residential areas. Socio-geographical factors of living place, such as inconvenience, may influence glycemic control of the residents.

Neighborhood Environmental Factors and Physical Activity Status among Rural Older Adults in Japan.

(1) Background: Although several neighborhood environmental factors have been identified to be associated with older adults' physical activity, little research has been done in rural areas where the population is aging. This study aimed to investigate neighborhood environmental factors and the longitudinal change of physical activity status among rural older adults in Japan. (2) Methods: The study included 2211 older adults, aged over 60 years, residing in three municipalities in Shimane prefecture and participating at least twice in annual health checkups between 2010 and 2019. Physical activity was identified based on self-report. Hilliness, bus stop density, intersection density, residential density, and distance to a community center were calculated for each subject. Hazard ratios for the incidence of physical inactivity were estimated using Cox proportional hazards models. (3) Results: We found that 994 (45%) of the study subjects became physically inactive during the follow-up. Those living far from a community center had a lower risk of becoming physically inactive compared to those living close to a community center. When the analysis was stratified by residential municipality, this association remained in Ohnan town. Those living in hilly areas had a higher risk of becoming physically inactive in Okinoshima town. (4) Conclusions: The impact of neighborhood environmental factors on older adults' physical activity status might differ by region possibly due to different terrain and local lifestyles.