Economic effects of dietary salt reduction policies for cardiovascular disease prevention in Japan: a simulation study of hypothetical scenarios.

Objective: Reducing dietary salt intake is an essential population strategy for cardiovascular disease (CVD) prevention, but evidence on healthcare costs and outcomes is limited in Japan. We aimed to conduct a pilot economic evaluation under hypothetical scenarios of applying the salt reduction policies of England to Japan. Methods: We examined salt reduction policies in England: media health promotion campaigns, front-of-pack labeling, and voluntary and mandatory reformulation with best-case and worst-case policy cost scenarios. We assumed that these policies were conducted in Japan for 10 years from 2019. We used published data on epidemiology and healthcare expenditures in Japan and the costs and effects of salt reduction policies in England, and defined the benefits as a decrease in national medical expenditures on CVD. We developed a Markov cohort simulation model of the Japanese population. To estimate the annual net benefits of each policy over 10 years, we subtracted monitoring and policy costs from the benefits. We adopted a health sector perspective and a 2% discount rate. Results: The cumulative net benefit over 10 years was largest for mandatory reformulation (best case) at 2,015.1 million USD (with costs of USD 48.3 million and benefits of USD 2063.5 million), followed by voluntary reformulation (net benefit: USD 1,895.1 million, cost: USD 48.1 million, benefit: USD 1,943.2 million), mandatory reformulation (worst case, net benefit: USD 1,447.9 million, cost: USD 1,174.5 million, benefit: USD 2,622.3 million), labeling (net benefit: USD 159.5 million, cost: USD 91.6 million, benefit: USD 251.0 million), and a media campaign (net benefit: USD 140.5 million, cost: USD 110.5 million, benefit: USD 251.0 million). There was no change in the superiority or inferiority of policies when the uncertainty of model parameters was considered. Conclusion: Mandatory reformulation with the best-case cost scenario might be economically preferable to the other alternatives in Japan. In future research, domestic data on costs and effects of salt reduction policies should be incorporated for model refinement.

Spatiotemporal variations in mean height of 17-year-old students born in 1957-2002 across 47 Japanese prefectures: Evidence from School Health Surveys.

This paper examines the secular trends and variations in mean height of 17-year-old students born in 1957-2002 across 47 prefectures in Japan. Mean height is consistently lower in southwest prefectures and greater in prefectures in the Greater Tokyo Area and from the south-central area to the north-western area facing Eurasia in the main island. Both the range and the coefficient of variation stay constant in the cohorts born during the 1970s or later, following rapid increases of mean height in the prefectures that initially have the lowest means. A comprehensive policy framework may be needed to address diverse factors affecting the physical growth of adolescents at the subnational level.

Reduction of Cardiovascular Events and Related Healthcare Expenditures through Achieving Population-Level Targets of Dietary Salt Intake in Japan: A Simulation Model Based on the National Health and Nutrition Survey.

Reducing population dietary salt intake is expected to help prevent cardiovascular disease and thus constrain increasing national healthcare expenditures in Japan's super-aged society. We aimed to estimate the impact of achieving global and national salt-reduction targets (8, <6, and <5 grams/day) on cardiovascular events and national healthcare spending in Japan. Using published data including mean salt intake and systolic blood pressure from the 2019 National Health and Nutrition Survey, we developed a Markov model of a closed cohort of adults aged 40−79 years in 2019 (n = 66,955,000) transitioning among six health states based on the disease course of ischemic heart disease (IHD) and stroke. If mean salt intake were to remain at 2019 levels over 10 years, cumulative incident cases in the cohort would be approximately 2.0 million for IHD and 2.6 million for stroke, costing USD 61.6 billion for IHD and USD 104.6 billion for stroke. Compared with the status quo, reducing mean salt intake towards the targets over 10 years would avert 1−3% of IHD and stroke events and save up to 2% of related national healthcare costs. Attaining dietary salt-reduction goals among adults would yield moderate health economic benefits in Japan.

Estimation of the Effect of Salt-Intake Reduction on Cardiovascular Mortality Decline between 1950 and 2017 in Japan: A Retrospective Simulation Study.

In Japan, a decrease in cardiovascular mortality has coincided with reduced population salt intake since the 1950s. The purpose of this study was to quantify the effect of reduced population salt intake on the long-term trends of cardiovascular mortality. Using government statistics and epidemiological study results in people of 20-69 years old from 1950 to 2017, including the National Health and Nutrition Survey, we developed a system dynamics model of age-specific cardiovascular mortality and salt intake. We estimated the period and cohort effects on mortality and calibrated the model for the historical mortality rate. We then simulated the counterfactual scenario of no decrease in salt intake to estimate the reduction in cardiovascular deaths associated with decreased mean salt intake. Compared with the base run and calibrated to the actual data, approximately 298,000 and 118,000 excess deaths were observed in men and women, respectively, assuming no change in salt intake over the entire period. The model suggests that the decline in salt intake since the 1950s has contributed to a non-negligible reduction in cardiovascular mortality.

Trends and Disparities in Adult Body Mass Index Across the 47 Prefectures of Japan, 1975-2018: A Bayesian Spatiotemporal Analysis of National Household Surveys.

Background: Among high-income countries, Japan has a low prevalence of obesity, but little is understood about subnational trends and variations in body mass index (BMI), largely owing to the lack of data from representative samples of prefectures. We aimed to examine long-term trends and distributions of adult BMI at the prefecture level in Japan from the late 1970s using a spatiotemporal model. Methods: We obtained cross-sectional data for 233,988 men and 261,086 women aged 20-79 years from the 44 annual National Health and Nutrition Surveys (NHNS) conducted during 1975-2018. We applied a Bayesian spatiotemporal model to estimate the annual time series of age-standardized and age-specific mean BMI by 20-year age group and sex for each of the 47 prefectures. We assessed socioeconomic inequalities in BMI across prefectures using the concentration index, according to population density. Results: In men, the age-standardized prefectural mean BMI ranged from 21.7 kg/m2 (95% credible interval, 21.6-21.9) to 23.1 kg/m2 (22.9-23.4) in 1975 and from 23.5 kg/m2 (23.3-23.7) to 24.8 kg/m2 (24.6-25.1) in 2018. In women, the age-standardized prefectural mean BMI ranged from 22.0 kg/m2 (21.9-22.2) to 23.4 kg/m2 (23.2-23.6) in 1975 and from 21.7 kg/m2 (21.6-22.0) to 23.5 kg/m2 (23.2-23.8) in 2018. Mean BMI was highest in the southernmost prefecture for most of the study period, followed by northeast prefectures. The increase in mean BMI was largest in southwest prefectures, which caught up with northeast prefectures over time. The concentration index was negative, indicating higher BMI in less-populated prefectures. Absolute values of the concentration index were greater in women than in men and increased over time. Conclusions: There were variations in adult mean BMI across prefectures, and geographic distributions changed over time. Further national and local efforts are needed to address the rising trend in mean BMI, particularly among men in rural prefectures, and socioeconomic inequalities among women. Bayesian hierarchical modeling is useful for reconstructing long-term spatiotemporal trends of mean BMI by integrating small-sized survey samples at the prefecture level in the NHNS.

[Use of simulation models in health economic evaluation studies of dietary salt-reduction policies for cardiovascular disease prevention].

Objectives　Social security costs related to the healthcare and long-term care of patients with cardiovascular diseases is a national burden that is expected to grow as Japan's population ages. Nutritional policies for improving the nation's diet could prevent cardiovascular diseases, but scientific evidence on their costs and outcomes is limited. This study gives an overview of health economic evaluation studies on population-wide dietary salt-reduction policies that have been instituted for the purposes of cardiovascular disease prevention. Thus, this study provides background information for the development of evaluation methods that can be utilized in Japan for analyzing the effects of nutritional policies on public health and social security cost containment.Methods　We extracted representative health economic simulation models that are used for predicting the effects of cardiovascular disease-related interventions: Cardiovascular Disease Policy Model, IMPACT Coronary Heart Disease Policy and Prevention Model, US IMPACT Food Policy Model, Assessing Cost-Effectiveness (ACE) approach to priority-setting, and Prevention Impacts Simulation Model (PRISM). Next, we collected original articles on studies that used these models for assessing the costs and effects of national population-wide dietary salt-reduction policies. We then outlined the background, structure, and applied studies associated with each model.Results　The five models utilized Markov cohort simulation, microsimulation, proportional multistate life tables, and system dynamics to predict the effect of dietary salt-reduction policies on blood pressure reduction and cardiovascular disease prevention. The models were applied to countries such as Australia, England, and the United States to simulate long-term (10 years to lifetime) costs and effects. These applied studies examined policies that included health promotion campaigns, sodium labels on the front of food packages, and mandatory or voluntary reformulation by the food industry to reduce the salt content of processed foods.Conclusion　Health economic simulation modeling is actively being used to evaluate scientific evidence on the costs and outcomes of national dietary salt-reduction policies. Similarly, leveraging simulation modeling techniques could facilitate the evaluation and planning of dietary salt-reduction policies and other nutritional policies in Japan.

Effective coverage of medical treatment for hypertension, diabetes and dyslipidaemia in Japan: An analysis of National Health and Nutrition Surveys 2003-2017.

OBJECTIVE: To examine trends in effective medical treatment coverage for hypertension, diabetes and dyslipidaemia in Japan, using a metric to assess effective coverage of health interventions derived from a health system performance assessment framework. METHODS: We obtained cross-sectional data for 96,863 individuals aged 40-74 years from the 15 annual Japanese National Health and Nutrition Surveys (2003-2017). We defined treatment need for hypertension, diabetes and dyslipidaemia as biomarkers equal to or greater than diagnostic thresholds or medication use. For individuals needing treatment, we conducted nearest-neighbour matching to estimate treatment effects and effective coverage, defined as the fraction of potential reductions in biomarkers actually achieved in treated individuals by medications. RESULTS: The age-standardized prevalence of treatment need for hypertension, diabetes and dyslipidaemia remained around 40%, 7% and 33%, respectively, in 2003-2017. Average treatment effects for those treated in 2013-2017 were 14.8 mmHg (95% confidence interval: 14.2-15.4) for systolic blood pressure, 1.2 percentage points (0.8-1.6) for haemoglobin A1c and 57.9 mg/dl (56.6-59.2) for non-high-density lipoprotein cholesterol. Effective coverage significantly increased between 2003-2007 (hypertension: 48.4% [44.7-52.0], diabetes: 43.8% [35.7-51.8], dyslipidaemia: 86.3% [83.1-89.5]) and 2013-2017 (hypertension: 76.2% [74.2-78.2], diabetes: 74.7% [71.0-78.5], dyslipidaemia: 94.6% [93.3-95.9]). CONCLUSIONS: Effective coverage of medical treatment for metabolic risk factors has increased. Most of the potential reductions in non-high-density lipoprotein cholesterol have been achieved by statins. Further efforts are necessary to improve the effectiveness of antihypertensive and antidiabetic drugs.

Trends in Energy Imbalance Gap and Body Weight Status in the Japanese Adult Population: A System Dynamics Approach.

BACKGROUND: The double burden of malnutrition is a growing public health problem in Japan. We estimated the dynamics of the energy imbalance gap (EIG) (average daily difference between energy intake and expenditure) to explain trends in the prevalence of underweight, overweight, and obese Japanese adults. METHODS: We used individual-level data on body height and weight from the National Health and Nutrition Surveys from 1975 to 2015. We calibrated a validated system dynamics model to estimate the EIG for Japanese adults aged 20 to 74 years by survey year, sex, and weight status classified by the body mass index (BMI). RESULTS: The overall EIG for men increased from 2.3 kcal/day in 1975 to 4.7 kcal/day in 1987 and then decreased to 2.3 kcal/day in 2015. The overall EIG for women consistently decreased from 4.3 kcal/day in 1975 to -0.5 kcal/day in 2015. By BMI class, the EIG for men with a BMI of <30 kg/m2 began to decrease around 1990, indicating a deceleration in the prevalence of overweight and obese men. The EIG consistently decreased for women with a BMI of <25 kg/m2 and reached negative values from the late 2000s to early 2010s, indicating a gradual decrease in the prevalence of overweight and obese women. CONCLUSIONS: The dynamics of the EIG were different across sex and weight groups. Public health interventions should target a further decrease in the EIG for normal-weight, overweight, and obese men and a stop in the decreasing trends of the EIG in underweight and normal-weight women.

Simulating the Impact of Long-Term Care Prevention Among Older Japanese People on Healthcare Costs From 2020 to 2040 Using System Dynamics Modeling.

Objectives: This study examined how healthcare costs might change by reducing long-term care needs among older Japanese people. Methods: A simulation model was constructed comprising two aging chains for independent and dependent people aged ≥65 years by sex. Changes in the base run from 2020 to 2040 were compared with those in two hypothetical scenarios: a 2% annual reduction in death rates (S1), and S1 plus a 2% annual reduction in the proportion of dependent people aged 65 years and in transition rates from the independent to dependent state for people aged ≥65 years (S2). Results: In the base run, the population increased by 13.0% for men and 11.3% for women, and the proportion of dependent people increased by 4.6% for men but decreased by 13.4% for women. The sum of medical and long-term care expenditure increased in the base run, S1, and S2 by 8.2, 27.4, and 16.4%, respectively, for men and women combined. Conclusions: Healthcare costs will increase as death rates fall, but the increase will be attenuated if the proportion of dependent people decreases.

[Key variable combinations for identifying non-participants in the Japan National Health and Nutrition Survey through record linkage with the Comprehensive Survey of Living Conditions].

Objectives　The identification of non-participants in the Japan National Health and Nutrition Survey (NHNS) requires record linkage with its master sample from the Comprehensive Survey of Living Conditions (CSLC). In principle, we can merge individual records between the two surveys by using key identifiers including household ID, but false matches and nonmatches can occur. We examined combinations of key variables for improving record linkage to identify nonparticipants in the NHNS.Methods　We used individual-level data from the NHNS and the CSLC from 1988 to 2015 (except 2012). We extracted from CSLC data individuals in participating unit blocks in the NHNS to merge records between the two surveys. We used four combinations of key variables: prefecture ID, census enumeration district ID, unit block ID, household ID, and household member ID (A); household member ID in A was replaced with sex and birth year and month or age (B); sex and birth year and month or age were added to A (C); two-stage linkage of B and C (D). We classified a sample of individuals into matched participants, unmatched NHNS participants, and unmatched CSLC participants (a proxy for nonparticipants). We compared the percentages of matched NHNS participants and unmatched CSLC participants across the four combinations of key variables.Results　We obtained a sample of 455,854 participants from the CSLC and 335,010 from the NHNS. The percentage of matched NHNS participants was highest in A (the upper 90%), followed by D (the lower 90%), B (the lower 90%), and C (the 80%). Compared to C, the percentage of matched NHNS participants was higher by 8-14 percentage points in A and 5-10 percentage points in B. Compared to B, it was higher by 0.1-0.4 percentage points in D. The percentage of unmatched CSLC participants was highest in C, followed by B, D, and A. The percentage of unmatched CSLC participants increased in D from the 20% level in the late 1980s to around 30% in the 1990s and stayed between the 30% level and the lower 40% level in the 2000s.Conclusion　The highest percentage of accurate matches of NHNS participants was obtained by considering changes in household member ID and incorrect entries on sex and birth year/month and age, and same-sex multiple births. However, there are limitations in handling unmatched participants due to changes in household ID or other reasons. It is therefore necessary to consider the possibility of false nonmatches included in unmatched CSLC participants in regarding them as non-participants in the NHNS.

First incidence and associated factors of overweight and obesity from preschool to primary school: longitudinal analysis of a national cohort in Japan.

BACKGROUND/OBJECTIVES: To assess longitudinal changes in the first incidence of overweight and obesity and associated factors from preschool to primary school age in Japan. SUBJECTS/METHODS: We obtained individual-level data from the "Longitudinal Survey of Newborns in the 21st Century" on children born in Japan in 2001. This analysis included 15,427 children (7951 boys and 7476 girls) with complete anthropometric data reported annually from age 42 months to 12 years. We followed the criteria of the International Obesity Task Force to define overweight and obesity. We assessed annual and cumulative incidence proportions and estimated odds ratios for the first incidence at preschool age (42-66 months) and primary school age (7-12 years), using multivariable logistic regression. RESULTS: The annual incidence of overweight and obesity combined was 3.8% at age 54 months (3.5% in boys, 4.2% in girls), and 1.2% at age 12 years (1.6% in boys, 0.7% in girls). The cumulative incidence was 19.7% at age 12 years (21.9% in boys, 17.3% in girls). Odds ratios (95% confidence intervals) of incidence for girls compared with boys were 1.28 (1.12-1.46) at preschool age and 0.62 (0.55-0.68) at primary school age. Other associated factors at preschool age included birth month, birthweight, gestational length, region and municipality of residence, living with grandparents, and behavioral factors (bedtime hours, television viewing time, and skipping breakfast). These associations persisted at primary school age except birthweight and gestational length and associated factors covered maternal education, living without siblings, and school travel mode. CONCLUSIONS: The first incidence decreases from preschool to primary school age and follows different age trajectories for boys and girls in a high-income population with low levels of childhood overweight and obesity. Policy-makers should consider such age-based changes in incidence and associated factors to target appropriate groups for primary prevention.

Effects of behavioral counseling on cardiometabolic biomarkers: A longitudinal analysis of the Japanese national database.

In Japan, health insurers are obliged to conduct Specific Health Checkup (SHC) for middle-aged and elderly persons. High-risk persons are referred to Specific Health Guidance (SHG) to receive behavioral counseling based on individual action plans including targets for modification of daily energy balance through diet and physical activity. Using individual-level observational data, we examined the effects of diet and physical activity counseling on cardiometabolic biomarkers across the country. Subjects were 363,440 high-risk persons aged 40-64 who participated in intensive support in SHG for ≥3 months between April 2008 and March 2012. We considered participants as receiving counseling on diet alone, physical activity alone, combined, or neither if they had targets for diet only, physical activity only, both, or neither, respectively. Biomarkers included body mass index, waist circumference, systolic and diastolic blood pressure, high-density lipoprotein cholesterol, and hemoglobin A1c. Under the difference-in-differences approach, we used multivariable linear regression on repeated measures of biomarkers at SHCs before and after SHG and estimated the effects of each counseling type as an interaction with time of SHC. Compared with neither counseling, diet and physical activity counseling, alone or combined, were significantly associated with additional improvements in biomarkers after SHG, for example, body mass index (men: 0.03-0.06 kg/m2, women: 0.10-0.15 kg/m2) and waist circumference (men: 0.16-0.29 cm, women: 0.43-0.47 cm) in both sexes and high-density lipoprotein cholesterol in men (0.13-0.29 mg/dL). Modest improvements in biomarkers were associated with diet and physical activity counseling, although effect sizes were small.

Vignettes and differential health reporting: results from the Japanese World Health Survey.

We examined the factors associated with the evaluation of health description vignettes and how Japanese people make decisions related to the eight health dimensions (mobility, emotions, pain, relationship with others, sleep and energy, vision, recognition/remembering abilities, and self-care). We investigated a dataset of 4,959 respondents (≥ 18 years) from the Japanese World Health Survey. Ordered probit models were used to identify factors associated with all health dimensions. On all dimensions, older people appraised extreme problems as less problematic than young people did. Compared with men, women reported greater severity in the case of extreme problems on three health dimensions: emotion, pain, and sleep/energy. The study also found negative effects of alcohol consumption in almost all dimensions. Doctors and other health care workers should be careful when assessing severity of health problems in older individuals; in this population, health problems may be more severe than reported.

Changes in the effects of living with no siblings or living with grandparents on overweight and obesity in children: Results from a national cohort study in Japan.

Effects of living without siblings and living with grandparents on overweight and obesity may change with child's age. We aimed to examine these effects from early childhood to school age at the national level in Japan. Subjects were 43,046 children born in Japan during two weeks in 2001 who were followed annually from 2.5 to 13 years of age in the Longitudinal Survey of Newborns in the 21st Century. We used measured body height and weight reported by participants at each survey and followed the criteria of the International Obesity Task Force to define overweight and obesity. Random-effects logit models by sex, adjusted for time-varying and time-invariant covariates, assessed odds ratios of overweight and obesity for living without siblings and for living with grandparents at each age. The likelihood of overweight and obesity was significantly higher at 8 years and older among children living without siblings, compared with those living with siblings, and odds ratios were highest at 11 years of age in boys (1.87, 95% confidence interval [CI]: 1.49, 2.33) and at 10 and 13 years of age in girls (1.75 [95% CI: 1.36, 2.23] and 1.73 [95% CI: 1.30, 2.31], respectively). It was also significantly higher at 5.5 years and older among children living with grandparents, compared with those living without grandparents, and odds ratios were highest at 10 and 13 years of age in boys (1.53 [95% CI: 1.30, 1.80] and 1.54 [95% CI: 1.27, 1.86], respectively) and at 11 years of age in girls (1.51, 95% CI: 1.24, 1.84). In Japan, living without siblings and living with grandparents may increase the likelihood of overweight and obesity at 8 and 5.5 years and older, respectively. Child's age should be considered during formulation of strategies for prevention of overweight and obesity in these groups.

Trends in prevalence and management of diabetes and related vascular risks in Japanese adults: Japan National Health and Nutrition Surveys 2003-2012.

AIMS: To examine temporal changes in health system performance for the control of diabetes and related risks for vascular complications in Japan over a decade. METHODS: Data of 51,128 individuals aged ≥20years were obtained from the National Health and Nutrition Surveys in 2003-2012. Diabetes was defined as currently being treated by insulin or oral hypoglycaemic agents or having a glycated haemoglobin (HbA1c) level ≥6.5% (≥48mmol/mol). We estimated the prevalence and proportions of people with diabetes being treated and achieving target goals of HbA1c <7.0% (<53mmol/mol), blood pressure <130/80mmHg, and non-high-density lipoprotein cholesterol <130mg/dL. All estimates were age-standardized using the Japanese population in 2010. RESULTS: The age-standardized prevalence of diabetes remained constant at approximately 8% and was significantly higher in men (P<0.001) and in individuals age ≥65years (P<0.001) throughout the study period. The proportion of people with diabetes being treated significantly increased from 41.8% (95% confidence interval, 37.2-46.5%) in 2003 to 54.9% (51.9-57.8%) in 2012, and the proportion of those having controlled HbA1c significantly increased from 13.4% (10.3-17.3%) in 2003 to 28.8% (26.3-31.5%) in 2012. These two rates were significantly higher in age ≥65years compared with younger adults in most of the survey years (P<0.05). The control rates of blood pressure and non-high-density lipoprotein cholesterol remained around 20% and 30-40%, respectively. CONCLUSIONS: Diabetes management in Japan has improved over the past decade but is still inadequate for prevention of vascular complications.

Laboratory-based and office-based risk scores and charts to predict 10-year risk of cardiovascular disease in 182 countries: a pooled analysis of prospective cohorts and health surveys.

BACKGROUND: Worldwide implementation of risk-based cardiovascular disease (CVD) prevention requires risk prediction tools that are contemporarily recalibrated for the target country and can be used where laboratory measurements are unavailable. We present two cardiovascular risk scores, with and without laboratory-based measurements, and the corresponding risk charts for 182 countries to predict 10-year risk of fatal and non-fatal CVD in adults aged 40-74 years. METHODS: Based on our previous laboratory-based prediction model (Globorisk), we used data from eight prospective studies to estimate coefficients of the risk equations using proportional hazard regressions. The laboratory-based risk score included age, sex, smoking, blood pressure, diabetes, and total cholesterol; in the non-laboratory (office-based) risk score, we replaced diabetes and total cholesterol with BMI. We recalibrated risk scores for each sex and age group in each country using country-specific mean risk factor levels and CVD rates. We used recalibrated risk scores and data from national surveys (using data from adults aged 40-64 years) to estimate the proportion of the population at different levels of CVD risk for ten countries from different world regions as examples of the information the risk scores provide; we applied a risk threshold for high risk of at least 10% for high-income countries (HICs) and at least 20% for low-income and middle-income countries (LMICs) on the basis of national and international guidelines for CVD prevention. We estimated the proportion of men and women who were similarly categorised as high risk or low risk by the two risk scores. FINDINGS: Predicted risks for the same risk factor profile were generally lower in HICs than in LMICs, with the highest risks in countries in central and southeast Asia and eastern Europe, including China and Russia. In HICs, the proportion of people aged 40-64 years at high risk of CVD ranged from 1% for South Korean women to 42% for Czech men (using a ≥10% risk threshold), and in low-income countries ranged from 2% in Uganda (men and women) to 13% in Iranian men (using a ≥20% risk threshold). More than 80% of adults were similarly classified as low or high risk by the laboratory-based and office-based risk scores. However, the office-based model substantially underestimated the risk among patients with diabetes. INTERPRETATION: Our risk charts provide risk assessment tools that are recalibrated for each country and make the estimation of CVD risk possible without using laboratory-based measurements. FUNDING: National Institutes of Health.

Vignettes and differential health reporting: results from the Japanese World Health Survey / Vinhetas e relatos diferenciais na saúde: os resultados do estudo japonês da Pesquisa Mundial de Saúde / Viñetas y relatos diferenciales en la salud: los resultados del estudio japonés de la Encuesta Mundial de Salud

We examined the factors associated with the evaluation of health description vignettes and how Japanese people make decisions related to the eight health dimensions (mobility, emotions, pain, relationship with others, sleep and energy, vision, recognition/remembering abilities, and self-care). We investigated a dataset of 4,959 respondents (≥ 18 years) from the Japanese World Health Survey. Ordered probit models were used to identify factors associated with all health dimensions. On all dimensions, older people appraised extreme problems as less problematic than young people did. Compared with men, women reported greater severity in the case of extreme problems on three health dimensions: emotion, pain, and sleep/energy. The study also found negative effects of alcohol consumption in almost all dimensions. Doctors and other health care workers should be careful when assessing severity of health problems in older individuals; in this population, health problems may be more severe than reported.

Os autores examinaram os fatores relacionados à avaliação das vinhetas para descrição da saúde e as maneiras pelas quais os japoneses tomam decisões nas oito dimensões da saúde (mobilidade, emoção, dor, relacionamento com outros, sono e energia, visão, habilidades de reconhecimento/memória e cuidados próprios). Foi analisado um conjunto de dados de 4.959 indivíduos (≥ 18 anos) do estudo japonês da Pesquisa Mundial de Saúde. O estudo usou modelos probit ordenados para identificar os fatores relacionados a todas as dimensões da saúde. Indivíduos mais idosos demonstravam uma leitura menos problemática dos problemas mais graves. As mulheres relatavam maior gravidade no caso de problemas extremos, em três dimensões da saúde: emoção, dor e sono/energia. O estudo também mostrou efeitos negativos do consumo de álcool em quase todas as dimensões. Médicos e outros profissionais da saúde devem ser criteriosos ao avaliar a gravidade dos problemas de saúde nos idosos, porque neste grupo etário, os problemas podem ser mais graves do que os próprios pacientes relatam.

Los autores examinaron los factores relacionados con la evaluación de las viñetas para la descripción de la salud y las maneras por las que los japoneses toman decisiones en las ocho dimensiones de la salud (movilidad, emoción, dolor, relación con otros, sueño y energía, visión, habilidades de reconocimiento/memoria y cuidados propios). Se analizó un conjunto de datos de 4.959 individuos (≥ 18 años) del estudio japonés de la Encuesta Mundial de Salud. El estudio usó modelos probit ordenados para identificar los factores relacionados con todas las dimensiones de la salud. Los individuos más ancianos demostraban una lectura menos problemática de los problemas más graves. Las mujeres relataban mayor gravedad, en el caso de problemas extremos, en tres dimensiones de la salud: emoción, dolor y sueño/energía. El estudio también mostró efectos negativos del consumo de alcohol en casi todas las dimensiones. Médicos y otros profesionales de la salud deben ser criteriosos al evaluar la gravedad de los problemas de salud en los ancianos, porque en este grupo de edad, los problemas pueden ser más graves de lo que los propios pacientes relatan.