Calculation of prefectural disability-adjusted life expectancy (DALE) using long-term care prevalence and its socioeconomic correlates in Japan

Quantifying health utilities of young adult orthodontic patients using the time trade-off method: a cross-sectional study

OBJECTIVE

To study the feasibility of time trade-off (TTO) method in quantifying health utility ratings in different types of malocclusion.

MATERIAL AND METHODS

In this cross-sectional study, 70 orthodontic patients aged 18 years or above, reporting for treatment/consultation, were included and interviewed. Malocclusion-related health utilities were assessed through the TTO method, and oral health-related quality of life was measured with the help of Orthognathic Quality of Life Questionnaire (OQLQ). Angle's classification of malocclusion was recorded. Bivariate analyses and multivariate Poisson's regression were done to find out an association between the oral health utility values, OQLQ and demographic and clinical characteristics.

RESULTS

Patients with skeletal Class III malocclusion had lower health utility values than those with Class I and Class II malocclusions (p=0.013). Poisson's regression showed that Angle's Class II division 1 (0.90, CI 0.84 to 0.97), Class III (0.68, CI 0.59 to 0.95) and Skeletal malocclusion (0.79, CI 0.71 to 0.87) and OQLQ scores (1.0, CI 1 to 1.003) were found to be significant predictors of TTO utility scores.

CONCLUSIONS

TTO utilities were found to be valid and well correlated with clinical findings. Health utilities could serve as useful and reliable markers of health-related quality of life (HRQL) among individuals or communities and help cost-effective preventive or intervention programs planning.

Geographical socioeconomic inequalities in healthy life expectancy in Japan, 2010-2014: An ecological study

Background

Area differences in life expectancy (LE) and healthy life expectancy (HLE) in large geographical units have been monitored around the world. Area characteristics may be based on culture, history, socioeconomic status and discrimination in smaller geographical units, so it is important to consider these when looking at health inequality. We aimed to evaluate LE, HLE, and non-healthy life expectancy (NHLE) in 1707 municipalities using Areal Deprivation Index (ADI) in Japan for the first time.

Methods

We calculated the observed LE, HLE, and NHLE using death, population, and Long-term care insurance data for 2010-2014 and applied the variance weighted least squares model to estimate LE, HLE, and NHLE by 100 percentiles using the standardized ADI.

Findings

The estimated LE, HLE, and NHLE became lower as the deprivation index worsened: the differences between the most and least deprived areas for HLE were 2·49 years for LE and 2·32 years for HLE in males; 1·22 years for LE and 0·93 years for HLE in females. The observed LE and HLE in the most deprived areas were much lower than other areas.

Interpretation

Using ADI has enabled us to see the disparity within municipalities precisely. LE and HLE outlier for the 100th percentile might be linked to historical areal deprivation and marginalization. Precise monitoring of socioeconomic status-based health inequalities could help manage these inequalities by identifying the groups most in need of intervention.

Funding

The Ministry of Education, Science and Culture of Japan (a Grant-in-Aid for Scientific Research [A] No. 20H00040 and 18H04071).

The effects of elastic band exercises and nutritional education on frailty, strength, and nutritional intake in elderly women

PURPOSE

The purpose of this study was to examine the effects of elastic band exercises and nutritional education, as well as to identify the factors influencing frailty, strength, and nutritional intake of elderly women.

METHODS

The subjects in this study were 30 elderly women who were divided into four groups. All groups agreed to participate in four programs: health education only (HE), elastic band exercises only (EX), nutritional education only (NU), and elastic band exercises plus nutritional education (EX+NU). Frailty was evaluated by measuring the frailty factors according to Fried et al. Leg strength was measured using a leg-extension machine. Nutritional intake was assessed by the 24-hour recall method and food records. Nutritional intake was analyzed by CAN Pro 5.0 program.

RESULTS

After three months, the prevalence of frailty significantly decreased in the EX+NU group (P=0.013) compared with that of the HE group (P=0.088). There was significant improvement in leg strength in both the EX (P=0.012) and EX+NU groups (P=0.003) compared with that of the HE group (EX, P=0.005; EX+NU, P=0.002). The nutritional intake significantly decreased in the EX group compared with that of the HE group (P<0.05, P<0.05).

CONCLUSION

The combination of elastic exercises and nutrition education had positive effects on frailty and leg strength, while having negative effects on total calories, carbohydrate, sodium, and iron intake in elderly women. Elastic exercises only had positive effects on leg strength while having negative effects on nutritional intake in elderly women.

Development of a risk assessment scale predicting incident functional disability among older people: Japan Gerontological Evaluation Study

Aim

The aim of the present study was to develop a risk assessment scale for predicting incident functional disability among older adults.

Methods

We used prospective cohort data from the Japan Gerontological Evaluation Study, a nationwide survey of 90 889 functionally independent older people collected from 23 municipalities. The incidence of functional disability was determined from long‐term care information obtained from municipal insurance databases. We constructed a Cox proportional hazards model with forward stepwise selection that used sex, age, and 12 of the essential items of the Public Survey of Long‐Term Care Prevention and Needs in Spheres of Daily Life (the Needs Survey). We assigned a score based on the obtained non‐standardized regression coefficients for each item and summed the scores to establish the risk assessment scale. The predictive validity was examined.

Results

The cumulative incidence of functional disability during the 3‐year follow‐up period was 9.7%. A risk assessment scale of 0–48 that used sex, age and the Needs Survey's 10 essential items was established. The area under the receiver operating characteristic curve was 0.804, and the sensitivity and specificity were both 0.733 (cut‐off 16/17). There was no significant intermunicipality difference in the associations between the total scores calculated by using the scale and the risk of new incidence (P = 0.135).

Conclusions

We developed a risk assessment scale predicting incident functional disability composed of 10 essential items of the Needs Survey, sex and age. The scale had superior predictive validity, regardless of the level of urbanness. Geriatr Gerontol Int 2018; 18: 1433–1438.

Effect of a community intervention programme promoting social interactions on functional disability prevention for older adults: propensity score matching and instrumental variable analyses, JAGES Taketoyo study

BACKGROUND

The efficacy of promoting social interactions to improve the health of older adults is not fully established due to residual confounding and selection bias.

METHODS

The government of Taketoyo town, Aichi Prefecture, Japan, developed a resident-centred community intervention programme called 'community salons', providing opportunities for social interactions among local older residents. To evaluate the impact of the programme, we conducted questionnaire surveys for all older residents of Taketoyo. We carried out a baseline survey in July 2006 (prior to the introduction of the programme) and assessed the onset of functional disability during March 2012. We analysed the data of 2421 older people. In addition to the standard Cox proportional hazard regression, we conducted Cox regression with propensity score matching (PSM) and an instrumental variable (IV) analysis, using the number of community salons within a radius of 350 m from the participant's home as an instrument.

RESULTS

In the 5 years after the first salon was launched, the salon participants showed a 6.3% lower incidence of functional disability compared with non-participants. Even adjusting for sex, age, equivalent income, educational attainment, higher level activities of daily living and depression, the Cox adjusted HR for becoming disabled was 0.49 (95% CI 0.33 to 0.72). Similar results were observed using PSM (HR 0.52, 95% CI 0.33 to 0.83) and IV-Cox analysis (HR 0.50, 95% CI 0.34 to 0.74).

CONCLUSIONS

A community health promotion programme focused on increasing social interactions among older adults may be effective in preventing the onset of disability.

Socioeconomic status, comorbidity, activity limitation, and healthy life expectancy in older men and women: a 6-year follow-up study in Japan

This study aimed to explore the structural contributions of socioeconomic status (SES), comorbidity, and activity limitation to the healthy life expectancy (HALE) of Japanese suburban elderly. A questionnaire survey was distributed to all residents aged 65 years and older in Tama City, Tokyo, in 2001; a follow-up study was conducted in 2004; and individual vital status data from the municipal residents' registry were tracked until 2007. In all, 7,905 respondents were included for analysis. Data analysis was performed by structural equation modeling (SEM). The data were well fit by the models, and HALE was found to be well explained by SES, comorbidity, and activity limitation (R (2) = .59 for men and R (2) = .71 for women). In conclusion, elderly people with higher SES were more likely to live longer with good self-rated health, via living with less chronic diseases and better performance in daily living activities, especially for elderly women.

Impact of urinary incontinence on the psychological burden of family caregivers

AIMS

The present study was conducted to assess the impact of urinary incontinence on the psychological burden of family caregivers providing care to disabled family members with urinary incontinence.

MATERIALS AND METHODS

This survey was conducted using an Internet panel for family caregivers in Japan, consisting of 7,316 members. We requested the members to respond to an online questionnaire to assess the impact of urinary incontinence on the burden of caregivers. The questionnaire included basic characteristics, and the Japanese version of the Zarit Caregiver Burden Interview (ZBI) comprising 22 questions related to the impact of the patient's disabilities on the burden of their caregivers. Additionally, the participants were asked to include the level of care need, ranging from 0 to 5 according to the grade of disability of the cared individuals.

RESULTS

Relevant data obtained from 757 caregivers were analyzed. Of these caregivers, 452 provided care to family members with urinary incontinence (group 1), and 305 provided care to those without urinary incontinence (group 2). The mean total ZBI score was significantly higher in group 1 than in group 2 (mean, 40.7 vs. 34.7, P < 0.001). The difference in the scores for each item was also significant in 20 of the 22 items. With regard to the level of care need, irrespective of the level, the ZBI scores in group 1 tended to be higher than those in group 2.

CONCLUSIONS

The present survey demonstrated a negative impact of urinary incontinence on the psychological burden of family caregivers.

Cost-utility analysis of antihypertensive combination therapy in Japan by a Monte Carlo simulation model

The objective of the present study was to analyze the cost-effectiveness of lifetime antihypertensive therapy with angiotensin II receptor blocker (ARB) monotherapy, calcium channel blocker (CCB) monotherapy, or ARB plus CCB (ARB+CCB) combination therapy in Japan. Based on the results of large-scale clinical trials and epidemiological data, we constructed a Markov model for patients with essential hypertension. Our Markov model comprised coronary heart disease (CHD), stroke, and progression of diabetic nephropathy submodels. Based on this model, analysis of the prognosis of each patient was repeatedly conducted by Monte Carlo simulation. The three treatment strategies were compared in hypothetical 55-year-old patients with systolic blood pressure (SBP) of 160 mmHg in the absence and presence of comorbid diabetes. Olmesartan medoxomil 20 mg/d was the ARB and azelnidipine 16 mg/d the CCB in our model. On-treatment SBP was assumed to be 125, 140, and 140 mmHg in the ARB+CCB, ARB alone, and CCB alone groups, respectively. Costs and quality-adjusted life years (QALYs) were discounted by 3%/year. The ARB+CCB group was the most cost-effective both in male and female patients with or without diabetes. In conclusion, ARB plus CCB combination therapy may be a more cost-effective lifetime antihypertensive strategy than monotherapy with either agent alone.

The cost-effectiveness of risedronate treatment in Japanese women with osteoporosis

We constructed a mathematical model for assessing the cost-effectiveness of providing BMD (bone mineral density) scans to Japanese women aged 55 years and over and treating, with risedronate, those that are shown to be osteoporotic. Fracture rates, cost data, utility values, and the increased risks of fractures associated with T-score and vertebral fracture history were taken from published literature. We estimated the cost of fractures avoided due to risedronate treatment, allowing the net changes in cost, incorporating both intervention and fracture costs to be calculated. The QALYs (quality adjusted life years) gained through treatment were calculated enabling cost per QALY ratios to be presented. Further analyses were undertaken assuming treatment was reserved for older women and/or those who had sustained a vertebral fracture in the previous 2 years. Cost per QALY values were inversely related to absolute risk of fracture. Assuming a cost per QALY value threshold of US dollars 100,000, we concluded that providing BMD scans to women aged 70 years and over who had sustained a vertebral fracture in the previous 2 years and treating those that were osteoporotic was cost-effective. However, providing BMD scans for women without a vertebral fracture in the previous 2 years was not cost-effective, even in women aged 85 years and older.