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Kodama S, Uwatoko F, Koriyama C. Relationship between changes in the public health nurses' workforce and the empirical Bayes estimates of standardized mortality ratio: a longitudinal ecological study of municipalities in Japan. BMC Health Serv Res 2023; 23:266. [PMID: 36932374 PMCID: PMC10022064 DOI: 10.1186/s12913-023-09273-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 03/09/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND The role of public health nurses (PHNs) in the community is expected to become increasingly important, along with the promotion of a comprehensive community care system. However, a comprehensive study of all municipalities is yet to be undertaken, and the relationship between the workforce of PHNs and health indicators is yet to be clarified. This study examined the effect of workforce change among PHNs, one of the structural indicators of PHNs' activities regarding changes in the empirical Bayes estimate of standardized mortality ratios (EBSMRs). METHODS An ecological study was conducted using municipality-level aggregate data. The data used were publicly available Japanese government statistics. The first-difference model of panel data analysis was used to examine the relationship between changes in EBSMR and changes in the number of PHNs per 100,000 population from 2010 to 2015, adjusting for the effects of population and other healthcare resources, including the number of physicians, medical clinics, general hospitals, and welfare facilities. The variation by the 47 prefectures was added to the linear model as a random effect. We also performed a sensitivity analysis using the full Bayesian inference using the Besag-York-Mollie model. RESULTS For males, EBSMRs for all causes and malignant neoplasms significantly decreased with an increase in the number of PHNs per population (coefficients: -1.00 and -0.89, p values: 0.008 and 0.043, respectively). For females, although all EBSMRs except malignant neoplasms showed decreased tendencies due to the increase in the number of PHNs per population, none of them were significant. The full Bayesian inference confirmed these associations. CONCLUSIONS An increase in the number of PHNs per population was significantly associated with a greater reduction in deaths from all causes and malignant neoplasms in males. The results of the full Bayesian inference also suggest that the workforce of PHNs may be related to changes in standardized mortality ratios for deaths from all causes in females.
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Affiliation(s)
- Shimpei Kodama
- Department of Comprehensive Community-Based Nursing Science, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan.
| | - Futoshi Uwatoko
- Department of Epidemiology and Preventive Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Chihaya Koriyama
- Department of Epidemiology and Preventive Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Tsuruda T, Hamahata T, Endo GJ, Tsuruda Y, Kaikita K. Bystander-witnessed cardiopulmonary resuscitation by nonfamily is associated with neurologically favorable survival after out-of-hospital cardiac arrest in Miyazaki City District. PLoS One 2022; 17:e0276574. [PMID: 36269785 PMCID: PMC9586377 DOI: 10.1371/journal.pone.0276574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Bystander intervention in cases of out-of-hospital cardiac arrest (OHCA) is a key factor in bridging the gap between the event and the arrival of emergency health services at the site. This study investigated the implementation rate of bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) and 1-month survival after OHCA in Miyazaki prefecture and Miyazaki city district as well as compared them with those of eight prefectures in the Kyushu-Okinawa region in Japan. In addition, we analyzed prehospital factors associated with survival outcomes in Miyazaki city district. METHODS We used data from an annual report released by the Fire and Disaster Management Agency of Japan (n = 627,982) and the Utstein reporting database in Miyazaki city district (n = 1,686) from 2015 to 2019. RESULT Despite having the highest rate of bystander CPR (20.8%), the 1-month survival rate (15.7%) of witnessed OHCA cases of cardiac causes in Miyazaki city district was comparable with that in the eight prefectures between 2015 and 2019. However, rates of survival (10.7%) in Miyazaki prefecture were lower than those in other prefectures. In 1,686 patients with OHCA (74 ± 18 years old, 59% male) from the Utstein reporting database identical to the 5-year study period in Miyazaki city district, binary logistic regression analysis demonstrated that age of the recipient [odds ratio (OR) 0.979, 95% confidential interval (CI) 0.964-0.993, p = 0.004)], witness of the arrest event (OR 7.501, 95% CI 3.229-17.428, p < 0.001), AED implementation (OR 14.852, 95% CI 4.226-52.201, p < 0.001), and return of spontaneous circulation (ROSC) before transport (OR 31.070, 95% CI 16.585-58.208, p < 0.001) predicted the 1-month survival with favorable neurological outcomes. In addition, chest compression at a public place (p < 0.001) and by nonfamily members (p < 0.001) were associated with favorable outcomes (p = 0.015). CONCLUSIONS We found differences in 1-month survival rates after OHCA in the Kyushu-Okinawa region of Japan. Our results suggest that on-field ROSC with defibrillation performed by nonfamily bystanders who witnessed the event determines 1-month neurological outcomes after OHCA in Miyazaki city district. Continued education of citizens on CPR techniques and better access to AED devices may improve outcomes.
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Affiliation(s)
- Toshihiro Tsuruda
- Faculty of Medicine, Department of Hemo-Vascular Advanced Medicine, Cardiorenal Research Laboratory, University of Miyazaki, Miyazaki, Japan
- * E-mail:
| | | | - George J. Endo
- Faculty of Medicine, Endowed Department of Disaster/Emergency Medical Support, University of Miyazaki, Miyazaki, Japan
- Department of Emergency Medicine, Kobayashi City Hospital, Kobayashi, Japan
| | - Yuki Tsuruda
- Department of Clinical Pharmacy, Doshisha Women’s College of Liberal Arts, Kyotanabe, Japan
| | - Koichi Kaikita
- Faculty of Medicine, Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, University of Miyazaki, Japan
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Regional Variation in National Healthcare Expenditure and Health System Performance in Central Cities and Suburbs in Japan. Healthcare (Basel) 2022; 10:healthcare10060968. [PMID: 35742020 PMCID: PMC9223123 DOI: 10.3390/healthcare10060968] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/14/2022] [Accepted: 05/18/2022] [Indexed: 11/19/2022] Open
Abstract
The increasing national healthcare expenditure (NHE) with the aging rate is a significant social problem in Japan, and efficient distribution and use of NHE is an urgent issue. It is assumed that comparisons in subregions would be important to explore the regional variation in NHE and health system performance in targeted municipalities of the metropolitan area of Tokyo (central cities) and the neighboring municipalities of Chiba Prefecture (suburbs). This study aimed to clarify the differences of the socioeconomic factors affecting NHE and the health system performances between subregions. A multiple regression analysis was performed to extract the factors affecting the total medical expenses of NHE (Total), comprising the medical expenses of inpatients (MEI), medical expenses of outpatients (MEO), and consultation rates of inpatients (CRI) and outpatients (CRO). Using the stepwise method, dependent variables were selected from three categories: health service, socioeconomic, and lifestyle. Then, health system performance analysis was performed, and the differences between regions were clarified using the Mann–Whitney U test. The test was applied to 18 indicators, classified into five dimensions referred to in the OECD indicators: health status, risk factors for health, access to care, quality of care, and health system capacity and resources. In the central cities, the number of persons per household was the primary factor affecting Total, MEI, MEO, and CRO, and the number of persons per household and the percentage of the entirely unemployed persons primarily affected CRI. In the suburbs, the ratio of the population aged 65–74 and the number of hospital beds were significantly positively related to Total, MEI, and CRI, but the number of workers employed in primary industries was negatively related to Total and MEI. The ratio of the population aged 65–74 was significantly positively related to MEO and CRO. Regarding health system performance, while risk factors for health was high in the central cities, the others, including access to care, quality of care, and health system capacity and resources, were superior in the suburbs, suggesting that the health system might be well developed to compensate for the risks. In the suburbs, while risk factors for health were lower than those in the central cities, access to care, quality of care, and health system capacity and resources were also lower, suggesting that the healthcare system might be poorer. These results indicate a need to prioritize mitigating healthcare disparities in the central cities and promoting the health of the elderly in the suburbs by expanding the suburbs’ healthcare systems and resources. This study clarified that the determinants of NHE and health system performance are drastically varied among subregional levels and suggested the importance of precise regional moderation of the healthcare system.
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Tsuboi H, Fujimori K. Effectiveness of Hospital Discharge Support by Medical and Nursing Care Workers in Reducing Readmission Rates of Patients in Long-Term Care Wards: An Observation Study in Japan. TOHOKU J EXP MED 2021; 251:225-230. [PMID: 32684534 DOI: 10.1620/tjem.251.225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
For increasing medical care demand by aging population, the Japanese government is shifting to home medical care for treatments that do not necessarily require hospitalization. It is therefore essential to identify factors involved in improving the quality and outcomes of home medical care. This study examined the effect of hospital discharge support in long-term care wards on readmission rates. We used medical insurance and the Long-Term Care Insurance data of patients aged ≥ 65. Participants were patients who discharged between April 2012 and March 2016 from long-term care wards that did not require 24-hour monitoring and had no specific incurable diseases. Participants were divided into two groups according to hospital discharge support, defined by medical fee incentives for discharge planning and coordination of medical and nursing services after discharge. We explored the association between hospital discharge support and risk-adjusted readmission based on patient characteristics for one year beginning the month after patient discharge. This study involved a total of 10,998 patients: 2,563 patients with hospital discharge support and 8,435 patients without relevant support. In the group with hospital discharge support, there was a significant reduction in readmission rates. When examined by patients' characteristics, this association was significant in groups with age ≥ 85, care needs levels 1 to 2 (conditions requiring partial care for daily living), dementia or fracture. Our results suggest that hospital discharge support by medical and nursing care workers is effective in reducing readmission rates. Moreover, patients' age, care needs, and underlying disease should be considered.
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Affiliation(s)
- Hirofumi Tsuboi
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine
| | - Kenji Fujimori
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine
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Hosokawa R, Ojima T, Myojin T, Aida J, Kondo K, Kondo N. Associations Between Healthcare Resources and Healthy Life Expectancy: A Descriptive Study across Secondary Medical Areas in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176301. [PMID: 32872538 PMCID: PMC7503367 DOI: 10.3390/ijerph17176301] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/22/2020] [Accepted: 08/26/2020] [Indexed: 12/28/2022]
Abstract
Japan has the highest life expectancy in the world. However, this does not guarantee an improved quality of life. There is a gap between life expectancy and healthy life expectancy. This study aimed to reveal the features of healthy life expectancy across all secondary medical areas (n = 344) in Japan and examine the relationship among healthcare resources, life expectancy, and healthy life expectancy at birth. Data were collected from Japan’s population registry and long-term insurance records. Differences in healthy life expectancy by gender were calculated using the Sullivan method. Maps of healthy life expectancy were drawn up. Descriptive statistics and correlation analysis were used for analysis. The findings revealed significant regional disparities. The number of doctors and therapists, support clinics for home healthcare facilities and home-visit treatments, and dentistry expenditure per capita were positively correlated with life expectancy and healthy life expectancy (correlation coefficients > 0.2). They also revealed gender differences. Despite controlling for population density, inequalities in healthy life expectancy were observed, highlighting the need to promote social policies to reduce regional disparities. Japanese policymakers should consider optimal levels of health resources to improve life expectancy and healthy life expectancy. The geographical distribution of healthcare resources should also be reconstituted.
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Affiliation(s)
- Rikuya Hosokawa
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
- Correspondence: ; Tel.: +81-75-751-4154
| | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Shizuoka 431-3192, Japan;
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara 634-8521, Japan;
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan;
- Division for Regional Community Development, Liaison Center for Innovative Dentistry, Graduate School of Dentistry, Tohoku University, Miyagi 980-8575, Japan
| | - Katsunori Kondo
- Center for Preventive Medical Sciences, Chiba University, Chiba 263-8522, Japan;
- Center for Well-being and Society, Nihon Fukushi University, Aichi 470-3295, Japan
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan
| | - Naoki Kondo
- Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Tokyo 113-0033, Japan;
- Department of Health Education and Health Sociology, School of Public Health, The University of Tokyo, Tokyo 113-0033, Japan
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Kim YS, Lee DH, Chae HS, Han K. Changing Disease Trends in the Northern Gyeonggi-do Province of South Korea from 2002 to 2013: A Big Data Study Using National Health Information Database Cohort. Osong Public Health Res Perspect 2018; 9:248-254. [PMID: 30402380 PMCID: PMC6202018 DOI: 10.24171/j.phrp.2018.9.5.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives To investigate the chronological patterns of diseases in Northern Gyeonggi-do province, South Korea, and compare these with national data. Methods A National Health Insurance cohort based on the National Health Information Database (NHID Cohort 2002–2013) was used to perform a retrospective, population-based study (46,605,433 of the target population, of which 1,025,340 were randomly sampled) to identify disease patterns from 2002 to 2013. Common diseases including malaria, cancer (uterine cervix, urinary bladder, colon), diabetes mellitus, psychiatric disorders, hypertension, intracranial hemorrhage, bronchitis/bronchiolitis, peptic ulcer, and end stage renal disease were evaluated. Results Uterine cervix cancer, urinary bladder cancer and colon cancer had the greatest rate of increase in Northern Gyeonggi-do province compared with the rest of the country, but by 2013 the incidence of these cancers had dropped dramatically. Acute myocardial infarction and end stage renal disease also increased over the study period. Psychiatric disorders, diabetes mellitus, hypertension and peptic ulcers showed a gradual increase over time. No obvious differences were found for intracranial hemorrhage or bronchitis/bronchiolitis between the Northern Gyeonggi-do province and the remaining South Korean provinces. Malaria showed a unique time trend, only observed in the Northern Gyeonggi province, peaking in 2004, 2007 and 2009 to 2010. Conclusion This study showed that the Northern Gyeonggi-do province population had a different disease profile over time, compared with collated data for the remaining provinces in South Korea. “Big data” studies using the National Health Insurance cohort database can provide insight into the healthcare environment for healthcare providers, stakeholders and policymakers.
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Affiliation(s)
- Young Soo Kim
- Epidemiology Study Cluster of Uijeongbu St. Mary's Hospital, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Dong-Hee Lee
- Epidemiology Study Cluster of Uijeongbu St. Mary's Hospital, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Hiun Suk Chae
- Epidemiology Study Cluster of Uijeongbu St. Mary's Hospital, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Kyungdo Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Okubo M, Gibo K, Wallace DJ, Komukai S, Izawa J, Kiyohara K, Callaway CW, Iwami T, Kitamura T. Regional variation in functional outcome after out-of-hospital cardiac arrest across 47 prefectures in Japan. Resuscitation 2017; 124:21-28. [PMID: 29294318 DOI: 10.1016/j.resuscitation.2017.12.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/10/2017] [Accepted: 12/28/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although prior work reported regional variation in survival after out-of-hospital cardiac arrest (OHCA), mechanisms of the variation have not been fully investigated. We sought to evaluate regional variation in favourable functional outcome after OHCA across 47 prefectures in Japan as our primary aim. We also evaluated the associations between favourable functional outcome and the numbers of basic life support (BLS) providers and public access automated external defibrillators (AEDs) within each prefecture as our secondary aim. METHODS Using the All-Japan Utstein Registry, a nationwide prospective, population-based OHCA database, we identified 97,408 patients with OHCA of medical origin across 47 prefectures in 2014. Primary outcome was 1-month survival with favourable functional outcome, defined as Cerebral Performance Category (CPC) scale 1 or 2. We fitted multivariable hierarchical logistic regression models (patients nested within prefectures) to adjust for potential confounding factors at patient- and prefecture-level and clustering of patients within prefectures. We calculated median odds ratios (ORs) from the hierarchical models to quantify the outcome variation at prefecture-level. We also evaluated the associations between OHCA outcome and the numbers of BLS providers and public access AEDs within each prefecture, using the hierarchical models. RESULTS A total of 2246 patients (2.3%) had 1-month survival with favourable functional outcome. The unadjusted rates of 1-month survival with favourable functional outcome in each prefecture ranged from 1.1% to 4.1% (median OR = 1.29; 95% credible interval, 1.20-1.40) and the adjusted rates varied from 0.9% to 3.5% (median OR = 1.34; 95% credible interval, 1.24-1.48). We observed no associations between 1-month survival with favourable functional outcome and the numbers of BLS providers (correlation coefficient = -0.25; 95% confidence interval [CI], -0.50 to 0.04; p = 0.09) and public access AEDs (correlation coefficient = -0.27; 95% CI, -0.51 to 0.02; p = 0.07) within prefectures. CONCLUSIONS We found substantial regional variation in favourable functional outcome after OHCA of medical origin that was not explained by the numbers of BLS providers and public access AEDs within each prefecture.
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Affiliation(s)
- Masashi Okubo
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, USA.
| | - Koichiro Gibo
- Department of Emergency Medicine, Okinawa Prefectural Chubu Hospital, Japan
| | - David J Wallace
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, USA; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, USA
| | - Sho Komukai
- Clinical Research Center, Saga University Hospital, Japan
| | - Junichi Izawa
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, USA; Department of Anaesthesiology, The Jikei University School of Medicine, Japan
| | - Kosuke Kiyohara
- Departments of Public Health, Tokyo Women's Medical University, Japan
| | - Clifton W Callaway
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, USA
| | | | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Services, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Japan
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Nomura S, Sakamoto H, Glenn S, Tsugawa Y, Abe SK, Rahman MM, Brown JC, Ezoe S, Fitzmaurice C, Inokuchi T, Kassebaum NJ, Kawakami N, Kita Y, Kondo N, Lim SS, Maruyama S, Miyata H, Mooney MD, Naghavi M, Onoda T, Ota E, Otake Y, Roth GA, Saito E, Tabuchi T, Takasaki Y, Tanimura T, Uechi M, Vos T, Wang H, Inoue M, Murray CJL, Shibuya K. Population health and regional variations of disease burden in Japan, 1990-2015: a systematic subnational analysis for the Global Burden of Disease Study 2015. Lancet 2017; 390:1521-1538. [PMID: 28734670 PMCID: PMC5613077 DOI: 10.1016/s0140-6736(17)31544-1] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/02/2017] [Accepted: 05/04/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Japan has entered the era of super-ageing and advanced health transition, which is increasingly putting pressure on the sustainability of its health system. The level and pace of this health transition might vary across regions within Japan and concern is growing about increasing regional variations in disease burden. The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) provides a comprehensive, comparable framework. We used data from GBD 2015 with the aim to quantify the burden of disease and injuries, and to attribute risk factors in Japan at a subnational, prefecture-level. METHODS We used data from GBD 2015 for 315 causes and 79 risk factors of death, disease, and injury incidence and prevalence to measure the burden of diseases and injuries in Japan and in the 47 Japanese prefectures from 1990 to 2015. We extracted data from GBD 2015 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), life expectancy, and healthy life expectancy (HALE) in Japan and its 47 prefectures. We split extracted data by prefecture and applied GBD methods to generate estimates of burden, and attributable burden due to known risk factors. We examined the prefecture-level relationships of common health system inputs (eg, health expenditure and workforces) to the GBD outputs in 2015 to address underlying determinants of regional health variations. FINDINGS Life expectancy at birth in Japan increased by 4·2 years from 79·0 years (95% uncertainty interval [UI] 79·0 to 79·0) to 83·2 years (83·1 to 83·2) between 1990 and 2015. However, the gaps between prefectures with the lowest and highest life expectancies and HALE have widened, from 2·5 to 3·1 years and from 2·3 to 2·7 years, respectively, from 1990 to 2015. Although overall age-standardised death rates decreased by 29·0% (28·7 to 29·3) from 1990 to 2015, the rates of mortality decline in this period substantially varied across the prefectures, ranging from -32·4% (-34·8 to -30·0) to -22·0% (-20·4 to -20·1). During the same time period, the rate of age-standardised DALYs was reduced overall by 19·8% (17·9 to 22·0). The reduction in rates of age-standardised YLDs was very small by 3·5% (2·6 to 4·3). The pace of reduction in mortality and DALYs in many leading causes has largely levelled off since 2005. Known risk factors accounted for 34·5% (32·4 to 36·9) of DALYs; the two leading behavioural risk factors were unhealthy diets and tobacco smoking in 2015. The common health system inputs were not associated with age-standardised death and DALY rates in 2015. INTERPRETATION Japan has been successful overall in reducing mortality and disability from most major diseases. However, progress has slowed down and health variations between prefectures is growing. In view of the limited association between the prefecture-level health system inputs and health outcomes, the potential sources of regional variations, including subnational health system performance, urgently need assessment. FUNDING Bill & Melinda Gates Foundation, Japan Ministry of Education, Science, Sports and Culture, Japan Ministry of Health, Labour and Welfare, AXA CR Fixed Income Fund and AXA Research Fund.
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Affiliation(s)
- Shuhei Nomura
- Department of Global Health Policy, Graduate School of Medicine, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Haruka Sakamoto
- Department of Global Health Policy, Graduate School of Medicine, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Scott Glenn
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sarah K Abe
- Department of Global Health Policy, Graduate School of Medicine, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Md M Rahman
- Department of Global Health Policy, Graduate School of Medicine, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Jonathan C Brown
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Satoshi Ezoe
- Department of Global Health Policy, Graduate School of Medicine, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Christina Fitzmaurice
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA
| | - Tsuyoshi Inokuchi
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
| | - Nicholas J Kassebaum
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington, Seattle, USA; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Norito Kawakami
- Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Yosuke Kita
- Health Promotion Division, Yamaguchi Prefectural Government, Yamaguchi, Japan
| | - Naoki Kondo
- Department of Health and Social Behaviour, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Stephen S Lim
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Satoshi Maruyama
- Department of Health Services Research and Policy, Stanford University, Stanford, CA, USA
| | - Hiroaki Miyata
- Department of Global Health Systems and Innovation, Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Meghan D Mooney
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Tomoko Onoda
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
| | - Erika Ota
- Global Health Nursing, Graduate School of Nursing Science, St Luke's International University, Tokyo, Japan
| | - Yuji Otake
- Health and Welfare Bureau, Hokkaido Prefectural Government, Hokkaido, Japan
| | - Gregory A Roth
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Eiko Saito
- Department of Global Health Policy, Graduate School of Medicine, School of Public Health, The University of Tokyo, Tokyo, Japan; Division of Cancer Statistics Integration, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Yohsuke Takasaki
- Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Tadayuki Tanimura
- Department of Public Health, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Manami Uechi
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Haidong Wang
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Manami Inoue
- Department of Global Health Policy, Graduate School of Medicine, School of Public Health, The University of Tokyo, Tokyo, Japan; Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | | | - Kenji Shibuya
- Department of Global Health Policy, Graduate School of Medicine, School of Public Health, The University of Tokyo, Tokyo, Japan; Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan.
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Ezoe S, Noda H, Akahane N, Sato O, Hama T, Miyata T, Terahara T, Fujishita M, Sakamoto H, Abe SK, Gilmour S, Shobayashi T. Trends in Policy on the Prevention and Control of Non-Communicable Diseases in Japan. Health Syst Reform 2017; 3:268-277. [PMID: 30359179 DOI: 10.1080/23288604.2017.1347125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract-For the past decades Japan has remained number one in a range of population health metrics including the world's longest healthy life expectancy. While this was achieved through various socioeconomic factors besides public health interventions, health promotion policies to prevent and control non-communicable diseases (NCDs) played a major role. Japan introduced its first comprehensive national plan to prevent and control NCDs in 1978 and has revised the plan every decade since. These 10-year policy packages were instrumental in galvanizing stakeholders, while adapting to changing social, behavioral, and epidemiological trends. In this article, we provide an overview of trends in policy on the prevention and control of NCDs in Japan with a focus on successes and challenges especially due to a rapidly aging population. Through this review we aim to share the lessons learned in Japan for other countries tackling or expecting to be challenged by NCDs. These lessons include the role of multisectoral approaches, clear goals and targets with effective monitoring and evaluation mechanisms, addressing social aspects, adjustment to the local context, and foreseeing future demographic transition. Japan is committed to contributing to the world as a forerunner of the health challenges posed by unprecedented demographic change, by sharing its lessons in the global quest to create a world where all people can live longer and healthier lives.
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Affiliation(s)
- Satoshi Ezoe
- a Health Service Bureau, Ministry of Health, Labour and Welfare, Government of Japan , Tokyo , Japan
| | - Hiroyuki Noda
- a Health Service Bureau, Ministry of Health, Labour and Welfare, Government of Japan , Tokyo , Japan
| | - Naoki Akahane
- a Health Service Bureau, Ministry of Health, Labour and Welfare, Government of Japan , Tokyo , Japan
| | - Osamu Sato
- a Health Service Bureau, Ministry of Health, Labour and Welfare, Government of Japan , Tokyo , Japan
| | - Takashi Hama
- a Health Service Bureau, Ministry of Health, Labour and Welfare, Government of Japan , Tokyo , Japan
| | - Tatsunori Miyata
- a Health Service Bureau, Ministry of Health, Labour and Welfare, Government of Japan , Tokyo , Japan
| | - Tomohiro Terahara
- a Health Service Bureau, Ministry of Health, Labour and Welfare, Government of Japan , Tokyo , Japan
| | - Manami Fujishita
- a Health Service Bureau, Ministry of Health, Labour and Welfare, Government of Japan , Tokyo , Japan
| | - Haruka Sakamoto
- b Department of Global Health Policy, Graduate School of Medicine , University of Tokyo , Tokyo , Japan
| | - Sarah Krull Abe
- b Department of Global Health Policy, Graduate School of Medicine , University of Tokyo , Tokyo , Japan
| | - Stuart Gilmour
- b Department of Global Health Policy, Graduate School of Medicine , University of Tokyo , Tokyo , Japan
| | - Tokuaki Shobayashi
- a Health Service Bureau, Ministry of Health, Labour and Welfare, Government of Japan , Tokyo , Japan
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Goto Y, Funada A, Goto Y. Subsequent Shockable Rhythm During Out-of-Hospital Cardiac Arrest in Children With Initial Non-Shockable Rhythms: A Nationwide Population-Based Observational Study. J Am Heart Assoc 2016; 5:e003589. [PMID: 27792647 PMCID: PMC5121473 DOI: 10.1161/jaha.116.003589] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 09/22/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND The effect of a subsequent treated shockable rhythm during cardiopulmonary resuscitation on the outcome of children who suffer out-of-hospital cardiac arrest with initial nonshockable rhythm is unclear. We hypothesized that subsequent treated shockable rhythm in children with out-of-hospital cardiac arrest would improve survival with favorable neurological outcomes (Cerebral Performance Category scale 1-2). METHODS AND RESULTS From the All-Japan Utstein Registry, we analyzed the records of 12 402 children (aged <18 years) with out-of-hospital cardiac arrest and initial nonshockable rhythms. Patients were divided into 2 cohorts: subsequent treated shockable rhythm (YES; n=239) and subsequent treated shockable rhythm (NO; n=12 163). The rate of 1-month cerebral performance category 1 to 2 in the subsequent treated shockable rhythm (YES) cohort was significantly higher when compared to the subsequent treated shockable rhythm (NO) cohort (4.6% [11 of 239] vs 1.3% [155 of 12 163]; adjusted odds ratio, 2.90; 95% CI, 1.42-5.36; all P<0.001). In the subsequent treated shockable rhythm (YES) cohort, the rate of 1-month cerebral performance category 1 to 2 decreased significantly as time to shock delivery increased (17.7% [3 of 17] for patients with shock-delivery time 0-9 minutes, 7.3% [8 of 109] for 10-19 minutes, and 0% [0 of 109] for 20-59 minutes; P<0.001 [for trend]). Age-stratified outcomes showed no significant differences between the 2 cohorts in the group aged <7 years old: 1.3% versus 1.4%, P=0.62. CONCLUSIONS In children with out-of-hospital cardiac arrest and initial nonshockable rhythms, subsequent treated shockable rhythm was associated with improved 1-month survival with favorable neurological outcomes. In the cohort of older children (7-17 years), these outcomes worsened as time to shock delivery increased.
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Affiliation(s)
- Yoshikazu Goto
- Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Akira Funada
- Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Yumiko Goto
- Department of Cardiology, Yawata Medical Center, Komatsu, Japan
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