Ichiro Tsuji

Association between body mass index and cardiovascular disease mortality in east Asians and south Asians: pooled analysis of prospective data from the Asia Cohort Consortium

Objective To evaluate the association between body mass index and mortality from overall cardiovascular disease and specific subtypes of cardiovascular disease in east and south Asians. Design Pooled analyses of 20 prospective cohorts in Asia, including data from 835u2009082 east Asians and 289u2009815 south Asians. Cohorts were identified through a systematic search of the literature in early 2008, followed by a survey that was sent to each cohort to assess data availability. Setting General populations in east Asia (China, Taiwan, Singapore, Japan, and Korea) and south Asia (India and Bangladesh). Participants 1u2009124u2009897 men and women (mean age 53.4 years at baseline). Main outcome measures Risk of death from overall cardiovascular disease, coronary heart disease, stroke, and (in east Asians only) stroke subtypes. Results 49u2009184 cardiovascular deaths (40u2009791 in east Asians and 8393 in south Asians) were identified during a mean follow-up of 9.7 years. East Asians with a body mass index of 25 or above had a raised risk of death from overall cardiovascular disease, compared with the reference range of body mass index (values 22.5-24.9; hazard ratio 1.09 (95% confidence interval 1.03 to 1.15), 1.27 (1.20 to 1.35), 1.59 (1.43 to 1.76), 1.74 (1.47 to 2.06), and 1.97 (1.44 to 2.71) for body mass index ranges 25.0-27.4, 27.5-29.9, 30.0-32.4, 32.5-34.9, and 35.0-50.0, respectively). This association was similar for risk of death from coronary heart disease and ischaemic stroke; for haemorrhagic stroke, the risk of death was higher at body mass index values of 27.5 and above. Elevated risk of death from cardiovascular disease was also observed at lower categories of body mass index (hazard ratio 1.19 (95% confidence interval 1.02 to 1.39) and 2.16 (1.37 to 3.40) for body mass index ranges 15.0-17.4 and <15.0, respectively), compared with the reference range. In south Asians, the association between body mass index and mortality from cardiovascular disease was less pronounced than that in east Asians. South Asians had an increased risk of death observed for coronary heart disease only in individuals with a body mass index greater than 35 (hazard ratio 1.90, 95% confidence interval 1.15 to 3.12). Conclusions Body mass index shows a U shaped association with death from overall cardiovascular disease among east Asians: increased risk of death from cardiovascular disease is observed at lower and higher ranges of body mass index. A high body mass index is a risk factor for mortality from overall cardiovascular disease and for specific diseases, including coronary heart disease, ischaemic stroke, and haemorrhagic stroke in east Asians. Higher body mass index is a weak risk factor for mortality from cardiovascular disease in south Asians.

Long-term impact of the 2011 Great East Japan Earthquake and tsunami on functional disability among older people: A 3-year longitudinal comparison of disability prevalence among Japanese municipalities

It has been unclear whether the prevalence of disability is higher in an area affected by natural disaster than in other areas even if more than one year has passed since the disaster. The aim of this ecological study was to examine whether the rate of increase in disability prevalence among the older population was higher in disaster-stricken areas during the 3 years after the Great East Japan Earthquake (GEJE) and tsunami. This analysis used public Long-term Care Insurance (LTCI) data covering 1570 municipalities. Disaster areas were considered to be the three prefectures most affected by the earthquake and tsunami: Iwate, Miyagi, and Fukushima. The outcome measure was the number of aged people (≥65 years) with LTCI disability certification. Rates of change in disability prevalence from January 2011 to January 2014 were used as the primary outcome variable, and compared by analysis of covariance between coastal disaster areas, inland disaster areas and non-disaster areas. The mean rate of increase in disability prevalence in coastal (14.7%) and inland (10.0%) disaster areas was higher than in non-disaster areas (6.2%) (Pxa0<xa00.001). During the 3 years after the earthquake, the increase of disability prevalence from before the GEJE continued to be higher in the disaster-stricken areas.

Longitudinal association between time-varying social isolation and psychological distress after the Great East Japan Earthquake

BACKGROUNDnThe association between social isolation and psychological distress among disaster survivors is inconclusive. In addition, because these previous studies were cross-sectional in design, the longitudinal association between time-varying social isolation and psychological distress was not clear. The present study examined the longitudinal association between social isolation and psychological distress after the Great East Japan Earthquake.nnnMETHODSnWe analyzed longitudinal data for 959 adults who had responded to the self-report questionnaires about Lubben Social Network Scale-6 (LSNS-6) and K6 in both a community-based baseline survey (2011) and a follow-up survey (2014) after the disaster. Participants were categorized into four groups according to changes in the presence of social isolation (<12/30 of LSNS-6) at two time points (2011 and 2014): remained socially isolated, became not socially isolated, remained not socially isolated, and became socially isolated. We defined a K6 score of ≥ 10/24 as indicating the presence of psychological distress. We used multiple logistic regression analysis to estimate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to indicate how the change in social isolation was related to changes in psychological distress over 3 years.nnnRESULTSnAmong the participants who had not shown psychological distress at the baseline, the rates of deterioration of psychological distress were significantly lower in participants who became not socially isolated (multivariate OR = 0.26, 95% CI = 0.08-0.70) and remained not socially isolated (multivariate OR = 0.49, 95% CI = 0.27-0.91), compared with participants who remained socially isolated. Among the participants who had psychological distress at the baseline, the rate of improvement of psychological distress was significantly higher in participants who remained not socially isolated (multivariate OR = 2.61, 95% CI = 1.08-6.44).nnnCONCLUSIONnThe present findings suggest that prevention of social isolation may be an effective public health strategy for preventing psychological distress after a natural disaster.

Dietary patterns and colorectal cancer risk in Japan: the Ohsaki Cohort Study

PurposeTo evaluate dietary patterns in relation to colorectal cancer risk in Japanese.MethodsWe prospectively assessed the association between dietary patterns among the Japanese and the risk of colorectal cancer. Dietary information was collected from 44,097 Japanese men and women aged 40–79xa0years without a history of cancer at the baseline in 1994.ResultsDuring 11xa0years of follow-up, we documented 854 cases of colorectal cancer, which included 554 cases of colon cancer and 323 cases of rectal cancer. Factor analysis (principal component analysis) based on a validated food frequency questionnaire identified three dietary patterns: (1) a Japanese dietary pattern, (2) an “animal food” dietary pattern, and (3) a high-dairy, high-fruit-and-vegetable, low-alcohol (DFA) dietary pattern. After adjustment for potential confounders, the DFA pattern was inversely associated with the risk of colorectal cancer (hazard ratio of the highest quartile vs the lowest, 0.76; 95xa0% confidence interval 0.60–0.97; p for trendxa0=xa00.02). When colon and rectal cancers were separated, the inverse association between the DFA pattern and cancer risk was observed for rectal cancer (p for trendxa0=xa00.003), but not for colon cancer (p for trendxa0=xa00.43). No apparent association was observed for either the Japanese dietary pattern or the “animal food” dietary pattern.ConclusionsThe DFA dietary pattern was found to be inversely associated with the risk of colorectal cancer. This association was observed for rectal cancer, but not for colon cancer.

Influence of living environments and working status on low back pain for survivors of the Great East Japan Earthquake

BACKGROUNDnThe Great East Japan Earthquake and devastating Tsunami caused irreparable damage on the northeastern coast of Japan. This study aimed to examine the influencing factors of Living environment and Working status on low back pain for the survivors of the earthquake evaluated by a self-report questionnaire.nnnMETHODSnBetween 2011 and 2013, survivors replied to the self-report questionnaire, and 986 people consented to join this study. The living environment was divided into 3 categories (1. Living in the same house as before the earthquake, 2. Living in a safe shelter or temporary small house, 3. Living in a house of relatives or apartment house) and working status was divided into 5 categories (1. Unemployed before the earthquake, 2. Unemployed after the earthquake, 3. Decrease in income, 4. Different occupation after the earthquake, 5. The same occupation as before the earthquake). Age, gender, living areas, past history of arthritis, arthropathy, osteoporosis, sleep disturbance, psychological distress, and economic status were considered as confounding factors. Generalized estimating regression models with logit link function were used because outcome variables are repeatedly measured and binomial. We evaluated the correlation between the presence/severity of low back pain over time and housing status/working status at 1 year after the earthquake.nnnRESULTSnThere were no significant differences between age, gender, living areas, working status, or living environment before or after the earthquake. There was no significant difference in the risk of having low back pain in living environment or gender. There was significant difference in the risk of having low back pain in those with Decrease in income (ORxa0=xa01.93, 95% CIxa0=xa01.23-3.03) and The same occupation as before the earthquake (ORxa0=xa01.67, 95% CIxa0=xa01.1-2.52).nnnCONCLUSIONSnThough living environment has little effect, Decrease in income and The same occupation as before the earthquake have strong influences on low back pain.

The Association Between Medical Treatment of Physical Diseases and Psychological Distress After the Great East Japan Earthquake: The Shichigahama Health Promotion Project.

OBJECTIVEnPhysical disease patients are known to experience high levels of psychological distress. This study examined the association between the medical treatment of physical diseases and psychological distress in the coastal area affected by the Great East Japan Earthquake.nnnMETHODSnUsing cross-sectional data, we studied 3032 individuals aged ≥40 years who lived in Shichigahama, Miyagi, Japan. We examined the associations between 8 medical treatments for physical diseases and psychological distress, defined as Kessler Psychological Distress scale score ≥13 of 24 points. To investigate the associations, we performed multiple logistic regression analyses.nnnRESULTSnThere were statistically significant associations between psychological distress and medical treatments for myocardial infarction/angina pectoris (odds ratio [OR]=1.8, 95% confidence interval [CI]=1.0-3.0) and liver disease (OR=3.1, 95% CI=1.0-7.7). The other 4 medical treatments for physical diseases had ORs of 1.3 or higher and were positively associated with psychological distress: cancer, hyperlipidemia, kidney disease, and diabetes mellitus. The degree of damage to homes did not affect the association between most of the medical treatments for physical diseases and psychological distress.nnnCONCLUSIONSnIn the disaster area, most of the medical treatments for physical diseases had positive associations with psychological distress, irrespective of the degree of damage to homes.

Prospect of the future housing and the risk of psychological distress at one year after an earthquake disaster

Since the Great East Japan Earthquake in 2011, many of the affected have been forced to live in temporary housing or at a relatives house. Special attention needs to be paid to the negative health impacts resulting from such changes in living conditions. This study examined the association between future housing prospects and the risk of psychological distress 1 year after the earthquake.

Personality and suicide risk: the impact of economic crisis in Japan.

Background The interactive effect of personal factors and social factors upon suicide risk is unclear. We conducted prospective cohort study to investigate whether the impact of the economic crisis in 1997–1998 upon suicide risk differed according to Neuroticism and Psychoticism personality traits. Methods The Miyagi Cohort Study in Japan with a follow-up for 19 years from 1990 to 2008 has 29 432 subjects aged 40–64 years at baseline who completed a questionnaire about various health habits and the Japanese version of the Eysenck Personality Questionnaire – Revised Short Form in 1990. Results The suicide mortality rate increased from 4.6 per 100 000 person-years before 1998 to 27.8 after 1998. Although both Neuroticism and Psychoticism were significantly associated with an increased risk of mortality during the whole period from 1990 to 2008, the impact of the economic crisis upon suicide risk differed between the Neuroticism and Psychoticism personality traits. Compared with the lowest category, the hazard ratios (HRs) for the highest Neuroticism increased from 0.66 before 1998 to 2.45 after 1998. On the other hand, the HRs for the highest Psychoticism decreased from 7.85 before 1998 to 2.05 after 1998. Conclusions The impact of the 1997–1998 economic crisis upon suicide risk differed according to personality. Suicide risk increased among these with higher Neuroticism after the economic crisis, but this was not the case for other personality subscales.

Unemployment risk among individuals undergoing medical treatment for chronic diseases.

BACKGROUNDnChronic diseases increase the risk of unemployment even in non-disaster settings; therefore, in post-disaster settings, special attention needs to be paid to the employment status of those suffering from chronic diseases.nnnAIMSnTo examine the association between chronic disease and the risk of unemployment in a disaster area.nnnMETHODSnThis cross-sectional study was conducted in Shichigahama Town, Miyagi, north-eastern Japan, where had been severely inundated by the 2011 tsunami. Logistic regression analyses were used to evaluate the association between undergoing medical treatment for a combination of chronic diseases (stroke, cancer, myocardial infarction and angina) and unemployment risk. Confounders such as psychological distress and levels of daily life activity were considered.nnnRESULTSnAmong the 2588 individuals studied, there was a statistically significant association between undergoing medical treatment for chronic disease and the risk of unemployment [odds ratio (OR) = 1.7, 95% confidence interval (CI) 1.02-2.7, P < 0.05]. In participants with a lower degree of psychological distress and better levels of daily life activity (n = 1967), no significant associations were observed (OR = 1.1, 95% CI 0.6-2.1). Conversely, in 536 participants with a higher degree of psychological distress and/or poorer levels of daily life activity, statistically significant associations were found (OR = 2.6, 95% CI 1.01-6.6, P < 0.05).nnnCONCLUSIONSnThe association between undergoing medical treatment for chronic disease and unemployment risk was observed only in participants with a higher degree of psychological distress and/or poorer levels of daily life activity.

Association between Coffee Consumption and Incident Risk of Disabling Dementia in Elderly Japanese: The Ohsaki Cohort 2006 Study

Epidemiological studies of the association between coffee consumption and dementia have yielded inconsistent results. Therefore, we investigated the association between coffee consumption and incident risk of dementia in an elderly Japanese population. 23,091 subjects aged ≥65 y living in Ohsaki City, northeastern Japan, responded to the baseline survey in 2006. Of these, we analyzed 13,137 subjects who gave informed consent and were not disabled at baseline. The outcome was the incidence of disabling dementia defined by usage of the Long-term Care Insurance database. We used the Cox proportional hazards regression model for multivariate analysis. During 5.7 y of follow-up period, we identified 1,107 cases of incident dementia. Overall, coffee consumption was significantly associated with a lower risk of incident dementia. The multivariate-adjusted HRs for the incidence of dementia according to coffee consumption categories (never, occasionally, 1-2 cups/d, and ≥3 cups/d) were 1.00, 0.73 (95% CI, 0.62-0.86), 0.72 (95% CI, 0.61-0.84), and 0.82 (95% CI, 0.65-1.02; p for trendu200a=u200a0.009), respectively. In addition, this significant inverse association was more remarkable among women, non-smokers, and non-drinkers. Coffee consumption is significantly associated with a lower risk of incident dementia.