Tomoya Hanibuchi

Relative deprivation and incident functional disability among older Japanese women and men: prospective cohort study.

Background: A prospective observational study was conducted to test the hypothesis that relative deprivation was associated with incident physical or cognitive disability, independent of absolute income. Methods: Study subjects consist of 9463 non-disabled people aged 65+ years in the Aichi Gerontological Evaluation Study (AGES), Aichi prefecture, Japan. Baseline mail-in survey in 2003 gathered information on income, educational attainment, lifestyle factors (smoking, alcohol consumption and health check-up) and healthcare utilisation. Three-year incidence of disability was assessed through public long-term care insurance databases and resident registry. Results: A total of 7673 subjects (81%) with complete information were analysed. Our measure of relative deprivation was the Yitzhaki index across eight reference groups, which calculates the deprivation suffered by each individual as a function of the aggregate income shortfall for each person relative to everyone else with higher incomes in that person’s reference group. Cox regression demonstrated that, after controlling for sociodemographic factors (including absolute income), the hazard ratio (and 95% confidence intervals) of incident physical/cognitive disability per one standard deviation increase in relative deprivation ranged from 1.13 (0.99 to 1.29) to 1.15 (1.01 to 1.31) in men and from 1.11 (0.94 to 1.31) to 1.18 (1.00 to 1.39) in women, depending on the definition of the reference group. Additional adjustment for lifestyle factors attenuated the hazard ratios to statistical non-significance. Conclusion: Relative deprivation may be a mechanism underlying the link between income inequality and disability in older age, at least among men. Lifestyle factors in part explain the association between relative deprivation and incident disability.

Does walkable mean sociable? Neighborhood determinants of social capital among older adults in Japan.

Why are some communities more cohesive than others? The answer to the puzzle has two parts: (a) due to variations in the attributes of residents, and/or (b) due to variations in the attributes of places. However, few studies have sought to examine the community-level determinants of social capital. In the present study, we examined the associations between social capital and different area characteristics: (1) neighborhood walkability, (2) date of community settlement, and (3) degree of urbanization. We based our analysis on 9414 respondents from the Aichi Gerontological Evaluation Study (AGES), conducted in 2003. No significant positive association was found between the walkability score and any of the social capital indices. In contrast, community age and degree of urbanization were associated with many of the social capital indicators, even after controlling for characteristics of the residents. Community social capital thus appears to be more consistently linked to the broader historical and geographic contexts of neighborhoods, rather than to the proximal built environment (as measured by walkability).

Perceived and Objective Measures of Neighborhood Walkability and Physical Activity among Adults in Japan: A Multilevel Analysis of a Nationally Representative Sample

Although associations between a person’s neighborhood and their health have been studied internationally, most studies have been limited to a few cities or towns. Therefore, we used a nationally representative sample to explore whether perceived and objective neighborhood walkability was associated with the physical activity of residents. Data were analyzed from the Japanese General Social Surveys of 2010 (n = 2395; 1114 men and 1281 women). Perceived walkability was scored using factor analysis for the respondents’ perceptions of neighborhood conditions, while objective walkability was measured using the geographic information system approach. Finally, multilevel logistic regression analysis was performed to examine whether neighborhood walkability was associated with the frequency of leisure-time physical activity (LTPA) among respondents. We found that perceived walkability was positively associated with the frequency of LTPA (odds ratio of the highest quartile was 1.53 (1.14–2.05) compared with the lowest quartile); however, objective walkability showed no association. When stratified by gender, an association between perceived walkability and LTPA was observed among women, but only a marginally significant association was present between objective walkability and LTPA among men. We conclude that the association between neighborhood walkability and LTPA can be partially generalized across Japan.

Impact of Neighborhood Socioeconomic Conditions on the Risk of Stroke in Japan

Background Neighborhood deprivation has been shown in many studies to be an influential factor in cardiovascular disease risk. However, no previous studies have examined the effect of neighborhood socioeconomic conditions on the risk of stroke in Asian countries. Methods This study investigated whether neighborhood deprivation was associated with the risk of stroke and stroke death using data from the Japan Public Health Center-based Prospective Study. We calculated the adjusted hazard ratios of stroke mortality (mean follow-up, 16.4 years) and stroke incidence (mean follow-up, 15.4 years) according to the area deprivation index (ADI) among 90 843 Japanese men and women aged 40–69 years. A Cox proportional-hazard regression model using a shared frailty model was applied. Results The adjusted hazard ratios of stroke incidence, in order of increasing deprivation with reference to the least deprived area, were 1.16 (95% CI, 1.04–1.29), 1.12 (95% CI, 1.00–1.26), 1.18 (95% CI, 1.02–1.35), and 1.19 (95% CI, 1.01–1.41), after adjustment for individual socioeconomic conditions. Behavioral and psychosocial factors attenuated the association, but the association remained significant. The associations were explained by adjusting for biological cardiovascular risk factors. No significant association with stroke mortality was identified. Conclusions Our results indicate that the neighborhood deprivation level influences stroke incidence in Japan, suggesting that area socioeconomic conditions could be a potential target for public health intervention to reduce the risk of stroke.BACKGROUND Neighborhood deprivation has been shown in many studies to be an influential factor in cardiovascular disease risk. However, no previous studies have examined the effect of neighborhood socioeconomic conditions on the risk of stroke in Asian countries. METHODS This study investigated whether neighborhood deprivation was associated with the risk of stroke and stroke death using data from the Japan Public Health Center-based Prospective Study. We calculated the adjusted hazard ratios of stroke mortality (mean follow-up, 16.4 years) and stroke incidence (mean follow-up, 15.4 years) according to the area deprivation index (ADI) among 90 843 Japanese men and women aged 40-69 years. A Cox proportional-hazard regression model using a shared frailty model was applied. RESULTS The adjusted hazard ratios of stroke incidence, in order of increasing deprivation with reference to the least deprived area, were 1.16 (95% CI, 1.04-1.29), 1.12 (95% CI, 1.00-1.26), 1.18 (95% CI, 1.02-1.35), and 1.19 (95% CI, 1.01-1.41), after adjustment for individual socioeconomic conditions. Behavioral and psychosocial factors attenuated the association, but the association remained significant. The associations were explained by adjusting for biological cardiovascular risk factors. No significant association with stroke mortality was identified. CONCLUSIONS Our results indicate that the neighborhood deprivation level influences stroke incidence in Japan, suggesting that area socioeconomic conditions could be a potential target for public health intervention to reduce the risk of stroke.

Neighborhood contextual factors for smoking among middle-aged Japanese: A multilevel analysis

The purpose of this study is to explore neighborhood contextual factors in terms of smoking behaviors among middle-aged Japanese, by using a multilevel analysis. Subjects were Japanese men and women, between 40 and 59 years of age (40,961 for the cross-sectional analysis, and 9,177 for the longitudinal analysis), nested in 39 neighborhoods (Kyuson). The results showed that women in a less residentially stable neighborhood were more likely to be smokers. No associations were seen between current smoking and neighborhood deprivation; however, women in the most deprived neighborhood were more likely to quit smoking. This study is the first to demonstrate the associations between neighborhood environment and current smoking or smoking cessation, in a Japanese setting. The findings imply that policy makers should consider targeting neighborhood conditions in order to help reduce smoking prevalence, especially among women.

Associations of street layout with walking and sedentary behaviors in an urban and a rural area of Japan

Abstract We examined whether street layout —a key urban design element— is associated with walking and sedentary behaviors in the context of a non‐Western country; and, whether such associations differ between an urban and a rural area. In 2011, 1076 middle‐to‐older aged adults living in an urban and a rural area of Japan reported their walking and sedentary (sitting) behaviors. Two objective measures of street layout (intersection density and street integration) were calculated. Participants exposed to more‐connected street layouts were more likely to walk for commuting and for errands, to meet physical activity recommendations through walking for commuting, and less likely to drive. These relationships differed between the urban and the rural area. This shows that previous findings from Western countries on associations of street connectivity with travel behaviors may also be applicable to Japan. HighlightsStreet layout was associated with walking for commuting and for errands.Participants who lived in more connected areas were less likely to use a car.These relationships differed between the urban and the rural area.

Trends in socioeconomic inequalities in self-rated health, smoking, and physical activity of Japanese adults from 2000 to 2010

Health disparities in Japan are attracting increasing attention. Temporal trends in health disparities should be continuously monitored using multiple indices of socioeconomic status (SES) and health-related outcomes. We explored changes in socioeconomic differences in the health of Japanese adults during 2000–2010. The data was taken from the Japanese General Social Surveys, the cross-sectional surveys for nationally representative samples of Japanese adults. We used 14,193 samples (individuals of 20–64 years of age) in our analysis. We estimated age-adjusted prevalence ratios of the lowest SES group in comparison with the highest SES group using Poisson regression models with robust error variance. Relative index of inequality (RII) and slope index of inequality (SII) were also calculated. We examined the changes in the association between health-related outcomes (self-rated health (SRH), smoking, and physical activity) and SES indices (income, education, occupation, and subjective social class identification). The results showed temporally expanding trends for the associations of current smoking with SES, especially among women, in both relative and absolute measures. In contrast, no expanding trends were seen for SRH and physical activity. Although the smoking rates declined through the first decade of the 21st century, the socioeconomic disparities in smoking prevalence among Japanese adults expanded, especially among women. Researchers and policymakers should continuously monitor the trends that may cause future disparities in smoking-related morbidity and mortality.

Validity of Walk Score® as a measure of neighborhood walkability in Japan

Objective measures of environmental attributes have been used to understand how neighborhood environments relate to physical activity. However, this method relies on detailed spatial data, which are often not easily available. Walk Score® is a free, publicly available web-based tool that shows how walkable a given location is based on objectively-derived proximity to several types of local destinations and street connectivity. To date, several studies have tested the concurrent validity of Walk Score as a measure of neighborhood walkability in the USA and Canada. However, it is unknown whether Walk Score is a valid measure in other regions. The current study examined how Walk Score is correlated with objectively-derived attributes of neighborhood walkability, for residential addresses in Japan. Walk Scores were obtained for 1072 residential addresses in urban and rural areas in Japan. Five environmental attributes (residential density, intersection density, number of local destinations, sidewalk availability, and access to public transportation) were calculated using geographic information systems for each address. Pearsons correlation coefficients between Walk Score and these environmental attributes were calculated (conducted in May 2017). Significant positive correlations were observed between Walk Score and environmental attributes relevant to walking. Walk Score was most closely associated with intersection density (r = 0.82) and with the number of local destinations (r = 0.77). Walk Score appears to be a valid measure of neighborhood walkability in Japan. Walk Score will allow urban designers and public health practitioners to identify walkability of local areas without relying on detailed geographic data.

Happiness, Social Cohesion and Income Inequalities in Britain and Japan

The above quotation is from the popular book entitled “The Spirit Level: Why More Equal Societies Almost Always Do Better”. This text describes the relationship between income distribution and well-being in affluent countries suggesting it is mediated through psychosocial pathways shaping the impacts of economic structure upon social relationships. In this model lower income inequality is seen to result in societies with more cohesion, greater trust and cooperation and lower social stress. Wilkinson and Pickett (2009) present evidence suggesting that social and economic policies affecting the income distribution of a society can make a huge difference to the psychosocial well-being of the whole populations of this society. For instance, according to the evidence used in this book if income inequality were halved in the UK then the murder rates in the country and obesity rates would also halve, mental illness could be reduced by two thirds, imprisonment could reduce by 80 %, teen births could reduce by 80 % and levels of trust could increase by 85 % (The Equality Trust 2011).

The association between objective measures of residence and worksite neighborhood environment, and self-reported leisure-time physical activities: The Aichi Workers' Cohort Study

The possible effects of a neighborhoods built environment on physical activity have not been studied in Asian countries as much as in Western countries. The present study cross-sectionally examined the relationship between geographic information system (GIS) measured residence and worksite neighborhood walkability, and the number of parks/green spaces and sports facilities within a 1 km radius of home and workplace, with self-reported leisure-time habitual (3–4 times per week or more) walking and moderate-to-vigorous intensity habitual exercise among local government workers aged 18 to 64 years living in an urban-suburban area of Aichi, Japan in 2013. A single-level binomial regression model was used to estimate the multivariable odds ratios (ORs) and 95% confidence intervals (95% CIs). Of the 1959 male and 884 female participants, 288 (15%) and 141 (16%) reported habitual walking, respectively, and 18% and 17% reported habitual exercise, respectively. Compared with women who resided in neighborhood with a walkability index of 4–30, those living in an area with that of 35–40 were significantly more likely to engage in leisure-time habitual exercise (multivariable OR: 1.70, 95% CI: 1.08–2.68). Marginally significant positive associations were found between leisure-time habitual exercise and the residential neighborhoods number of parks/green spaces among women, as well as the number of sports facilities among men. In conclusion, a residential neighborhood environment characterized by higher walkability may contribute to the initiation or maintenance of moderate-to-vigorous intensity leisure-time exercise among working women living in an urban-suburban area of Japan.