Yoshiharu Fukuda

Accumulation of health risk behaviours is associated with lower socioeconomic status and women's urban residence: a multilevel analysis in Japan

BackgroundLittle is known about the socioeconomic differences in health-related behaviours in Japan. The present study was performed to elucidate the effects of individual and regional socioeconomic factors on selected health risk behaviours among Japanese adults, with a particular focus on regional variations.MethodsIn a nationally representative sample aged 25 to 59 years old (20,030 men and 21,076 women), the relationships between six risk behaviours (i.e., current smoking, excessive alcohol consumption, poor dietary habits, physical inactivity, stress and non-attendance of health check-ups), individual characteristics (i.e., age, marital status, occupation and household income) and regional (N = 60) indicators (per capita income and unemployment rate) were examined by multilevel analysis.ResultsDivorce, employment in women, lower occupational class and lower household income were generally associated with a higher likelihood of risk behaviour. The degrees of regional variation in risk behaviour and the influence of regional indicators were greater in women than in men: higher per capita income was significantly associated with current smoking, excessive alcohol consumption, stress and non-attendance of health check-ups in women.ConclusionIndividual lower socioeconomic status was a substantial predictor of risk behaviour in both sexes, while a marked regional influence was observed only in women. The accumulation of risk behaviours in individuals with lower socioeconomic status and in women in areas with higher income, reflecting an urban context, may contribute to their higher mortality rates.

Age‐related hypermethylation of the hMLH1 promoter in gastric cancers

To determine whether methylation of the hMLH1 promoter is related to increasing age and gastric carcinogenesis, we examined hMLH1 methylation and expression in 100 gastric cancers. hMLH1 methylation and aberrant protein expression were observed in 9 and 13 cancers, respectively. Normal and intestinal metaplastic tissues adjacent to cancers with hypermethylation did not exhibit any hMLH1 methylation, indicating that it may be specific to gastric cancers. The frequency of hMLH1 methylation significantly increased with age. These results suggest that hMLH1 methylation plays an important role in gastric carcinogenesis in old people.

Variations in societal characteristics of spatial disease clusters: examples of colon, lung and breast cancer in Japan

BackgroundSpatial analyses and ecological studies are essential for epidemiology and public health. The present study combining these two methods was performed to identify spatial clusters of selected types of cancer in Japan and to determine their societal characteristics focusing on homogeneity among clusters.ResultsSpatial clusters of high mortality rates of male colon and lung cancer and of female breast cancer were identified by the spatial scan statistic using Japanese municipal data (N = 3360) from 1993 to 1998 and also municipalities were divided into four societal clusters based on socioeconomic indicators and population density (urban-rich, suburban, rural-poor, and clutter). Five, seven, and four mortality clusters were identified for lung, colon and breast cancer, respectively. For colon and breast cancer, most municipalities of all except one cluster were included in a single societal cluster (urban-rich). The municipalities associated with mortality clusters for lung cancer belonged to various societal clusters.ConclusionIncreased mortality rates of colon and breast cancer can be explained by homogenous societal characteristics related to urbanisation, although there were exceptional areas with higher mortality rates. The regional variation in lung cancer mortality rate appeared to be due to heterogeneous factors. These findings and the analysis performed in the present study will contribute to both nationwide and region-specific cancer prevention strategies.

Municipal health expectancy in Japan: decreased healthy longevity of older people in socioeconomically disadvantaged areas

BackgroundLittle is known about small-area variation in healthy longevity of older people and its socioeconomic correlates. This study aimed to estimate health expectancy at 65 years (HE65) at the municipal level in Japan, and to examine its relation to area socio-demographic conditions.MethodsHE65 of municipalities (N = 3361) across Japan was estimated by a linear regression formula with life expectancy at 65 years and the prevalence of those certificated as needing nursing care. The relation between HE65 and area socio-demographic indicators was examined using correlation coefficients.ResultsThe estimated HE65 (years) ranged from 13.13 to 17.39 for men and from 14.84 to 20.53 for women. HE65 was significantly positively correlated with the proportion of elderly and per capita income, and negatively correlated with the percentage of households of a single elderly person, divorce rate, and unemployment rate. These relations were stronger in large municipalities (with a population of more than 100,000) than in small and medium-size municipalities.ConclusionA decrease in healthy longevity of older people was associated with a higher percentage of households of a single elderly person and divorce rate, and lower socioeconomic conditions. This study suggests that older people in urban areas are susceptible to socio-demographic factors, and a social support network for older people living in socioeconomically disadvantaged conditions should be encouraged.

Age-adjusted mortality and its association to variations in urban conditions in Shanghai

The objective of this study was to explore the association between health and urbanization in a megacity, Shanghai, by calculating the age-adjusted mortality ratio by ward-unit of Shanghai and by examining relationships between mortalities and urban indicators. Crude mortality rates and age-adjusted mortality ratios by ward-unit were calculated. Demographic, residential environment, healthcare, and socioeconomic indicators were formulated for each of the ward-units between 1995 and 1998. Correlation and Poisson regression analyses were performed to examine the association between urban indicators and mortalities. The crude mortality rate by ward-unit in 1997 varied from 6.3 to 9.4 deaths per 1000 population. The age-adjusted mortality ratio in 1997 by ward-units as reference to the average mortality of urban China varied from 57.8 to 113.3 within Shanghai. Age-adjusted mortalities were inversely related with indicators of a larger floor space of dwellings per population, a larger proportion of parks, gardens, and green areas to total land area; a greater number of health professionals per population; and a greater number of employees in retail business per population. Spacious living showed independent association to a higher standard of community health in Shanghai (P < 0.05). Consequences of health policy and the developments of urban infrastructural resources from the viewpoint of the Healthy Cities concept were discussed.

Different Income Information as an Indicator for Health Inequality among Japanese Adults

BACKGROUND There are several alternative indicators of income information, which is a fundamental measure of individual socioeconomic position. In this study, we compared the degrees of associations of four types of income information with health variables among Japanese adults. METHODS Using a nationally representative sample of 29,446 men and 32,917 women aged 20 years and over, the associations between four income indicators and health variables were examined using the odds ratio in logistic regression analysis and the concentration index by sex and age group (20-59 years and 60+ years). Income indicators consisted of total household income, equivalent household income, total household expenditure, and equivalent household expenditure. Current smoking and self-rated health statuses were used as health variables. RESULTS A low income was associated with a high prevalence of smoking and fair/poor self-rated health, with some differences among sex and age groups and income indicators, but less difference among methods of statistical analyses. Total and equivalent incomes were similarly and more markedly associated with smoking and self-rated health statuses, whereas equivalent expenditure showed the smallest degree of health difference. For the population aged 60+ years, the degree of health differences in smoking was similar between income and expenditure. CONCLUSIONS Although the degree of income-related health differences is dependent on health outcome and both sex and age group, this study suggests that either crude or equivalent household income is a useful indicator for health inequality among Japanese adults.

Socioeconomic Status and Cancer Screening in Japanese Males : Large Inequlaity in Middle-Aged and Urban Residents

ObjectivesCancer screening has become common in Japan. However, little is known about the socioeconomic factors affecting cancer screening participation. This study was performed to examine the association between socioeconomic status and cancer screening participation in Japanese males.MethodsUsing the data of 23,394 males sampled from across Japan, the associations between self-reported participation in screenings for three types of cancer (i.e., stomach, lung and colon) and socioeconomic variables, including marital status, types of residential area (metropolitan/nonmetropolitan), household income, and employment status, were examined using multilevel logistic regression by age group (40 to 64 and ≥65 years).ResultsThe cancer screening participation rates were 34.5% (stomach), 21.3% (lung), and 24.8% (colon) for the total population studied. Being married, living in a nonmetropolitan area, having a higher income and being employed in a large-scale company showed independent associations with a higher rate of cancer screening participation for all three types of cancer. Income-related differences in cancer screening were more pronounced in the middle-aged population than in the elderly population, and in metropolitan areas than in nonmetropolitan areas.ConclusionsThere are notable socioeconomic differences in cancer screening participation in Japan. To promote cancer screening, socioeconomic factors should be considered, particularly for middle-aged and urban residents.

Social Course Patterns of Urban Dwellers with Tuberculosis under Fragile Living Conditions in Tokyo, Japan

BACKGROUND People under fragile-living conditions show a high rate of interruption of tuberculosis treatment. We examined the social courses of fragile-living urban dwellers with tuberculosis without customary and regular access to a conventional residence and investigated the factors associated with interruption of treatment. METHODS One hundred and nineteen tuberculosis patients without customary and regular access to a conventional residence who were discharged from a hospital with the largest number of tuberculosis beds in Tokyo between January 1998 and October 2000 were followed up. The associations between demographic, social, and clinical characteristics and interruption of treatment were examined. RESULTS The subjects (mean age, 51.2 years) were followed up for a median of 342 days. The percentage of cases of interruption of treatment during inpatient care among patients with alcohol problems (56%) was significantly higher than that among patients without such problems (11%). The proportion of cases of interruption of treatment during outpatient care among patients who were literally homeless before admission (40%) was significantly higher than that in others (5%), and that among those who used transient hostels after the initial inpatient treatment (55%) was significantly higher than that in others (4%). The prevalence of drug resistance was higher in cases with than without a history of tuberculosis treatment (P<0.05). CONCLUSIONS Factors associated with interruption of tuberculosis treatment in patients under fragile-living conditions were identified. Interruption during inpatient care was significantly associated with alcohol problems, and interruption during outpatient care was significantly associated with the use of transient hostels.

A combination of an extrapolation method and a benchmark method to develop quantitative health targets for Japan

The aim of the present study was to propose a methodology to formulate quantitative health targets which combined an extrapolation method and a benchmark method, and to estimate the targets for mortality rates (Mb) for selected causes of death by the year 2010 in Japan. Using the extrapolation method, based on the nationwide Mt from 1988 to 1997, the Mt in 2010 was predicted using a regression model. Using the benchmark method, the paired-mean of the age-adjusted mortality rates (Mts) of the top five prefectures among 47 prefectures was calculated as the benchmark. Combining the predicted mortality and the benchmark mortality, year 2010 targets were determined. As a results year 2010 targets as percentages compared with Mt in 1997 for cancer at all sites, stomach cancer, lung cancer, colo-rectal cancer, liver cancer and stroke were estimated to be 93, 52, 94, 102, 53 and 52% for males, and 84, 43, 86, 82, 60, and 45%, for females, respectively. The methodology presented in this article could be used as a standard procedure to formulate realistic quantified health targets, which can be adopted to develop health policies in nations, regions and communities.

An Experimental Study on Depigmenting Activity of 4-(p-Hydroxyphenyl)-2-Butanone in C57 Black Mice

An Experimental Study on Depigmenting Activity of 4‐(p‐Hydroxyphenyl)‐2‐Butanone in C57 Black Mice: Depigmenting Activity of HPB in Black Mice: Yoshiharu Fukuda, et al. Department of Public Health, Kumamoto University School of Medicine—The authors previously reported three cases of occupational leukoderma in workers engaged in a 4‐(p‐hydroxyphenyl)‐2‐butanone (HPB, Raspberry Ketone) manufacturing process. These cases suggested that HPB might be a chemical causing the leukoderma and it had depigmenting activity. The purpose of this study is to evaluate the depigmenting activity of HPB by using laboratory animals. HPB, its two crude products and monomethyl ether of hydroquinone as the positive control were topically applied to the dorsal surface of C57 black mice. Depigmentation was shown in black mice to which HPB and its crude products were topically applied but the effect produced by these chemicals was weaker than that seen with monomethyl ether of hydroquinone. Though evidence of a reduction in melanocytes and pigmentation was not documented in the microscopic analysis, spectrophotometric assay showed a decrease in melanin content in the hair of mice to which HPB and the crude product had been applied. The results indicated a depigmenting activity of HPB and supported the conclusion that the leukoderma which we reported in a companion paper was induced by exposure to HPB and/or its crude products. Nevertheless, the potential of this depigmenting activity is so weak that the development of leukoderma due to these chemicals may be limited to those who are occupationally exposed.