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Introduction: Healthy life expectancy (HLE) remains the principal target of various health plans. We aimed to identify the areas of priority and determinants of mortality to extend HLE across local governments in Japan. Methods: HLE according to secondary medical areas was calculated using the Sullivan method. People requiring long-term care of level 2 or higher were considered unhealthy. Standardized mortality ratios (SMRs) for major causes of death were calculated using vital statistics data. The association between HLE and SMR was analyzed using simple and multiple regression analyses. Results: The average (standard deviation) HLE values were 79.24 (0.85) and 83.76 (0.62) years for men and women, respectively. A comparison of HLE revealed regional health gaps of 4.46 (76.90-81.36) and 3.46 (81.99-85.45) years for men and women, respectively. The coefficients of determination for the SMR of malignant neoplasms with HLE were the highest and were 0.402 and 0.219 among men and women, respectively, followed by those of cerebrovascular diseases, suicide, and heart diseases among men and those of heart disease, pneumonia, and liver disease among women. When all major preventable causes of death were analyzed simultaneously in a regression model, the coefficients of determination were 0.738 and 0.425 among men and women, respectively. Conclusions: Our findings suggest that local governments should prioritize preventing cancer deaths via cancer screening and smoking cessation measures in health plans, with a special focus on men.

BACKGROUND: Little research has examined associations between disaster-related home loss and multiple domains of health and well-being, with extended long-term follow-up and comprehensive adjustment for pre-disaster characteristics of survivors. OBJECTIVES: We examined the longitudinal associations between disaster-induced home loss and 34 indicators of health and well-being, assessed similar to 9 y post-disaster. METHODS: We used data from a preexisting cohort study of Japanese older adults in an area directly impacted by the 2011 Japan Earthquake (n = 3,350 and n = 2,028, depending on the outcomes). The study was initiated in 2010, and disaster-related home loss status was measured in 2013 retrospectively. The 34 outcomes were assessed in 2020 and covered dimensions of physical health, mental health, health behaviors/sleep, social well-being, cognitive social capital, subjective well-being, and prosocial/altruistic behaviors. We estimated the associations between disaster-related home loss and the outcomes, using targeted maximum likelihood estimation and SuperLearner. We adjusted for pre-disaster characteristics from the wave conducted 7 months before the disaster (i.e., 2010), including prior outcome values that were available. RESULTS: After Bonferroni correction for multiple testing, we found that home loss (vs. no home loss) was associated with increased posttraumatic stress symptoms (standardized difference = 0.50; 95% CI: 0.35, 0.65), increased daily sleepiness (0.38; 95% CI: 0.21, 0.54), lower trust in the community (-0.36; 95% CI: -0.53, -0.18), lower community attachment (-0.60; 95% CI: -0.75, -0.45), and lower prosociality (-0.39; 95% CI: -0.55, -0.24). We found modest evidence for the associations with increased depressive symptoms, increased hopelessness, more chronic conditions, higher body mass index, lower perceived mutual help in the community, and decreased happiness. There was little evidence for associations with the remaining 23 outcomes. DISC, Funding Agencies|National Institutes of Health; Japan Society for the Promotion of Science [R01 AG042463]; Health Labour Sciences Research Grant from the Japanese Ministry of Health, Labour, and Welfare [KAKENHI 23243070, KAKENHI 22390400, KAKENHI 20H00557, KAKENHI 24390469]; Strategic Research Foundation Grant-Aided Project for Private Universities from the Japanese Ministry of Education, Culture, Sports, Science, and Technology [H24-Choju-Wakate-009]; Japan Agency for Medical Research and Development [S0991035]; Well-being for Planet Earth Foundation [JP17dk0110017, JP18dk0110027, JP18ls0110002, JP18le0110009, JP19dk0110034, JP19dk0110037, JP20dk0110034]; Japan Society for the Promotion of Science Research Fellowship for Young Scientists; Swedish Research Council [KAKENHI 21J01171]; Royal Swedish Academy of Letters, History, and Antiquities, Stockholm, Sweden

BACKGROUND: Little research has examined associations between disaster-related home loss and multiple domains of health and well-being, with extended long-term follow-up and comprehensive adjustment for pre-disaster characteristics of survivors. OBJECTIVES: We examined the longitudinal associations between disaster-induced home loss and 34 indicators of health and well-being, assessed similar to 9 y post-disaster. METHODS: We used data from a preexisting cohort study of Japanese older adults in an area directly impacted by the 2011 Japan Earthquake (n = 3,350 and n = 2,028, depending on the outcomes). The study was initiated in 2010, and disaster-related home loss status was measured in 2013 retrospectively. The 34 outcomes were assessed in 2020 and covered dimensions of physical health, mental health, health behaviors/sleep, social well-being, cognitive social capital, subjective well-being, and prosocial/altruistic behaviors. We estimated the associations between disaster-related home loss and the outcomes, using targeted maximum likelihood estimation and SuperLearner. We adjusted for pre-disaster characteristics from the wave conducted 7 months before the disaster (i.e., 2010), including prior outcome values that were available. RESULTS: After Bonferroni correction for multiple testing, we found that home loss (vs. no home loss) was associated with increased posttraumatic stress symptoms (standardized difference = 0.50; 95% CI: 0.35, 0.65), increased daily sleepiness (0.38; 95% CI: 0.21, 0.54), lower trust in the community (-0.36; 95% CI: -0.53, -0.18), lower community attachment (-0.60; 95% CI: -0.75, -0.45), and lower prosociality (-0.39; 95% CI: -0.55, -0.24). We found modest evidence for the associations with increased depressive symptoms, increased hopelessness, more chronic conditions, higher body mass index, lower perceived mutual help in the community, and decreased happiness. There was little evidence for associations with the remaining 23 outcomes. DISC, Funding Agencies|National Institutes of Health; Japan Society for the Promotion of Science [R01 AG042463]; Health Labour Sciences Research Grant from the Japanese Ministry of Health, Labour, and Welfare [KAKENHI 23243070, KAKENHI 22390400, KAKENHI 20H00557, KAKENHI 24390469]; Strategic Research Foundation Grant-Aided Project for Private Universities from the Japanese Ministry of Education, Culture, Sports, Science, and Technology [H24-Choju-Wakate-009]; Japan Agency for Medical Research and Development [S0991035]; Well-being for Planet Earth Foundation [JP17dk0110017, JP18dk0110027, JP18ls0110002, JP18le0110009, JP19dk0110034, JP19dk0110037, JP20dk0110034]; Japan Society for the Promotion of Science Research Fellowship for Young Scientists; Swedish Research Council [KAKENHI 21J01171]; Royal Swedish Academy of Letters, History, and Antiquities, Stockholm, Sweden

BACKGROUND: Little research has examined associations between disaster-related home loss and multiple domains of health and well-being, with extended long-term follow-up and comprehensive adjustment for pre-disaster characteristics of survivors. OBJECTIVES: We examined the longitudinal associations between disaster-induced home loss and 34 indicators of health and well-being, assessed similar to 9 y post-disaster. METHODS: We used data from a preexisting cohort study of Japanese older adults in an area directly impacted by the 2011 Japan Earthquake (n = 3,350 and n = 2,028, depending on the outcomes). The study was initiated in 2010, and disaster-related home loss status was measured in 2013 retrospectively. The 34 outcomes were assessed in 2020 and covered dimensions of physical health, mental health, health behaviors/sleep, social well-being, cognitive social capital, subjective well-being, and prosocial/altruistic behaviors. We estimated the associations between disaster-related home loss and the outcomes, using targeted maximum likelihood estimation and SuperLearner. We adjusted for pre-disaster characteristics from the wave conducted 7 months before the disaster (i.e., 2010), including prior outcome values that were available. RESULTS: After Bonferroni correction for multiple testing, we found that home loss (vs. no home loss) was associated with increased posttraumatic stress symptoms (standardized difference = 0.50; 95% CI: 0.35, 0.65), increased daily sleepiness (0.38; 95% CI: 0.21, 0.54), lower trust in the community (-0.36; 95% CI: -0.53, -0.18), lower community attachment (-0.60; 95% CI: -0.75, -0.45), and lower prosociality (-0.39; 95% CI: -0.55, -0.24). We found modest evidence for the associations with increased depressive symptoms, increased hopelessness, more chronic conditions, higher body mass index, lower perceived mutual help in the community, and decreased happiness. There was little evidence for associations with the remaining 23 outcomes. DISC, Funding Agencies|National Institutes of Health; Japan Society for the Promotion of Science [R01 AG042463]; Health Labour Sciences Research Grant from the Japanese Ministry of Health, Labour, and Welfare [KAKENHI 23243070, KAKENHI 22390400, KAKENHI 20H00557, KAKENHI 24390469]; Strategic Research Foundation Grant-Aided Project for Private Universities from the Japanese Ministry of Education, Culture, Sports, Science, and Technology [H24-Choju-Wakate-009]; Japan Agency for Medical Research and Development [S0991035]; Well-being for Planet Earth Foundation [JP17dk0110017, JP18dk0110027, JP18ls0110002, JP18le0110009, JP19dk0110034, JP19dk0110037, JP20dk0110034]; Japan Society for the Promotion of Science Research Fellowship for Young Scientists; Swedish Research Council [KAKENHI 21J01171]; Royal Swedish Academy of Letters, History, and Antiquities, Stockholm, Sweden

BACKGROUND: Little research has examined associations between disaster-related home loss and multiple domains of health and well-being, with extended long-term follow-up and comprehensive adjustment for pre-disaster characteristics of survivors. OBJECTIVES: We examined the longitudinal associations between disaster-induced home loss and 34 indicators of health and well-being, assessed similar to 9 y post-disaster. METHODS: We used data from a preexisting cohort study of Japanese older adults in an area directly impacted by the 2011 Japan Earthquake (n = 3,350 and n = 2,028, depending on the outcomes). The study was initiated in 2010, and disaster-related home loss status was measured in 2013 retrospectively. The 34 outcomes were assessed in 2020 and covered dimensions of physical health, mental health, health behaviors/sleep, social well-being, cognitive social capital, subjective well-being, and prosocial/altruistic behaviors. We estimated the associations between disaster-related home loss and the outcomes, using targeted maximum likelihood estimation and SuperLearner. We adjusted for pre-disaster characteristics from the wave conducted 7 months before the disaster (i.e., 2010), including prior outcome values that were available. RESULTS: After Bonferroni correction for multiple testing, we found that home loss (vs. no home loss) was associated with increased posttraumatic stress symptoms (standardized difference = 0.50; 95% CI: 0.35, 0.65), increased daily sleepiness (0.38; 95% CI: 0.21, 0.54), lower trust in the community (-0.36; 95% CI: -0.53, -0.18), lower community attachment (-0.60; 95% CI: -0.75, -0.45), and lower prosociality (-0.39; 95% CI: -0.55, -0.24). We found modest evidence for the associations with increased depressive symptoms, increased hopelessness, more chronic conditions, higher body mass index, lower perceived mutual help in the community, and decreased happiness. There was little evidence for associations with the remaining 23 outcomes. DISC, Funding Agencies|National Institutes of Health; Japan Society for the Promotion of Science [R01 AG042463]; Health Labour Sciences Research Grant from the Japanese Ministry of Health, Labour, and Welfare [KAKENHI 23243070, KAKENHI 22390400, KAKENHI 20H00557, KAKENHI 24390469]; Strategic Research Foundation Grant-Aided Project for Private Universities from the Japanese Ministry of Education, Culture, Sports, Science, and Technology [H24-Choju-Wakate-009]; Japan Agency for Medical Research and Development [S0991035]; Well-being for Planet Earth Foundation [JP17dk0110017, JP18dk0110027, JP18ls0110002, JP18le0110009, JP19dk0110034, JP19dk0110037, JP20dk0110034]; Japan Society for the Promotion of Science Research Fellowship for Young Scientists; Swedish Research Council [KAKENHI 21J01171]; Royal Swedish Academy of Letters, History, and Antiquities, Stockholm, Sweden

BACKGROUND: Little research has examined associations between disaster-related home loss and multiple domains of health and well-being, with extended long-term follow-up and comprehensive adjustment for pre-disaster characteristics of survivors. OBJECTIVES: We examined the longitudinal associations between disaster-induced home loss and 34 indicators of health and well-being, assessed similar to 9 y post-disaster. METHODS: We used data from a preexisting cohort study of Japanese older adults in an area directly impacted by the 2011 Japan Earthquake (n = 3,350 and n = 2,028, depending on the outcomes). The study was initiated in 2010, and disaster-related home loss status was measured in 2013 retrospectively. The 34 outcomes were assessed in 2020 and covered dimensions of physical health, mental health, health behaviors/sleep, social well-being, cognitive social capital, subjective well-being, and prosocial/altruistic behaviors. We estimated the associations between disaster-related home loss and the outcomes, using targeted maximum likelihood estimation and SuperLearner. We adjusted for pre-disaster characteristics from the wave conducted 7 months before the disaster (i.e., 2010), including prior outcome values that were available. RESULTS: After Bonferroni correction for multiple testing, we found that home loss (vs. no home loss) was associated with increased posttraumatic stress symptoms (standardized difference = 0.50; 95% CI: 0.35, 0.65), increased daily sleepiness (0.38; 95% CI: 0.21, 0.54), lower trust in the community (-0.36; 95% CI: -0.53, -0.18), lower community attachment (-0.60; 95% CI: -0.75, -0.45), and lower prosociality (-0.39; 95% CI: -0.55, -0.24). We found modest evidence for the associations with increased depressive symptoms, increased hopelessness, more chronic conditions, higher body mass index, lower perceived mutual help in the community, and decreased happiness. There was little evidence for associations with the remaining 23 outcomes. DISC, Funding Agencies|National Institutes of Health; Japan Society for the Promotion of Science [R01 AG042463]; Health Labour Sciences Research Grant from the Japanese Ministry of Health, Labour, and Welfare [KAKENHI 23243070, KAKENHI 22390400, KAKENHI 20H00557, KAKENHI 24390469]; Strategic Research Foundation Grant-Aided Project for Private Universities from the Japanese Ministry of Education, Culture, Sports, Science, and Technology [H24-Choju-Wakate-009]; Japan Agency for Medical Research and Development [S0991035]; Well-being for Planet Earth Foundation [JP17dk0110017, JP18dk0110027, JP18ls0110002, JP18le0110009, JP19dk0110034, JP19dk0110037, JP20dk0110034]; Japan Society for the Promotion of Science Research Fellowship for Young Scientists; Swedish Research Council [KAKENHI 21J01171]; Royal Swedish Academy of Letters, History, and Antiquities, Stockholm, Sweden

© 2020 Elsevier Ltd The underlying mechanism for deterioration in cardiometabolic health after major natural disasters is unknown. We leveraged natural experiment data stemming from the 2011 Great East Japan Earthquake and Tsunami (n = 1165) to examine whether specific types of post-disaster accommodations explain the association between disaster-related property damage and objectively measured cardiometabolic profiles of older disaster survivors. Causal mediation analysis showed that relocation to trailer-style temporary shelters largely mediated the associations between home loss and unhealthy changes in anthropometric measures (72.6% of 0.65 kg/m2 for body mass index and 62.3% of 3.89 cm for waist circumference), but it did not mediate the associations with serum lipid measures. This study demonstrates that there are outcome-specific pathways linking disaster damage and health of survivors.

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. Background: The association between neighborhood environment and health may be biased due to confounding by residential self-selection. The displacement of disaster victims can act as a natural experiment that exposes residents to neighborhood environments they did not select, allowing for the study of neighborhood effects on health. Methods: We leveraged data from a cohort of older adults 65 years of age or older living in Iwanuma, Japan, located 80 km west of the 2011 Great East Japan Earthquake and Tsunami. Surveys were conducted 7 months before the disaster, as well as 2.5 and 5.5 years afterward, and linked with medical records. We classified each individual’s type of exposure to neighborhood environment based on proximity to local food and recreation destinations and walkability. Results: Fixed-effect models indicated that change in the exposure type from low to high urban density was associated with increased body mass index (0.46kg/m2; 95% confidence interval [CI] = 0.20, 0.73), waist circumference (1.8cm; 95% CI = 0.56, 3.0), low-density lipoprotein cholesterol (11mg/dl; 95% CI = 5.0, 17), and decreased high-densitylipoproteincholesterol(−3.1mg/dl;95%CI=−5.0,−1.3). We observed similar trends when we analyzed only the individuals who experienced postdisaster relocation to temporary homes. Conclusions: Increased proximity to food outlets was simultaneously correlated with greater walkability and accessibility to recreational destinations; however, any protective association of physical activity-promoting built environment appeared to be offset by proximity to unhealthy food outlets, especially fast-food restaurants and bars.

Cognitive disability following traumatic experiences of disaster has been documented; however, little is known about heterogeneity in the association across individuals. In this natural experiment study of approximately 3000 Japanese older adults in an area directly affected by the 2011 Great East Japan Earthquake, the baseline survey was established 7 months before the 2011 earthquake. To inductively identify heterogeneity in post-disaster cognitive disability by predisaster characteristics, we applied a machine learning-based causal inference approach-generalized random forest. We identified strong evidence for heterogeneity in the association between home loss and cognitive disability objectively assessed 2.5 and 5.5 years after the 2011 earthquake. The subgroups with the strongest disaster-dementia associations tended to be from low socioeconomic backgrounds and have predisaster health problems. The study demonstrated that some subpopulations are particularly prone to experience cognitive disability after disasters, which could be overlooked in studies assessing population average associations only., Funding Agencies|National Institutes of HealthUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [R01 AG042463]; Japan Society for the Promotion of ScienceMinistry of Education, Culture, Sports, Science and Technology, Japan (MEXT)Japan Society for the Promotion of Science [KAKENHI 23243070, KAKENHI 22390400, KAKENHI 20H00557, KAKENHI 24390469]; Japanese Ministry of Health, Labour, and WelfareMinistry of Health, Labour and Welfare, Japan [H24-Choju-Wakate-009]; Strategic Research Foundation Grant-Aided Project for Private Universities from the Japanese Ministry of Education, Culture, Sports, Science, and Technology [S0991035]; Japan Agency for Medical Research and Development (AMED)Japan Agency for Medical Research and Development (AMED) [JP17dk0110017, JP18dk0110027, JP18ls0110002, JP18le0110009, JP19dk0110034, JP19dk0110037, JP20dk0110034]

Cognitive disability following traumatic experiences of disaster has been documented; however, little is known about heterogeneity in the association across individuals. In this natural experiment study of approximately 3000 Japanese older adults in an area directly affected by the 2011 Great East Japan Earthquake, the baseline survey was established 7 months before the 2011 earthquake. To inductively identify heterogeneity in post-disaster cognitive disability by predisaster characteristics, we applied a machine learning-based causal inference approach-generalized random forest. We identified strong evidence for heterogeneity in the association between home loss and cognitive disability objectively assessed 2.5 and 5.5 years after the 2011 earthquake. The subgroups with the strongest disaster-dementia associations tended to be from low socioeconomic backgrounds and have predisaster health problems. The study demonstrated that some subpopulations are particularly prone to experience cognitive disability after disasters, which could be overlooked in studies assessing population average associations only., Funding Agencies|National Institutes of HealthUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [R01 AG042463]; Japan Society for the Promotion of ScienceMinistry of Education, Culture, Sports, Science and Technology, Japan (MEXT)Japan Society for the Promotion of Science [KAKENHI 23243070, KAKENHI 22390400, KAKENHI 20H00557, KAKENHI 24390469]; Japanese Ministry of Health, Labour, and WelfareMinistry of Health, Labour and Welfare, Japan [H24-Choju-Wakate-009]; Strategic Research Foundation Grant-Aided Project for Private Universities from the Japanese Ministry of Education, Culture, Sports, Science, and Technology [S0991035]; Japan Agency for Medical Research and Development (AMED)Japan Agency for Medical Research and Development (AMED) [JP17dk0110017, JP18dk0110027, JP18ls0110002, JP18le0110009, JP19dk0110034, JP19dk0110037, JP20dk0110034]

Cognitive disability following traumatic experiences of disaster has been documented; however, little is known about heterogeneity in the association across individuals. In this natural experiment study of approximately 3000 Japanese older adults in an area directly affected by the 2011 Great East Japan Earthquake, the baseline survey was established 7 months before the 2011 earthquake. To inductively identify heterogeneity in post-disaster cognitive disability by predisaster characteristics, we applied a machine learning-based causal inference approach-generalized random forest. We identified strong evidence for heterogeneity in the association between home loss and cognitive disability objectively assessed 2.5 and 5.5 years after the 2011 earthquake. The subgroups with the strongest disaster-dementia associations tended to be from low socioeconomic backgrounds and have predisaster health problems. The study demonstrated that some subpopulations are particularly prone to experience cognitive disability after disasters, which could be overlooked in studies assessing population average associations only., Funding Agencies|National Institutes of HealthUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [R01 AG042463]; Japan Society for the Promotion of ScienceMinistry of Education, Culture, Sports, Science and Technology, Japan (MEXT)Japan Society for the Promotion of Science [KAKENHI 23243070, KAKENHI 22390400, KAKENHI 20H00557, KAKENHI 24390469]; Japanese Ministry of Health, Labour, and WelfareMinistry of Health, Labour and Welfare, Japan [H24-Choju-Wakate-009]; Strategic Research Foundation Grant-Aided Project for Private Universities from the Japanese Ministry of Education, Culture, Sports, Science, and Technology [S0991035]; Japan Agency for Medical Research and Development (AMED)Japan Agency for Medical Research and Development (AMED) [JP17dk0110017, JP18dk0110027, JP18ls0110002, JP18le0110009, JP19dk0110034, JP19dk0110037, JP20dk0110034]

Cognitive disability following traumatic experiences of disaster has been documented; however, little is known about heterogeneity in the association across individuals. In this natural experiment study of approximately 3000 Japanese older adults in an area directly affected by the 2011 Great East Japan Earthquake, the baseline survey was established 7 months before the 2011 earthquake. To inductively identify heterogeneity in post-disaster cognitive disability by predisaster characteristics, we applied a machine learning-based causal inference approach-generalized random forest. We identified strong evidence for heterogeneity in the association between home loss and cognitive disability objectively assessed 2.5 and 5.5 years after the 2011 earthquake. The subgroups with the strongest disaster-dementia associations tended to be from low socioeconomic backgrounds and have predisaster health problems. The study demonstrated that some subpopulations are particularly prone to experience cognitive disability after disasters, which could be overlooked in studies assessing population average associations only., Funding Agencies|National Institutes of HealthUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [R01 AG042463]; Japan Society for the Promotion of ScienceMinistry of Education, Culture, Sports, Science and Technology, Japan (MEXT)Japan Society for the Promotion of Science [KAKENHI 23243070, KAKENHI 22390400, KAKENHI 20H00557, KAKENHI 24390469]; Japanese Ministry of Health, Labour, and WelfareMinistry of Health, Labour and Welfare, Japan [H24-Choju-Wakate-009]; Strategic Research Foundation Grant-Aided Project for Private Universities from the Japanese Ministry of Education, Culture, Sports, Science, and Technology [S0991035]; Japan Agency for Medical Research and Development (AMED)Japan Agency for Medical Research and Development (AMED) [JP17dk0110017, JP18dk0110027, JP18ls0110002, JP18le0110009, JP19dk0110034, JP19dk0110037, JP20dk0110034]

Cognitive disability following traumatic experiences of disaster has been documented; however, little is known about heterogeneity in the association across individuals. In this natural experiment study of approximately 3000 Japanese older adults in an area directly affected by the 2011 Great East Japan Earthquake, the baseline survey was established 7 months before the 2011 earthquake. To inductively identify heterogeneity in post-disaster cognitive disability by predisaster characteristics, we applied a machine learning-based causal inference approach-generalized random forest. We identified strong evidence for heterogeneity in the association between home loss and cognitive disability objectively assessed 2.5 and 5.5 years after the 2011 earthquake. The subgroups with the strongest disaster-dementia associations tended to be from low socioeconomic backgrounds and have predisaster health problems. The study demonstrated that some subpopulations are particularly prone to experience cognitive disability after disasters, which could be overlooked in studies assessing population average associations only., Funding Agencies|National Institutes of HealthUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [R01 AG042463]; Japan Society for the Promotion of ScienceMinistry of Education, Culture, Sports, Science and Technology, Japan (MEXT)Japan Society for the Promotion of Science [KAKENHI 23243070, KAKENHI 22390400, KAKENHI 20H00557, KAKENHI 24390469]; Japanese Ministry of Health, Labour, and WelfareMinistry of Health, Labour and Welfare, Japan [H24-Choju-Wakate-009]; Strategic Research Foundation Grant-Aided Project for Private Universities from the Japanese Ministry of Education, Culture, Sports, Science, and Technology [S0991035]; Japan Agency for Medical Research and Development (AMED)Japan Agency for Medical Research and Development (AMED) [JP17dk0110017, JP18dk0110027, JP18ls0110002, JP18le0110009, JP19dk0110034, JP19dk0110037, JP20dk0110034]

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Background: Although many previous studies have examined the determinants of happiness in older adults, few have investigated the association between pension types and happiness. When compared to other conventional socioeconomic indicators, pension types may be more indicative of long-term socioeconomic status as they can reflect a person’s job history over their life course. This study examined the association between pension types and happiness in Japanese older people. Methods: Cross-sectional survey data from the Japan Gerontological Evaluation Study were used to analyze the association between pension types and happiness. The study population comprised 120152 participants from 2013. We calculated the prevalence ratios of happiness for the different pension types using Poisson regression models that controlled for age, sex, marital status, equivalent income, wealth, education level, working status, occupation, depression, and social support. Results: After controlling for socioeconomic indicators, the prevalence ratios (95% confidence intervals) of happiness for no pension benefits, low pension benefits, and moderate pension benefits relative to high pension benefits were 0.77 (0.73–0.81), 0.95 (0.94–0.97), and 0.98 (0.97–0.99), respectively. However, the inclusion of depression as a covariate weakened the association between pension types and happiness. Conclusions: While pension types were associated with happiness after adjusting for other proxy measures of socioeconomic status, the association diminished following adjustment for depression. Pension types may provide rich information on socioeconomic status and depression throughout the course of life. In addition to conventional socioeconomic indicators, pension types should also be considered when assessing the determinants of happiness in older adults.

Background: We examined the relationship between incident functional disability and social participation from the perspective of number of types of organizations participated in and type of social participation in a prospective cohort study. Method: The study was based on the Aichi Gerontological Evaluation Study (AGES) Cohort Study data. We followed 13,310 individuals aged 65 years or older for 4 years. Analysis was carried out on 12,951 subjects, excluding 359 people whose information on age or sex was missing. Social participation was categorized into 8 types. Results: Compared to those that did not participate in any organizations, the hazard ratio (HR) was 0.83 (95% CI: 0.73–0.95) for participation in one, 0.72 (0.61–0.85) for participation in two, and 0.57 (0.46–0.70) for participation in three or more different types of organizations. In multivariable adjusted models, participation in the following types of organization was protective for incident disability: local community organizations (HR = 0.85, 95% CI: 0.76–0.96), hobby organizations (HR = 0.75, 95% CI: 0.64–0.87), and sports organizations (HR = 0.64, 95% CI: 0.54–0.81). Conclusion: Social participation may decrease the risk of incident functional disability in older people in Japan. This effect may be strengthened by participation in a variety of different types of organizations. Participating in a local community, hobby, or sports group or organization may be especially effective for decreasing the risk of disability.

Objective To examine if self-reported number of teeth, denture use and chewing ability are associated with incident falls. Design Longitudinal cohort study (the Aichi Gerontological Evaluation Study). Setting 5 Japanese municipalities. Participants 1763 community-dwelling individuals aged 65 years and older without experience of falls within the previous year at baseline. Main outcome measures Self-reported history of multiple falls during the past year at the follow-up survey about 3 years later. Baseline data on the number of teeth present and/or denture use and chewing ability were collected using self-administered questionnaires. Logistic regression analyses controlled for sex, age, functional disability during follow-up period, depression, self-rated health and educational attainment. Results 86 (4.9%) subjects reported falls at the follow-up survey. Logistic regression models fully adjusted for all covariates showed that subjects having 19 or fewer teeth but not using dentures had a significantly increased risk for incident falls (OR 2.50, 95% CI 1.21 to 5.17, p=0.013) compared with those having 20 or more teeth. Among subjects with 19 or fewer teeth, their risk of falls was not significantly elevated so long as they wore dentures (OR 1.36, 95% CI 0.76 to 2.45, p=0.299). No significant association was observed between chewing ability and incident falls in the fully adjusted model. Conclusions Having 19 or fewer teeth but not using dentures was associated with higher risk for the incident falls in older Japanese even after adjustment for multiple covariates. Dental care to prevent tooth loss and denture treatment for older people might prevent falls, although the authors cannot exclude the possibility that the association is due to residual confounding.