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BackgroundJapan 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.MethodsWe 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.FindingsLife 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.InterpretationJapan 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.FundingBill & 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.

Objectives: Gender norms embedded in communities may restrict opportunities and harm the mental health of older adults, yet this phenomenon has received little attention. This study investigates the connection between older adults' perceptions of community gender norms and mental health and suicide-related outcomes. Design: Cross-sectional. Setting: This study analyzed data from the 2019 wave of the Japan Gerontological Evaluation Study. Participants: In total, 25,937 participants aged 65 years or older in 61 municipalities. Measurements: Perceptions of community gender norms were assessed by the respondents' perceptions of the gender-differentiating language used by those around them such as "You should/should not do XXX, because you are a man/woman." Results: The prevalence of all mental health outcomes was higher among both men and women who perceived community gender norms as restrictive. These associations remained in fully adjusted multivariable analyses. Prevalence ratios for men were 1.36 [95% confidence interval: 1.13, 1.65] for psychological resistance to obtaining help, 1.85 [1.54, 2.23] for depressive symptoms, 1.99 [1.34, 2.96] for suicidal ideation, and 2.15 [1.21, 3.80] for suicide attempts. The corresponding figures for women were 1.39 [1.17, 1.65], 1.80 [1.55, 2.10], 2.13 [1.65, 2.74], 2.62 [1.78, 3.87]. There was a more pronounced association between perceiving community gender norms as restrictive and depressive symptoms and suicidal behaviors among those with nonconventional gender role attitudes compared to those with conventional attitudes. Conclusions: Considering the effects of community gender norms, in addition to individual gender role attitudes, may be critical in designing effective public health interventions for improving mental health. [ABSTRACT FROM AUTHOR]

Objectives: Exemption from paying dental care costs among recipients of public assistance contributes to universal health care coverage. Although this system might reduce the financial barriers to dental care among patients, there are still several other barriers for public assistance recipients. Therefore, this study examined whether receiving public assistance was associated with a higher prevalence of dental visits for any reason, treatment and prevention. Methods: Data were obtained from 16 366 respondents from the 2019 wave of a nationwide cohort study on older adults in Japan. Poisson regression analyses with robust error variance were used to examine the associations between receiving public assistance and dental visits, adjusting for number of teeth, dental pain, periodontal conditions, age, sex, number of family members, education, equivalent household income, working status, instrumental activities of daily living, medical conditions, depressive symptoms, instrumental support and geographical variations. Results: More than half of the non‐recipients of public assistance visited a dentist for some reason in the past 6 months. Meanwhile, only 37% of the recipients visited a dentist. In addition, almost half of the non‐recipients had treatment visits, while only 34% of the recipients visited. Furthermore, 46% of the non‐recipients had dental visits for prevention, while 32% of the recipients had preventive visits. In the fully adjusted models, compared to non‐recipients, public assistance recipients were 24% (Prevalence Ratio [PR]: 0.76, 95% Confidence Intervals [CI]: 0.64, 0.90), 23% (PR: 0.77, 95% CI: 0.65, 0.92) and 21% (PR: 0.79, 95% CI: 0.65, 0.95) less likely to have dental visits for any reason, treatment, and prevention, respectively. Conclusions: Although recipients were exempted from dental treatment fees, receiving public assistance was associated with a lower prevalence of dental visits for any reason, treatment and prevention. Future studies should identify the barriers to accessing dental care among public assistance recipients to improve dental visits. [ABSTRACT FROM AUTHOR]

Background this study aimed to identify distinct subgroups of trajectories of disability over time before 3 years of death and examine the factors associated with trajectory group membership probabilities among community-dwelling Japanese older adults aged 65 years and above. Methods participants included 4,875 decedents from among community-dwelling Japanese older adults, aged ≥ 65 years at baseline (men: 3,020; women: 1,855). The certified long-term care levels of the national long-term care insurance (LTCI) system were used as an index of functional disability. We combined data from the 2010 Japan Gerontological Evaluation Study and data from the 2010 to 2016 LTCI system. Group-based mixture models and multinominal logistic regression models were used for data analysis. Results five distinct trajectories of functional disability in the last 3 years of life were identified: 'persistently severe disability' (10.3%), 'persistently mild disability' (13.0%), 'accelerated disability' (12.6%), 'catastrophic disability' (18.8%) and 'minimum disability' (45.2%). Multinominal logistic regression analysis found several factors associated with trajectory membership; self-rated health was a common predictor regardless of age and gender. The analysis also showed a paradoxical association; higher education was associated with trajectory group membership probabilities of more severe functional decline in men over 85 years at death. Conclusions individual perception of health was a strong predictor of trajectories, independent of demographic factors and socio-economic status. Our findings contribute to the development of policies for the long-term care system, particularly for end-of-life care, in Asian countries. [ABSTRACT FROM AUTHOR]

Aim: There is a large discrepancy between people's preferred and actual place of death in Japan. To manage this discrepancy, this study aimed to identify the variability in preferred places of death and their associated factors among Japanese older people. Methods: Cross‐sectional survey data were collected in 2016 as part of the Japan Gerontological Evaluation Study, in which 20 204 participants were asked about their preferred place of death. Logistic regression analyses were conducted to examine the final determinants for home as the preferred place of death. Results: Based on survey data, 35.8% of respondents preferred home as the place of death, 42.7% preferred some sort of facility and 21.5% were unsure. Those who preferred to be at home when receiving end‐of‐life care were more likely to be older in age, live with others, be employed, be homeowners, have lived in their current residence for a longer period, not be vaccinated for influenza in the past year, engage in physical work or intense sports, not have participated in end‐of‐life discussions regarding preferred place of death, have experienced relatives dying at home, practice norms of reciprocity, have a sense of attachment to their neighborhood, receive instrumental social support, interact with neighbors and live in a rural area. Conclusions: Factors related to community attachment were associated with choosing home as the preferred place of death. To fulfill the preferences of Japanese older people, a broad range of demographic, health, behavioral, social, cultural and environmental factors should be considered. Geriatr Gerontol Int 2021; 21: 345–352. [ABSTRACT FROM AUTHOR]

Aim: Weight and height are usually self‐reported in population‐based epidemiological surveys. While the accuracy of self‐reports has been extensively studied in younger populations, less is known in older populations. We investigated the accuracy of self‐reported weight, height and body mass (BMI) in an older cohort in Japan, where overweight/obesity and underweight coexist. Methods: We used data from older Japanese adults (≥65 years) participating in the Japan Gerontological Evaluation Study in 2016 to 2017 (7357 men and 9271 women). Self‐report data were linked to objective data obtained from clinical examinations. Results: The mean ± standard deviation (SD) age was 74.5 ± 5.8 years, mean ± SD weight, height and BMI were 55.7 ± 10.1 kg, 156.0 ± 8.9 cm and 22.8 ± 3.1, respectively. Results showed high intraclass correlation coefficients for self‐reported and measured values (0.97 for weight; 0.96 for height). While weight/height were overestimated among men (weight by 0.096 kg; height by 0.27 cm) and women (weight by 0.18 kg; height by 0.27 cm), BMI tended to be slightly underestimated (−0.034 kg/m2 for men; −0.037 kg/m2 for women). However, the absolute differences between self‐reported and measured values were not negligible; people had a higher risk for both under‐ and overestimation of their BMI category with increasing age. Lower education predicted BMI overestimation, whereas lower income predicted BMI underestimation. Conclusions: Overall accuracy of self‐reported body habitus was higher in this cohort of older Japanese compared with previous reports. Nevertheless, misclassification of BMI due to the misreporting of their weight/height was more common among the oldest‐old, as well as those with lower education and income. Geriatr Gerontol Int 2020; 20: 803–810. [ABSTRACT FROM AUTHOR]

Aim: To examine whether patterns of social participation vary in their associations with functional disability. Methods: Data from 44 978 participants (22 750 men and 22 228 women) who participated in the 2010 Japan Gerontological Evaluation Study were analyzed; a study of those aged ≥65 years from 23 municipalities in eight prefectures. Social participation information was obtained at baseline with an eight‐item questionnaire. Incidence of functional disability from 2010 to 2013 was defined as a new certification of eligibility for municipal public long‐term care insurance. Social participation patterns were analyzed using exploratory factor analysis and participants were classified into quartiles of factor scores of social participation patterns. A competing risk model was used to calculate the hazard ratios and 95% confidence intervals for the incidence of functional disability in 3 years of follow‐up. Results: Two social patterns were identified: sports groups/clubs and hobby groups, and political groups/organizations and industry/trade associations. For both patterns, compared with participants in the lowest quartile, participants in the highest quartile were more likely to be male, college educated, high‐income and current drinkers. Both patterns were associated with reduced incidence of functional disability (adjusted hazard ratios for top quartile of sports and hobby pattern: 0.66, 95% confidence interval: 0.59, 0.74; for political and industry/trade pattern: 0.81, 95% confidence interval: 0.72, 0.90; P for trend <0.001 for both). Conclusions: Those whose social participation patterns were characterized by frequent participation in sports groups/clubs and hobby groups or political groups/organizations and industry/trade associations were less likely to develop a functional disability. Geriatr Gerontol Int 2020; 20: 765–772. [ABSTRACT FROM AUTHOR]

Despite policy efforts to increase adolescent happiness, their impact has been unsatisfactory. Their limited impact may be rooted from a discrepancy between values that adolescents pursued and those that the policies were based on. To provide policy implications, our study aims to identify prevailing values for South Korean, Japanese, and Chinese adolescents and to examine the relationship between the values and self-rated happiness (SRH). A cross-sectional study was conducted using survey data collected on approximately 2000 middle and high school students (7th to 12th school grade) from each country in 2008. Firstly, an explanatory factor analysis was conducted to identify salient adolescent values from each country. Subsequently, a multiple logistic regression analysis was conducted for each population group to examine the relationship between the identified values and adolescent SRH after controlling for sociodemographic characteristics. We found that benevolence and altruism were positively associated with adolescent SRH in all three population groups. Patriarchy was associated with SRH positively in Chinese yet inversely in Japanese. Success pursuit was inversely associated with SRH in Korean. Policy efforts based on values of communities or social harmony may benefit adolescents' SRH in these three countries. [ABSTRACT FROM AUTHOR]

Although studies have suggested that community social capital contributes to narrow income-based inequality in depression, the impacts may depend on its components. Our multilevel cross-sectional analysis of data from 42,208 men and 45,448 women aged 65 years or older living in 565 school districts in Japan found that higher community-level civic participation (i.e., average levels of group participation in the community) was positively associated with the prevalence of depressive symptoms among the low-income groups, independent of individual levels of group participation. Two other social capital components (cohesion and reciprocity) did not significantly alter the association between income and depressive symptoms. [ABSTRACT FROM AUTHOR]

We investigated cross-sectional associations between social support and access to health care among older Japanese people. From larger cohort datasets of community-dwelling people aged 65 years or older, 23 079 respondents were extracted. We summarized patterns of social support by gender and age group, then analyzed associations between social support and the experience of unmet health care needs, as a negative indicator of access. Adjusting for socioeconomic factors, multiple logistic regression identified that respondents who received instrumental support were less likely to experience unmet health care needs except males aged 65 to 69 years. The effect of receiving instrumental social support was larger than for household income and similar to anxiety about unexpected expenses. In the low-income group, these findings were highlighted among females aged 65 to 69 years and males aged 70 years and older. In addition to redistribution of financial resources, facilitating suitable social support may contribute to alleviating the access gap among older people. [ABSTRACT FROM AUTHOR]

Aim: Long-term care systems may alleviate caregiver burdens, particularly for those with fewer resources. However, it remains unclear whether socioeconomic disparity in caregiver burdens exists under a public, universal long-term care insurance (LTCI) system. This study examined income-based inequalities in caregiving time and depressive symptoms in Japanese older family caregivers. We further compared inequality in depressive symptoms with that of non-caregivers to evaluate whether family caregiving exacerbates this disparity. Methods: Data were obtained from a cross-sectional, nationwide survey conducted by the Japan Gerontological Evaluation Study in 2013. Participants were functionally independent older adults aged ≥65 years (N = 21,584). Depressive symptoms were assessed using the Geriatrics Depression Scale (GDS); caregiving hours per week, household income, and other covariates were also assessed. Results: Family caregivers occupied 8.3% of the total. A Poisson regression model revealed that caregivers in lower income groups (compared to those in the highest) were 1.32 to 1.95 and 1.63 to 2.68 times more likely to engage in ≥36 and ≥72 hours/week of caregiving, respectively. As for the GDS (≥5), an excess risk was found in the caregivers in lower (compared to higher) income groups (adjusted prevalence ratio: 1.57–3.10). However, an interaction effect of income by caregiving role indicated no significant difference in inequality between caregivers and non-caregivers (p = .603). The excess risk for GDS (≥5) in the caregivers compared to non-caregivers was observed across income groups. Conclusions: Our findings revealed a possible disparity in family caregivers under the public LTCI system. Further studies should examine factors associated with longer caregiving hours in lower income households. Our findings also suggest the necessity for more efforts to alleviate depressive symptoms in family caregivers under the LTCI system regardless of income level, rather than exclusively supporting those with a low income. [ABSTRACT FROM AUTHOR]

Background: Empirical evidence investigating heterogeneous impact of retirement on mental health depending on social backgrounds is lacking, especially among older adults.Methods: We examined the impact of changes in working status on changes in mental health using Japanese community-dwelling adults aged ≥65 years participating in the Japan Gerontological Evaluation Study between 2010 and 2013 (N = 62,438). Between-waves changes in working status ("Kept working", "Retired", "Started work", or "Continuously retired") were used to predict changes in depressive symptoms measured by the Geriatric Depression Scale. First-difference regression models were stratified by gender, controlling for changes in time-varying confounding actors including equivalised household income, marital status, instrumental activities of daily living, incidence of serious illnesses and family caregiving. We then examined the interactions between changes in working status and occupational class, changes in marital status, and post-retirement social participation.Results: Participants who transitioned to retirement reported significantly increased depressive symptoms (β = 0.33, 95% CI: 0.21-0.45 for men, and β = 0.29, 95% CI: 0.13-0.45 for women) compared to those who kept working. Men who were continuously retired reported increased depressive symptoms (β = 0.13, 95% CI: 0.05-0.20), whereas males who started work reported decreased depressive symptoms (β = -0.20, 95% CI: -0.38--0.02). Men from lower occupational class (compared to men from higher class) reported more increase in depressive symptoms when continuously retired (β = -0.16, 95% CI: -0.25--0.08). Those reporting recreational social participation after retirement appeared to be less influenced by transition to retirement.Conclusions: Retirement may increase depressive symptoms among Japanese older adults, particularly men from lower occupational class backgrounds. Encouraging recreational social participation may mitigate the adverse effects of retirement on mental health of Japanese older men. [ABSTRACT FROM AUTHOR]

Aim: The present study examined whether social support, informal socializing and social participation are associated with glycemic control in older people. Methods: Data for this population-based cross-sectional study was obtained from the Japan Gerontological Evaluation Study (JAGES) 2010 linked to the annual health check-up data in Japan. We analyzed 9,554 individuals aged ≥65 years without the certification of needed long-term care. Multivariate logistic regression models were used to assess the effect of social support, informal socializing and social participations on glycemic control. The outcome measure was HbA1c ≥8.4%. Results: 1.3% of the participants had a level of HbA1c over 8.4%. Better glycemic control was significantly associated with meeting with friends one to four times per month (odds ratio [OR] 0.51, 95% confidence interval [CI]0.30–0.89, compared to meeting with friends a few times per year or less) and participation in sports groups (OR 0.50, 95% CI 0.26–0.97) even after adjusting for other variables. Meeting with friends more than twice per week, receiving social support, and being married were not associated with better control of diabetes. Conclusions: Meeting with friends occasionally is associated with better glycemic control among older people. [ABSTRACT FROM AUTHOR]

The impact of social participation on older adults' health may differ by individual socioeconomic status (SES). Consequently, we examined SES effect modification on the associations between types of social activity participation and incident functional disability. Cohort data from the 2003 Japan Gerontological Evaluation Study (JAGES) was utilized. This included individuals who were aged 65 or older and functionally independent at baseline. Analysis was carried out on 12,991 respondents after acquisition of information about their long-term care (LTC) status in Japan. Incident functional disability was defined based on medical certification and LTC information was obtained from municipal insurance databases. Cox proportional hazard regression was conducted for analysis. Results indicated that participants in a sport (hazard ratio [HR]: 0.66; 95% confidence interval [CI]: 0.51, 0.85) or hobby group (HR: 0.69; 95% CI: 0.55, 0.87), or who had a group facilitator role (HR: 0.82; 95% CI: 0.66, 1.02) were less likely to be disabled. While men with 13 or more years of education were less likely to become disabled if they held facilitator roles, this association was weak among men with 0-5years of education (HR of interaction term between 0 and 5years of education and facilitator role dummy variable=3.95; 95% CI: 1.30, 12.05). In conclusion, the association between group participation and smaller risk of the functional disability was stronger among highly educated older adults. Intervention programs promoting social participation should consider participants' socioeconomic backgrounds. [ABSTRACT FROM AUTHOR]

Background: Low serum albumin levels are associated with aging and medical conditions such as cancer, liver dysfunction, inflammation, and malnutrition and might be an independent predictor of long-term mortality in healthy older populations. We tested the hypothesis that economic status is associated with serum albumin levels and explained by nutritional and health status in Japanese older adults. Design: We performed a cross-sectional analysis using data from the Japan Gerontological Evaluation study (JAGES). The study participants were 6528 functionally independent residents (3189 men and 3339 women) aged ≥65 years living in four municipalities in Aichi prefecture. We used household income as an indicator of economic status. Multiple linear regression was used to compare serum albumin levels in relation to household income, which was classified as low, middle, and high. Additionally, mediation by nutritional and health-related factors was analyzed in multivariable models. Results: With the middle-income group as reference, participants with low incomes had a significantly lower serum albumin level, even after adjustment for sex, age, residential area, education, marital status, and household structure. The estimated mean difference was −0.17 g/L (95% confidence interval, −0.33 to −0.01 g/L). The relation between serum albumin level and low income became statistically insignificant when “body mass index”, “consumption of meat or fish”, “self-rated health”, “presence of medical conditions”, “hyperlipidemia”, or “respiratory disease “was included in the model. Conclusion: Serum albumin levels were lower in Japanese older adults with low economic status. The decrease in albumin levels appears to be mediated by nutrition and health-related factors with low household incomes. Future studies are needed to reveal the existence of other pathways. [ABSTRACT FROM AUTHOR]

Background: Social participation is known to predict longevity. However, little is known about the effect of social participation according to an individual's position in civic groups. We evaluated the influence of social position on mortality, using data from a large cohort of Japanese older adults (the AGES cohort).Methods: Of 14,804 individuals aged 65 years and older enrolled in the AGES, 14,286 individuals were followed up for approximately 5 years from 2003 to 2008. We performed inverse probability of treatment weighted (IPTW) Cox proportional hazards regression with multiple imputation of missing values to compute hazard ratios (HR) for all-cause mortality according to the individual's position in the community organization(s) to which they belonged. We examined participation in the following civic groups: neighborhood association/senior citizen club/fire-fighting team, religious group, political organization or group, industrial or trade association, volunteer group, citizen or consumer group, hobby group, and sports group or club. The values for IPTW were computed based on demographic variables, socioeconomic status, and self-reported medical condition.Results: During 22,718 person-years of follow-up for regular members of community groups and 14,014 person-years of follow-up for participants in leadership positions, 479 deaths and 214 deaths were observed, respectively. Relative to regular members, crude HR for all-cause mortality for occupying leadership positions (e.g. president, manager, or having administrative roles) was 0.72 (95 % CI:0.62-0.85). The IPTW-HR was 0.88 (95 % CI: 0.79-0.99) for participants occupying leadership positions.Conclusions: Holding leadership positions in community organization(s) may be more beneficial to health than being regular members. [ABSTRACT FROM AUTHOR]

Month of birth (MOB) has been linked to a variety of health conditions in adulthood. This study examined the association between MOB and mortality among the healthy elderly in Japan, where a practice of traditional age reckoning was employed up until the late 1940s. The results showed male participants born in December were more likely to die earlier while those born in January had lower mortality. It is possible that social factors in early life, such as the time period when a birth is officially registered, may have implications for health that stretch across the life course. [ABSTRACT FROM AUTHOR]

Evidence consistently shows that low education is associated with unhealthy behaviors. A recent study in behavioral economics argued that high time preferences – the tendency to prefer immediate gain to later reward – explain the limited self-control of individuals in making preventive health-related choices. The aim of this study was to examine the mediating effect of time preference on the associations between education and smoking, binge drinking and overweight in young and middle-aged adults living in a Japanese metropolitan area, using a quantitatively measured time discount rate. A population-based probabilistic sample of residents of 25–50 years of age living in four municipalities within Japanese metropolitan areas where economic disparity is relatively large was obtained from the Japanese Study on Stratification, Health, Income, and Neighborhood (J-SHINE). Respondents answered the questionnaire items using a computer-aided personal instrument (CAPI). Data from 3457 respondents were used in this study. Time preferences measured as categorical responses were converted into a continuous number of time discount rates by using the maximum likelihood method. Smoking habit, binge drinking, and body mass index were regressed on educational attainment with demographics and other confounders. The mediating effects of the time discount rate were examined with the bootstrapping method. Results showed that the time discount rate did not mediate the association between education and binge drinking and BMI. Even for smoking, the mediating effect of time discount rate was quite limited, indicating that the proportion of total effect of education mediated was only 4.3% for men and 3.0% for women. The results suggest that modifying time preferences through educational intervention has only limited efficacy in closing disparities in health-related behaviors, and that other mediators fostered by schooling, such as knowledge/skills, group norms and supportive peers/networks, may be more important as modifiable mediators in the link between education and smoking. [ABSTRACT FROM AUTHOR]

Background: Empirical evidence investigating heterogeneous impact of retirement on mental health depending on social backgrounds is lacking, especially among older adults. Methods: We examined the impact of changes in working status on changes in mental health using Japanese community-dwelling adults aged ≥65 years participating in the Japan Gerontological Evaluation Study between 2010 and 2013 (N = 62,438). Between-waves changes in working status (“Kept working”, “Retired”, “Started work”, or “Continuously retired”) were used to predict changes in depressive symptoms measured by the Geriatric Depression Scale. First-difference regression models were stratified by gender, controlling for changes in time-varying confounding actors including equivalised household income, marital status, instrumental activities of daily living, incidence of serious illnesses and family caregiving. We then examined the interactions between changes in working status and occupational class, changes in marital status, and post-retirement social participation. Results: Participants who transitioned to retirement reported significantly increased depressive symptoms (β = 0.33, 95% CI: 0.21–0.45 for men, and β = 0.29, 95% CI: 0.13–0.45 for women) compared to those who kept working. Men who were continuously retired reported increased depressive symptoms (β = 0.13, 95% CI: 0.05–0.20), whereas males who started work reported decreased depressive symptoms (β = −0.20, 95% CI: -0.38–-0.02). Men from lower occupational class (compared to men from higher class) reported more increase in depressive symptoms when continuously retired (β = −0.16, 95% CI: -0.25–-0.08). Those reporting recreational social participation after retirement appeared to be less influenced by transition to retirement. Conclusions: Retirement may increase depressive symptoms among Japanese older adults, particularly men from lower occupational class backgrounds. Encouraging recreational social participation may mitigate the adverse effects of retirement on mental health of Japanese older men. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4427-0) contains supplementary material, which is available to authorized users.

Objective This study examined how maternal work-related factors, including the availability of paid maternal leave, affect childhood vaccination status. Relatively little is known about the association between the employment status of mothers and the vaccination status of their children. Method We examined data from the Japanese Study on Stratification, Health, Income, and Neighborhood (J-SHINE), an ongoing epidemiologic household panel study in Japan. We used surveys taken in 2010-2011 in this study. Results We found that mothers who returned to work after giving birth were much less likely to follow recommended vaccine schedules for their children compared with mothers who stayed at home and those who had left the workforce by the time of childbirth. However, taking parental leave significantly reduced the risk of not being up-to-date with the vaccination schedule at 36months of age. We also found that children whose mother was younger and less educated, and those from an economically deprived family were at a high risk of not being up-to-date with the vaccination status at 36months of age. Conclusion Because vaccination is free and widely available in Japan, our findings indicate that provision of free vaccinations is not sufficient to achieve high vaccination rates. [ABSTRACT FROM AUTHOR]

Background: Social participation is known to predict longevity. However, little is known about the effect of social participation according to an individual’s position in civic groups. We evaluated the influence of social position on mortality, using data from a large cohort of Japanese older adults (the AGES cohort). Methods: Of 14,804 individuals aged 65 years and older enrolled in the AGES, 14,286 individuals were followed up for approximately 5 years from 2003 to 2008. We performed inverse probability of treatment weighted (IPTW) Cox proportional hazards regression with multiple imputation of missing values to compute hazard ratios (HR) for all-cause mortality according to the individual’s position in the community organization(s) to which they belonged. We examined participation in the following civic groups: neighborhood association/senior citizen club/fire-fighting team, religious group, political organization or group, industrial or trade association, volunteer group, citizen or consumer group, hobby group, and sports group or club. The values for IPTW were computed based on demographic variables, socioeconomic status, and self-reported medical condition. Results: During 22,718 person-years of follow-up for regular members of community groups and 14,014 person-years of follow-up for participants in leadership positions, 479 deaths and 214 deaths were observed, respectively. Relative to regular members, crude HR for all-cause mortality for occupying leadership positions (e.g. president, manager, or having administrative roles) was 0.72 (95 % CI:0.62–0.85). The IPTW-HR was 0.88 (95 % CI: 0.79–0.99) for participants occupying leadership positions. Conclusions: Holding leadership positions in community organization(s) may be more beneficial to health than being regular members.

Abstract: To evaluate the gender-specific impact of social exclusion on the mortality of older Japanese adults, we performed a prospective data analysis using the data of the Aichi Gerontological Evaluation Study (AGES). In AGES, we surveyed functionally independent residents aged 65 years or older who lived in six municipalities in Aichi prefecture, Japan. We gathered baseline information from 13,310 respondents in 2003. Information on mortality was obtained from municipal databases of the public long-term care insurance system. All participants were followed for up to 4 years. We evaluated social exclusion in terms of the combination of social isolation, social inactivity, and relative poverty. Cox’s proportional hazard model revealed that socially excluded older people were at significantly increased risk (9–34%) for premature mortality. Those with simultaneously relative poverty and social isolation and/or social inactivity were 1.29 times more likely to die prematurely than those who were not socially excluded. Women showed stronger overall impact of social exclusion on mortality, whereas relative poverty was significantly associated with mortality risks for men. If these associations are truly causal, social exclusion is attributable to 9000–44,000 premature deaths (1–5%) annually for the older Japanese population. Health and social policies to mitigate the issue of social exclusion among older adults may require gender-specific approaches. [Copyright &y& Elsevier]

Objective: It is well known that depression deteriorates basic activities of daily living (ADLs), such as eating and bathing, among the elderly, but little is known about the early impact of depression symptoms on the next higher level of functioning, namely higher-levels ADLs, such as instrumental self-maintenance, intellectual activities, and social roles. The objective of this study was to determine whether symptoms of depression are associated with a subsequent decline in higher-level ADLs within a 12-month period of time. Methods: The study cohort consisted of a random sample of 587 non-institutionalized adults aged ≥65 years living in Yamanashi prefecture, Japan. The baseline survey was conducted in 2003. After 12 months, a mailed follow-up survey evaluated changes in higher-level ADLs (follow-up rate 98.6%). Results: After adjusting for sociodemographic and behavioral confounders, logistic regression indicated that baseline severe depression symptoms were associated with a 3.2-fold (95% confidence interval 1.6-6.3) higher chance of a subsequent decline in higher-level ADLs compared to those without severe depression symptoms. The presence of severe depression symptoms was selected by stepwise logistic regression in all models, except for the model with intellectual activities as an outcome, while other lifestyle factors were not selected. Conclusions: Symptoms of severe depression may adversely affect higher-level ADLs even in a relatively short time-frame. In addition, the early effects of depression symptoms may be stronger than those of other traditional lifestyle risk factors. Monitoring a wide range of ADLs in elderly individuals showing signs of depression may be important to prevent a functional decline in health and the need for long-term care. [ABSTRACT FROM AUTHOR]

Relative deprivation has been hypothesized as one of the pathways accounting for the link between income inequality and health. We tested this hypothesis in a large national sample of men and women in Japan. Our survey included a probability sample of 22,871 men and 24,243 women aged 25–64, from whom information was gathered on demographic variables, household income, occupation or employment status, and self-rated health. Our measure of relative deprivation was the Yitzhaki Index, 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. We modeled several alternative reference groups, including others with the same occupation, others of the same age group, and others living in the same geographic area (prefecture), as well as combinations of these. Generalized estimating equations demonstrated that higher relative deprivation was associated with worse self-rated health. Even after controlling for absolute income as well as other sociodemographic factors, the odds ratio and its 95% confidence intervals (CI) for poor health ranged from 1.09 (95% CI: 1.02–1.16) to 1.18 (95% CI: 1.11–1.26) for men and from 1.10 (95% CI: 1.04–1.16) to 1.16 (95% CI: 1.09–1.23) for women per 1 million increase in the Yitzhaki Index. As such, relative income deprivation is associated with poor self-rated health independently of absolute income, and relative deprivation may be a mechanism underlying the link between income inequality and population health. [Copyright &y& Elsevier]

Abstract: Objective: We investigated the impact of mental health on the decline in higher activities of daily living (ADL) defined in terms of social role performance (SR, the highest ADL), intellectual activity (IA), and instrumental ADL (IADL), as well as the onset of basic ADL disability. Methods: Six hundred older adults were randomly selected from Yamanashi prefecture, Japan. An interview survey collected baseline information from 581 people (97%) in 2003. Of those, 93% were followed for 25 months by mail. Cox''s proportional hazard model was used. Results: Among people aged 75+ years, those with severe depressive symptoms had a relative risk (95% confidence intervals) of 3.22 (1.35–7.71), 3.11 (1.38–6.98), and 2.41 (1.07–5.40) for subsequent decline in SR, IA, and IADL, respectively, compared to those without depressive symptoms. The excess risk of IADL decline among people aged 65–74 years was also statistically significant. Social inactivity partly explained the excess risk. Conclusions: Severe depressive symptoms in older adults may accelerate the progression of higher ADL decline. The adverse effect of depressive symptoms is more pronounced in senior elderly. By screening depressive symptoms and higher ADL, and promoting social activities of people at high risk, their risk for basic ADL disability could be reduced. [Copyright &y& Elsevier]

Abstract: The Mujin is a traditional Japanese rotating saving and credit association (RoSCA) that provided financial aid for the lower-middle class in Japan until the postwar reconstruction period. The traditional Mujin has disappeared from most regions, and the surviving Mujin provides more of a social networking than a financial function for its members. We investigated the association between level of participation in the Mujin and the capacity for independent living in older adults. Baseline data of an ongoing cohort study of 581 self-sufficient older adults were analyzed. The Tokyo Metropolitan Institute of Gerontology Index of Competence was used to measure higher-level functional capacity, and the level of engagement in the Mujin was determined by a score derived by factor analysis. We found that a higher level of engagement in the Mujin was associated with greater functional capacity, especially social role performance, the highest-level function. We conclude that the Mujin provides a venue for community interaction that serves to increase the social capital of the community and may have psychosocial benefits for its members due to strong membership ties and mutual trust. Further investigation of the causal relationship between participation in the Mujin and functional capacity, and the psychosocial effects of similar financial mutual-aid systems in other social contexts is warranted. [Copyright &y& Elsevier]

The aim of this study was to evaluate the association of laughter with subjective health independent of socioeconomic status and social participation among older people in Japan. We used the data of 26,368 individuals (men, 12,174; women, 14,194) 65 years or older who participated in the Japan Gerontological Evaluation Study (JAGES) in 2013. Participants provided information on laughter and self-rated health, depression, socioeconomic, and psychosocial factors. We evaluated laughter from three perspectives: frequency, opportunities, and interpersonal interactions. Even after adjustment for depression, sociodemographic factors, and social participation, the prevalence ratio for poor subjective health among women who never or almost never laugh was 1.78 (95% confidence interval, 1.48–2.15) compared with those who reported laughing every day. Similar associations were observed among men. Laughter may be an important factor for the promotion of general and mental health of older adults. The mechanisms linking laughter and health warrant further study.

• Nexus between living arrangement, frailty, gender among Japanese older adults. • Women living with a spouse had a high risk of frailty. • Diverse forms of social participation decreased the risk of frailty in men. • Women living with children with social participation had lower risk of frailty. Frailty is a common global concern that is closely related to aging, especially in Japan. This study clarifies the relationship between living arrangements and frailty among older Japanese adults and the effect of social participation based on gender, with the aim of developing social preventive and intervention strategies. Panel data were obtained from the 2016 and 2019 Japan Gerontological Evaluation Studies. A total of 23,630 older adults, aged 65 years and older, were included. Frailty was assessed using the Kihon Checklist. Multivariable logistic regression models were used to examine the association between living arrangements and frailty and the effect of social participation based on gender. A total of 1,589 (6.72 %) participants reported the new onset of frailty. No independent association was found between living arrangements and frailty, regardless of gender, after controlling for covariates. Diverse forms of social participation decreased the risk for frailty among men. For women, living with a spouse was associated with a higher risk for frailty, compared with women who lived alone; however, women who lived with children and participated in three or more social activities had a lowered risk for frailty. For men, social participation played a more important role in the risk for frailty than did living arrangement. However, social participation moderated the association between living arrangements and frailty in women. Therefore, the promotion of social participation can be included in health prevention and intervention programs to decrease the risk for frailty. [ABSTRACT FROM AUTHOR]

The article examines the Asian financial crisis in 1997 to determine whether suicide increases during economic crisis. The analysis found that although economic impacts were the most severe in Thailand, Indonesia, South Korea and Malaysia, Japan showed the sharpest rise in suicide rate following the crisis. The study also found that despite a macroeconomic recovery afterwards, suicide rate in Japan is still at a record high.

Abstract: Previous studies reported that social disorganization/fragmentation could predict mental well-being of residents in a community. The aim of this study is to examine how area and individual level of social distance could predict likelihood of mental health among older people in Japan. We empirically derived an index of “social distance” by taking averaged differences in sociodemographic characteristics that are income, education, hometown of origin, the duration of residency, and life stage, between the study participants and their neighbors. We used the study participants (n = 9147) from the Aichi Gerontological Evaluation Study, which targeted residents with aged 65 years or over in a central part in Japan. Depressive symptoms of the study participants were assessed using the short version of the Geriatric Depression Scale (GDS-15). We also tested if area-level social capital would moderate the association between social distance and depressive symptoms. Using multilevel analyses, we found that higher social distance from neighbors was associated with increased depressive symptoms, independently of respondents'' own values of income and educational attainment. At the individual level, each standard deviation in income-based and education-based social distance was associated with an odds ratio for depressive symptoms of 1.15 (95% CI: 1.01–1.30) and 1.17 (95% CI: 1.03–1.32), respectively. However, the area-aggregated indices of social distance were not associated with depressive symptoms. Additionally, area-level social capital indicating higher levels of trust between neighbors and social participation, buffered the adverse effect of social distance on depressive risk. In an instance of the “dark side” of social capital, we also found that stronger social cohesion increased depressive symptoms for residents whose hometown of origin differed from the communities where they currently resided. [Copyright &y& Elsevier]

Abstract: The erosion of social capital in more unequal societies is one mechanism for the association between income inequality and health. However, there are relatively few multi-level studies on the relation between income inequality, social capital and health outcomes. Existing studies have not used different types of health outcomes, such as dental status, a life-course measure of dental disease reflecting physical function in older adults, and self-rated health, which reflects current health status. The objective of this study was to assess whether individual and community social capital attenuated the associations between income inequality and two disparate health outcomes, self-rated health and dental status in Japan. Self-administered questionnaires were mailed to subjects in an ongoing Japanese prospective cohort study, the Aichi Gerontological Evaluation Study Project in 2003. Responses in Aichi, Japan, obtained from 5715 subjects and 3451 were included in the final analysis. The Gini coefficient was used as a measure of income inequality. Trust and volunteering were used as cognitive and structural individual-level social capital measures. Rates of subjects reporting mistrust and non-volunteering in each local district were used as cognitive and structural community-level social capital variables respectively. The covariates were sex, age, marital status, education, individual- and community-level equivalent income and smoking status. Dichotomized responses of self-rated health and number of remaining teeth were used as outcomes in multi-level logistic regression models. Income inequality was significantly associated with poor dental status and marginally significantly associated with poor self-rated health. Community-level structural social capital attenuated the covariate-adjusted odds ratio of income inequality for self-rated health by 16% whereas the association between income inequality and dental status was not substantially changed by any social capital variables. Social capital partially accounted for the association between income inequality and self-rated health but did not affect the strong association of income inequality and dental status. [Copyright &y& Elsevier]

The types of social networks, their prevalence, and their relationship to health outcomes in older age have been different across countries and cultures. Most of the literature has focused on USA or in European countries and little is known about the social network typologies among older adults from Japan. This study aimed to identify these patterns of social network typologies and examine the differences in sociodemographic and related to health variables. 23894 participants from the JAGES project (2019), aged 65 or older (M = 74.74, DT = 6.39) from Japan. Statistical analyses included Latent Profile Analysis (LPA) followed by ANOVAs, Chi square and multinomial logistic regressions tests to compare the profiles. Four profiles were identified: family (66.9%), spouse (16.6%), diverse (14.5%), and neighbor/others (1.9%). The profiles differ statistically (p < 0.001) in all sociodemographic characteristics and in the means of depression, loneliness, self-perceived health, and happiness. Compared with the "family" network, younger men, with fewer chronic illnesses but higher levels of depression and loneliness were more likely to be in the "spouse" profile, older women with lower socioeconomic status, but less lonely and happier in the "diverse" profile and adults who still working, have lower socioeconomic status and are less happy into the "neighbors/others" group. We discuss the differences between the profiles found, the potential differences with previous studies and the specific cultural Japanese nuances that may explain the characteristics of the network types founded. • Familial, spouse, diverse and neighbor/others social networks profiles were identified. • Differ statistically in depression, loneliness, self-perceived health, and happiness. • The diverse group presents the best health outcomes, followed by "family". • Spouse group has protective sociodemographic factors but poor health outcomes. [ABSTRACT FROM AUTHOR]

• We examined psychosocial changes after surrendering driver's licence in older adults. • Elapsed years after surrender was considered to examine acute trend after transition. • Social interactions with friends decreased within three years after surrendering. • This trend was not moderated by the number of public transportations in neighbourhood. This study aimed to examine how the associations between surrendering driving licence and changes in self-rated health and social interactions among older adults differ by the years elapsed since surrendering and the number of public transportation systems (PTS) in the neighbourhood. We used the 2013 and 2016 survey data from the Japan Gerontological Evaluation Study targeting residents aged ≥65 years in 30 municipalities in Japan. Two-waves longitudinal data from 4894 older adults were evaluated. Based on the difference-in-differences method, the interaction terms of respondents' driving status, which was the categorical exposure variable representing respondents' driving status for three years during the study period, and a dummy variable of year (2016) were used as explanatory variables in logistic regression analyses to examine changes in outcomes (poor self-rated health and infrequent meeting with friends) between 2013 and 2016 by driving status during this period. Analyses were stratified based on neighbourhood PTS ('more PTS' and 'fewer PTS' groups). We found that, while surrendering licence within three years was associated with increased probability of poor self-rated health in more PTS group, the confidence interval was large. Although surrendering licence within three years was associated with decreased social interactions, this association weakened if licence was surrendered more than three years ago. These associations were not markedly affected by neighbourhood PTS. Our findings suggested that, regardless of neighbourhood PTS, support and care to promote social interactions at or shortly after surrendering licence may be beneficial to the well-being of older adults who lost their driving licence. [ABSTRACT FROM AUTHOR]

Understanding the effect of neighborhood facilities on older adults' participation in hobbies and sports activities can provide solid evidence for effective health promotion policies. However, few studies have considered the relationship between the geographic accessibility of neighborhood facilities and their degree of spatial clustering with changes in group participation over time. This study examined whether the geographical distribution of neighborhood facilities—their geographic accessibility and degree of spatial clustering—can facilitate older adults' group participation. Longitudinal data of 20,151 older adults living in 339 elementary school districts were collected through the Japan Gerontological Evaluation Study. The findings within the Japanese context show that high geographic accessibility of neighborhood facilities and their spatially clustered patterns are related to an increase in group participation. Meanwhile, for older adults who have close ties with neighbors, an increase in sports group participation can be negatively impacted despite the great geographic accessibility to city parks. Spatially dispersed eating facilities are also related to good relationships with neighbors, facilitating participation in sports groups. Therefore, policymakers should carefully consider the various dynamics in the effect when discussing the choice of facility location to facilitate older adults' participation in hobbies and sports groups. • Accessibility of facilities and their clustering degree is considered. • Accessibility of parks shows the greatest direct effect on group participation. • Accessibility of parks shows a negative indirect effect on sports participation. • Clustered eating places and food stores increase group participation. • Dispersed eating places also increase participation in sports groups. [ABSTRACT FROM AUTHOR]

Background Little is known about the differential impact of combinations of parental smoking behavior (indoor or outdoor smoking, or not smoking) on preventing childhood asthma. Our objective was to examine the association between parental smoking behavior and children's asthma. Methods A nationally representative population-based birth cohort of 40,580 babies, aged 0.5 years in 2001 (response rate, 87.8%), was studied to estimate adjusted odds ratios of combinations of maternal and paternal indoor or outdoor smoking at home for physician visits and hospitalization for childhood asthma up to 8-years-old, and population attributable fractions. Results Odds of hospitalization for asthma among children whose father alone smokes indoors at home did not largely increase (up to 20%). However, if the mother also smokes indoors at home, the odds strongly increased. After adjusting for demographic, perinatal and socioeconomic factors, the increase in odds for children whose father and mother both smoke indoors compared to children with non-smoking parents was 54% (95% confidence interval: 21–96%), 43% (8–90%) and 72% (22–143%) for children aged 0.5 < −2.5, 2.5 < −4.5 and 4.5 < −8 years-old, respectively. The odds ratios of smoking outdoors did not largely differ from those of smoking indoors. Our estimation of population attributable fractions revealed that if all parents in Japan quit smoking, hospitalization of children for asthma could be reduced by 8.3% (2.2–14.3%), 9.3% (0.9–17.6%) and 18.2% (7.7–28.8%), respectively. Conclusions Parental indoor smoking at home increased and exacerbated children's asthma. Smoking at home, whether it is indoors or outdoors, may increase the risks for asthma attacks of their children. [ABSTRACT FROM AUTHOR]

• We examined factors governing commencement and termination of public assistance. • Higher perception of mutual help is a predictor of initiation of public assistance. • Higher attachment to community is a predictor of termination of public assistance. • Social role in community is a predictor of termination of public assistance. • Psychosocial factors are key to accessing and terminating public assistance. Public assistance programs guarantee a minimum living standard, promoting independence for impoverished citizens. Although public assistance eligibility is mainly based on economic factors like poverty, psychosocial factors may be important in initiating and terminating participation. We explored factors governing commencement and termination of public assistance by the older Japanese population between 2013 and 2016. We used panel data from the Japan Gerontological Evaluation Study (JAGES), conducted in 2013 and 2016. Fixed-effects regression was used to examine variables in 2013 that were related to receiving public assistance in 2016. The Tokyo Metropolitan Institute of Gerontology -competence index (TMIG-CI) was used to assess higher-level activities of daily living (ADL, i.e., instrumental ADL, intellectual activity, and social role). The role of individual perceptions of community social cohesion (community trust, mutual help, and attachment), and sociodemographic factors were considered. While 215 people (0.5%) started receiving public assistance between 2013 and 2016, almost 50% stopped participating. People with higher perceived mutual community help were 1.21 times (95% confidence interval [CI]: 1.02–1.46) more likely to commence public assistance three years later. Public assistance recipients who felt community attachment to their resident community, and had social roles were 1.16 (95% CI: 1.06–1.28) and 1.15 (95% CI: 1.01–1.30) times more likely to give up public assistance three years later, respectively, independent of socioeconomic statuses. Psychosocial factors, including maintaining good relationships with community residents, could be important in accessing and terminating public assistance services. [ABSTRACT FROM AUTHOR]

Public assistance recipients in Japan are financially empowered by social welfare but are also exposed to social stigma. Therefore, when their status of receiving public assistance changes, the conditions of their social life likely change. We examined whether the social relationships of older adults receiving public welfare are influenced by either starting or terminating their use of public assistance. This study used the Japan Gerontological Evaluation Study panel data from 2013 to 2016. To measure social relationships, we used four indicators: the frequency of meeting with friends, the number of friends whom the participants had met with in the past month, their frequency of participating in sports clubs, and their frequency of participating in hobby clubs. In the analyses, changes in social relationships between 2013 and 2016 were used as the study outcomes. Linear regression analyses were conducted to examine if their social relationships changed before and after starting or terminating public assistance while adjusting for confounders. We found that people who stopped receiving public assistance experienced an increase in their frequency of meeting with friends (coefficient: 0.56; 95% CI: 0.06, 1.07), the number of friends (coefficient: 0.60; 95% CI: 0.20, 0.99), participation in sports clubs (coefficient: 0.91; 95% CI: 0.46, 1.39), and participation in hobby clubs (coefficient: 0.70; 95% CI: 0.26, 1.13) compared to those who continued to receive public assistance. Contrarily, the measured social relationships did not change after the participants started receiving public assistance. Our main findings were that terminating one's reception of public assistance increases informal socializing and social participation while starting public assistance does not interrupt pre-existing relationships. These findings contribute to the literature by adding that social relationships are not negatively influenced by either terminating or starting public assistance. Targeted promotions of social connections would effectively maintain the health statuses of low-income older adults. • People who stop receiving public assistance more frequently meet with friends. • When people stop receiving public assistance, their number of friends increases. • People participate more frequently in social clubs once they stop receiving welfare. • Starting to receive public welfare does not impact one's pre-existing. [ABSTRACT FROM AUTHOR]

Social activities in the community help older adults maintain functional ability. Community organizing, based on the assessment of health risks, community assets, and fostering intersectoral organizational partnerships, could increase participation opportunities. Supporting municipality staff members in building their capacity to take those actions might benefit them. Nevertheless, the effectiveness of such support remains unclear. This real-world-setting study evaluated the effectiveness of providing support for municipality health sectors in relation to older residents' social activities. Based on the Japan Gerontological Evaluation Study (JAGES), a nationwide study of community-dwelling older adults, from 2013 to 2016 researchers collaborated with health sector staff members in 13 participating municipalities (intervention group) in utilizing the JAGES-based community assessment data and building organizational partnerships. The remaining 12 municipalities (control) obtained the data only. We analyzed the longitudinal data of 47,106 older residents, performing a difference-in-differences (DID) analysis, weighted by the inverse of propensity to be selected for the intervention group, allowing for a multilevel (municipality/individual) data structure. In the intervention group, the estimated group participation prevalence in men increased by 10.4 percentage points from 47.5% to 57.9%, while in the control group, participation increased by 7.9 percentage points from 47.2% to 55.0% (DID estimated = 0.025, P = 0.011). No statistically significant difference between the two groups was observed among women (P = 0.131). Support for community organizing may improve group participation among older male residents. The community-attributable impact could be large, given that the intervention has the potential to work for all older residents in the municipality. • Older men participated more where researchers and health sector collaborated well. • The effects were specifically strong for participation in leisure activity groups. • Community organizing might encourage older men to engage in social activities. [ABSTRACT FROM AUTHOR]