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Abstract Background During the coronavirus disease (COVID-19) pandemic, essential workers (e.g. medical workers) may be at a high prevalence of contracting COVID-19; however, the trend remains unclear in Japan. This study aimed to investigate occupational differences in the prevalence of COVID-19. Methods Data were retrieved from the 2022 Japan COVID-19 and Society Internet Survey. We analyzed the self-reported SARS-CoV-2 infection as of October 2022. We included 21,875 participants aged 20–64 years. Participants were classified into five occupation groups (“medical workers,” “off-site medical workers,” “care workers,” “other essential workers”, and “non-essential workers”), as well as those unemployed. The prevalence ratio of COVID-19 was computed using Poisson regression. We included sex, age, SARS-CoV-2 vaccination history, number of households, education level, and residential area as covariates. Additionally, we performed similar analyses for three time periods: (1) August–September 2022, (2) October 2021 to July 2022, and (3) before September 2021. Results The overall cumulative prevalence of COVID-19, as of October 2022, was 16.5%. Regarding occupation, medical workers had a higher prevalence than non-essential workers (23.5% vs 16.2% (difference: 7.2% point [95% confidence interval (CI): 4.2–10.2])). Similar results were observed among care workers compared with non-essential workers (22.1% vs 16.2% (difference: 5.9% point [95% CI: 2.5%–9.3%])). Other essential workers had a similar prevalence to non-essential workers (17.6% vs 16.2% (difference: 1.4% point [95% CI: -0.1%–2.8%]). In relative terms, medical workers and care workers were associated with an increased prevalence of COVID-19 (prevalence ratio: 1.44 [95% CI: 1.20–1.73] and 1.36 [95% CI: 1.11–1.66], respectively). In addition, we found that younger age, living in endemic region (e.g., Tokyo and Osaka), and living with more than four people contributed to the higher prevalence. According to the time period, the prevalence was significantly higher in medical and care workers than in non-essential workers only during August–September 2022, which corresponded to the severest outbreak period in Japan. Conclusions In Japan, medical and care workers had a higher prevalence of contracting COVID-19 compared to non-essential workers. However, this trend emerged during the peak of the COVID-19 spreading in the summer of 2022.

Background: In Japan, heated tobacco products (HTPs) are promoted by the tobacco industry as reduced-risk tobacco products despite the lack of evidence for this claim. This study determined the distribution of HTP-harmfulness perception and identified the explanatory factors associated with the perception of HTP as less harmful than conventional cigarettes. Methods: A nationwide cross-sectional survey was conducted with Japanese people aged 20 years or older (INFORM Study 2020) using a self-administered questionnaire. We performed descriptive analysis and weighted logistic regression analysis to examine the relationship between explanatory factors (eg, individual characteristics, socioeconomic status, and trusted sources of cancer information) and the perception of HTPs as less harmful. Results: Among 3,420 participants, the proportions of those who perceived HTPs as less harmful were 40.3% and 18.3% for users and non-users of tobacco, respectively. For participants aged 20–39 years, the proportions were 49.9% and 30.4%, respectively. Among 1,160 tobacco non-users who were familiar with HTPs, male, aged under 39 years, and having lower education were associated with the perception of HTPs as less harmful. Trusted sources of cancer information were not associated with the perception of HTPs as less harmful. Conclusion: This study showed that, among tobacco non-users, being male, aged under 39 years, and having lower education were associated with a perception of HTPs as less harmful. Public health stakeholders should provide the latest evidence about HTP harmfulness in their daily practice and strengthen the regulations on HTP marketing directed at both tobacco- and tobacco non-users.

Introduction The global market of flavour capsule cigarettes (FCCs) has grown significantly over the past decade; however, prevalence data exist for only a few countries. This study examined prevalence and perceptions of FCCs among adults who smoke across five countries.Methods Cross-sectional data among adults who smoked cigarettes came from the International Tobacco Control Policy Evaluation Project Surveys—Brazil (2016/2017), Japan (2021), Republic of Korea (2021), Malaysia (2020) and Mexico (2021). FCCs use was measured based on reporting one’s usual/current brand or favourite variety has flavour capsule(s). Perceptions of the harmfulness of one’s usual brand versus other brands were compared between those who used capsules versus no capsules. Adjusted logistic regression models examined correlates of FCC use.Results There were substantial differences in the prevalence of FCC use among adults who smoke across the five countries: Mexico (50.3% in 2021), Republic of Korea (31.8% in 2021), Malaysia (26.5% in 2020), Japan (21.6% in 2021) and Brazil (6.7% in 2016/2017). Correlates of FCC use varied across countries. Capsule use was positively associated with being female in Japan and Mexico, younger age in Japan, Republic of Korea and Malaysia, high education in Brazil, Japan and Mexico, non-daily smoking in Republic of Korea, and having plans to quit in Japan and Republic of Korea. There was no consistent pattern of consumer perceptions of brand harmfulness.Conclusion Our study documented the high prevalence of FCCs in some countries, pointing to the need to develop and implement regulatory strategies to control these attractive products.

Background: Since 2011, commercial truck drivers have been required to take alcohol breath tests at the beginning and end of their working hours due to their employers’ legal obligations. However, non-commercial truck drivers are not required to do so. We examined whether alcohol-related crashes had decreased after 2011 among commercial truck drivers. Methods: Using police data, we conducted a joinpoint regression analysis to examine the trend in the proportion of alcohol-related crashes from 1995 through 2020 caused by commercial truck drivers (who were subjected to alcohol breath testing) and non-commercial truck drivers (who were not subjected to testing). The annual percentage change in this trend was also estimated. Results: During the 26-year study period, truck drivers caused 1,846,321 at-fault crashes, and 0.4% of the crashes involved intoxicated driving. A significant decreasing trend in the proportion of alcohol-related crashes was identified among both commercial and non-commercial truck drivers in the 2000s, during which several legal amendments were made against drunk driving. The annual percentage change was −13.5% from 2001 to 2012 among commercial truck drivers, and −14.9% from 2001 to 2011 among non-commercial truck drivers. No decreasing trend was observed afterwards, despite the introduction of mandatory alcohol breath testing in 2011. Conclusion: The effect of mandatory alcohol breath testing on reducing alcohol-related crashes among commercial truck drivers was not evident.

Abstract Objective Although there is increasing evidence to suggest the cost‐effectiveness of aspirin use to prevent colorectal cancer (CRC) in the general population, no study has assessed cost‐effectiveness in patients with familial adenomatous polyposis (FAP), who are at high risk of developing CRC. We examined the cost‐effectiveness of preventive use of low‐dose aspirin in FAP patients who had undergone polypectomy in comparison with current treatment practice. Design We developed a microsimulation model that simulates a hypothetical cohort of the Japanese population with FAP for 40 years. Three scenarios were created based on three intervention strategies for comparison with no intervention, namely intensive downstaging polypectomy (IDP) of colorectal polyps at least 5.0 mm in diameter, IDP combined with low‐dose aspirin, and total proctocolectomy with ileal pouch‐anal anastomosis (IPAA). Cost‐effective strategies were identified using a willingness‐to‐pay threshold of USD 50,000 per QALY gained. Results Compared with no intervention, all strategies resulted in extended QALYs (21.01–21.43 QALYs per individual) and showed considerably reduced colorectal cancer mortality (23.35–53.62 CRC deaths per 1000 individuals). Based on the willingness‐to‐pay threshold, IDP with low‐dose aspirin was more cost‐effective than the other strategies, with an incremental cost‐effectiveness ratio of $57 compared with no preventive intervention. These findings were confirmed in both one‐way sensitivity analyses and probabilistic sensitivity analyses. Conclusion This study suggests that the strategy of low‐dose aspirin with IDP may be cost‐effective compared with IDP‐only or IPAA under the national fee schedule of Japan.

Background: The 2015 Japan Standard Population (JSP) was established in response to changes in the age structure. However, the effects of major updates, especially the recategorization of older age groups, for interpreting various health metrics have not been clarified. Methods: Population data were collected and estimated for older age categories (85–89, 90–94, and ≥95 years). Data on the number of deaths were also collected from the Vital Statistics. We recalculated the all-cause and leading cause-specific age-standardized mortality rate (ASMR) using the 2015 JSP by the direct standardization method for data from 1950 to 2020. We compared ASMRs calculated using the 2015 JSP with those calculated using the 1985 JSP. Pearson’s correlation coefficients were used to evaluate the consistency of mortality trends between the 2015 and 1985 JSPs. Results: The absolute all-cause ASMRs calculated using the 2015 JSP were 2.22–3.00 times higher than those calculated using the 1985 JSP. The ASMR ratios increased gradually over time. While trends in all-cause and cause-specific ASMRs calculated using the 2015 JSP and 1985 JSP were generally highly correlated (Pearson’s correlation coefficient [r] = 0.993 for all-cause), correlations were relatively low for malignant neoplasms (r = 0.720 for men and r = 0.581 for women) and pneumonia/bronchitis (r = 0.543 for men and r = 0.559 for women) due to non-monotonous trends over time and fluctuations in earlier time periods. Conclusion: The effect of introducing the new JSP for interpreting trends in all-cause mortality was considered minimal. However, caution is needed when interpreting trends in some cause-specific mortality rates.

Background Patients with comorbidity are at higher risk of deteriorating COVID-19, but they need to access healthcare services regularly for their primary disease. This study aimed to investigate whether patients restricted healthcare utilization due to the COVID-19 pandemic and to understand the relations between restriction of healthcare utilization and psychological distress of patients with a disease potentially vulnerable to COVID-19. Methods Participants were a sub-sample of 6,360 individuals suffering from chronic diseases with hypertension, diabetes, respiratory diseases, cerebrovascular disease, and cancer from the nationally representative cross-sectional internet survey data of Japan. Participants reported healthcare utilization during the first state of emergency, as well as psychological distress (K6: The Kessler Psychological Distress Scale 6) in three months after the state of emergency was ended. Multivariate linear regression analyses were performed to examine the correlation between psychological distress and healthcare utilization. Results In total, 16% restrained from visiting a hospital as scheduled or canceled a doctor visit. Approximately less than 2% experienced cancellation or delay of hospitalization, treatment, or nursing-care services. After controlling for confounders, multivariate linear regression analysis showed that those who lacked medicines, experienced deteriorated health conditions, and could not visit a hospital during the state of emergency reported severe psychological distress three months later among the patients with all disease types except cancer (β = 0.10∼0.25). Conclusions The study indicated the restriction in healthcare utilization might be a risk factor for psychological distress among patients. Careful attention to the mental status of patients, especially those who were restricted in healthcare utilization, is necessary.

Abstract Aims/Introduction Among colorectal cancer (CRC) patients, pre‐existing diabetes is suggested to influence poor prognosis, but the impact on adjuvant chemotherapy implementation is largely unknown. We aimed to compare the implementation rate of adjuvant chemotherapy between CRC patients with and without pre‐existing diabetes in a retrospective cohort study. Materials and Methods Colorectal cancer diagnosis information was obtained from the hospital‐based cancer registry of patients with stage III CRC who underwent curative surgery in 2013 in Japan (n = 6,344). Health claims data were used to identify diabetes and chemotherapy. We examined the association between diabetes and the implementation rate of adjuvant chemotherapy using a generalized linear model adjusted for age, sex, updated Charlson Comorbidity Index, hospital type and prefecture. Furthermore, we applied a mediation analysis to examine the extent to which postoperative complications mediated the association. Results Of the 6,344 patients, 1,266 (20.0%) had diabetes. The mean ages were 68.2 and 71.3 years for patients without and with diabetes, respectively. Compared with those without diabetes, patients with diabetes were less likely to receive adjuvant chemotherapy (crude rate 58.9 and 49.8%; adjusted percentage point difference 4.6; 95% confidence interval 1.7–7.5). The difference was evident for patients aged

Objective The COVID-19 pandemic led to an increase in mortality in most countries in 2020, deviating from prior decreasing trends. In Japan, however, mortality was suggested to decrease in 2020. This study investigated long-term mortality trends and cause-specific contributions, focusing on the period of the COVID-19 pandemic in Japan.Design We analysed Japanese age-standardised mortality rates (ASMRs) from 1995 to 2021 using vital statistics.Main outcome measures The cause-specific annual ASMR changes were calculated in comparison with the previous year over the abovementioned period.Results There was a general downward trend in overall ASMR for both sexes until 2020 followed by a small increase in 2021. In men, the all-cause ASMR (per 100 000 persons) decreased from 1352.3 to 1328.8 in 2020 (−1.74% from 2019), and increased to 1356.3 in 2021 in men (+2.07% from 2020). In women, the all-cause ASMR decreased from 746.0 to 722.1 in 2020 (−3.20% from 2019), and increased to 737.9 (+2.19% from 2020) in 2021. ASMRs from malignant neoplasms, pneumonia, accidents and suicide (men only) continued to decrease during the COVID-19 pandemic while the trend of cardiovascular mortality increased in 2021. Analysis of ASMR changes revealed that COVID-19, senility, cardiovascular disease and ‘other causes not classified as major causes’ contributed to the all-cause mortality increase in 2021.Conclusions In Japan, the decreasing trend in overall mortality continued in 2020 despite the COVID-19 pandemic. However, approximately 2% mortality increase was observed in 2021, which was attributable to COVID-19, senility, cardiovascular disease and ‘other causes’. The year 2021 was a turning point of mortality trends in Japan, although continued monitoring is warranted.

Abstract Background While esophageal squamous cell carcinoma (ESCC) is the predominant histological type in Japan, concern has been expressed over an increase in the proportion of esophageal adenocarcinoma (EAC), especially in middle‐aged populations. This study aimed to assess long‐term trends in esophageal cancer incidence by histological type. Methods We used data from three population‐based cancer registries in Japan with 10,642 esophageal cancer cases diagnosed between 1993 and 2014. The multiple imputation approach was used to impute a specific histological type (ESCC, EAC, and others) for cases with “Unknown” or missing status. We calculated the age‐standardized incidence rates by histological type from 1993 to 2014 and fitted age‐period‐cohort models to estimate the annual percent changes (APCs) and adjusted incidence rate ratios (IRRs). Results After imputation of missing data, the largest mean APC increase was seen in the incidence of EAC in men aged 40–49 years (7.1%) followed by those aged 50–59 years (5.5%). The age‐period‐cohort analysis showed that men who were born in the 1960s and later were more likely to develop EAC relative to men who were born in 1950–1959 (1960–1969 cohort, IRR: 1.42; 1970–1974 cohort, IRR: 2.23), with a period effect indicating a constant increase after 2003. For women, no significant trend in EAC incidence was observed. Conclusions The incidence of EAC has increased more prominently compared with that of ESCC, especially in men aged 40–59 years, suggesting the impact of increasing obesity in men and a reduction in H. pylori prevalence in Japan.

Objectives This study aimed to examine whether and how the COVID-19 pandemic has affected the postponement or cancellation of elective surgeries in Japan.Design and setting A cross-sectional, web-based, self-administered survey was conducted nationwide from August 25 to September 30 2020. We used data from the Japan ‘COVID-19 and Society’ Internet Survey collected by a large internet research agency, Rakuten Insight, which had approximately 2.2 million qualified panellists in 2019.Participants From a volunteer sample of 28 000 participants, we extracted data from 3678 participants with planned elective surgeries on any postponement or cancellation of elective surgeries.Outcome measures The main outcome measure was any postponement or cancelltion of elective surgeries. In addition, for all respondents, we extracted data on sociodemographic, health-related characteristics, psychological characteristics and prefectural-level residential areas. We used weighted logistic regression approaches to fulfil the study objectives, minimising potential bias relating to web-based surveys.Results Of the 3678 participants, 431 (11.72%) reported experiencing postponement or cancellation of their elective surgeries. Notably, the participants living in prefectures where the declaration of the state of emergency was made on 7 April 2020 were significantly more likely to experience postponement or cancellation of elective surgeries than those residing in prefectures with the state of emergency beginning on 16 April 2020 (174 (26.02%) vs 153 (12.15%)).Conclusions The proportion of patients whose elective surgery had been postponed was limited during Japan’s first wave of the COVID-19 pandemic, although the declaration of a state of emergency increased the likelihood of postponement. It is imperative to increase awareness of the secondary health effects related to policy intervention in pandemics and other health crises and to use appropriate countermeasures such as standard infectious control measures and triage of surgical patients.

Background: Research findings indicate that four health-related behaviors (HRBs), smoking, alcohol, diet, and physical activity, do not co-occur within individuals by chance and therefore cluster. To date, there is a lack of research investigating the clustering of these HRBs in the Japanese population. Methods: The Japanese National Health and Nutrition Survey 2010 was used, containing information on 8,015 community-dwelling adults. Latent profile analysis identified distinct cluster patterns of four HRBs: smoking status, alcohol consumption, calorie intake, and the number of steps per day. Results: For men, four distinct HRB clusters were identified. The largest cluster (54%) was characterized by drinking more than Japan’s recommended alcohol guidelines and walking an inadequate number of steps per day. A small cluster (4%) also emerged, characterized by smoking, high calorie intake, and exceeding alcohol guidelines. Members of these clusters had higher systolic blood pressure than those in the remaining clusters. For women, five distinct HRB clusters were identified. The largest cluster (57%) was characterized by not smoking or drinking and walking an inadequate number of steps per day. For both genders, there was a relationship between cluster membership and age. Cluster membership was associated with income and health status among men but not women. Conclusion: Detecting distinct clusters of HRBs in a Japanese population-based survey provides a person-centered understanding of Japanese lifestyles. This approach can assist policy makers in Japan and overseas to identify new strategies for targeting behavioral risk factors and make health promotion policies more effective in their respective countries.

Background: Unlike many North American and European countries, Japan has observed a continuous increase in cancer incidence over the last few decades. We examined the most recent trends in population-based cancer incidence and mortality in Japan. Methods: National cancer mortality data between 1958 and 2018 were obtained from published vital statistics. Cancer incidence data between 1985 and 2015 were obtained from high-quality population-based cancer registries maintained by three prefectures (Yamagata, Fukui, and Nagasaki). Trends in age-standardized rates (ASR) were examined using Joinpoint regression analysis. Results: For males, all-cancer incidence increased between 1985 and 1996 (annual percent change [APC] +1.1%; 95% confidence interval [CI], 0.7–1.5%), increased again in 2000–2010 (+1.3%; 95% CI, 0.9–1.8%), and then decreased until 2015 (−1.4%; 95% CI, −2.5 to −0.3%). For females, all-cancer incidence increased until 2010 (+0.8%; 95% CI, 0.6–0.9% in 1985–2004 and +2.4%; 95% CI, 1.3–3.4% in 2004–2010), and stabilized thereafter until 2015. The post-2000 increase was mainly attributable to prostate in males and breast in females, which slowed or levelled during the first decade of the 2000s. After a sustained increase, all-cancer mortality for males decreased in 1996–2013 (−1.6%; 95% CI, −1.6 to −1.5%) and accelerated thereafter until 2018 (−2.5%; 95% CI, −2.9 to −2.0%). All-cancer mortality for females decreased intermittently throughout the observation period, with the most recent APC of −1.0% (95% CI, −1.1 to −0.9%) in 2003–2018. The recent decreases in mortality in both sexes, and in incidence in males, were mainly attributable to stomach, liver, and male lung cancers. Conclusion: The ASR of all-cancer incidence began decreasing significantly in males and levelled off in females in 2010.

Abstract Background Despite prophylactic human papillomavirus (HPV) vaccination being a safe, effective and cost-effective public health intervention for the prevention of cervical cancer, the HPV vaccine is not actively recommended or promoted by the Ministry of Health Labour and Welfare in Japan. With already very low levels of cervical screening below 30%, and vaccination levels that are below levels that award any population effect at 0.3% of the eligible population, cervical cancer mortality is higher than other similar high-income countries at 4.4/100,000 (2900) deaths per year in 2015. There is limited population-based or nationally representative data for HPV genotype distribution in Japan, thus making an assessment of the burden of vaccine-preventable cervical cancer difficult. Therefore, this systematic review and meta-analysis aims to determine the HPV genotype prevalence and age distribution of HPV infection in women with a cytological or histological diagnosis of normal through cervical cancer in Japan. We anticipate this information will guide and enhance programme interventions to reduce vaccine-preventable cervical cancer mortality in Japan. Methods PubMed, Embase and the Japan Medical Abstract Society Database will be searched from the date of establishment to March 2021 to identify original research articles that report the prevalence of HPV genotypes in Japanese women with normal cervical cytology, low grade, high grade and cancerous cervical lesions. No exclusion criteria relating to language or publication date will be applied. The quality of the studies will be assessed using the Joanna Briggs checklist for prevalence studies. Randomised control trials, cohort studies, cross-sectional and prevalence studies will be considered eligible. Study findings will be combined using a traditional random-effects or fixed-effects meta-analysis to summarise pooled prevalence and 95% confidence intervals depending on heterogeneity. Subgroup analyses and meta-regression will be used to investigate heterogeneity, and sensitivity analyses will be conducted to assess the robustness of the findings. Discussion To our knowledge, this is the first systematic review protocol that includes both Japanese and English peer-reviewed articles for the determination of genotype-specific HPV prevalence in cytological or histological confirmed normal cervical specimens, low- and high-grade intraepithelial lesions and cervical cancers by age in Japan. We anticipate this information will guide and enhance programme interventions to reduce vaccine-preventable cervical cancer mortality in Japan. Systematic review registration PROSPERO CRD42018117596

Objectives Promoting smoke-free policies is a key intervention for reducing secondhand smoke (SHS) exposure. During the COVID-19 pandemic in Japan, many indoor smoking spaces in workplaces were closed. This study aimed to reveal the association between a workplace smoke-free policy and SHS exposure among non-smoking employees, distinguishing between SHS exposure from cigarettes and exposure to secondhand heated tobacco product (HTP) aerosol, which have recently become popular in Japan.Design and setting We used data from the Japan COVID-19 and Society Internet Survey conducted in August–September 2020.Participants Among the 25 482 eligible respondents, 8196 non-smoking employees were analysed.Primary outcome measure Multivariable logistic regression models were used to examine the impact of smoke-free policies in the workplace.Results Compared with complete smoking bans, the ORs and 95% CIs for workplace SHS exposure at least once a week from cigarettes were 2.06 (95% CI: 1.60 to 2.65) for partial bans with no longer available smoking spaces, 1.92 (95% CI: 1.63 to 2.25) for partial smoking bans with still available smoking spaces and 5.33 (95% CI: 4.10 to 6.93) for no smoking bans. The corresponding ORs and 95% CIs for exposure to secondhand HTP aerosol were 4.15 (95% CI: 3.22 to 5.34), 2.24 (95% CI: 1.86 to 2.71) and 3.88 (95% CI: 2.86 to 5.26), respectively.Conclusions The effect of partial bans was limited, and temporary closure of smoking spaces might contribute to increased exposure to secondhand HTP aerosol. Complete smoking bans in the workplace were reaffirmed to be the best way to reduce SHS exposure from cigarettes and exposure to secondhand HTP aerosol.

Abstract Cancer patients with diabetes experience a poorer prognosis, yet the population burden of this multimorbidity remains unknown. This study aimed to estimate the latest incidence and prevalence of cancer with diabetes mellitus in Japan. We used projection of cancer incidence and latest survival data from population‐based cancer registries. The incidence of cancer associated with diabetes was estimated separately for patients with pre‐existing diabetes and those without diabetes, and used to estimate the 5‐year cancer prevalence for those with and without diabetes. The prevalence of pre‐existing diabetes in cancer patients at any cancer site was estimated to be 20.7% (647,160 men and women). Among cancer sites, diabetes prevalence was high in patients with liver and pancreatic cancers in both sexes. In conclusion, our study shows a large burden of diabetes in cancer patients in Japan, which warrants further attention by health practitioners and policy‐makers.

Abstract Background A national endoscopic screening program for gastric cancer was rolled out in Japan in 2015. We used a microsimulation model to estimate the cost-effectiveness of current screening guidelines and alternative screening strategies in Japan. Methods We developed a microsimulation model that simulated a virtual population corresponding to the Japanese population in risk factor profile and life expectancy. We evaluated 15 endoscopic screening scenarios with various starting ages, stopping ages, and screening intervals. The primary outcomes were quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratio. Cost-effective screening strategies were determined using a willingness-to-pay threshold of $50,000 per QALY gained. One-way sensitivity and probabilistic sensitivity analyses were done to explore model uncertainty. Results Using the threshold of $50,000 per QALY, a triennial screening program for individuals aged 50 to 75 years was the cost-effective strategy, with an incremental cost-effectiveness ratio of $45,665. Compared with no endoscopic screening, this strategy is predicted to prevent 63% of gastric cancer mortality and confer 27.2 QALYs gained per 1000 individuals over a lifetime period. Current screening guidelines were not on the cost-effectiveness efficient frontier. The results were robust on one-way sensitivity analyses and probabilistic sensitivity analysis. Conclusions This modeling study suggests that the endoscopic screening program in Japan would be cost-effective when implemented between age 50 and 75 years, with the screening repeated every 3 years. These findings underscore the need for further evaluation of the current gastric cancer screening recommendations.

Objective To examine the status of food expense insufficiency in Japan during the coronavirus disease 2019 (COVID-19) pandemic and the socioeconomic and sociodemographic factors associated with food expense insufficiency. Design Food expense insufficiency before and after the pandemic was assessed. The multivariable-adjusted odds ratio (AOR) and 95% confidence interval (CI) were calculated for the association between food expense insufficiency and socioeconomic and sociodemographic factors. Setting A large-scale, cross-sectional online questionnaire survey. Participants From August to September 2020, 25,482 participants aged 15–79 years completed the questionnaire (JACSIS 2020 study; Group 1). In October 2020, 917 single parents were surveyed for oversampling purposes. There were 179 single parents in Group 1 and a total of 1096 single parents in Group 2. Results Group 1 and Group 2 had 747 (2.9%) and 55 (5.0%) participants, respectively, who experienced food expense insufficiency for the first time after April 2020. Young age, part-time employment, being a single parent (in Group 1), and the number of people in the household (five or more in Group 1 and child/children alone in Group 2) were significantly associated with food expense insufficiency. As being a single parent was significantly associated with food expense insufficiency in Group 1 (AOR [95% CI] = 7.23 [5.40–9.68]), we further examined it in Group 2. Single parents who exhibited multiple factors (young age, part-time employment, living only with child/children) were likely to experience food expense insufficiency (15.3–15.8%). Conclusions Triggered by the pandemic, a small percentage of individuals experienced food expense insufficiency. We identified that factors such as young age, part-time employment, and being a single parent were significantly associated with food expense insufficiency, and discovered that a multiplicity of these factors further increased the risk. Our findings suggest an urgent need to support individuals with a potentially high risk of food expense insufficiency.

Abstract Aims/Introduction The aim of the present study was to examine the associations of pregestational body mass index (BMI) and gestational weight change with birthweight for gestational age in Japanese mothers with gestational diabetes mellitus (GDM). Materials and Methods We retrospectively examined the clinical and laboratory characteristics of 101 mothers with GDM (pregestational BMI 24.7 ± 5.8 kg/m2; maternal age at delivery 34.7 ± 5.1 years; gestational age 38.5 ± 1.4 weeks) at a single center from January 2011 to December 2016. Results Gestational weight changes were 6.22 ± 5.39 kg, and infant birthweights were 2,987.3 ± 393.6 g. Multivariable analysis showed that, in all mothers, pregestational BMI and gestational weight change were positively associated with infant birthweight (P

Abstract Aims/Introduction To examine the association between adult‐onset diabetes and life‐course bodyweight changes. Materials and Methods In a cross‐sectional study, 17,398 Japanese female nurses aged ≥30 years completed a self‐administered questionnaire in 2001–2007. Bodyweight indices were calculated for three life stages: birthweight (adjusted for gestational age), body mass index (BMI) at age 18 years and current BMI. Odds ratios for being diagnosed with adult‐onset diabetes were calculated according to the combined bodyweight categories of two life stages: at birth and age 18 years; and at age 18 years and the survey (current). Path analysis was carried out to decompose the effect of each bodyweight index into direct and mediating effects. Results After adjustment for age at survey and parental diabetes history, “low” birthweight (

Background: There has been no nationwide analysis of travel time for hospital admission in Japan. Factors associated with travel time are also unknown. This study aimed to describe the distribution of travel time for hospital admission of cancer patients and identify underlying factors. Methods: The individual data from the Patient Survey in 2011 were linked to those from the Survey of Medical Institutions in the same year, and GIS data were used to calculate driving travel time between the addresses of medical institutions and the population centers of municipalities where patients lived. Proportions of patients with travel time exceeding versus not exceeding 45 minutes were calculated. To analyze the data with consideration of both individual factors of patients and geographical characteristics of areas where patients lived, multilevel logistic model analysis was performed. Results: The analysis included 50,845 cancer inpatients. The majority of the cancer patients (approximately 80%) were admitted to hospitals located less than a 45-minute drive from their residences. The travel time tended to be longer for younger patients. The proportion of patients with travel time ≥45 minutes was lower among those with stomach or colorectal cancer (approximately 15%) than those with cervical cancer or leukemia (approximately 30%). The lack of designated cancer care hospitals in the secondary healthcare service areas was significantly associated with travel time. Conclusions: Selection of hospitals by cancer inpatients is affected by age, cancer sites, and availability of designated cancer care hospitals in the secondary healthcare service areas where patients live.

Background: Although birth weight is considered as a fetal determinant of the development of adult-onset diabetes mellitus (DM), its public health importance relative to adult body mass index (BMI) remains unclear. We aimed to examine the association between adult-onset DM and birth weight in relation to adult BMI. Methods: We conducted a self-administered questionnaire as a baseline survey of the Japanese Nurses' Health Study cohort between 2001 and 2007. Exclusion criteria were applied to the volunteer sample of 49,927 female nurses (age

Objective Smoking rate varies across Japanese prefectures. However, it isn’t clear whether there are differences in trends in smoking rate by prefecture. In this study, we estimated the trend in smoking rate by prefecture and categorized by feature. Methods Male smoking rates by prefecture from 2001 through 2016 were obtained from dataset which is provided by Cancer Registry and Statistics, Cancer Information Service, National Cancer Center, Japan. Joinpoint analysis was used to compute annual percentage changes (APC) in male smoking rate by prefecture. And we categorized based on whether the prefecture had a joinpoint and how large the APC was. Results and Conclusions We showed that three prefectures had a joinpoint. Specifically, Saitama, Chiba and Nara prefectures. In all those prefectures, the point was observed at 2010. And smoking rates showed a significant decrease until 2010, while trends were flat thereafter. Although the other 44 prefectures had no joinpoint, those prefectures’ APCs showed wide ranges (Min: -10.77, Max: -5.21). In 2010, tax rate of tobacco was increased. That is, after tax increase of tobacco, there were differences about decrease of smoking rate between prefectures with and without a joinpoint. Furthermore, there were differences in the slope of decrease even across the prefectures without a joinpoint. We need to examine reasons of those differences considering the situation of prefectural tobacco control policy.

Background Although Japan is a nation where the world first epidemiological evidence on the health effect of secondhand smoke was produced, no indoor smoking ban was realized on a national level. In 2013, Tokyo was selected as the city of 2020 Olympic Paralympic Games, since when the Japanese Ministry of Health, Labour and Welfare (MHLW) and various concerned parties have been working to realize smoking ban in public places. However, as of July, 2017, the legislation has been unsuccessful. We chronologically reviewed the related events to clarify underlying obstacles to the legislation. Methods Events related to the movement of the national smoking ban in Japan were extracted from the internet and public available data sources. The concerned bodies were classified into five categories (academic/medical, administration, politics, industry, and advocacy), and chronological relations were analyzed. Results Academic/medical and administrative bodies closely collaborated and effectively released scientific rationale of smoking ban in 2016. The MHLW's draft policy released in Mar. 2017 included an exception of smoking ban for restaurants and bars (allowing designated smoking rooms). However, even this partial banning policy was faced with fierce objections from the allied industry including restaurant, hotel businesses and tobacco industry. Diet members in the ruling Liberal Democratic Party acted in a coordinated manner; reportedly 90% of the Diet members attending the party committee on health, labour and welfare objected to the MHLW's draft policy. The allied industry spread a signature collecting activity earlier and much more organizationally than academic/medical and advocacy groups. The party committee of the LDP was held only twice. Although the MHLW proposed a temporary amendment, the committee failed to reach an agreement. Conclusions The series of events suggest that the tobacco lobbies are more powerful in the policy-making process in Japan than tobacco control advocates.

BackgroundThe population of Japan has achieved the longest life expectancy in the world. To further improve population health, consistent and comparative evidence on mortality attributable to preventable risk factors is necessary for setting priorities for health policies and programs. Although several past studies have quantified the impact of individual risk factors in Japan, to our knowledge no study has assessed and compared the effects of multiple modifiable risk factors for non-communicable diseases and injuries using a standard framework. We estimated the effects of 16 risk factors on cause-specific deaths and life expectancy in Japan.Methods and findingsWe obtained data on risk factor exposures from the National Health and Nutrition Survey and epidemiological studies, data on the number of cause-specific deaths from vital records adjusted for ill-defined codes, and data on relative risks from epidemiological studies and meta-analyses. We applied a comparative risk assessment framework to estimate effects of excess risks on deaths and life expectancy at age 40 y. In 2007, tobacco smoking and high blood pressure accounted for 129,000 deaths (95% CI: 115,000-154,000) and 104,000 deaths (95% CI: 86,000-119,000), respectively, followed by physical inactivity (52,000 deaths, 95% CI: 47,000-58,000), high blood glucose (34,000 deaths, 95% CI: 26,000-43,000), high dietary salt intake (34,000 deaths, 95% CI: 27,000-39,000), and alcohol use (31,000 deaths, 95% CI: 28,000-35,000). In recent decades, cancer mortality attributable to tobacco smoking has increased in the elderly, while stroke mortality attributable to high blood pressure has declined. Life expectancy at age 40 y in 2007 would have been extended by 1.4 y for both sexes (men, 95% CI: 1.3-1.6; women, 95% CI: 1.2-1.7) if exposures to multiple cardiovascular risk factors had been reduced to their optimal levels as determined by a theoretical-minimum-risk exposure distribution.ConclusionsTobacco smoking and high blood pressure are the two major risk factors for adult mortality from non-communicable diseases and injuries in Japan. There is a large potential population health gain if multiple risk factors are jointly controlled.

BackgroundBetter information on lung cancer occurrence in lifelong nonsmokers is needed to understand gender and racial disparities and to examine how factors other than active smoking influence risk in different time periods and geographic regions.Methods and findingsWe pooled information on lung cancer incidence and/or death rates among self-reported never-smokers from 13 large cohort studies, representing over 630,000 and 1.8 million persons for incidence and mortality, respectively. We also abstracted population-based data for women from 22 cancer registries and ten countries in time periods and geographic regions where few women smoked. Our main findings were: (1) Men had higher death rates from lung cancer than women in all age and racial groups studied; (2) male and female incidence rates were similar when standardized across all ages 40+ y, albeit with some variation by age; (3) African Americans and Asians living in Korea and Japan (but not in the US) had higher death rates from lung cancer than individuals of European descent; (4) no temporal trends were seen when comparing incidence and death rates among US women age 40-69 y during the 1930s to contemporary populations where few women smoke, or in temporal comparisons of never-smokers in two large American Cancer Society cohorts from 1959 to 2004; and (5) lung cancer incidence rates were higher and more variable among women in East Asia than in other geographic areas with low female smoking.ConclusionsThese comprehensive analyses support claims that the death rate from lung cancer among never-smokers is higher in men than in women, and in African Americans and Asians residing in Asia than in individuals of European descent, but contradict assertions that risk is increasing or that women have a higher incidence rate than men. Further research is needed on the high and variable lung cancer rates among women in Pacific Rim countries.

Background: We provide comprehensive sex-stratified projections of cancer prevalence for 22 cancer sites in Japan from 2020 to 2050. Methods: Using a scenario-based approach, we projected cancer prevalence by combining projected incidence cases and survival probabilities. Age-specific incidences were forecasted using age-period-cohort models, while survival rates were estimated using a period-analysis approach and multiple parametric survival models. To understand changes in cancer prevalence, decomposition analysis was conducted, assessing the contributions of incidence, survival, and population demographics. Results: By 2050, cancer prevalence in Japan is projected to reach 3,665,900 (3,210,200 to 4,201,400) thousand cases, representing a 13.1% increase from 2020. This rise is primarily due to a significant increase in female survivors (+27.6%) compared with a modest increase in males (+0.8%), resulting in females overtaking males in prevalence counts from 2040 onward. In 2050, the projected most prevalent cancer sites in Japan include colorectal, female breast, prostate, lung, and stomach cancers, accounting for 66.4% of all survivors. Among males, the highest absolute increases in prevalence are projected for prostate, lung, and malignant lymphoma cancers, while among females, the highest absolute increases are expected for female breast, colorectal, and corpus uteri cancers. Conclusions: These findings emphasize the evolving cancer prevalence, influenced by aging populations, changes in cancer incidence rates, and improved survival. Effective prevention, detection, and treatment strategies are crucial to address the growing cancer burden. Impact: This study contributes to comprehensive cancer control strategies and ensures sufficient support for cancer survivors in Japan. [ABSTRACT FROM AUTHOR]