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Purpose: We validated claims‐based algorithms using the International Classification of Diseases, Tenth Revision (ICD‐10) to identify patients with the first‐ever coronavirus disease (COVID‐19) onset between May 2020 and August 2022. Methods: The study cohort was comprised of residents of one municipality enrolled in a public insurance program. This study used data provided by the municipality, including residents' insurer‐based medical claims data linked to the Health Center Real‐time Information‐Sharing System (HER‐SYS). The HER‐SYS data included positive results from COVID‐19 tests and were used as reference standards. Claims‐based algorithms #1 and #2 were U07.1, B34.2, with and without suspicious diagnoses, respectively. Claims‐based algorithms #3 and #4 were U07.1 with and without suspicious diagnoses, respectively. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each algorithm. Results: The study cohort included 165 038 residents, including 13 402 residents were the reference standard. For the entire period, the sensitivity, specificity, PPV, and NPV were 55.7% (95% confidence interval: 54.8%–56.5%), 65.4% (65.2%–65.6%), 11.5% (11.3%–11.8%), and 98.9% (98.8%–99.0%) for Algorithm #1, and 67.0% (66.2%–67.8%), 88.1% (87.9%–88.3%), 31.6% (31.1%–32.2%), and 97.8% (97.7%–97.8%) for Algorithm #2, and 52.9% (52.0%–53.7%), 67.1% (66.9%–67.3%), 11.5% (11.2%–11.8%), and 98.3% (98.3%–98.4%) for Algorithm #3, 62.6% (61.8%–63.4%), 88.5% (88.3%–88.7%), 30.9% (30.3%–31.4%), and 97.3% (97.2%–97.4%) for Algorithm #4, respectively. Conclusions: Our study showed that the validity of claims‐based algorithms consisting of COVID‐19‐related ICD‐10 codes to identify patients with first‐onset COVID‐19 is limited. [ABSTRACT FROM AUTHOR]

This retrospective matched cohort study investigated the protective effects of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) against pneumonia mortality and all-cause mortality in Japanese adults aged ≥65 years. We analyzed claims data, vaccination records, and death certificate records between October 2016 and December 2019 from 55 509 PPSV23-vaccinated individuals and 55 509 unvaccinated individuals. Cox proportional hazards analyses were performed to calculate the adjusted hazard ratios (HRs) of PPSV23 vaccination for mortality. The results showed that PPSV23 vaccination was significantly associated with a reduction in all-cause mortality (adjusted HR, 0.52; P <.001) but not pneumonia mortality (adjusted HR, 0.70; P =.374). [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown a possible association between statin use and a decreased risk of dementia, but the association has not been sufficiently established, especially in the super-aging society of Japan. Objective: This study aimed to determine the association between statin use and the risk of dementia among Japanese participants aged> =65 years old. Methods: Data from the Longevity Improvement and Fair Evidence (LIFE) Study were utilized, including medical and long-term care (LTC) claim data from 17 municipalities between April 2014 and December 2020. A nested case-control study was conducted with one case matched to five controls based on age, sex, municipality, and year of cohort entry. We used a conditional logistic regression model to calculate the odds ratios (ORs) and 95% confidence intervals (95% CIs). Results: This study included 57,302 cases and 283,525 controls, with 59.7% of the participants being woman. After adjusting for potential confounders, statin use was associated with a lower risk of dementia (OR, 0.70; 95% CI: 0.68–0.73) and Alzheimer's disease (OR: 0.66; 95% CI: 0.63–0.69). Compared with non-users, the ORs of dementia were as follows: 1.42 (1.34–1.50) for 1–30 total standardized daily dose (TSDD), 0.91 (0.85–0.98) for 31–90 TSDD, 0.63 (0.58–0.69) for 91–180 TSDD, and 0.33 (0.31–0.36) for >180 TSDD in dose-analysis. Conclusions: Statin use is associated with a reduced risk of dementia and Alzheimer's disease among older Japanese adults. A low cumulative statin dose is associated with an increased risk of dementia, whereas a high cumulative statin dose is a protective factor against dementia. [ABSTRACT FROM AUTHOR]

Background The association between care needs level (CNL) at hospitalisation and postdischarge outcomes in older patients with acute heart failure (aHF) has been insufficiently investigated. Methods This population-based cohort study was conducted using health insurance claims and CNL data of the Longevity Improvement & Fair Evidence study. Patients aged ≥65 years, discharged after hospitalisation for aHF between April 2014 and March 2022, were identified. CNLs at hospitalisation were classified as no care needs (NCN), support level (SL) and CNL1, CNL2–3 and CNL4–5 based on total estimated daily care time as defined by national standard criteria, and varied on an ordinal scale between SL&CNL1 (low level) to CNL4–5 (fully dependent). The primary outcomes were changes in CNL and death 1 year after discharge, assessed by CNL at hospitalisation using Cox proportional hazard models. Results Of the 17 724 patients included, 7540 (42.5%), 4818 (27.2%), 3267 (18.4%) and 2099 (11.8%) had NCN, SL&CNL1, CNL2–3 and CNL4–5, respectively, at hospitalisation. One year after discharge, 4808 (27.1%), 3243 (18.3%), 2968 (16.7%), 2505 (14.1%) and 4200 (23.7%) patients had NCN, SL&CNL1, CNL2–3, CNL4–5 and death, respectively. Almost all patients' CNLs worsened after discharge. Compared to patients with NCN at hospitalisation, patients with SL&CNL1, CNL2–3 and CNL4–5 had an increased risk of all-cause death 1 year after discharge (hazard ratio [95% confidence interval]: 1.19 [1.09–1.31], 1.88 [1.71–2.06] and 2.56 [2.31–2.84], respectively). Conclusions Older patients with aHF and high CNL at hospitalisation had a high risk of all-cause mortality in the year following discharge. [ABSTRACT FROM AUTHOR]

Background: Several studies have investigated post‐extraction bleeding in patients on antithrombotic therapy, but most included a small sample size. Objective: This study aimed to analyse post‐extraction bleeding in patients on antithrombotic therapy using data from a large database. Materials and Methods: Claims data of National Health Insurance and Late‐Stage Elderly Healthcare System enrollees who underwent tooth extraction between October 2014 and March 2019 (n = 107 767) in a large multiregional cohort study (Longevity Improvement and Fair Evidence study) were included. Antithrombotic therapy was determined based on the drug codes used at the time of tooth extraction (classified into six groups: no antithrombotic, single antiplatelet, dual antiplatelet, Direct Oral Anticoagulant, warfarin and combined antiplatelet and anticoagulant therapies). The outcome was defined as the presence of "post‐extraction bleeding" as a receipt disease name in the same month as tooth extraction. To examine the association between antithrombotic therapy and post‐extraction bleeding in detail, multiple logistic regression analysis was performed with post‐extraction bleeding as the objective variable; each antithrombotic therapy as the explanatory variable; and age, sex and comorbidities as adjustment variables. Results: Antithrombotic therapy was administered in 14 343 patients (13.3%), and post‐extraction bleeding was observed in 419 patients (0.4%). The rate of post‐extraction bleeding was significantly lower in the no antithrombotic therapy and single antiplatelet groups than that in the other groups (odds ratio: 2.00–9.02). Conclusion: The frequency of post‐extraction bleeding is high in patients on anticoagulation or dual antithrombotic therapy. Therefore, careful preparation before extraction is necessary in these patients. [ABSTRACT FROM AUTHOR]

Background: Bivalent COVID-19 vaccines have been implemented worldwide since the booster vaccination campaigns of autumn of 2022, but little is known about their effectiveness. Thus, this study holistically evaluated the effectiveness of bivalent vaccines against infection in older adults in Japan. Methods: We adopted the test-negative design using COVID-19 test data of individuals, aged ≥ 65 years, residing in three municipalities in Japan, who underwent tests in medical institutions between October 1 and December 30, 2022. Logistic regression analyses were conducted to estimate the odds of testing positive according to vaccination status. Vaccine effectiveness was defined as (1 − odds ratio) × 100%. Results: A total of 3,908 positive and 16,090 negative results were included in the analyses. Receiving a bivalent dose in addition to ≥ 2 monovalent doses was 33.6% (95% confidence interval [CI]: 20.8, 44.3%) more effective than receiving no vaccination, and 18.2% (95% CI: 9.4, 26.0%) more effective than receiving ≥ 2 monovalent doses but not receiving a bivalent vaccination. In addition, the effectiveness peaked at 14–20 days after administration and then gradually declined over time. Furthermore, a bivalent booster dose provided 18.6% (95% CI: 9.9, 26.5%) additional protection among those vaccinated with ≥ 2 monovalent doses, in the absence of a previous infection history. However, we did not find sufficient evidence of effectiveness of bivalent vaccines among previously infected older adults. Conclusions: Bivalent vaccines are effective against COVID-19 infections among older adults without a history of infection. [ABSTRACT FROM AUTHOR]

Background Seasonal influenza vaccination might be considered an antimicrobial resistance (AMR) countermeasure because it can reduce unnecessary antimicrobial use for acute respiratory infection by mitigating the burden of such diseases. Objectives To examine the association between seasonal influenza vaccination and antimicrobial use (AMU) in Japan at the community level and to examine the impact of influenza vaccination on the frequency of unnecessary antimicrobial prescription for upper respiratory infection. Methods For patients who visited any healthcare facility in one of the 23 wards of Tokyo, Japan, due to upper respiratory infection and who were aged 65 years or older, we extracted data from the Vaccine Effectiveness, Networking, and Universal Safety (VENUS) study database, which includes all claims data and vaccination records from the 2015–16 to 2020–21 seasons. We used the average treatment effect (ATE) with 1:1 propensity score matching to examine the association of vaccination status with frequency of antibiotic prescription, frequency of healthcare facility consultation, risk of admission and risk of death in the follow-up period of the same season (from 1 January to 31 March). Results In total, 244 642 people were enrolled. Matched data included 101 734 people in each of the unvaccinated and vaccinated groups. The ATE of vaccination was −0.004 (95% CI −0.006 to −0.002) for the frequency of antibiotic prescription, −0.005 (−0.007 to −0.004) for the frequency of healthcare facility consultation, −0.001 (−0.002 to −0.001) for the risk of admission and 0.00 (0.00 to 0.00) for the risk of death. Conclusions Our results suggest that seasonal influenza vaccination is associated with lower frequencies of unnecessary antibiotic prescription and of healthcare facility consultation. [ABSTRACT FROM AUTHOR]