近藤 克則

日本には脳卒中データバンク、J-ASPECT、日本リハビリテーション・データベース、回復期リハビリテーション病棟協会の調査、脳卒中登録事業、脳卒中地域連携クリティカルパスなど、様々な脳卒中データベースがある。データベースの利点は多施設データ、脳卒中診療の可視化と質の向上、臨床試験に貢献可能、臨床研究の活性化などがある。課題は参加施設数、データ欠損、運用に多くの労力と費用が必要なこと、データベース間の連携である。これらの課題を解決し、またデータベースを用いた研究の信頼性を高めて、日本における脳卒中のエビデンスを明らかにしていく必要がある。特に、全国的なリハビリテーションのデータベースの充実が望まれる。(著者抄録)

We investigated the contextual effects of community social capital on functional ability among older people with functional disability in Japan, and the cross-level interaction effects between community social capital and individual psychosocial characteristics. We used data from the Japan Gerontological Evaluation Study for 1936 men and 2207 women nested within 320 communities and followed for 46 months. We used objective data for functional ability trajectories derived from the national long-term care-insurance system, and a validated measure of health-related community social capital comprising three components: civic participation, social cohesion, and reciprocity. A multilevel survival analysis with a community-level random intercept showed that in communities with high civic participation, women who actively participated in any community group showed greater functional ability improvement than did women who did not participate (pinteraction = 0.05). In communities with high social cohesion, older men who perceived that their communities' social cohesion was high showed greater functional ability improvement than men who perceived it to be low (pinteraction = 0.02). Community social capital can thus affect functional ability improvements variously, depending on individual psychosocial characteristics and gender. Community interventions aiming to foster social capital should focus on people who are excluded from existing opportunities to participate.

目的：介護予防を目的とした住民運営の通いの場で間接的支援を行う作業療法士の役割について明確化すること．対象：A 県B 町憩いのサロンプロジェクトを主導してきたリハビリテーション専門医であるA 氏，サロンのボランティア養成講座の講師を担当してきた作業療法士B 氏．方法：A 氏，B 氏へ個別インタビュー調査を行い，目的に沿って結果を整理した．結果：サロン全体の取り組みと作業療法士が関与する点，ボランティア養成講座を通した作業療法士の支援の視点が明らかになった．考察：作業療法士の役割として，サロンの企画・運営の支援，ボランティア養成講座の企画・講師，サロン実施の際のサポートと振り返りの助言，サロン参加者の評価と行政へのフィードバック，の4点があった．

Instrumental activities of daily living (IADL) represent the most relevant action capacity in older people with regard to independent living. Previous studies have reported that there are geographical disparities in IADL decline. This study examined the associations between each element of community-level social capital (SC) and IADL disability. This prospective cohort study conducted between 2010 and 2013 by the Japan Gerontological Evaluation Study (JAGES) surveyed 30,587 people aged 65 years or older without long-term care requirements in 380 communities throughout Japan. Multilevel logistic-regression analyses were used to determine whether association exists between community-level SC (i.e., civic participation, social cohesion, and reciprocity) and IADL disability, with adjustment for individual-level SC and covariates such as demographic variables, socioeconomic status, health status, and behavior. At three-year follow-up, 2886 respondents (9.4%) had suffered IADL disability. Residents in a community with higher civic participation showed significantly lower IADL disability (odds ratio: 0.90 per 1 standard deviation increase in civic participation score, 95% confidence interval: 0.84⁻0.96) after adjustment for covariates. Two other community-level SC elements showed no significant associations with IADL disability. Our findings suggest that community-based interventions to promote community-level civic participation could help prevent or reduce IADL disability in older people.

This cross-sectional study aimed to compare access to the nearest food stores with perceived access associated with intake frequencies of vegetables/fruits and meat/fish among older Japanese people. We used intake frequencies of vegetables/fruits and meat/fish from a self-administered questionnaire in the Japan Gerontological Evaluation Study among 83,384 adults aged over 65 years. We defined distance over 1 km as poor objective access in community level. We performed multilevel regression analysis to investigate the association of objective and perceived access with intake frequencies of vegetables/fruits and meat/fish, respectively. Participants who lived in poor objective access had a significantly higher intake frequency of vegetables/fruits than those who lived in good access. In contrast, residents with poor perceived access consumed lower frequent intake of vegetables/fruits (beta coefficient (standard error) 0.086 (0.021) for objective access; -0.093 (0.009) for perceived access). There was no significant association between objective access and intake frequency of meat/fish, but poor perceived access showed a significant association with lower intake frequency of meat/fish. There was inconsistency between objective and perceived measurement of access to food stores associated with dietary habits among older Japanese adults. Food access needs to be comprehensively assessed, while considering characteristics of measurements.

INTRODUCTION: Interventions targeting built environmental factors may encourage older people to engage in favorable behaviors and decrease dementia risk, but epidemiologic evidence is limited. This study investigated the association between neighborhood food environment and dementia incidence. METHODS: A 3-year follow-up (2010-2013) was conducted among participants in the Japan Gerontological Evaluation Study, a population-based cohort study of older adults aged ≥65 years. Dementia incidence for 49,511 participants was assessed through the public long-term care insurance system. Availability of food stores (defined as the number of food stores selling fruits and vegetables within 500 meters or 1 kilometer of residence) was assessed for each participant using objective (GIS-based) and subjective (participant-reported) measurements. Data were analyzed from 2017 to 2018. RESULTS: A total of 3,162 cases of dementia occurred during the follow-up. Compared with the highest quartile for objective availability of food stores, the hazard ratio adjusting for age and sex was 1.60 (95% CI=1.43, 1.78) for the second-lowest quartile. Compared with the highest subjective availability of food stores, the hazard ratio was 1.74 (95% CI=1.49, 2.04) for the lowest category. After successive adjustment for sociodemographic characteristics, health status, and other geographic neighborhood factors (availability of restaurants, convenience stores, and community centers), the hazard ratio remained statistically significant. CONCLUSIONS: Lower food store availability was associated with increased dementia incidence. Given that food shopping is a routine activity and a main motive for going out among older adults, increasing the availability of food stores may contribute to dementia prevention.

BACKGROUND: Recovery from functionally disabled status is an important target of public health measures for older adults. This study aimed to examine socioeconomic inequalities in the improvement of functional ability among older adults stratified by the level of disability at baseline. METHODS: In the Japan Gerontological Evaluation Study, we conducted a mail survey of community-dwelling older adults (1937 men and 2212 women) who developed functional impairment during 2010-2014. The survey data were individually linked to the longitudinal records of changes in the levels of functional disability based on the Public Long-Term Care Insurance System. RESULTS: The mean (standard deviation) follow-up period was 316 (269) days. During follow-up, 811 participants (19.5%) showed improved functional ability. Among those with severe disabilities at baseline, men with 13 or more years of education were more likely to improve functional ability than men with 9 or fewer years of education (hazard ratio: 1.97, 95% confidence interval: 1.12-3.45). A similar association was observed among women (hazard ratio: 2.16, 95% confidence interval: 1.03-4.53). Neither income nor occupation was statistically associated with improved functional ability. CONCLUSIONS: There are education-related inequalities in the improvement of functional ability, especially among older adults with severe disabilities. Health policy makers and practitioners should consider the educational background of individuals with reduced functionality in formulating strategies to improve their functional ability.

BACKGROUND: We explored the distinct trajectories of functional decline among older adults in Japan, and evaluated whether the frequency of outings, an important indicator of social activity, predicts the identified trajectories. METHODS: We analyzed data on 2,364 adults aged 65 years or older from the Japan Aichi Gerontological Evaluation Study. Participants were initially independent and later developed functional disability during a 31-month follow-up period. We used the level of long-term care needs certified in the public health insurance system as a proxy of functional ability and linked the fully tracked data of changes in the care levels to the baseline data. A low frequency of outings was defined as leaving one's home less than once per week at baseline. We applied a growth mixture model to identify trajectories in functional decline by sex and then examined the association between the frequency of outings and the identified trajectories using multinomial logistic regression analysis. RESULTS: Three distinct trajectories were identified: "slowly declining" (64.3% of men and 79.7% of women), "persistently disabled" (4.5% and 3.7%, respectively), and "rapidly declining" (31.3% and 16.6%, respectively). Men with fewer outings had 2.14 times greater odds (95% confidence interval, 1.03-4.41) of being persistently disabled. The association between outing frequency and functional decline trajectory was less clear statistically among women. CONCLUSIONS: While the majority of older adults showed a slow functional decline, some showed persistent moderate disability. Providing more opportunities to go out or assistance in that regard may be important for preventing persistent disability, and such needs might be greater among men.

＜文献概要＞はじめに 脳卒中は,心血管疾患のなかでも頻度が高く,2017年には再び死因の第3位となり,要介護状態に陥る疾患では認知症に続く第2位である.また,今後の高齢者人口の増加に伴い,脳卒中患者数は2014年の118万人から増加して2020年には166万人と将来推計されている.脳卒中医療では,急性期の入院治療以外にも,脳卒中の発症予防,後遺症に対するリハビリテーション,在宅介護など膨大な資源が投入されており,2016年度の国民医療費における脳血管疾患の年間医療費は1兆7439億円であったことが報告されている.限られた医療費のなかで良質な医療を提供するためには,脳卒中診療の体制整備や効率化が必要であり,そのためには悉皆性と信頼性を合わせもつ国家的な脳卒中登録事業が不可欠とされている.海外においては,1990年代よりビッグデータを利用した全国規模の脳卒中登録研究が進められている.一方,わが国においても医療のIT化が進み,近年ではビッグデータの解析による医療への活用が注目されてきている.本稿では,まず脳卒中登録研究における海外の動向を紹介し,日本の脳卒中診療における症例登録(事業/研究)の目的やデータベース構築の意義および継続性の課題を述べる.

＜文献概要＞はじめに リハビリテーションのデータベースには,多施設データの利点,リハビリテーションの可視化と質の向上,臨床試験や診療報酬・介護報酬への貢献,臨床研究の活性化などさまざまな効果がある.しかし,リハビリテーションのデータベースの現状は十分とはいえない.本稿では,日本リハビリテーション・データベースの概要,登録データ数,活用,今後の展開などについて概説する.また,回復期リハビリテーション病棟協会のデータベースについても述べる.

BACKGROUND: Low back pain is an important public health issue across the world. However, it is unclear whether socioeconomic status (SES) is associated with low back pain. This study determines an association between SES and low back pain among older people. METHODS: We used cross-sectional data derived from the year 2013 across 30 Japanese municipalities. The survey was conducted between October 2013 to December 2013. Functionally independent community-dwelling older adults aged 65 and above (n = 26,037) were eligible for the study. Multilevel Poisson regression analysis with a robust variance estimator was used to examine the association between SES and low back pain. Self-reported low back pain in the past year was used as a dependent variable. Educational attainment, past occupation, equivalized household income, wealth, and subjective economic situation represented SES and were separately analyzed as independent variables, adjusted for covariates including age and sex. RESULTS: The prevalence of low back pain was 63.4%. Overall, lower SES were more likely to suffer from low back pain compared with that for the highest. First, as for the educational attainment, the prevalence ratio (PR) (95% credible interval (CI)) for the lowest level was 1.07 (1.02-1.12). Second, as for the past occupation, the PR (95% CI) for the blue-collared workers compared with professionals was 1.06 (1.01-1.11). Third, as for the equalized household income, the PRs (95% CI) for lower middle and the lowest income levels were 1.08 (1.02-1.13) and 1.16 (1.10-1.23), respectively. Fourth, as for the wealth, the PRs (95% CI) for lower middle and the lowest wealth levels were 1.11 (1.04-1.19) and 1.18 (1.11-1.27), respectively. Fifth, as for the subjective economic situation, the PRs (95% CI) for lower middle and the lowest financial conditions were 1.18 (1.10-1.26) and 1.32 (1.22-1.44), respectively. CONCLUSIONS: Significant socioeconomic inequalities were observed in low back pain among older individuals in Japan. Policymakers and clinicians must understand the nature of these inequalities.

Most studies have evaluated poverty in terms of income status, but this approach cannot capture the diverse and complex aspects of poverty. To develop commodity-based relative deprivation indicators and evaluate their associations with mortality, we conducted a 6-year follow-up of participants in the Japan Gerontological Evaluation Study (JAGES), a population-based cohort of Japanese adults aged 65 and older. We analyzed mortality for 7614 respondents from 2010 to 2016. Cox regression models with multiple imputation were used to estimate hazard ratios (HRs) for mortality. Seven indicators were significantly associated with mortality: no refrigerator, no air conditioner, cut-off of essential services in the past year for economic reasons, and so on. Among participants, 12.0% met one item, and 3.3% met two items or more. The HRs after adjusting for relative poverty and some confounders were 1.71 (95%CI: 1.18⁻2.48) for relative deprivation, and 1.87 (95%CI: 1.14⁻3.09) for a combination of relative poverty and deprivation. Relative deprivation was attributable to around 27,000 premature deaths (2.3%) annually for the older Japanese. Measurement of relative deprivation among older adults might be worthwhile in public health as an important factor to address for healthy aging.

Health communication inequality is one of the potential mechanisms linking socioeconomic status (SES) to health disparities. To our knowledge, no previous study has examined the association between exposure to health information and mortality. We analyzed 3-year follow-up cohort data from the Japan Gerontological Evaluation Study (JAGES), involving 8544 males and 9698 females aged 65 years or older, to examine associations between exposure to health information via different types of media and mortality. The baseline survey was conducted from October to December 2013 in 21 municipalities in Japan. Adjusted for health conditions, health behaviors, and other potential confounders, Cox proportional hazards models were used to estimate hazard ratios (HRs) of all-cause mortality. Over a mean of 3.2 years of follow-up, 956 deaths occurred. Among females, receiving health information from TV programs was associated with lower mortality (HR = 0.90; 95% confidence interval [CI] = 0.83, 0.98). By contrast, there were no significant associations among males. Our findings suggest that improving the accuracy of health information delivered via television might be beneficial.

＜文献概要＞【背景】地域づくりによる介護予防に有用な地域診断の量的指標と今後の課題を明らかにすることを目的とした.【方法】医学中央雑誌Web,PubMedで検索し入手した日本における31論文を対象に,(1)研究デザイン,(2)地域単位,(3)介護予防アウトカム指標,(4)関連指標を抽出した.2つ以上の論文で指標間に有意な関連(再現性)があった指標について,5人の評価者が相談せずに量的指標に必要な6基準を満たすか評価した.【結果】横断研究による市町村・校区レベルを地域単位とした研究が多く,アウトカム28指標,関連69指標が報告されていた.再現性があった27指標のうち3人以上が6基準を満たすと評価したのは14指標で,社会参加やサポートあり割合などが高い地域ほど,うつ,閉じこもり,転倒,残存歯数少ない,要支援・介護認定の割合が低かった.【結語】14指標が地域診断に有用と思われた.今後は,低栄養,認知機能低下などにかかわる指標開発や縦断研究による予測妥当性の検証が望まれる.

BACKGROUND: No studies have examined the associations between the numbers of teeth and sleep disturbance. Therefore, we examined the associations between the number of teeth and sleep duration in older people, considering the evidence linking fewer teeth and sleep apnoea through changes in jaw position. METHODS: For this study we used information from a sample of 23,444 cohort participants, randomly selected from the Japan Gerontological Evaluation Study 2010 (N = 169,215). The outcome variable was self-reported sleep duration (h/day), and the explanatory variable was self-reported number of teeth (0, 1-9, 10-19, ≥20). We treated age, sex, body mass index, educational attainment, annual equalized household income, depressive symptoms, physical activity, activities of daily living, presence of diabetes, and smoking status as covariates. Multinomial logistic regression was used among the 20,548 eligible participants with all necessary information. RESULTS: The mean age was 73.7 (standard deviation = 6.13) years. Most participants (28.1%) reported sleep duration of 7 h, while a small proportion of the participants reported short (≤4 h, 2.7%) or long (≥10 h, 4.7%) sleep duration. The proportion of edentulous participants was 14.7%. Taking the 7-h sleep duration as the reference category, edentulous participants (relative risk ratio (RRR) = 1.43, 95% confidence interval (CI) = 1.07-1.90) or one to nine teeth (RRR = 1.29, 95% CI = 1.02-1.63) had a significantly higher relative risk ratio for short sleep, independent of covariates. Furthermore, they had a higher relative risk ratio for long sleep duration (RRR = 1.75, 95% CI = 1.40-2.19; RRR = 1.48, 95% CI = 1.21-1.81, respectively). CONCLUSIONS: Compared to people with 20 or more teeth, older adults with fewer than 10 teeth have higher risks for short and long sleep durations.

それぞれの地域における地域包括ケアシステムが機能するかどうかは、"4つの助(自助、互助、共助、公助)"や、"地域マネジメント"が機能するかどうかにかかっている。その鍵を握ると考えられるのがソーシャルキャピタルである。その定義や介護予防における実証研究を紹介しながら地域包括ケアとのかかわりについて述べる。(著者抄録)

BACKGROUND: Previous research has linked lower availability of food stores selling fruits and vegetables to unhealthy diet. However, the longitudinal association between the availability of healthy food stores and mortality is unknown. This study examined the association between neighborhood availability of food stores and mortality by driving status among older adults. METHODS: This study drew upon a three-year follow up of participants in the Japan Gerontological Evaluation Study, a population-based cohort study of Japanese adults aged 65 years or older. Mortality from 2010 to 2013 was analyzed for 49,511 respondents. Neighborhood availability of food stores was defined as the number of food stores selling fruits and vegetables within a 500-m or 1-km radius of a person's residence. Both subjective (participant-reported) and objective (geographic information system-based) measurements were used to assess this variable. Cox regression models were used to estimate hazard ratios (HR) for mortality. RESULTS: A total of 2049 deaths occurred during the follow up. Lower subjective availability of food stores was significantly associated with increased mortality. Compared with participants reporting the highest availability, the age- and sex-adjusted HR for those reporting the lowest availability was 1.28 (95% CI: 1.04-1.58; p = 0.02). The association remained significant after adjustment for sociodemographic (education, income, cohabitation, marital status, and employment status) and environmental (driving status, use of public transportation, and study site) status (HR = 1.24, 95% CI: 1.01-1.53, p = 0.04). This association was stronger among non-car users, among whom the HR for those reporting the lowest availability of food stores was 1.61 (95% CI: 1.08-2.41, p = 0.02). In contrast, no significant association was seen between objective availability and mortality. CONCLUSIONS: Lower availability of healthy food stores measured subjectively, but not objectively, was associated with mortality, especially among non-car users. Considering the decline in mobility with age, living in a neighborhood with many options for procuring fruits and vegetables within walking distance may be important for healthy aging.

BACKGROUND: There is little longitudinal evidence on the impact of specific living arrangements (ie, who individuals live with) on mental health among older adults, and no studies have examined the modifying effect of residential social cohesion level on this association. We aimed to examine the association between living arrangements and depressive symptoms and whether this association varies with residential neighborhood social cohesion level among 19,656 men and 22,513 women aged 65 years and older in Japan. METHODS: We analyzed the association between baseline living arrangements in 2010 and depressive symptoms in 2013. We calculated gender-specific odds ratios (ORs) of living arrangements for depressive symptoms using a logistic regression and conducted subgroup analyses by neighborhood social cohesion level. RESULTS: Among men (but not women), living alone (OR 1.43; 95% confidence intervals [CI], 1.18-1.73) and living with spouse and parent (OR 1.47, 95% CI, 1.09-1.98) were associated with increased odds of depressive symptoms compared with living with a spouse only. Living with spouse and child was a risk for men in the young age group but a protective factor for women. We also identified that the negative impact of living arrangements on depressive symptoms was attenuated in neighborhoods with higher levels of social cohesion. CONCLUSIONS: Living arrangements are associated with risk of depressive symptoms among men and women; these associations differ by gender and neighborhood social cohesion level. Our results suggest the need to pay more attention to whether individuals live alone, as well as who individuals live with, to prevent depressive symptoms among older adults.

OBJECTIVES: Laughter has a positive and quantifiable effect on certain aspects of health, and previous studies have suggested that income influences the emotion. However, it is unknown whether social relationship-related factors modify the association between equivalised income and laughter among older people. In the present study, we examined the relationship between equivalised income and the frequency of laughter. In addition, we examined the impact of social relationship-related factors on the association between equivalised income and frequency of laughter using a cross-sectional study design. DESIGN: Cross-sectional study and binomial regression analysis. SETTING: We sampled from 30 municipalities in Japan. PARTICIPANTS: We examined 20 752 non-disabled Japanese individuals aged ≥65 years using data from the Japan Gerontological Evaluation Study. PRIMARY OUTCOME: Frequency of laughter. RESULTS: Laughter increased significantly with an increase in equivalent income (p for trend <0.0001). Prevalence ratios (PR) for laughing almost every day were calculated according to quartile equivalised income after adjusting for age, instrumental activities of daily living, depression, frequency of meeting friends, number of social groups and family structure. The results revealed that PRs in Q4 (men; ≥€24 420, women; ≥€21 154) were 1.21 (95% CI 1.13 to 1.30) among men and 1.14 (95% CI 1.08 to 1.20) among women, as compared with Q1 (men; <€12 041, women; <€9518), respectively. After excluding participants with depression, the association remained significant. In addition, we found inadequate social relationships and living alone were associated with a lower frequency of laughter. In comparison with the lowest equivalent income with meeting friends less frequently and living alone, the PRs of the highest equivalent income with meeting friends frequently and living with someone were higher, respectively. CONCLUSIONS: The results revealed a significant relationship between equivalent income and the frequency of laughter. Social relationships and family structure were also associated with the frequency of laughter.

In Japan, the prevalence of dementia is expected to reach 4.7 million by 2025. This study aimed to develop a risk score for the prediction of incident dementia in community-dwelling older adults. In this longitudinal observational study, we used data from the Japan Gerontological Evaluation Study (JAGES) conducted in K City. We performed Cox regression analyses to develop three risk score models for the prediction of incident dementia in older adults using a frailty index and health checkup data. Analyses of the area under the receiver operating characteristic curve were conducted to compare the models’ predictive abilities. We identified 6656 (9.2%) individuals who developed incident dementia during the observation period. The C-statistics of the risk scores ranged from 0.733 to 0.790. The risk score models were able to predict incident dementia in older adults and may help non-medical professionals detect dementia risk at an early stage.

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.

Background: Increasing evidence suggests an impact of childhood disadvantage on late-life functional impairment in Western countries. However, the processes by which childhood disadvantage affects functional capacity are influenced by several factors unique to particular societies. We examined the impact of childhood disadvantage on functional decline among older Japanese, using a large-scale prospective cohort study. Methods: Data came from surveys conducted in 2010 and 2013 as part of the Japan Gerontological Evaluation Study (JAGES), a nationwide cohort study targeting community-dwelling people aged 65 years and over. Childhood disadvantage included subjective childhood socioeconomic status (SES), body height, and educational level. The sample was stratified by age at baseline (65-69, 70-74, 75-79, and ≥ 80 years). Results: A total of 11,601 respondents were analyzed. In the 65-69-year group, lower childhood SES was associated with functional decline but this association was mediated by adult SES. In contrast, childhood SES was independently associated with functional decline in the older cohort. In the 75-79-year group, lower childhood SES was associated with functional decline. However, in the ≥ 80-year group, people with higher childhood SES were more likely to experience functional decline. Shorter height was associated with functional decline in the 70-74-year group. Higher education was related to functional decline in all age groups except the ≥ 80-year group. Conclusions: These findings suggest that childhood disadvantage affects functional decline but its effect varies by age cohort. The mechanisms underlying the association between childhood disadvantage and functional decline may be influenced by social and historical context.

Purpose Community-level group participation is a structural aspect of social capital that may have a contextual influence on an individual's health. Herein, we sought to investigate a contextual relationship between community-level prevalence of sports group participation and depressive symptoms in older individuals. Methods We used data from the 2010 Japan Gerontological Evaluation Study, a population-based, cross-sectional study of individuals 65 yr or older without long-term care needs in Japan. Overall, 74,681 participants in 516 communities were analyzed. Depressive symptoms were diagnosed as a 15-item Geriatric Depression Scale score of ≥5. Participation in a sports group 1 d·month-1 or more often was defined as "participation." For this study, we applied two-level multilevel Poisson regression analysis stratified by sex, calculated prevalence ratios (PR), and 95% confidence intervals (CI). Results Overall, 17,420 individuals (23.3%) had depressive symptoms, and 16,915 (22.6%) participated in a sports group. Higher prevalence of community-level sports group participation had a statistically significant relationship with a lower likelihood of depressive symptoms (male: PR, 0.89 (95% CI, 0.85-0.92) female: PR, 0.96 (95% CI, 0.92-0.99), estimated by 10% of participation proportion) after adjusting for individual-level sports group participation, age, diseases, family form, alcohol, smoking, education, equivalent income, and population density. We found statistically significant cross-level interaction terms in male participants only (PR, 0.86 95% CI, 0.77-0.95). Conclusions We found a contextual preventive relationship between community-level sports group participation and depressive symptoms in older individuals. Therefore, promoting sports groups in a community may be effective as a population-based strategy for the prevention of depression in older individuals. Furthermore, the benefit may favor male sports group participants.

Previous studies on trust and health have not fully considered the nature of trust in relation to types of trust and socio-cultural background. The present study aimed to examine whether generalized trust (trust in general people; GT) and particularized trust (trust in particular people; PT) in urban and rural areas had different associations with health. This prospective cohort study on older adults used panel data obtained in 2010 and 2013. Surveys were conducted in 24 municipalities in Japan. Of 20,209 respondents, 13,657 participants were followed up. The independent variables were GT and PT in neighbors; the dependent variable was self-rated health (SRH) at follow-up. We examined the interaction term between population density and each trust variable. Age, sex, SRH at the baseline, and other potential confounders were adjusted. The median age was 72 years (females: 53.4%). Percentages of high GT and high PT were 21.0% and 72.4%, respectively. Prevalence of poor SRH at the follow-up was 15.5% and 28.5% in high and low GT, respectively, and 16.9% and 32.8% in high and low PT, respectively. After adjusting for covariates in logistic regression models, low GT and PT were significantly associated with higher odds ratios (ORs) for poor SRH compared to high trust (GT: OR = 1.43 [95% confidence interval (95%CI) = 1.17, 1.75] and PT: OR = 1.44 [95%CI = 1.15, 1.81]). Associations of low PT with poor SRH significantly strengthened when population density increased (interaction term of low PT: OR = 1.16 [95%CI = 1.04, 1.27]). On the other hand, associations of GT with SRH were not significantly interacted by population density. The mediation analysis showed that the direct effects of PT influenced SRH in urban areas only. In urban areas with high social uncertainty, trust in particular neighbors was more beneficial to health.

BACKGROUND: Although reducing socioeconomic inequalities in depression is necessary, their associated factors have rarely been studied. This study aimed to screen the potential contextual factors associated with income-based inequality in older adults' depression. METHODS: Using data from the Japan Gerontological Evaluation Study (JAGES) of 2013, we conducted an ecological study covering 77 communities in Japan. Our measures of socioeconomic inequalities in depression were the slope index of inequalities (SII) and the relative index of inequalities (RII) of the prevalence of depressive symptoms across three income levels. We categorized available community-level factors, including socio-demographic factors, social participation, social relationships, subjective changes in the residential area, and the built environment. These indicators were aggregated from individual responses of 51,962 and 52,958 physically independent men and women, respectively, aged 65 years or more. We performed multiple linear regression analyses to explore factors with statistical significance of a two-tailed P-value less than 0.05. RESULTS: Factors associated with shallower gradients in depression for men included higher participation in local activities and reception or provision of social support, which did not show significant association among women. Perceived increases in unemployment and economic inequalities were positively associated with larger inequalities in both genders (P < 0.05). The built environment did not indicate any significant association. CONCLUSIONS: A community environment fostering social activities and relationships might be associated with smaller income-based inequalities in depression. There is a need for more deterministic studies for planning of effective community interventions to address socioeconomic inequalities in depression.

The 2011 Great East Japan Earthquake and Tsunami resulted in widespread property destruction and over 250,000 displaced residents. We sought to examine whether the type of housing arrangement available to the affected victims was associated with a differential incidence of depressive symptoms. In this prospective cohort study, which comprised participants aged ≥65 years from Iwanuma as a part of the Japan Gerontological Evaluation Study, we had information about the residents' mental health both before the disaster in 2010 and 2.5 years afterward. The Geriatric Depression Scale was used. Type of accommodation after the disaster was divided into 5 categories: no move, prefabricated housing (temporary housing), existing private accommodations (temporary apartment), newly established housing, and other. Poisson regression analysis was adopted, with and without multiple imputation. Among the 2,242 participants, 16.2% reported depressive symptoms at follow-up. The adjusted rate ratio for depressive symptoms among persons moving into prefabricated housing, compared with those who did not, was 2.07 (95% confidence interval: 1.45, 2.94). Moving into existing private accommodations or other types of accommodations was not associated with depression. The relationship between living environment and long-term mental health should be considered for disaster recovery planning.