近藤 克則

Background: Childhood socioeconomic disadvantage has been previously linked to increased mortality risk in adulthood. However, most previous studies have focused on middle-aged adults in Western contexts. Here, we sought to examine the association between childhood socioeconomic status (SES) and mortality among healthy older Japanese adults. Methods: We conducted a 3-year follow-up of participants in the Japan Gerontological Evaluation Study (JAGES), a population-based cohort of 65- to 103-year-old Japanese adults. Childhood SES was assessed by survey at baseline. Mortality from 2010 to 2013 was analysed for 15 449 respondents (7143 men and 8306 women). Cox regression models were used to estimate hazard ratios (HR) for risk of death. Results: A total of 754 deaths occurred during the 3-year follow-up. Lower childhood SES was significantly associated with lower mortality in men, but not in women. Compared with men growing up in more advantaged childhood socioeconomic circumstances, the age-adjusted HR for men from low childhood SES backgrounds was 0.75 [95% confidence interval (CI): 0.56-1.00]. The association remained significant after adjustment for height, education, adult SES, municipalities of residence, health behaviours, disease status and current social relationships (HR = 0.64; 95% CI 0.47-0.87). This association was stronger among men aged 75 years or older, HR = 0.67 (95% CI: 0.47-0.95), compared with men aged 65- 74 years, HR = 0.90 (95% CI: 0.54-1.51). Conclusions: Childhood socioeconomic disadvantage is associated with lower mortality among men aged 75 years or older, which may be due to selective survival, or alternatively to childhood physical training or postwar calorie restriction in this generation of Japanese males.

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 individualswhowere 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 0-5 years of education (HR of interaction term between 0 and 5 years 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. (C) 2016 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license.

Background We sought to examine social network diversity as a potential determinant of oral health, considering size and contact frequency of the social network and oral health behaviors. Methods Our cross-sectional study was based on data from the 2010 Japan Gerontological Evaluation Study. Data from 19,756 community-dwelling individuals aged 65 years or older were analyzed. We inquired about diversity of friendships based on seven types of friends. Ordered logistic regression models were developed to determine the association between the diversity of social networks and number of teeth (categorized as >= 20, 10-19, 1-9, and 0). Results Of the participants, 54.1% were women (mean age, 73.9 years; standard deviation, 6.2). The proportion of respondents with >= 20 teeth was 34.1%. After adjusting for age, sex, socioeconomic status (income, education, and occupation), marital status, health status (diabetes and mental health), and size and contact frequency of the social network, an increase in the diversity of social networks was significantly associated with having more teeth (odds ratio = 1.08; 95% confidence interval, 1.04-1.11). Even adjusted for oral health behaviors (smoking, curative/preventive dental care access, use of dental floss/fluoride toothpaste), significant association was still observed (odds ratio = 1.05 (95% confidence interval, 1.02-1.08)). Conclusion Social connectedness among people from diverse backgrounds may increase information channels and promote the diffusion of oral health behaviors and prevent tooth loss.

We sought to investigate prospectively the association between exposure to disaster (the 2011 East Japan Earthquake) and change in depressive symptoms among community-dwelling older adult survivors. We used two waves of data from the Japan Gerontological Evaluation Study (JAGES), an ongoing population based, prospective cohort study in Japan. A unique feature of our study was the availability of information about mental health status pre-dating the disaster. Our sample comprised community-dwelling survivors aged 65 and older, who responded to surveys in 2010 (i.e. one year before the disaster) and in 2013 (n = 3464). We categorized disaster exposure according to three types of experiences: loss of family/friends, property damage, and disruption in access to medical service. Our main outcome was change in depressive symptoms, measured by the 15-item geriatric depression scale (GDS). Among the participants, 917 (26.5%) reported losing a family member to the disaster, while a further 537 (15.5%) reported losing a friend. More than half of the participants reported some damage to their homes. After adjusting for demographics and baseline mental health, people whose homes were completely destroyed had significantly elevated depressive symptom scores three years later (+1.22 points, 95%CI: 0.80, 1.64, p < 0.0001). Disruption of psychiatric care was also associated with change in GDS scores (+2.51 points, 95%CI: 1.28, 3.74, p < 0.0001). By contrast, loss of family/friends was no longer associated with GDS after 3 years; +0.18 points (95%CI: -0.018, 0.37, p = 0.08) for loss of family, and -0.045 points (95%Cl: -0.28, 0.19, p = 0.71) for loss of friends. Three years after the disaster, survivors of the 2011 earthquake and tsunami appeared to have recovered from loss of loved ones. By contrast, property loss and disruption of psychiatry care were associated with persistent adverse impact on mental health. (C) 2016 Elsevier Ltd. All rights reserved.

Aging is a prominent topic in global health. The purpose of this report is to document progress in two of our research projects in Japan, which currently is the most aged society in the world. The Japan Gerontological Evaluation Study (JAGES) is one of the largest nation-wide research projects on aging, with more than 100 000 participants in 2010 and 2013. One of the notable findings is that community participation is a significant determinant of older people's health. We have also made progress in the development of the JAGES Health Equity Assessment and Response Tools (HEART), which is a management tool for developing age-friendly cities. This progress suggests that community perspective and management of health promotion in the communities are valuable and require further research.

BACKGROUND: Involuntary weight loss and underweight increase the risks of mortality and disability in older people. However, the association and interaction of poor oral health and dietary intake with body mass index (BMI) have not been elucidated. METHODS: Data were analyzed for 96 794 respondents aged >65 years who were randomly selected from 31 Japanese municipalities in the Japan Gerontological Evaluation Study. Weight loss was defined as ≥2-3 kg of loss over the preceding 6 months. BMI was evaluated in respondents without weight loss. Multiple logistic regression analysis was performed with weight loss, underweight, and obesity as dependent variables and having fewer teeth (<20) and infrequent food intake as independent variables, with adjustment for potential confounders. RESULTS: Weight loss was associated with having fewer teeth (men: odds ratio [OR] 1.3; 95% confidence interval [CI], 1.2-1.3; women: OR 1.2; 95% CI, 1.1-1.3) and infrequent fruit/vegetable intake (men: OR 1.1; 95% CI, 1.1-1.2; women: OR 1.4; 95% CI, 1.3-1.5) and fish/meat intake (OR 1.2; 95% CI, 1.1-1.3 for both sexes). No interaction was observed between having fewer teeth and food intake. Obesity was associated with the same factors: having fewer teeth (ORs 1.2 and 1.3 for men and women, respectively) and infrequent intake of fruit/vegetables (ORs 1.1 and 1.2 for men and women, respectively) and fish/meat (OR 1.1 for both sexes). Infrequent fruit/vegetable intake showed a higher OR for underweight in women with fewer teeth than for others. CONCLUSIONS: Having fewer teeth and infrequent food intake were associated with both weight loss and obesity. A significant interaction was observed in the associations of having fewer teeth and infrequent food intake with underweight in women.

In the aftermath of a disaster, the risk of posttraumatic stress disorder (PTSD) is high. We sought to examine whether the predisaster level of community social cohesion was associated with a lower risk of PTSD after the earthquake and tsunami in Tohoku, Japan, on March 11, 2011. The baseline for our natural experiment was established in a survey of older community-dwelling adults who lived 80 kilometers west of the epicenter 7 months before the earthquake and tsunami. A follow-up survey was conducted approximately 2.5 years after the disaster. We used a spatial Durbin model to examine the association of community-level social cohesion with the individual risk of PTSD. Among our analytic sample (n = 3,567), 11.4% of respondents reported severe PTSD symptoms. In the spatial Durbin model, individual- and community-level social cohesion before the disaster were significantly associated with lower risks of PTSD symptoms (odds ratio = 0.87, 95% confidence interval: 0.77, 0.98 and odds ratio = 0.75, 95% confidence interval: 0.63, 0.90, respectively), even after adjustment for depression symptoms at baseline and experiences during the disaster (including loss of loved ones, housing damage, and interruption of access to health care). Community-level social cohesion strengthens the resilience of community residents in the aftermath of a disaster.

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.

Background: Depression is the leading cause of impaired quality of life and burden upon societies. Social supports can buffer against depressive symptoms effectively. The aim of this study is to determine the type of social support to have a positive relationship with depressive symptoms in healthy population. Methods: 11,869 male and 12,763 female residents within the age range of 65-100 were analyzed cross-sectionally with regard to depressive symptoms (evaluated by the Japanese version of the 15-item Geriatric Depression Scale), social supports (four dimensions: giving or receiving, emotional or instrumental), and covariates utilizing data collected by the Japan Gerontological Evaluation Study. Analyzed participants were GDS scores &lt;= 10 and independence in ADL, who could give and receive supports well. Multiple linear models were applied for the analysis. Results: All supports between husband and wife were significantly associated with lower depressive degrees. In comparison with the differences between receiving and giving supports in predictive effects on depressive degrees, giving social supports to outside family, emotional or instrumental, were associated with fewer depressive symptoms. Conclusions: There is a possibility that not only supports between husband and wife but giving social supports to outside family accounts for psychological benefits against depression, in addition to supports between husband and wife.

BACKGROUND: Being homebound is an important risk factor of functional disability in older people. There is a possibility of bidirectional relationship between homeboundness and dental health. This prospective cohort study examined the association of dental health, which includes social function, on homeboundness in the future. METHODS: The participants were ≥ 65 years, responded to two postal surveys conducted in 2006 and 2010, and were not homebound at baseline. Logistic regression analysis was used to estimate the odds ratios for homeboundness, defined as going out of one's home less than once weekly. Self-reported baseline dental status was used as the main predictor. Age, sex, marital status, educational attainment, income, comorbidity, depression, walking time, living alone, and area of residence were used as covariates. RESULTS: Among 4390 non-homebound respondents, 7.4 % were homebound four years later. The proportions of homebound respondents with < 20 teeth without dentures, < 20 teeth with dentures, and ≥ 20 teeth were 9.7, 8.8, and 4.4 %, respectively. The odds for being homebound in the 65-74-year age group, adjusted for covariates, was 1.78 (95 % CI: 1.01-3.13; p < 0.05) times higher for respondents with < 20 teeth and no dentures than that for respondents with ≥ 20 teeth. Among the participants in the ≥ 75-year age group, a significant association of homeboundness and dental health was not observed. CONCLUSIONS: Among the young-old population, poor dental health predicted future onset of homeboundness, while depressive symptoms did not show any significant association.

日本リハビリテーション・データベース協議会（Japan Association of Rehabilitation Database：JARD）が運用するデータベース（Japan Rehabilitation Database，以下JRD）には，脳卒中（一般病棟・回復期リハビリテーション病棟），大腿骨頸部骨折，脊髄損傷の患者データが登録されており，2014年度末における累積症例数は23,067例に達した．JRDを利用した論文は徐々に増え2015年10月現在31編ある．多施設データの利点は，症例数の多さと一施設にとどまらない知見を導ける点にある．一方で，参加施設が累積でも60施設と少ないことや欠損値などデータの質に改善の余地があるなどの課題もある．JRDがより代表性の高いものになるために，日本リハビリテーション医学会はじめ，3療法士協会の会員のいっそうの協力が必要である．

目的 高齢者における中学校区別の肺炎球菌ワクチン接種率に関する調査を行い,接種率の背景要因について個人要因と環境要因の双方から実態を明らかにし,定期接種化された後に接種率の向上に必要な取り組みについて検討した。方法 N市在住の65歳以上の住民を対象として,要支援・要介護認定を受けていない8,000名の高齢者に郵送法で無記名自記式アンケート調査を実施した。57中学校区別に接種率を求め,住民構成を調整した後の地域差を分析した。接種の有無に関連する個人要因についてロジスティック回帰分析に加え,中学校区別の相関分析,個人と校区別集団の2つのレベルでマルチレベル相関分析を実施し,さらに,クラスタ標準誤差を使ったロジスティック回帰分析を行い,集団レベルの環境要因の影響も加味して接種率の地域差を評価した。結果 肺炎球菌ワクチンの接種率は13.5%(男性14.5%,女性12.5%)で,男性の方が若干高い値であった。年代別では,男女とも前期高齢者では10%以下であり,80〜84歳では20%を超えていた。中学校区別の接種率では,5%以下の地域が4ヶ所ある一方で20%を超える地域も2ヶ所存在し,性別と年齢を調整した後においても有意(P&lt;0.01)な接種状況の地域差が認められた。ロジスティック回帰分析の結果,ワクチン接種を促進する要因として,高い年齢(P&lt;0.01),低い主観的健康感(P&lt;0.05),呼吸器疾患あり(P&lt;0.01)が認められた。相関分析で中学校区別の接種率と関連する要因は認めず,マルチレベル相関分析において個人レベルでのみ,高い年齢,低い主観的健康感,呼吸器疾患あり,短い教育年数が接種ありと有意に相関した(P&lt;0.01)。また,地域レベルの変数を説明変数に加えクラスタ標準誤差を使ったロジスティック回帰分析において,環境要因として中学校区別の教育年数や所得格差は有意ではなく,個人レベルの年齢,主観的健康感や呼吸器疾患の有無とは異なり,ワクチン接種に与える影響は認められなかった。結論 高齢で主観的健康感が優れず呼吸器疾患を持った住民が多い地域において,肺炎球菌ワクチンの接種率が高く,調査した範囲で接種の有無に環境要因の影響は認められなかった。また,健康リテラシーが高いと推定される教育年数が長い集団ほど接種率は低い傾向が認められたことから,ワクチンの有用性について広く啓発活動を実施し,現在の健康状態に過信することなくワクチン接種を推奨する取り組みが求められている。(著者抄録)

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.

Objective: To date, no study has prospectively examined the association between social capital (SC) in the community and oral health. The aim of this longitudinal cohort study was to examine the association between both community-level and individual-level SC and tooth loss in older Japanese people. Design: Prospective cohort study Setting: We utilised data from the Japan Gerontological Evaluation Study (JAGES) performed in 2010 and 2013 and conducted in 525 districts. Participants: The target population was restricted to non-institutionalised people aged 65 years or older. Participants included 51 280 people who responded to two surveys and who had teeth at baseline. Primary outcome measure: The primary outcome measure was loss of remaining teeth, measured by the downward change of any category of remaining teeth, between baseline and follow-up. Results: The mean age of the participants was 72.5 years (SD=5.4). During the study period, 8.2% (n=4180) lost one or more of their remaining teeth. Among three community-level SC variables obtained from factor analysis, an indicator of civic participation significantly reduced the risk of tooth loss (OR 0.93; 95% CI 0.88 to 0.99). The individual-level SC variables 'hobby activity participation' and 'sports group participation' were also associated with a reduced risk of tooth loss (OR 0.88; 95% CI 0.81 to 0.95 and OR 0.90; 95% CI 0.82 to 0.99, respectively). Conclusions: Living in a community with rich SC and individuals with good SC is associated with lower incidence of tooth loss among older Japanese people.

We examined whether eating alone is associated with dietary behaviors and body weight status, and assessed the modifying effects of cohabitation status in older Japanese people. Data from the 2010 Japan Gerontological Evaluation Study, with a self-reported questionnaire for 38,690 men and 43,674 women aged &gt;= 65 years, were used. Eating status was classified as eating with others, sometimes eating alone, or exclusively eating alone. We calculated adjusted prevalence ratios (APRs) of unhealthy dietary behaviors, obesity, and underweight, adjusting for age, education, income, disease, and dental status using Poisson regression. Overall, 16% of men and 28% of women sometimes or exclusively ate alone. Among those who exclusively ate alone, 56% of men and 68% of women lived alone. Men who exclusively ate alone were 3.74 times more likely to skip meals than men who ate with others. Among men who exclusively ate alone, those who lived alone had a higher APR than men who lived with others. Compared with subjects who ate and lived with others, the APRs of being obese (BMI &gt;= 30.0 kg/m(2)) among men who exclusively ate alone were 1.34 (1.01-1.78) in those who lived alone and 1.17 (0.84-1.64) in those who lived with others. These combined effects of eating and living alone were weaker in women, with a potential increase in the APRs among those who ate alone despite living with others. Men who exclusively ate alone were more likely to be underweight (BMI &lt; 18.5 kg/m(2)) than men who ate with others in both cohabitation statuses. Eating alone and living alone may be jointly associated with higher prevalence of obesity, underweight and unhealthy eating behaviors in men. (C) 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Health Japan 21 plan establishes specific targets for aspects of health including oral health for 2010, in an effort to increase health expectancy. Despite this, there has been insufficient improvement in oral health status in adults. The objective of this cross-sectional study was to determine the factors associated with effective oral health programs for adults in Japanese municipalities. Questionnaires were mailed to all 1,472 municipalities in Japan and responses were obtained from 862 municipalities (response rate: 58.6%). After excluding 71 municipalities with "unknown" answer, no answer, or lack of relevant information, we analyzed the data from the remaining 791 municipalities with or without oral health programs for adults self-reported as effective within three years. Multilevel Poisson regression models were used to examine the associations of effective programs with oral health personnel, contact with related agencies, the establishment of Health Japan 21 goals, financial status, the density of dentists and population density at the municipality level, and having oral health personnel at the prefecture level. Three hundred and fifty-four municipalities reported having effective programs. In the fully adjusted model, having dental hygienists in the municipal office (P &lt; 0.05) and a high number of contacts with related agencies (P &lt; 0.05) were significantly associated with having effective programs. These results suggest that having dental hygienists and contact with related agencies such as residents, local dental associations, companies, community general support centers, or medical, nursing or welfare facilities are promoting factors for effective adult oral health programs in Japanese municipalities.

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.

Background: eating by oneself may be a risk factor for mental illness among older adults, but may be influenced by cohabitation status. We examined the association between eating alone and depression in the context of cohabitation status in older adults in Japan. Design: a longitudinal, population-based study. Setting: data from the Japan Gerontological Evaluation Study. Subjects: we analysed 17,612 men and 19,581 women aged a parts per thousand yen65 without depression (Geriatric Depression Scale &lt; 5) at baseline in 2010. Methods: eating status was classified into two categories: eating with others and eating alone. The risk of depression onset by 2013 was estimated using Poisson regression. Results: after adjusting for socioeconomic status, physical health, nutritional status, social support, social participation, frequency of meet friends, employment status and marital status, the adjusted rate ratio (ARR) for depression onset in men who ate alone compared with those who ate with others was 2.36 (95% confidence intervals [CI]: 1.18-4.71) for those living alone and 1.03 (95% CI: 0.81-1.32) for those living with others. Among women, the ARR for depression for those who ate alone compared with those who ate with others was 1.31 (95% CI: 1.00-1.72) for those living alone and 1.21 (95% CI: 1.01-1.44) for those living with others. Conclusions: eating alone may be a risk factor for depression. Among men, the effect of eating alone on depression may be reinforced by living alone, but appears to be broadly comparable in women living alone and women living with others.

Background Participation in a sports group is key for the prevention of incident functional disability. Little is known about the correlates of older adults' participation in sports groups, although this could assist with the development of effective health strategies. The purpose of this study was to identify the demographic and biological, psychosocial, behavioral, social and cultural, and environmental correlates of sports group participation among Japanese older adults. Methods Data were obtained from the Japan Gerontological Evaluation study, which was a population-based cohort of people aged &gt;= 65 years without disability enrolled from 31 municipalities across Japan (n = 78,002). Poisson regression analysis was used to determine the associations between the factors and participation in sports groups. Results Non-regular participation in sports groups was associated with lower educational level, being employed, and working the longest in the agricultural/forestry/fishery industry among the demographic and biological factors and poor self-rated health and depression among the psychosocial factors. Of the behavioral factors, current smoking was negatively associated and current drinking was positively associated with regular participation in sports groups. Among the social and cultural factors, having emotional social support and participating in hobby clubs, senior citizen clubs, or volunteer groups were associated with a high prevalence of participation in sports groups. Perceptions of the presence of parks or side-walks, good access to shops, and good accessibility to facilities were positively associated with participation in sports groups among the environmental factors. Conclusions Our study suggests that the promotion of activities that could increase older adults' participation in sports groups should consider a broad range of demographic and biological, psychosocial, behavioral, social and cultural, and environmental factors. Although future longitudinal studies to elucidate the causal associations are needed, encouraging participation in community groups through social networks might be effective for participation in sports groups.

Background The efficacy of promoting social interactions to improve the health of older adults is not fully established due to residual confounding and selection bias. Methods The government of Taketoyo town, Aichi Prefecture, Japan, developed a resident-centred community intervention programme called 'community salons', providing opportunities for social interactions among local older residents. To evaluate the impact of the programme, we conducted questionnaire surveys for all older residents of Taketoyo. We carried out a baseline survey in July 2006 (prior to the introduction of the programme) and assessed the onset of functional disability during March 2012. We analysed the data of 2421 older people. In addition to the standard Cox proportional hazard regression, we conducted Cox regression with propensity score matching (PSM) and an instrumental variable (IV) analysis, using the number of community salons within a radius of 350 m from the participant's home as an instrument. Results In the 5 years after the first salon was launched, the salon participants showed a 6.3% lower incidence of functional disability compared with non-participants. Even adjusting for sex, age, equivalent income, educational attainment, higher level activities of daily living and depression, the Cox adjusted HR for becoming disabled was 0.49 (95% CI 0.33 to 0.72). Similar results were observed using PSM (HR 0.52, 95% CI 0.33 to 0.83) and IV-Cox analysis (HR 0.50, 95% CI 0.34 to 0.74). Conclusions A community health promotion programme focused on increasing social interactions among older adults may be effective in preventing the onset of disability.

Objective. Many studies have suggested a U-shaped curve for the association between body size and mortality risks, i.e., mortality risks increase in those who are both overweight and underweight. The strength of the associations may vary according to socioeconomic statuses (SES), as they determine levels of access to healthcare and psychosocial stresses. We investigated the modifying effects of SES on the relationship between body mass index (BMI) and mortality. Method. We used prospective cohort data of participants in the Aichi Gerontological Evaluation Study in 2003 (n = 14,931), who were 65 years or older and physically and cognitively independent at baseline, and residing in eight municipalities in Japan. Data on all-causes mortality and mortality from cancer, cardiovascular disease, and respiratory disease was obtained from municipal government registries. Results. Proportional hazard regression analyses showed that, among men, the associations between overweight (BMI &gt;= 25 kg/m(2)) and higher mortality risks by any cause were stronger among lower income groups. Even adjusting for multiple confounding factors, hazard ratios (95% confidence intervals) for mortality by all causes among low income group (household income &lt;15 million yen) were 1.96 (1.02-3.73) for overweight compared with BMIs between 23.0 and 24.9, whereas they were 0.94 (0.57-138) among men in high income group (income &gt; 3 million yen). The modifying effects of income were not marked among women. Conclusion. Household income, which may directly reflect accessibility to healthcare and psychosocial stress among older Japanese men, may be an important modifying factor in the health risks attributable to overweight. (C) 2015 Elsevier Inc. All rights reserved.

Background Relative deprivation of income is hypothesised to generate frustration and stress through upward social comparison with one's peers. If psychosocial stress is the mechanism, relative deprivation should be more strongly associated with specific health outcomes, such as cardiovascular disease (compared with other health outcomes, eg, non-tobacco-related cancer). Methods We evaluated the association between relative income deprivation and mortality by leading causes, using a cohort of 21 031 community-dwelling adults aged 65 years or older. A baseline mail-in survey was conducted in 2003. Information on cause-specific mortality was obtained from death certificates. Our relative deprivation measure was the Yitzhaki Index, derived from the aggregate income shortfall for each person, relative to individuals with higher incomes in that person's reference group. Reference groups were defined according to gender, age group and same municipality of residence. Results We identified 1682 deaths during the 4.5 years of follow-up. A Cox regression demonstrated that, after controlling for demographic, health and socioeconomic factors including income, the HR for death from cardiovascular diseases per SD increase in relative deprivation was 1.50 (95% CI 1.09 to 2.08) in men, whereas HRs for mortality by cancer and other diseases were close to the null value. Additional adjustment for depressive symptoms and health behaviours (eg, smoking and preventive care utilisation) attenuated the excess risks for mortality from cardiovascular disease by 9%. Relative deprivation was not associated with mortality for women. Conclusions The results partially support our hypothesised mechanism: relative deprivation increases health risks via psychosocial stress among men.

BACKGROUND: Community-level factors as well as individual-level factors affect individual health. To date, no studies have examined the association between community-level social gradient and edentulousness. The aim of this study was to investigate individual- and community-level social inequalities in edentulousness and to determine any explanatory factors in this association. METHODS: We analyzed the data from the Japan Gerontological Evaluation Study (JAGES). In 2010-2012, 112,123 subjects aged 65 or older responded to the questionnaire survey (response rate = 66.3%). Multilevel logistic regression analysis was applied to determine the association between community-level income and edentulousness after accounting for individual-level income and demographic covariates. Then, we estimated the probability of edentulousness by individual- and community-level incomes after adjusted for covariates. RESULTS: Of 79,563 valid participants, the prevalence of edentulousness among 39,550 men (49.7%) and 40,013 women (50.3%) were both 13.8%. Living in communities with higher mean incomes and having higher individual-level incomes were significantly associated with a lower risk of edentulousness (odds ratios [ORs] by 10,000 USD increments were 0.37 (95% confidence interval [CI] [0.22-0.63]) for community-level and 0.85 (95% CI [0.84-0.86]) for individual-level income). Individual- and community-level social factors, including density of dental clinics, partially explained the social gradients. However, in the fully adjusted model, both community- and individual-level social gradients of edentulousness remained significant (ORs = 0.43 (95% CI [0.27-0.67]) and 0.90 (95% CI [0.88-0.91]), respectively). One standard deviation changes in community- and individual-level incomes were associated with 0.78 and 0.84 times lower odds of edentulousness, respectively. In addition, compared to men, women living in communities with higher average incomes had a significantly lower risk of edentulousness (p-value for interaction < 0.001). CONCLUSIONS: Individual- and community-level social inequalities in dental health were observed. Public health policies should account for social determinants of oral health when reducing oral health inequalities.

The purpose of this study is to investigate healthcare access disparity that will cause delayed and unmet healthcare needs for the elderly, and to examine health inequality and healthcare cost burden for the elderly. To produce clear policy applications, this study adapts a modified PRECEDE-PROCEED model for framing theoretical and experimental approaches. Data were collected from a large collection of the Community Tracking Study Household Survey 2003–2004 of the USA. Reliability and construct validity are examined for internal consistency and estimation of disparity and inequality are analyzed by using probit/ols regressions. The results show that predisposing factors (e.g., attitude, beliefs, and perception by socio-demographic differences) are negatively associated with delayed healthcare. A 10% increase in enabling factors (e.g., availability of health insurance coverage, and usual sources of healthcare providers) are significantly associated with a 1% increase in healthcare financing factors. In addition, information through a socio-economic network and support system has a 5% impact on an access disparity. Income, health status, and health inequality are exogenously determined. Designing and implementing easy healthcare accessibility (healthcare system) and healthcare financing methods, and developing a socio-economic support network (including public health information) are essential in reducing delayed healthcare and health inequality.

The purpose of this study is to investigate healthcare access disparity that will cause delayed and unmet healthcare needs for the elderly, and to examine health inequality and healthcare cost burden for the elderly. To produce clear policy applications, this study adapts a modified PRECEDE-PROCEED model for framing theoretical and experimental approaches. Data were collected from a large collection of the Community Tracking Study Household Survey 2003-2004 of the USA. Reliability and construct validity are examined for internal consistency and estimation of disparity and inequality are analyzed by using probit/ols regressions. The results show that predisposing factors (e.g., attitude, beliefs, and perception by socio-demographic differences) are negatively associated with delayed healthcare. A 10% increase in enabling factors (e.g., availability of health insurance coverage, and usual sources of healthcare providers) are significantly associated with a 1% increase in healthcare financing factors. In addition, information through a socio-economic network and support system has a 5% impact on an access disparity. Income, health status, and health inequality are exogenously determined. Designing and implementing easy healthcare accessibility (healthcare system) and healthcare financing methods, and developing a socio-economic support network (including public health information) are essential in reducing delayed healthcare and health inequality.

【目的】本研究では,多施設データを用い,急性期と,回復期の退院時Functional Independence Measure(FIM)の予測式を開発することを目的とした.【方法】急性期4,311人(22病院)と回復期1,941人(24病院)のデータをそれぞれ(開発群と検証群の)2群に分け,重回帰分析により退院時FIMの予測式を開発し,検証群での妥当性も検証した.【結果】急性期の退院時FIMの予測式は85.04+(-0.53×年齢)+(12.06×くも膜下出血)+(-7.90×合併症あり)+(-0.70×発症後入院病日)+(1.24×入院時GCS)+(-1.08×入院時NIHSS)+(-4.15×発症前mRS)+(0.30×入院時運動FIM)+(1.03×入院時認知FIM)となった(R2=0.78).回復期の退院時FIM予測式は33.04+(-0.34×年齢)+(-3.88×合併症あり)+(-0.11×発症後入院病日)+(2.44×入院時GCS)+(-1.68×発症前mRS)+(0.53×入院時運動FIM)+(1.25×入院時認知FIM)となった(R2=0.66).【結論】多施設大規模データベースを用い急性期と回復期を分け外的妥当性を検証した退院時FIMの予測式を開発した.(著者抄録)

目的 社会的孤立や孤立死の問題への関心は高い一方で，孤立状態の操作的定義に関する根拠は蓄積されていない。社会的孤立が健康の社会的決定要因の 1 つであることを考慮し，健康リスクが高まる交流の乏しさ（頻度）があるのかを明らかにすることを目的にした。<br/>方法 2003年10月に愛知県下 6 市町村における要介護認定を受けていない高齢者14,804人を対象にした AGES（Aichi Gerontological Evaluation Study，愛知老年学的評価研究）プロジェクトのデータの一部を用いた（回収率=50.4%）。性別・年齢が不明な人を除き，調査時点で歩行・入浴・排泄が自立であった12,085人について分析した。要介護認定・賦課データに基づいて，調査時点から2013年10月時点までの約10年間を追跡し，要介護状態（全認定および要介護 2 以上）への移行，認知症の発症と死亡状況を把握した。社会的孤立の指標には，別居家族・親族および友人と会う頻度と手紙・電話・メールなどで連絡を取り合う頻度を用いた。1 か月を4.3週と換算してすべての交流頻度を加算後，「月 1 回未満」から「毎日頻繁（週に 9 回以上）」群に分類した。<br/>結果 Cox 比例ハザードモデルの結果，調査時点での性別・年齢や同居者の有無，治療疾患の有無等を調整したうえでも，毎日頻繁群と比べて，月 1 回未満群では，1.37（95%CI:1.16–1.61）倍要介護 2 以上に，1.45（95%CI:1.21–1.74）倍認知症に，1.34（95%CI:1.16–1.55）倍早期死亡に至りやすいということが示された。月 1～週 1 回未満群でも同様に，いずれの健康指標とも有意な関連が認められたが，週 1 回以上の群では有意な関連は消失した。なお，調査後 1 年以内に従属変数のイベントが発生したケースを除外しても結果は大きく変わらなかった。同居者以外との交流頻度が月 1 回未満を孤立の基準とすると，高齢者の7.4%（男性で10.2%，女性で4.7%）が該当し，週 1 回未満を含めると15.8%（男性で21.2%，女性で10.6%）が該当した。<br/>結論 同居者以外との対面・非対面交流をあわせて週に 1 回未満という状態までがその後の要介護状態や認知症と関連し，月 1 回未満になると早期死亡とも密接に関連する交流の乏しさであることから，これらが社会的孤立の妥当な操作的定義であることが示唆された。

The victims of the Great East Japan Earthquake and Tsunami have been forced to live in temporary housing, mainly by two different methods of resettlement: group allocation that preserved pre-existing local social ties and lottery allocation. We examined the effects of various factors, including the resettlement methods and social support, on mental health. From February to March 2012, we completed a cross-sectional survey of 281 refugees aged 40 years or older, who had lost their homes in the tsunami and were living in temporary housing in lwanuma city. Psychological distress of the victims was assessed using the Kessler Psychological Distress Scale (K6) that consists of six self-reported items. Participants were also asked whether they had provided or received social support during this time. Participants were categorized as "providing social support" if they listened to someone else's concerns and complaints, or "receiving social support" if they have someone who listened to their concerns and complaints. After adjusting for age and sex, multiple log-binomial regression analysis showed that participants without social support had a higher risk of psychological distress. Group allocation victims were more likely to receive social support than those who underwent lottery allocation. However, the resettlement approach did not significantly correlate with distress. Other factors associated with a higher risk of psychological distress were a younger age (55 or younger), living with either 3 people or 6 or more people, and having a lower income. The present results suggest that social support promotes the mental health of disaster victims.

Background: Inequality in oral health is a major challenge. Oral diseases and their risk factors accumulate throughout life. The objective of this cross-sectional study was to examine the association of longest job with oral health status and oral health behavior among older Japanese. Methods: Subjects were a total of 23,191 (11,310 males and 11,881 females) community-dwelling individuals aged 65 or over, living independently and able to perform daily activities from 30 municipalities across Japan. The outcome variables were oral health status (number of teeth, use of denture or bridge and subjective oral health status) and oral health behavior (dental visit for treatment and use of interdental brush or dental floss). The longest job was used as an explanatory variable. Age, educational attainment, equivalent income, and densities of dentists and population in municipalities were used as covariates. Two-level (first level: individual, second level: municipality) multilevel Poisson regression analyses were performed for each sex. Results: Multilevel Poisson regression analyses showed that all variables of oral health status and oral health behavior were significantly associated with longest job after adjusting for all covariates except denture/bridge use and dental visit for females. People whose longest jobs were sales/service, skilled/labor, agriculture/forestry/fishery or others, or who had no occupation were more likely to have poor oral health status and oral health behavior compared to those whose longest jobs were professional/technical. Conclusions: The longest job may be one of the major determinants of oral health status and oral health behavior in Japanese older people.

To evaluate the association between relative deprivation (lacking daily necessities) and subjective health in older Japanese adults, we performed a cross-sectional analysis using data from the Japan Gerontological Evaluation Study (JAGES). The data were obtained from functionally independent residents aged &gt;= 65 years from 24 municipalities in Japan (n = 24,742). Thirteen items in three dimensions were used to evaluate relative deprivation of material conditions. Approximately 28% of older Japanese people indicated that they lacked some daily necessities (non-monetary poverty). A two-level Poisson regression analysis revealed that relative deprivation was associated with poor self-rated health (PR = 1.3-1.5) and depressive symptoms (PR = 1.5-1.8) in both men and women, and these relationships were stronger than those observed in people living in relative poverty (monetary poverty). The interaction effect between relative deprivation and relative poverty was not associated with poor health. As a dimension of the social determinants of health, poverty should be evaluated from a multidimensional approach, capturing not only monetary conditions but also material-based, non-monetary conditions.

We examined the associations between childhood socioeconomic status and adulthood height with functional limitations in old age. Data were obtained from the baseline survey of the Japan Gerontological Evaluation Study 2010, a population-based cohort of people aged a parts per thousand yen65 years enrolled from 27 municipalities across Japan (N = 15,499). People aged 65-69, 70-74, 75-79, and a parts per thousand yen80 years experienced the end of World War II when they were aged 0-4, 5-9, 10-14, and a parts per thousand yen15 years, respectively. Subjective socioeconomic status during childhood and current height were obtained by self-report through questionnaire in 2010. Higher-level functional capacity was assessed using a validated questionnaire scale. Poisson regression with robust variance estimator was employed to determine the association between childhood subjective socioeconomic status, height, and functional limitations. Lower childhood subjective socioeconomic status was consistently associated with higher prevalence rate ratio of limitations in higher-level functional capacity, regardless of age cohort. Height was associated with functional limitation only among the group aged 70-74 years: taller (a parts per thousand yen170cm for men and a parts per thousand yen160cm for women) people were 16% less likely to report functional limitation in comparison with shorter (&lt; 155 cm for men and &lt; 145 cm for women) individuals in the fully adjusted model (prevalence rate ratio: 0.84, 95% confidence interval: 0.74-0.96). Low childhood subjective socioeconomic status had a robust association with functional limitation regardless of age cohort. In addition, those who lived through World War II before they reached puberty and attained shorter height were more likely to report functional limitations in old age.

Background: Studies suggest that using a denture/bridge may prevent disability in older people. However, not all older people with few remaining teeth use a denture/bridge. This cross-sectional study aimed to examine the social determinants which promote denture/bridge use among older Japanese. Methods: A total of 54,388 (25,630 males and 28,758 females) community-dwelling individuals aged 65 or over, living independently, able to perform daily activities, and with 19 or fewer teeth. The dependent variable was denture/bridge use. Socio-demographics, number of teeth, present illness, social participation, social support, and social networks were used as individual-level independent variables. Data for social capital were aggregated and used as local district (n = 561 for males, n = 562 for females) -level independent variables. Number of dentists working in hospitals/clinics per population and population density were used as municipality (n = 28) -level independent variables. Three-level multilevel Poisson regression analysis was performed for each sex. Results: High equivalent income, low number of teeth, present illness, and living in a municipality with high population density were significantly associated with denture/bridge use in both sexes in the fully adjusted models (p &lt; 0.05). Denture/bridge use was significantly associated with high educational attainment in males and participating in social groups in females in the fully adjusted model (p &lt; 0.05). No significant associations were observed between denture/bridge use and social capital. Conclusions: Denture/bridge use was significantly associated with high economic status and present illness in both sexes, high educational attainment in males, and participation in social groups in females among community-dwelling older Japanese after adjusting for possible confounders.

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

Background Social inequalities in oral health exist in various countries. In Japan, a country with universal healthcare insurance policy, people can receive medical and dental care and pay only 10-30% of the total cost of treatment. Additionally, very poor Japanese can receive care without any charge, by the benefit of public assistance. These policies are considered to affect oral health inequalities. Objectives This study examined the association between using a dental prosthesis and household income among older Japanese people. Methods Self-administered questionnaires were mailed to subjects as part of the Japan Gerontological Evaluation Study (JAGES) project in 2010. Of the 8576 people aged 65years or more living in Iwanuma, Japan, 5058 responded. We used 4001 respondents with no missing values. We stratified into two groups by having 20 teeth or not. Then, cross-tabulation, univariate logistic regression, and multivariate logistic regression were conducted for these two groups. The covariates are sex, age, education, and size of household. Results Of the all respondents included in the analyses, poorer respondents tended to have lower proportions with 20 or more teeth, and 54.6% respondents used dental prostheses. In the respondents with 19 or fewer teeth, higher-income group tended to show significantly higher dental prosthesis use. But the poorest income group showed high prevalence of dental prosthesis use as same as highest income group. Multiple logistic regression among respondents with 19 or fewer teeth showed that after adjustment for sex, age, education, and size of household, compared with the respondents with annual incomes of US$ &lt;5000, those with incomes of US$5000-9999 and US$10000-14999 had significantly lower odds ratios for using a dental prosthesis (OR=0.48 [95% CI=0.28-0.83], 0.56 [95% CI=0.33-0.95], respectively). The other respondents did not show significant differences. Conclusions Although universal healthcare insurance covered dental prostheses, a social gradient in dental prosthesis use was still observed. Low-income respondents tended to not use dental prosthesis, but the poorest respondents showed dental prosthesis utilization as high as the highest income group.