Socioeconomic Predictors of Diabetes Mortality in Japan: An Ecological Study Using Municipality-specific Data

ObjectivesThe aim of this study was to examine the geographic distribution of diabetes mortality in Japan and identify socioeconomic factors affecting differences in municipality-specific diabetes mortality.MethodsDiabetes mortality data by year and municipality from 2013 to 2017 were extracted from Japanese Vital Statistics, and the socioeconomic characteristics of municipalities were obtained from government statistics. We calculated the standardized mortality ratio (SMR) of diabetes for each municipality using the empirical Bayes method and represented geographic differences in SMRs in a map of Japan. Multiple linear regression was conducted to identify the socioeconomic factors affecting differences in SMR. Statistically significant socioeconomic factors were further assessed by calculating the relative risk of mortality of quintiles of municipalities classified according to the degree of each socioeconomic factor using Poisson regression analysis.ResultsThe geographic distribution of diabetes mortality differed by gender. Of the municipality-specific socioeconomic factors, high rates of single-person households and unemployment and a high number of hospital beds were associated with a high SMR for men. High rates of fatherless households and blue-collar workers were associated with a high SMR for women, while high taxable income per-capita income and total population were associated with low SMR for women. Quintile analysis revealed a complex relationship between taxable income and mortality for women. The mortality risk of quintiles with the highest and lowest taxable per-capita income was significantly lower than that of the middle-income quintile.ConclusionsSocioeconomic factors of municipalities in Japan were found to affect geographic differences in diabetes mortality.     

Perinatal Mortality and Associated Risk Factors: A Case Control Study

Background

Perinatal mortality is reported to be five times higher in developing than in developed nations. Little is known about the commonly associated risk factors for perinatal mortality in Southern Nations National Regional State of Ethiopia.

Methods

A case control study for perinatal mortality was conducted in University hospital between 2008 and 2010. Cases were stillbirths and early neonatal deaths. Controls were those live newborns till discharged from the hospital. Subgroup binary logistic regression analyses were done to identify associated risk factors for perinatal mortality, stillbirths and early neonatal deaths.

Results

A total of 1356 newborns (452 cases and 904 controls) were included in this analysis. The adjusted perinatal mortality rate was 85/1000 total delivery. Stillbirths accounted for 87% of total perinatal mortality. The proportion of hospital perinatal deaths was 26%. Obstructed labor was responsible for more than one third of perinatal deaths. Adjusted odds ratios revealed that obstructed labor, malpresentation, preterm birth, antepartum hemmorrhage and hypertensive disorders of pregnancy were independent predictors for high perinatal mortality. In the subgroup analysis, among others, obstructed labor and antepartum hemorrhage found to have independent association with both stillbirths and early neonatal deaths.

Conclusion

The perinatal mortality rate was more than two fold higher than the estimated national perinatal mortality;and obstructed labor, malpresentation, preterm birth, antepartum hemmorrhage and hypertensive disorders of pregnancy were independent predictors. The reason for the poor progress of labor and developing obstructed labor is an area of further investigation.     

气象因素与霍乱发病关系的生态学研究

目的探讨气象因素与霍乱发病的关系.方法将绍兴地区1991～2001年霍乱各年6～11月份月平均发病率数据进行正态化处理后,再利用方差分析、回归分析对可能影响霍乱发病的气温、气压、相对湿度、日照时数、降水量等5项研究变量进行单因素相关分析和多元逐步回归分析.结果霍乱的发病与气温呈显著性正相关,与气压呈显著性负相关.结论霍乱发病与高气温、低气压有关.     

Late Hyponatremia in Very-Low-Birth-Weight Infants: Incidence and Associated Risk Factors

Objective To determine the incidence of late hyponatremia in very-low-birth-weight infants and to identify associated risk factors. Low serum sodium concentration in otherwise healthy premature infants beyond 2 weeks of life is referred to as late hyponatremia.Design Retrospective cohort review.Setting/subjects The intensive care nursery at St Luke's Hospital Perinatal Center, Kansas City, Mo. Criteria for subject selection were birth weight of 1,500 g or less; survival for more than 21 days; development of late hyponatremia or hospitalization for 42 days or more; and measurement of serum sodium concentration at least once between the 14th and 56th day of life. Of 515 infants admitted to the nursery for the 1992 calendar year, 124 had a birth weight of 1,500 g or less and survived for more than 21 days; however, 16 of these infants were discharged at 42 days of life or less, 11 did not have a serum sodium concentration measurement after the second week of life, and 1 did not have complete medical records. Thus, the final sample was 96 subjects.Statistical analyses Percentages to determine incidence of late hyponatremia; t test or χ² test to determine differences between infants with and without late hyponatremia; multiple logistic regression to determine the strongest indicators of late hyponatremia.Results Incidence of late hyponatremia was 62.5%. Significant risk factors for late hyponatremia were birth weight of 1,000 g or less (P<.001), feedings of fortified human milk (P<.013), and occurrence of an intraventricular hemorrhage (P<.036). Fortified human milk feeding was a significant risk factor for late hyponatremia in both weight groups (ie, birth weight greater than or less than 1,000 g).Conclusion Despite standard fortification, human milk may contain an insufficient quantity of sodium to met the needs of very-low-birth-weight infants. J Am Diet Assoc. 1996; 96:880-884.     

Deprescribing in Nursing Home Residents on Polypharmacy: Incidence and Associated Factors

ObjectivesTo assess 1-year incidence and factors related to deprescribing in nursing home (NH) residents in Europe.DesignLongitudinal multicenter cohort study based on data from the Services and Health for Elderly in Long TERm care (SHELTER) study.SettingNHs in Europe and Israel.Participants1843 NH residents on polypharmacy.MethodsPolypharmacy was defined as the concurrent use of 5 or more medications. Deprescribing was defined as a reduction in the number of medications used over the study period. Residents were followed for 12 months.ResultsResidents in the study sample were using a mean number of 8.6 (standard deviation 2.9) medications at the baseline assessment. Deprescribing was observed in 658 residents (35.7%). Cognitive impairment (mild/moderate impairment vs intact, odds ratio [OR] 1.41, 95% confidence interval [CI] 1.11-1.79; severe impairment vs intact, OR 1.60, 95% CI 1.23-2.09), presence of the geriatrician within the facility staff (OR 1.41, 95% CI 1.15-1.72), and number of medications used at baseline (OR 1.10, 95% CI 1.06-1.14) were associated with higher probabilities of deprescribing. In contrast, female gender (OR 0.76, 95% CI 0.61-0.96), heart failure (OR 0.69, 95% CI 0.53-0.89), and cancer (OR 0.64, 95% CI 0.45-0.90) were associated with a lower probability of deprescribing.Conclusions and ImplicationsDeprescribing is common in NH residents on polypharmacy, and it is associated with individual and organizational factors. More evidence is needed on deprescribing, and clear strategies on how to withdraw medications should be defined in the future.     

Factors Associated with the Development of Childhood Asthma in Japan: A Nationwide Longitudinal Study

Maternal and Child Health Journal - Many environmental factors are related to the development of asthma. However, the key factors of childhood asthma onset have not been sufficiently elucidated....     

妊娠期糖代谢异常的发病情况及相关因素探讨

目的了解妊娠期糖代谢异常的发生率，探讨其相关因素，为制定干预措施提供科学依据。方法采用回顾性研究的方法，收集2006年4月至2006年9月在本院产科门诊产检并行50g口服葡萄糖筛查试验（oral glucose challengetest，OGCT）的2020例孕妇的临床资料，进行统计分析。结果以50g OGCT≥7．8mmol／L为临界值，本组患者OGCT结果显示，妊娠期糖代谢异常的发生率为8．51％（172／2020）。本研究将个体的年龄、文化程度、孕前和行50g OGCT时，体重是否超重（体重≥80kg）或肥胖（BMI≥28kg／m^2），是否有糖尿病家族史，确定为妊娠期糖代谢异常的相关因素。对50g OGCT≥7．8mmol／L的患者进行Logistic回归分析发现，年龄越大（超过35岁），文化程度高（为研究生及以上者），糖代谢筛查时体重指数高（BMI≥28kg／m^2）及有糖尿病家族史，为妊娠期糖代谢异常发病的独立危险因素。结论妊娠期糖代谢异常的发生率较高，应根据相关因素对其进行积极干预。     

Neighborhood Inequalities in Hepatitis C Mortality: Spatial and Temporal Patterns and Associated Factors

Deaths attributable to hepatitis C (HCV) infection are increasing in the USA even as highly effective treatments become available. Neighborhood-level inequalities create barriers to care and treatment for many vulnerable populations. We seek to characterize citywide trends in HCV mortality rates over time and identify and describe neighborhoods in New York City (NYC) with disproportionately high rates and associated factors. We used a multiple cause of death (MCOD) definition for HCV mortality. Cases identified between January 1, 2006, and December 31, 2014, were geocoded to NYC census tracts (CT). We calculated age-adjusted HCV mortality rates and identified spatial clustering using a local Moran’s I test. Temporal trends were analyzed using joinpoint regression. A multistep global and local Poisson modeling approach was used to test for neighborhood associations with sociodemographic indicators. During the study period, 3697 HCV-related deaths occurred in NYC, with an average annual percent increase of 2.6% (p = 0.02). The HCV mortality rates ranged from 0 to 373.6 per 100,000 by CT, and cluster analysis identified significant clustering of HCV mortality (I = 0.23). Regression identified positive associations between HCV mortality and the proportion of non-Hispanic black or Hispanic residents, neighborhood poverty, education, and non-English-speaking households. Local regression estimates identified spatially varying patterns in these associations. The rates of HCV mortality in NYC are increasing and vary by neighborhood. HCV mortality is associated with many indicators of geographic inequality. Results identified neighborhoods in greatest need for place-based interventions to address social determinants that may perpetuate inequalities in HCV mortality.     

Long-term Trends in Incidence and Mortality of Intrahepatic and Extrahepatic Bile Duct Cancer in Japan

Background

A report of multiple cases of bile duct cancer at a Japanese printing company raised concern about such cancers. We examined long-term trends in bile duct cancer in Japan.

Methods

Data from 4 population-based cancer registries were used to calculate incidence between 1985 and 2007, and vital statistics were used to estimate mortality between 1985 and 2011. Age-standardized rates were calculated and analyzed using a joinpoint regression model.

Results

Among men, the incidence rate of intrahepatic bile duct cancer increased throughout the observation period; among women, it increased until 1996–1998 and remained stable thereafter. The incidence rate of extrahepatic bile duct cancer was stable in men and decreased from 1993–1995 in women. In people aged 30 to 49 years, the incidence rates of intra- and extrahepatic bile duct cancer remained stable or decreased. The mortality rate of intrahepatic bile duct cancer increased in both sexes and in all age groups since 1996, while that of extrahepatic bile duct cancer decreased since 1992. In people aged 30 to 49 years, the mortality rates of intra- and extrahepatic bile duct cancer remained stable and decreased, respectively.

Conclusions

The incidence and mortality rates of intrahepatic bile duct cancer remained stable or increased throughout the observation period. The incidence rate of extrahepatic bile duct cancer remained stable or decreased, and the mortality rate decreased since 1992. In people aged 30 to 49 years, the incidence and mortality rates of intra- and extrahepatic bile cancer remained stable or decreased.Key words: intrahepatic bile duct cancer, extrahepatic bile duct cancer, incidence, mortality     

重症监护病房获得性感染的发生及其相关危险因素分析

目的探讨重症监护病房（ICU）获得性感染的发生率及其相关危险因素。方法对2006年4月-2007年3月在ICU住院时间〉48h的150例患者进行ICU获得性感染的调查分析。结果150例ICU患者中发生了106例次获得性感染,感染率为70.7%;肺炎（35.4%）和败血症（18.2%）是主要的感染;大肠埃希菌（32.4%）和铜绿假单胞菌（27.0%）是分离到最常见病原菌;多因素Logistic回归分析结果表明,ICU获得性感染的危险因素有ICU住院时间（〉7d）（OR：7.02,95%CI：2.80～17.56）;作为入ICU的一个主要原因的呼吸衰竭（OR值：3.7,95%CI：1.41～9.70）;镇静药物的应用（OR值：3.34,95%CI：1.27～8.79）;手术（入ICU之前和之后）（OR值：2.56,95%CI：1.06～6.18）。结论该研究提示了医院感染的高发病率,明确ICU获得性感染的相关危险因素,采取有效的预防措施,防止ICU获得性感染的发生。     

The Burden of Early Childhood Caries in Children under 5 Years Old in the European Union and Associated Risk Factors: An Ecological Study

The associations among early childhood caries (ECC), socioeconomic status, and sugar consumption are of the utmost importance, due to their potential policy implications. The purpose of this study was to identify trends in ECC burden in children under 5 years old among European Union (EU) member states over time and to evaluate the relationship with its risk factors. Global Burden of Disease 2019 data were analyzed to estimate the burden of ECC over time, specifically incidence, prevalence, and years lived with disability (YLDs) for children under 5 years old. Four ecological variables with a potential effect on YLDs for ECC were used to investigate the association between 2014 and 2017. The YLDs rate was consistently higher among Eastern EU countries over time. Univariate models showed a positive significant association between at-risk-of-poverty rate and YLDs rate, while GDP per capita and urbanization were inversely associated with YLDs rate. In the multivariate analysis, sugar consumption, GDP per capita and urbanization showed significant association with YLDs rate. After stratification by region, association remained significant only in the Eastern EU countries between GDP, urbanization, and YLDs rate, while sugar consumption and at-risk-of-poverty rate had no significant impact on YLDs rates. This study found increasing ECC burden in the EU. The complexity of the problem indicates the need for innovative and personalized policy approaches to tackle the disease.     

Road Traffic and Urban Form Factors Correlated with the Incidence of Lung Cancer in High-density Areas: An Ecological Study in Downtown Shanghai,China

The incidence of lung cancer is affected by air pollution, especially in high-density urban areas with heavy road traffic and dense urban form. Several studies have examined the direct relationship between lung cancer incidence and road traffic as well as urban form. However, the results are still inconsistent for high-density urban areas. This study focused on urban form and road traffic, aiming at revealing their relationship with lung cancer incidence in high-density urban areas at the neighborhood level. For this, an ecological study was conducted in downtown Shanghai to identify important indicators and explore quantitative associations. Negative binomial regression was fitted with lung cancer incidence as the dependent variable. The independent variables included indicators for road traffic and urban form, greenness, demographic, and socio-economic factors. The results showed that building coverage, averaged block perimeter area ratio, density of metro station without the glass barrier system, and the percentage of low-quality residential land were positively correlated with lung cancer incidence in the neighborhood, while population density was negatively correlated with lung cancer incidence. This study found a strong self-selection effect of socio-economic factors in the relationship between lung cancer incidence and greenness. These results may be useful for conducting health impact assessments and developing spatial planning interventions for respiratory health in high-density urban areas.     

Supper Timing and Cardiovascular Mortality: The Japan Collaborative Cohort Study

Evidence on the role of supper timing in the development of cardiovascular disease (CVD) is limited. In this study, we examined the associations between supper timing and risks of mortality from stroke, coronary heart disease (CHD), and total CVD. A total of 28,625 males and 43,213 females, aged 40 to 79 years, free from CVD and cancers at baseline were involved in this study. Participants were divided into three groups: the early supper group (before 8:00 p.m.), the irregular supper group (time irregular), and the late supper group (after 8:00 p.m.). Cox proportional hazards regression models were used to calculate hazard ratios (HRs) for stroke, CHD, and total CVD according to the supper time groups. During the 19-year follow-up, we identified 4706 deaths from total CVD. Compared with the early supper group, the multivariable HR of hemorrhagic stroke mortality for the irregular supper group was 1.44 (95% confidence interval [CI]: 1.05–1.97). There was no significant association between supper timing and the risk of mortality from other types of stroke, CHD, and CVD. We found that adopting an irregular supper timing compared with having dinner before 8:00 p.m. was associated with an increased risk of hemorrhagic stroke mortality.     

外勤交通警察呼吸系统症状发生率及相关因素的研究

目的调查长沙市外勤交通警察呼吸系统症状发生率及相关影响因素,为交通性空气污染对人体呼吸系统影响提供科学依据。方法应用横断面调查方法,对长沙市429名外勤交警的呼吸系统症状发生率及其影响因素进行了初步调查。结果(1)外勤交警呼吸系统症状:咳嗽、有痰、咳嗽并有痰、呼吸困难的发生率分别为45.22%、55.71%、36.82%、48.95%,明显高于对照组(P<0.05)。(2)Logistic逐步回归分析表明危险因素主要有外勤工作年限(X1)、吸烟(X2)、年龄(X3)。结论外勤交警呼吸系统症状发生率随着外勤工作年限的增加而明显升高。     

医院感染相关因素的调查研究

目的 探讨医院感染的相关因素，为医院感染的控制提供依据。方法 对2005年1—12月29842例住院患者在前瞻性监测的同时进行回顾性调查。结果 发生医院感染1917例，感染率为6．4％，感染例次2114例，例次感染率为7．1％。结论 医院感染的发生与患者年龄大、基础疾病严重、免疫功能低下及相关部位侵袭性操作等均有密切联系，对此类患者应加强医院感染监控，以减少各部位医院感染的发生。