Age-period-cohort analysis of chronic obstructive pulmonary disease mortality in Japan, 1950-2004

Background

We examined trends in chronic obstructive pulmonary disease (COPD) mortality in Japan.

Methods

An age-period-cohort model was used to examine trends in COPD mortality by age, time period, and birth cohort among adults aged 40 years or older from 1950 to 2004.

Results

During the study period, the age-standardized rate of COPD mortality substantially decreased from 71.3 per 100 000 to 19.7 in men and from 41.7 to 4.3 in women. The period effects rapidly declined during the early period in both sexes. They have increased in recent years in men but have continued to decrease in women. The cohort effects began increasing in the 1865–1869 birth cohort, peaked in the 1880–1889 cohort, and decreased thereafter among the recent cohorts.

Conclusions

An early decrease in the period effects might have been associated with changes in disease structure and misclassification of COPD in the early period. Changes in cohort effects might have been mostly associated with changes in cigarette consumption and smoking prevalence in the Japanese population. Changes in those effects may also be a proxy for other social changes over time.Key words: age-period-cohort model, birth cohort analysis, COPD, secular trends     

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     

Effects of smoking and smoking cessation on life expectancy in an elderly population in Beijing, China, 1992-2000: an 8-year follow-up study

Background

We assessed the effects of smoking and smoking cessation on life expectancy and active life expectancy among persons aged 55 years or older in Beijing.

Methods

This study included 1593 men and 1664 women who participated in the Beijing Longitudinal Study of Aging, which commenced in 1992 and had 4 survey waves up to year 2000. An abridged life table was used to estimate life expectancy, in which age-specific mortality and age-specific disability rates were adjusted by using a discrete-time hazard model to control confounders.

Results

The mean ages (SD) for men and women were 70.1 (9.25) and 70.2 (8.72) years, respectively; mortality and disability rates during follow-up were 34.7% and 8.0%, respectively. In both sexes, never smokers had the highest life expectancy and active life expectancy across ages, as compared with current and former smokers. Current heavy smokers had a shorter life expectancy and a shorter active life expectancy than light smokers. Among former smokers, male long-term quitters had a longer life expectancy and longer active life expectancy than short-term quitters, but this was not the case in women.

Conclusions

Older adults remain at higher risk of mortality and morbidity from smoking and can expect to live a longer and healthier life after smoking cessation.Key words: smoking, smoking cessation, life expectancy, active life expectancy, elderly population, discrete-time hazard model     

Use of a Population-Based Cancer Registry to Calculate Twenty-Year Trends in Cancer Incidence and Mortality in Fukui Prefecture

Background

There have been only a limited number of trend analyses of incidence and mortality using population-based cancer registry data in Japan, and the national statistics regarding incidence are estimated data. In the present study, data from the Fukui Prefecture cancer registry, which is the most accurate in Japan, were used to observe trends in incidence and mortality rates.

Methods

Cancer incidence and mortality rates from 1984 through 2004 were obtained from the Fukui Prefecture cancer registry. Joinpoint analysis developed for the US National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program was used to compute and graphically present annual percentage changes in age-adjusted incidence and mortality in Fukui Prefecture.

Results

On joinpoint analysis, there were slight increases in incidence at all cancer sites combined for both sexes from 1986, but the trend was not significant in Fukui. Mortality in women appeared to significantly decrease, while mortality in men, which had been increasing until 1999, began to significantly decrease thereafter. In an analysis by anatomical site, both the incidence and mortality of stomach cancer significantly decreased in both sexes. However, the incidence and mortality of breast and prostate cancers significantly increased. The mortality of liver and lung cancers also increased in both sexes.

Conclusions

Cancer mortality has been declining in recent years, and the reduction in mortality from stomach cancer has significantly affected the trends in Fukui. Urgent cancer control planning by the Fukui local government is necessary, especially for cancers of the liver, lung, prostate, and breast.Key words: incidence, mortality, population-based cancer registry     

Peer Reviewed: Mortality of Urban Aboriginal Adults in Canada, 1991–2001

Objective

To compare mortality patterns for urban Aboriginal adults with those of urban non-Aboriginal adults.

Methods

Using the 1991–2001 Canadian census mortality follow-up study, our study tracked mortality to December 31, 2001, among a 15% sample of adults, including 16 300 Aboriginal and 2 062 700 non-Aboriginal persons residing in urban areas on June 4, 1991. The Aboriginal population was defined by ethnic origin (ancestry), Registered Indian status and/or membership in an Indian band or First Nation, since the 1991 census did not collect information on Aboriginal identity.

Results

Compared to urban non-Aboriginal men and women, remaining life expectancy at age 25 years was 4.7 years and 6.5 years shorter for urban Aboriginal men and women, respectively. Mortality rate ratios for urban Aboriginal men and women were particularly elevated for alcohol-related deaths, motor vehicle accidents and infectious diseases, including HIV/AIDS. For most causes of death, urban Aboriginal adults had higher mortality rates compared to other urban residents. Socio-economic status played an important role in explaining these disparities.

Conclusion

Results from this study help fill a data gap on mortality information of urban Aboriginal people of Canada.

Keywords

Aboriginal people, First Nations, Métis, Inuit, North American Indians, age-standardized mortality rates, mortality rate, life expectancy     

Trends in Ischemic Heart Disease Mortality in Korea, 1985-2009: An Age-period-cohort Analysis

Objectives

Economic growth and development of medical technology help to improve the average life expectancy, but the western diet and rapid conversions to poor lifestyles lead an increasing risk of major chronic diseases. Coronary heart disease mortality in Korea has been on the increase, while showing a steady decline in the other industrialized countries. An age-period-cohort analysis can help understand the trends in mortality and predict the near future.

Methods

We analyzed the time trends of ischemic heart disease mortality, which is on the increase, from 1985 to 2009 using an age-period-cohort model to characterize the effects of ischemic heart disease on changes in the mortality rate over time.

Results

All three effects on total ischemic heart disease mortality were statistically significant. Regarding the period effect, the mortality rate was decreased slightly in 2000 to 2004, after it had continuously increased since the late 1980s that trend was similar in both sexes. The expected age effect was noticeable, starting from the mid-60''s. In addition, the age effect in women was more remarkable than that in men. Women born from the early 1900s to 1925 observed an increase in ischemic heart mortality. That cohort effect showed significance only in women.

Conclusions

The future cohort effect might have a lasting impact on the risk of ischemic heart disease in women with the increasing elderly population, and a national prevention policy is need to establish management of high risk by considering the age-period-cohort effect.     

Incidence and Short-term Mortality From Perforated Peptic Ulcer in Korea: A Population-Based Study

Background

Perforated peptic ulcer (PPU) is associated with serious health and economic outcomes. However, few studies have estimated the incidence and health outcomes of PPU using a nationally representative sample in Asia. We estimated age- and sex-specific incidence and short-term mortality from PPU among Koreans and investigated the risk factors for mortality associated with PPU development.

Methods

A retrospective population-based study was conducted from 2006 through 2007 using the Korean National Health Insurance claims database. A diagnostic algorithm was derived and validated to identify PPU patients, and PPU incidence rates and 30-day mortality rates were determined.

Results

From 2006 through 2007, the PPU incidence rate per 100 000 population was 4.4; incidence among men (7.53) was approximately 6 times that among women (1.24). Incidence significantly increased with advanced age, especially among women older than 50 years. Among 4258 PPU patients, 135 (3.15%) died within 30 days of the PPU event. The 30-day mortality rate increased with advanced age and reached almost 20% for patients older than 80 years. The 30-day mortality rate was 10% for women and 2% for men. Older age, being female, and higher comorbidity were independently associated with 30-day mortality rate among PPU patients in Korea.

Conclusions

Special attention should be paid to elderly women with high comorbidity who develop PPU.Key words: peptic ulcer perforation, incidence, mortality, population     

Disparities in cervical and breast cancer mortality in Brazil

OBJECTIVE

To analyze cervical and breast cancer mortality in Brazil according to socioeconomic and welfare indicators.

METHODS

Data on breast and cervical cancer mortality covering a 30-year period (1980-2010) were analyzed. The data were obtained from the National Mortality Database, population data from the Brazilian Institute of Geography and Statistics database, and socioeconomic and welfare information from the Institute of Applied Economic Research. Moving averages were calculated, disaggregated by capital city and municipality. The annual percent change in mortality rates was estimated by segmented linear regression using the joinpoint method. Pearson’s correlation coefficients were conducted between average mortality rate at the end of the three-year period and selected indicators in the state capital and each Brazilian state.

RESULTS

There was a decline in cervical cancer mortality rates throughout the period studied, except in municipalities outside of the capitals in the North and Northeast. There was a decrease in breast cancer mortality in the capitals from the end of the 1990s onwards. Favorable socioeconomic indicators were inversely correlated with cervical cancer mortality. A strong direct correlation was found with favorable indicators and an inverse correlation with fertility rate and breast cancer mortality in inner cities.

CONCLUSIONS

There is an ongoing dynamic process of increased risk of cervical and breast cancer and attenuation of mortality because of increased, albeit unequal, access to and provision of screening, diagnosis and treatment.      

Incidence of total stroke, stroke subtypes, and myocardial infarction in the Japanese population: the JMS Cohort Study

Background

Previous reports indicated that the incidence rate of stroke was higher in Japan than in Western countries, but the converse was true in the case of myocardial infarction (MI). However, few population-based studies on the incidence rates of stroke and MI have been conducted in Japan.

Methods

The Jichi Medical School (JMS) Cohort Study is a multicenter population-based cohort study that was conducted in 12 districts in Japan. Baseline data were collected between April 1992 and July 1995. We examined samples from 4,869 men and 7,519 women, whose mean ages were 55.2 and 55.3 years, respectively. The incidence of stroke, stroke subtypes, and MI were monitored.

Results

The mean follow-up duration was 10.7 years. A total of 229 strokes and 64 MIs occurred in men, and 221 strokes and 28 MIs occurred in women. The age-adjusted incidence rates (per 100,000 person-years) of stroke were 332 and 221 and those of MI were 84 and 31 in men and women, respectively. In the case of both sexes, the incidence rates of stroke and MI were the highest in the group of subjects aged > 70 years.

Conclusion

We reported current data on the incidence rates of stroke and MI in Japan. The incidence rate of stroke remains high, considerably higher than that of MI, in both men and women. The incidence rates of both stroke and MI were higher in men than in women.Key words: Incidence, Stroke, Myocardial Infarction, Cohort Studies, Asian Continental Ancestry Group     

Social capital and suicide: an ecological study in Tokyo,Japan

Objective

The aim of this study is to clarify the association between area-based social capital and suicide rate among municipalities of Tokyo.

Methods

The study areas were 20 administrative municipalities of Tokyo. Social capital (i.e., organizational membership, social trust, fairness, helpfulness, and confidence in organizations) was measured based on data from a previous survey (response rate 28 %). Gender-specific age-adjusted suicide rates averaged over 5 years, sociodemographic, and other area characteristics were obtained from relevant national statistics. Multiple linear regression analysis of suicide rates was applied on each social capital variable, adjusting for the other area characteristics.

Results

There was no significant crude Pearson’s correlation between any social capital variable and suicide rate. Multiple regression analyses revealed a significant negative association between social trust and suicide rate for men (p = 0.04).

Conclusions

While based on only limited evidence from a cross-sectional ecological study, area-based social trust may be associated with decreased suicide rates for men in Tokyo.     

Associations of Dietary Iron Intake With Mortality From Cardiovascular Disease: The JACC Study

Background

We investigated the relationship between dietary iron intake and mortality from cardiovascular disease (CVD) in a population-based sample of Japanese adults.

Methods

The study cohort consisted of 58 615 healthy Japanese (23 083 men and 35 532 women), aged between 40 and 79 years, who had no history of stroke, coronary heart disease (CHD), or cancer at baseline. Dietary iron intake was assessed at baseline by a validated food frequency questionnaire administered between 1988 and 1990 as part of the Japan Collaborative Cohort (JACC) Study.

Results

We documented 2690 (1343 men and 1347 women) deaths from CVD: 1227 (607 men and 620 women) deaths from total stroke, 651 from ischemic stroke (355 men and 296 women), 459 (196 men and 263 women) from hemorrhagic stroke, and 557 (311 men and 246 women) from CHD. Dietary intake of total iron was positively associated with mortality from total and ischemic stroke and total CVD in men. The multivariable hazard ratio for the highest versus the lowest quintile of total iron intake was 1.43 (95% CI, 1.02–2.00; P for trend = 0.009) for total stroke and 1.27 (1.01–1.58; 0.023) for total CVD in men. Dietary total iron intake was not associated with mortality from other endpoints in men, and was not associated with any endpoints in women.

Conclusions

Dietary intake of total iron was positively associated with mortality from stroke and total CVD in Japanese men.Key words: dietary iron, mortality, stroke, coronary heart disease, cardiovascular disease, follow-up studies     

Geographic and Demographic Disparities in Late-stage Breast and Colorectal Cancer Diagnoses Across the US

Problem

In 2009, breast cancer was the most common cancer in women, and colorectal cancer was the third most common cancer in both men and women. Currently, the majority of colorectal and almost 1/3 of breast cancers are diagnosed at an advanced stage in the US, which results in higher morbidity and mortality than would obtain with earlier detection. The incidence of late-stage cancer diagnoses varies considerably across the US, and few analyses have examined the entire US.

Purpose

Using the newly available US Cancer Statistics database representing 98% of the US population, we perform multilevel analysis of the incidence of late-stage cancer diagnoses and translate the findings via bivariate mapping, answering questions related to both Why and Where demographic and geographic disparities in these diagnoses are observed.

Methods

To answer questions related to Why disparities are observed, we utilize a three-level, random-intercepts model including person-, local area-, and region- specific levels of influence. To answer questions related to Where disparities are observed, we generate county level robust predictions of late-stage cancer diagnosis rates and map them, contrasting counties ranked in the upper and lower quantiles of all county predicted rates. Bivariate maps are used to spatially translate the geographic variation among US counties in the distribution of both BC and CRC late-stage diagnoses.

Conclusions

Empirical modeling results show demographic disparities, while the spatial translation of empirical results shows geographic disparities that may be quite useful for state cancer control planning. Late stage BC and CRC diagnosis rates are not spatially random, manifesting as place-specific patterns that compare counties in individual states to counties across all states. Providing a relative comparison that enables assessment of how results in one state compare with others, this paper is to be disseminated to all state cancer control and central cancer registry program officials.     

Self-reported diabetes mellitus and risk of mortality from all causes, cardiovascular disease, and cancer in Takayama: a population-based prospective cohort study in Japan

Background

Diabetes mellitus has been reported to be a major risk factor for cardiovascular disease (CVD), and higher risk of CVD among women than that among men has been observed in many studies. Further, the association of diabetes with increasing risk of cancer has also been reported. Well-designed studies conducted among men and women in the general Japanese population remain scarce.

Methods

Our cohort consisted of 13355 men and 15724 women residing in Takayama, Japan, in 1992. At the baseline, the subjects reported diabetes in a questionnaire. Any deaths occurring in the cohort until 1999 were noted by using data from the Office of the National Vital Statistics. The risk of mortality was separately assessed for men and women by using a Cox proportional hazard model after adjusting for age; smoking status; body mass index (BMI); physical activity; years of education; history of hypertension; and intake of total energy, vegetables, fat, and alcohol.

Results

Diabetes significantly increased the risk of mortality from all causes [hazard ratio (HR): 1.35, 95% confidence interval (CI): 1.11-1.64] and from coronary heart disease (CHD) (HR: 2.96, 95% CI: 1.59-5.50) among men, and that from all causes (HR: 1.74, 95% CI: 1.34-2.26) and cancer (HR: 1.88, 95% CI: 1.16-3.05) among women. Diabetes was not significantly associated with mortality from CHD among women.

Conclusion

The findings suggest that diabetes increases the risk of mortality from CVD among men and that from cancer among women. The absence of increased risk of mortality from CHD among women may suggest a particular pattern in the Japanese population.Key words: Diabetes mellitus, Mortality, Cardiovascular disease, Cancer, Cohort study     

Disability-adjusted life years (DALY) for cancer in Japan in 2000

Background

We used disability-adjusted life years (DALY) to estimate the cancer burden in Japan for the year 2000.

Methods

We estimated years of life lost (YLL) by using mortality data and years lived with disability (YLD) by using incidence data. The DALY for cancer was calculated as the sum of YLL and YLD.

Results

For all cancers combined, 2 733 884 years of DALY were estimated in men and 2 091 874 years were estimated in women. Among men, stomach and lung cancers accounted for the largest proportions of DALY, followed by liver cancer and colorectal cancer. Among women, the greatest contributors to DALY were stomach, colorectal, breast, and lung cancers.

Conclusions

The national cancer burden in Japan was expressed in terms of DALY, which might be useful in assessing future changes with respect to mortality and morbidity in Japan.Key words: cancer, DALY, disability-adjusted life years, premature mortality, years lived with disability     

Retrospective mortality cohort study of Italian workers compensated for silicosis

Objectives

To estimate cause specific mortality in a large cohort of Italian workers compensated for silicosis.

Methods

The cohort included 14 929 subjects (14 098 men and 831 women) compensated for silicosis between 1946 and 1979, alive on 1 January 1980, and resident in Tuscany (a region of central Italy with 3 547 000 inhabitants). Mortality follow up ranged from 1980 to 1999. Vital status and the causes of death were determined by linkage with the regional mortality registry and with the national mortality database. The cohort mortality rates were compared to the rates of the local reference population. SMRs and their 95% confidence intervals were computed assuming a Poisson distribution of the observed deaths. Specific SMR analyses were performed according to the level of disability, the year of compensation assignment, and the job type.

Results

A significant excess mortality was observed in male silicotics for cancer of the lung, trachea, and bronchus and cancer of the liver, respiratory diseases (silicosis, asbestosis, antracosilicosis, and other pneumoconiosis), and for tubercolosis. Statistically significant mortality excess was observed in female silicotics for respiratory diseases (specifically silicosis and other pneumoconiosis) and tuberculosis. Analyses for period of compensation assignment showed a twofold increased SMR for biliary tract cancer among female workers and for liver cancer among male workers compensated before 1970.

Conclusions

The excess mortality from respiratory tract cancers and respiratory tract diseases detected in Italian compensated silicotics are in agreement with previous epidemiological studies. Although the twofold increased risk for liver cancer among males is suggestive of a possible association with silica dust exposure, the finding needs to be confirmed.     

Associations Between Socio-demographic Characteristics and Healthy Lifestyles in Korean Adults: The Result of the 2010 Community Health Survey

Objectives

Several previous studies have found that healthy behaviors substantially reduce non-communicable disease incidence and mortality. The present study was performed to estimate the prevalence of four modifiable healthy behaviors and a healthy lifestyle among Korean adults according to socio-demographic and regional factors.

Methods

We analyzed data from 199 400 Korean adults aged 19 years and older who participated in the 2010 Korean Community Health Survey. We defined a healthy lifestyle as a combination of four modifiable healthy behaviors: non-smoking, moderate alcohol consumption, regular walking, and a healthy weight. We calculated the prevalence rates and odds ratios of each healthy behavior and healthy lifestyle according to socio-demographic and regional characteristics.

Results

The prevalence rates were as follows: non-smoking, 75.0% (53.7% in men, 96.6% in women); moderate alcohol consumption, 88.2% (79.7% in men, 96.9% in women); regular walking, 45.0% (46.2% in men, 43.8% in women); healthy weight, 77.4% (71.3% in men, 73.6% in women); and a healthy lifestyle, 25.5% (16.4% in men, 34.6% in women). The characteristics associated with a low prevalence of healthy lifestyle were male gender, younger age (19 to 44 years of age), low educational attainment, married, living in a rural area, living in the Chungcheong, Youngnam, or Gwangwon-Jeju region, and poorer self-rated health.

Conclusions

Further research should be implemented to explore the explainable factors of disparities for socio-demographic and regional characteristics to engage in the healthy lifestyle among adults.     

Validity of self-reported height and weight in a Korean population

Background

Accessible public information on self-reported height and weight is not widely used in studies of obesity, mainly because of the questionable validity of body mass index (BMI) values calculated from these data. To assess the utility of self-reported measurement, we compared self-reported and standard measurements of height and weight in a Korean population that is leaner than Western populations.

Methods

A cross-sectional comparison of self-reported and measured height and weight was conducted among a population of participants in a cancer screening program. A total of 557 men and 1010 women aged 30 to 70 years were included in the current analysis.

Results

Self-reported height was higher than measured values in both men and women. Self-reported weight was higher than measured weight in women, but was not different in men. BMI calculated from measured values was higher than BMI derived from self-reported height and weight among men. Younger age was a predictor of accuracy in self-reported height, and higher weight and BMI were predictors of under-reporting of weight. The prevalence of obesity based on self-reported values was lower than the true prevalence of obesity. With respect to classifying individuals as obese, the specificity and sensitivity of BMI calculated from self-reported values were very high for both sexes.

Conclusions

Self-reported height and weight were reasonably valid in this study population.Key words: validity, height, weight, body mass index, self-report     

Cohort profile: the ages 2003 cohort study in Aichi, Japan

Background

The longevity of Japanese is thought to be associated with psychosocial factors such as sense of coherence, social support, and social capital. However, the actual factors responsible and the extent of their contribution to individual health status are not known.

Methods

The Aichi Gerontological Evaluation Study (AGES) 2003 Cohort Study is a prospective cohort study of community-dwelling, activities of daily living-independent people aged 65 or older living in 6 municipalities in Chita peninsula, Aichi Prefecture, Japan. Information on psychosocial factors and other individual- and community-level factors was collected in the second half of 2003 using a baseline questionnaire. Vital status and physical and cognitive decline have been followed using data derived from long-term care insurance certification. Geographical information on the study participants was also obtained.

Results

A total of 13 310 (6508 men; 6802 women) study participants were registered in the study. For an interim report, we followed the cohort for 48 months, yielding 24 753 person-years of observation among men and 26 456 person-years among women.

Conclusions

The AGES 2003 Cohort Study provides useful evidence for research in social epidemiology, gerontology, and health services.Key words: Japanese longevity, social support, social capital, cohort profile, the AGES project