scholarly journals 828Dietary Variety and Incident Disabling Dementia in Elderly Japanese Adults

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Yuri Yokoyama ◽  
Akihiko Kitamura ◽  
Yu Nofuji ◽  
Satoshi Seino ◽  
Hidenori Amano ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Community Dwelling ◽  
Cox Proportional Hazards Model ◽  
Term Care ◽  
Dietary Variety ◽  
Japanese Adults ◽  
Elderly Japanese ◽  
A Prospective Study

Abstract Background Although consuming a variety of foods is an internationally accepted recommendation for a healthy diet, little is known about the association between dietary variety and incident dementia. This study aimed to examine the association between dietary variety and incident disabling dementia in community-dwelling elderly Japanese adults. Methods We conducted a prospective study of 721 participants (age range: 65–97 years) of the 2012–2013 Kusatsu Longitudinal Study. Dietary variety was assessed based on a food frequency questionnaire that encompassed the 10 main food components of Japanese meals: meat, fish/shellfish, eggs, milk, soybean products, green/yellow vegetables, potatoes, fruit, seaweed, and fats/oils). Participants were then categorized into low (0–2 points), middle (3–5 points), and high (6–10 points) groups based on the scores. Data regarding incident disabling dementia were retrieved from the public Long-term Care Insurance database. The Cox proportional hazards model was used to estimate the hazard ratios (HRs) with 95% confidence intervals (CIs). Results During the median follow-up of 6.5 years, the incidence of disabling dementia was 9.3%. After adjusting for confounders, the multivariate HR for incident disabling dementia was 0.52 (95% CI, 0.27–1.00) for participants in the highest category of the dietary variety score compared to that for those in the lowest category. Conclusions Greater dietary variety is associated with a reduced risk of incident disabling dementia in elderly Japanese adults. Key messages Consuming a variety of foods may be necessary for dementia prevention.

scholarly journals Smoking cessation and incident dementia in elderly Japanese: the Ohsaki Cohort 2006 Study

2020 ◽  
Vol 35 (9) ◽  
pp. 851-860
Author(s):  
Yukai Lu ◽  
Yumi Sugawara ◽  
Shu Zhang ◽  
Yasutake Tomata ◽  
Ichiro Tsuji
Keyword(s):  
Smoking Cessation ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Smoking Status ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Term Care ◽  
Incident Dementia ◽  
Increased Risk ◽  
Elderly Japanese

Abstract To investigate the association of smoking status and years since smoking cessation with the risk of incident dementia among elderly Japanese. We conducted a longitudinal analysis of smoking status and smoking cessation with dementia in prospective cohort study of 12,489 Japanese individuals aged ≥ 65 years who were followed up for 5.7 years. Information on smoking status and other lifestyle factors was collected via a questionnaire in 2006. Data on incident dementia were retrieved from the public Long-term Care Insurance Database. The Cox proportional hazards model was used to estimate the multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) for incident dementia. During 61,613 person-years of follow-up, 1110 cases (8.9%) of incident dementia were documented. Compared with individuals who had never smoked, current smokers showed a higher risk of dementia (HR 1.46, 95% CI 1.17, 1.80). Among ex-smokers, the risk for those who had stopped smoking for ≤ 2 years was still high (HR 1.39, 95% CI 0.96, 2.01), however, quitting smoking for 3 years or longer mitigated the increased risk incurred by smokers; the multivariable HRs (95% CIs) were 1.03 (0.70, 1.53) for those who had stopped smoking for 3–5 years, 1.04 (0.74, 1.45) for 6–10 years, 1.19 (0.84, 1.69) for 11–15 years, and 0.92 (0.73, 1.15) for > 15 years. Our study suggests that the risk of incident dementia among ex-smokers becomes the same level as that of never smokers if they maintain abstinence from smoking for at least 3 years.

scholarly journals Pre-Existing Disability and Its Risk of Fragility Hip Fracture in Older Adults

2019 ◽  
Vol 16 (7) ◽  
pp. 1237
Author(s):  
Jayeun Kim ◽  
Soong-Nang Jang ◽  
Jae-Young Lim
Keyword(s):  
Older Adults ◽  
Hip Fracture ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Cox Proportional Hazards Model ◽  
Mental Disabilities ◽  
Term Care ◽  
Fragility Hip Fracture

Background: Hip fracture is one of the significant public concerns in terms of long-term care in aging society. We aimed to investigate the risk for the incidence of hip fracture focusing on disability among older adults. Methods: This was a population-based retrospective cohort study, focusing on adults aged 65 years or over who were included in the Korean National Health Insurance Service–National Sample from 2004 to 2013 (N = 90,802). Hazard ratios with 95% confidence interval (CIs) were calculated using the Cox proportional hazards model according to disability adjusted for age, household income, underlying chronic diseases, and comorbidity index. Results: The incidence of hip fracture was higher among older adults with brain disability (6.3%) and mental disability (7.5%) than among those with other types of disability, as observed during the follow-up period. Risk of hip fracture was higher among those who were mildly to severely disabled (hazard ratio for severe disability = 1.59; 95% CI, 1.33–1.89; mild = 1.68; 95% CI, 1.49–1.88) compared to those who were not disabled. Older men with mental disabilities experienced an incidence of hip fracture that was almost five times higher (hazard ratio, 4.98; 95% CI, 1.86–13.31) versus those that were not disabled. Conclusions: Older adults with mental disabilities and brain disability should be closely monitored and assessed for risk of hip fracture.

scholarly journals Circulating Inflammatory and Hemostatic Biomarkers are Associated with All-Cause Death and Cancer Death in a Population of Community-Dwelling Japanese: The Tanushimaru Study

2014 ◽  
Vol 8s3 ◽  
pp. CMC.S17065
Author(s):  
Mika Enomoto ◽  
Hisashi Adachi ◽  
Ako Fukami ◽  
Ayako Yoshimura ◽  
Aya Obuchi ◽  
...  
Keyword(s):  
Cardiovascular Diseases ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Inflammatory Diseases ◽  
Cox Proportional Hazards ◽  
Predictive Markers ◽  
Community Dwelling ◽  
Cox Proportional Hazards Model ◽  
Cancer Death ◽  
Hazards Model

Background In patients with cardiovascular diseases, inflammatory and hemostatic biomarkers are significant indicators of prognosis. We investigated whether circulating inflammatory and hemostatic biomarkers were predictive markers for all-cause death and cancer death in a population of community-dwelling Japanese. Methods We studied 1,920 healthy Japanese adults who underwent health examinations in 1999. Those who reported a history of inflammatory diseases and malignancy on a baseline questionnaire were excluded. Inflammatory and hemostatic biomarkers were measured in the remaining 1,862 participants, who were followed up periodically for 10 years. Multivariate proportional hazards regression analysis was used to estimate all-cause and cancer mortality. Results A total of 258 participants died during follow-up: 87 from cancer, 38 from cerebro-cardiovascular diseases, and 133 from other diseases. Mean C-reactive protein (CRP) levels at baseline were significantly higher in decedents than in survivors. Mean von Willebrand factor (vWF) levels at baseline were significantly higher in decedents than in survivors. The Cox proportional hazards model after adjustments for age and sex showed that CRP (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.06-1.51) and vWF (HR, 1.01; 95% CI, 1.00-1.01) were independent predictors of all-cause death. CRP (HR, 1.40; 95% CI, 1.06-1.86) and vWF (HR, 1.01; 95% CI, 1.00-1.02) were also independent predictive markers for cancer death. Conclusions Serum CRP and vWF were predictors of all-cause death and cancer death in the population of community dwelling Japanese.

scholarly journals Predictors for depressive symptoms by four types of disability

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sun Wook Jung ◽  
Jin-Ha Yoon ◽  
Wanhyung Lee
Keyword(s):  
Depressive Symptoms ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Depressive Symptomatology ◽  
Cox Proportional Hazards ◽  
Community Dwelling ◽  
Cox Proportional Hazards Model ◽  
Mental Disability ◽  
Multivariate Logistic Regression Model ◽  
Industrial Disaster

AbstractThis study aimed to examine the longitudinal relationship between disability and depressive symptoms, by comparing four types of disability in community-dwelling individuals with disabilities in South Korea. A total of 3347 South Koreans with disabilities from the second wave of the Panel Survey of Employment for the Disabled was utilized. Depressive symptomatology was assessed by whether the participant had experienced depressive symptoms for more than two weeks during the past year. A multivariate logistic regression model was used to calculate the odds ratio (OR) for depressive symptoms, and a Cox proportional hazards model to calculate the hazard ratio (HR) for two-year survival analysis. Persons who acquired mental disability from accident or industrial disaster and persons with congenital physical-internal disability were at higher risk for depressive symptoms. Maintaining employment was found to be an effective way to decrease the risk of depressive symptoms in persons with physical-external disability, sensory/speech disability, or mental disability. In contrast, in physical-internal disability, retaining normal ability to work seemed to be the key to reduce the risk of depressive symptoms. Predictors of depressive symptoms were found to differ depending on the type of disability. Such differences should be reflected in clinical and policy-level interventions to address the specific psychiatric needs of persons with different disabilities.

scholarly journals Socioeconomic Status, Frailty, and All-Cause Mortality in Korean Older Adults: A 3-Year Population-Based Prospective Study

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Jinkyung Cho ◽  
Inhwan Lee ◽  
Soo Hyun Park ◽  
Youngyun Jin ◽  
Donghyun Kim ◽  
...  
Keyword(s):  
Older Adults ◽  
Socioeconomic Status ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Community Dwelling ◽  
Cox Proportional Hazards Model ◽  
Low Ses ◽  
Increased Risk ◽  
All Cause Mortality

Background. Little is known regarding the effects of socioeconomic status (SES) and frailty on mortality in Korea. Objective. This study investigated the combined impact of low SES and frailty on all-cause mortality in Korean older adults. Methods. Study sample at baseline comprised 7,960 community-dwelling adults (56.8% women) aged 65 years and older. The Cox proportional hazards model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of low SES and frailty for all-cause mortality. Results. Overall, low SES plus frailty resulted in an increased risk of all-cause mortality (HR = 1.56, 95% CI = 1.09–2.23, P=0.015) even after adjustments for all the measured covariates, as compared with high SES plus nonfrailty (HR = 1). Among older adults aged 65–75 years, the increased mortality risk of either low SES plus nonfrailty (HR = 1.37, 95% CI = 1.02–1.84, P=0.038) or high SES plus frailty (HR = 2.09, 95% CI = 1.12–3.91, P=0.021) remained significant even after adjustments for all the covariates, as compared with high SES plus nonfrailty (HR = 1). Conclusion. The current findings suggest that either low SES or frailty is significantly associated with increased all-cause mortality in Korean older adults.

scholarly journals Covid-19 Vaccine Effectiveness in Healthcare Personnel in six Israeli Hospitals (CoVEHPI)

2021 ◽  
Author(s):  
Mark A. Katz ◽  
Efrat Bron Harlev ◽  
Bibiana Chazan ◽  
Michal Chowers ◽  
David Greenberg ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Vaccine Effectiveness ◽  
Cox Proportional Hazards Model ◽  
Healthcare Personnel ◽  
Primary Analysis ◽  
Exact Test ◽  
Alpha Variant ◽  
A Prospective Study

Background Methodologically rigorous studies on Covid-19 vaccine effectiveness (VE) in preventing SARS-CoV-2 infection are critically needed to inform national and global policy on Covid-19 vaccine use. In Israel, healthcare personnel (HCP) were initially prioritized for Covid-19 vaccination, creating an ideal setting to evaluate real-world VE in a closely monitored population. Methods We conducted a prospective study among HCP in 6 hospitals to estimate the effectiveness of the BNT162b2 mRNA Covid-19 vaccine in preventing SARS-CoV-2 infection. Participants filled out weekly symptom questionnaires, provided weekly nasal specimens, and three serology samples - at enrollment, 30 days and 90 days. We estimated VE against PCR-confirmed SARS-CoV-2 infection using the Cox Proportional Hazards model and against a combined PCR/serology endpoint using Fishers exact test. Findings Of the 1,567 HCP enrolled between December 27, 2020 and February 15, 2021, 1,250 previously uninfected participants were included in the primary analysis; 998 (79.8%) were vaccinated with their first dose prior to or at enrollment, all with Pfizer BNT162b2 mRNA vaccine. There were four PCR-positive events among vaccinated participants, and nine among unvaccinated participants. Adjusted two-dose VE against any PCR-confirmed infection was 94.5% (95% CI: 82.6%-98.2%); adjusted two-dose VE against a combined endpoint of PCR and seroconversion for a 60-day follow-up period was 94.5% (95% CI: 63.0%-99.0%). Five PCR-positive samples from study participants were sequenced; all were alpha variant. Interpretation Our prospective VE study of HCP in Israel with rigorous weekly surveillance found very high VE for two doses of Pfizer BNT162b2 mRNA vaccine against SARS-CoV-2 during a period of predominant alpha variant circulation.

scholarly journals Poor self-rated health predicts the incidence of functional disability in elderly community dwellers in Japan: a prospective cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Shuko Takahashi ◽  
◽  
Kozo Tanno ◽  
Yuki Yonekura ◽  
Masaki Ohsawa ◽  
...  
Keyword(s):  
Functional Disability ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Large Population ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Term Care ◽  
Self Rated Health ◽  
Japanese Elderly ◽  
Community Dwellers

Abstract Background Although previous large population studies showed elderly with poor self-rated health (SRH) to be at a high risk of functional disability in Western countries, there have been few studies in which the association between SRH and functional disability was investigated in Japanese community dwellers. The association between SRH and functional disability, defined as certification of the long-term care insurance (LTCI) system, in Japanese elderly community dwellers was examined in this study. Methods A total of 10,690 individuals (39.5% men, mean age of 71.4 years) who were 65 years of age or more who did not have a history of cardiovascular disease or LTCI certification were followed in this prospective study for 10.5 years. SRH was classified into four categories: good, rather good, neither good nor poor, and poor. A Cox proportional-hazards model was used to determine the hazard ratios (HRs) for the incidence of functional disability among the SRH groups for each sex. Results The number of individuals with functional disability was 3377. Men who rated poor for SRH scored significantly higher for functional disability (HR [95% confidence interval]: poor = 1.74 [1.42, 2.14]) while women who rated rather good, neither good nor poor, and poor scored significantly higher for functional disability (rather good =1.12 [1.00, 1.25], neither good nor poor = 1.29 [1.13, 1.48], poor = 1.92 [1.65, 2.24]: p for trend < 0.001 in both sexes). Conclusion Self-rated health, therefore, might be a useful predictor of functional disability in elderly people.

scholarly journals The effect of the 2018 Japan Floods on cognitive decline among long-term care insurance users in Japan: a retrospective cohort study

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Shuhei Yoshida ◽  
Saori Kashima ◽  
Masatoshi Matsumoto
Keyword(s):  
Cognitive Decline ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
The Elderly ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Residential Environment ◽  
Cox Proportional Hazards Model ◽  
Term Care ◽  
Hazards Model

Abstract Background The July 2018 Japan Floods caused enormous damage to western Japan. Such disasters can especially impact elderly persons. Research has shown that natural disasters exacerbated a decline in cognitive function, but to date, there have been no studies examining the effects of this disaster on the elderly. The object of this study was to reveal the effect of this disaster in terms of cognitive decline among the elderly. Methods Study participants were certified users of the long-term care insurance (LTCI) system in Hiroshima, Okayama, and Ehime prefectures from May 2018 to June 2018. The observation period was from July 2018 to December 2018. Our primary outcome was cognitive decline after the disaster using a dementia symptomatology assessment. In addition to a crude model, a multivariate Cox proportional hazards model was used to assess the cognitive decline of victims, adjusting for age classification, gender, the level of dementia scale before the disaster occurred, residential environment, whether a participant used facilities shut down after the disaster, and population density. After we confirmed that the interaction term between victims and residential environment was statistically significant, we stratified them for the analysis. Results The total number of participants was 264,614. Victims accounted for 1.10% of the total participants (n = 2,908). For the Cox proportional hazards model, the hazard ratio of the victims was 1.18 (95% confidential interval (CI): 1.05–1.32) in the crude model and 1.12 (95% CI: 1.00–1.26) in the adjusted model. After being stratified by residential environment, the hazard ratio of home victims was 1.20 (95% CI: 1.06–1.36) and the hazard ratio of facility victims was 0.89 (95% CI: 0.67–1.17). Conclusions This study showed that elderly living at home during the 2018 Japan Floods were at risk for cognitive decline. Medical providers, care providers, and local governments should establish a system to check on the cognitive function of elderly victims and provide necessary care support.

Underweight rather than adiposity is an important predictor of death in rural Chinese adults: a cohort study

2021 ◽  
pp. jech-2020-214821
Author(s):  
Yun Chen ◽  
Na Wang ◽  
Xiaolian Dong ◽  
Xuecai Wang ◽  
Jianfu Zhu ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Normal Weight ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Important Predictor ◽  
Hazards Model ◽  
Increased Risk ◽  
All Cause Mortality ◽  
A Prospective Study

BackgroundTo assess the associations of body mass index (BMI) with all-cause and cause-specific mortalities among rural Chinese.MethodsA prospective study of 28 895 individuals was conducted from 2006 to 2014 in rural Deqing, China. Height and weight were measured. The association of BMI with mortality was assessed by using Cox proportional hazards model and restricted cubic spline regression.ResultsThere were a total of 2062 deaths during an average follow-up of 7 years. As compared with those with BMI of 22.0–24.9 kg/m2, an increased risk of all-cause mortality was found for both underweight men (BMI <18.5 kg/m2) (adjusted HR (aHR): 1.45, 95% CI: 1.18 to 1.79) and low normal weight men (BMI of 18.5–21.9 kg/m2) (aHR: 1.20, 95% CI: 1.03 to 1.38). A J-shaped association was observed between BMI and all-cause mortality in men. Underweight also had an increased risk of cardiovascular disease and cancer mortalities in men. The association of underweight with all-cause mortality was more pronounced in ever smokers and older men (60+ years). The results remained after excluding participants who were followed up less than 1 year.ConclusionThe present study suggests that underweight is an important predictor of mortality, especially for elderly men in the rural community of China.

scholarly journals Association between coordination of long-term care insurance service and adverse outcome after discharge in older patients with heart failure

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
Y Tsunekawa ◽  
T Adachi ◽  
T Kameyama ◽  
K Kobayashi ◽  
A Matsuoka ◽  
...  
Keyword(s):  
Older Patients ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Adverse Outcome ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Rank Test ◽  
Term Care ◽  
Hazards Model ◽  
Group I

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Long-term care insurance (LTCI) has a key role in the disease management of older patients in Japan. However, clinical benefit of coordinating LTCI service during hospitalization has not been examined in patients with heart failure (HF). Purpose We aimed to examine the association between the coordination of LTCI service and adverse outcome after discharge in Japanese older patients with HF. Methods The inclusion criteria of this retrospective cohort study were patients aged ≥ 65 years hospitalised for HF who used any LTCI services after discharge. In Japan, people aged ≥ 65 who satisfy the eligibility criteria are eligible to receive LTCI services. Questionnaires regarding daily life and activities are used to assess eligibility and create the 7 certification levels: support required 1 or 2, and care levels 1 (least disabled) to 5 (most disabled). In this study, patients were divided into 1) patients without any change in LTCI service during hospitalisation (Group N), 2) patients with coordination of LTCI services during hospitalization (Group C), 3) patients who newly initiated LTCI service after discharge (Group I). The primary outcome was a composite of HF rehospitalisation and all-cause mortality. Survival rate was compared using Kaplan-Meier curve analysis and log-rank test. Multivariate analysis was conducted using Cox proportional-hazards model adjusted for propensity score calculated based on age, gender, brain natriuretic peptide, β-blocker, angiotensin converting enzyme inhibitor /angiotensin II receptor blocker, need of any walking device or assistance at discharge, living alone, LTCI level. Results A total of 135 older patients were included (mean age 84 years, men 46%). During the median follow-up of 580 days, 43 events occurred. The number of patients for each group was as following: Group N, n = 91; Group C, n = 20; Group I, n = 24. The survival rates were significantly different among the three groups (log-rank test p = 0.039 , Figure 1). In Cox proportional-hazards model with Group N as a reference, Group C was associated with reduced risk of the study outcome (hazard ratio 0.22, 95% confidence interval 0.05-0.91, p = 0.036). Group I also showed lower event rate but not statistically significant (hazard ratio 0.81, 95% confidence interval 0.20-0.30, p = 0.756). All the patients in Group C used visiting nurse service, whereas the implementation rates were 12.1% and 37.5% in Group N and Group I, respectively. Implementation rate of visiting rehabilitation was higher in Group C (20.0%) compared to Group N (1.1%) and Group I (4.2). Conclusions Patients with coordination of LTCI service during HF hospitalization showed reduced risk of adverse outcome after discharge, implying the clinical benefits of utilization of LTCI service. Further large-scale studies are needed to examine the optimal utilization of tailor-made LTCI service according to the patient’s condition.

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