Papers - Nomura, Shuhei

The Unseen Aftermath: Associations Between the COVID-19 Pandemic and Shifts in Mortality Trends in Japan

Hasan Jamil, Shuhei Nomura, Stuart Gilmour

International Journal of Environmental Research and Public Health 22 ( 1 ) 74 2025.01

Accepted,  ISSN  16617827

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The COVID-19 pandemic disrupted healthcare systems globally, potentially altering mortality trends for non-COVID-19 diseases, particularly in aging populations like Japan’s. Assessing these impacts is essential for responsive healthcare planning. We analyzed Japanese vital registration mortality records from January 2018 to December 2021 for adults aged 25 and older, excluding COVID-19-related deaths. Data were stratified by sex and ICD-10 cause-of-death chapters. Poisson regression models assessed changes in mortality rates and trends, incorporating pandemic-related variables and interactions between time, age group, and the pandemic term. Among the 4,920,942 deaths analyzed, 2,456,750 occurred during the pandemic years. Significant sex-specific changes in mortality trends were observed. Women experienced increases in mortality rates and trends for endocrine, nutritional, and metabolic diseases; skin and subcutaneous tissue diseases; circulatory diseases; and genitourinary diseases, reversing some pre-pandemic declines. Men showed increases in mortality trends for endocrine, nutritional, and metabolic diseases and genitourinary diseases but no significant changes for skin or circulatory diseases. These findings indicate that the pandemic differentially affected mortality trends between sexes, with women experiencing broader increases across multiple disease categories. The COVID-19 pandemic was associated with significant changes in mortality trends for certain non-COVID-19 diseases in Japan, with notable sex differences. Increased mortality among women across multiple disease categories highlights the pandemic’s indirect health impacts and underscores the need for sex-specific healthcare strategies in the post-pandemic era.

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Cost-Benefit Analysis of Pre-Entry Tuberculosis Screening Policy: Nepalese and Japanese Perspectives

Y Iwaki, T Hayashi, S Nomura, S Shimamura, R Gauchan, MC Huang

 2025

Trading-Off Privacy and Willingness to Share Personal Health Information: A Survey of Municipal Employees in Fukuoka City, Japan

Shuhei Nomura, Yasumasa Segawa, Cyrus Ghaznavi, Takanori Fujita, Keiko Maruyama-Sakurai, Manae Uchibori, Akifumi Eguchi, Masaharu Ishigaki, Kazuto Fujiwara, Masayuki Kido, Hiroaki Miyata, Takanori Yamashita, Naoki Nakashima

Health (Scientific Research Publishing, Inc.)  16 ( 12 ) 1315 - 1331 2024.12

Lead author, Corresponding author, Accepted,  ISSN  1949-4998

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Lifestyle differences in the metabolic comorbidity score of adult population from South Asian countries: a cross-sectional study

Sabera Sultana, Shuhei Nomura, Chris Fook Sheng, Masahiro Hashizume

AJPM Focus (Elsevier BV)  3 ( 6 ) 100273 - 100273 2024.12

Accepted,  ISSN  2773-0654

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Introduction: Metabolic comorbidities are involved in the development and progression of noncommunicable diseases. There is convincing evidence that lifestyles are important contributors to metabolic comorbidities. This study measured the metabolic comorbidity score of South Asian adults and identified its relationship with lifestyles. Methods: The authors studied 5 South Asian countries, including Afghanistan, Bangladesh, Bhutan, Nepal, and Sri Lanka, using the World Health Organization's STEPwise approach to noncommunicable disease risk factor surveillance data between 2014 and 2019. This was a nationally representative and cross-sectional survey on participants aged 15–69 years. The sample size was 27,616. The outcome was metabolic comorbidity score, calculated on the basis of total cholesterol, fasting plasma glucose, blood pressure, and abdominal obesity. Total metabolic comorbidity score of each participant varied between 0 and 8. It was then divided into 3 ranges: the lowest range (total metabolic comorbidity score <3), medium range (total metabolic comorbidity score ≥3 and ≤5), and the highest range (total metabolic comorbidity score ≥6). On the basis of the outcome of nonparametric receiver operating characteristics analysis, the medium and the highest ranges together were considered as higher metabolic comorbidity score. The lowest range was considered as lower metabolic comorbidity score. The higher metabolic comorbidity score was coded as 1, and the lower metabolic comorbidity score was coded as 0. Thus, the outcome variable, metabolic comorbidity score, became a binary variable. Exposures included physical inactivity (<150 minutes of medium-to-vigorous physical activity/week), high daily sedentary time (≥9 hours/day), use of tobacco (present or past smoking or daily use of smokeless tobacco products), and consumption of alcohol (at least once per month in the last 1 year). Binomial logistic regression model produced the OR with corresponding 95% CIs. Results: The prevalence of higher metabolic comorbidity score was 34% among South Asian adults, 25% among the male respondents, and 41% among the female respondents. Participants who were physically inactive (OR=1.26; 95% CI= 1.17, 1.36), had high sedentary time (OR=1.24; 95% CI=1.11, 1.33), and consumed alcohol (OR=1.40; 95% CI=1.23, 1.53) showed higher metabolic comorbidity score than participants who were physically active, had low sedentary time, and did not consume alcohol respectively. However, the authors found an inverse association (OR=0.75; 95% CI=0.71, 0.81) between the use of tobacco and metabolic comorbidity score. Conclusions: One third of South Asian adults had higher metabolic comorbidity score. Physical inactivity, daily sedentary hours, and minimal alcohol consumption were associated with higher metabolic comorbidity score.

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Indirect and direct effects of nighttime light on COVID-19 mortality using satellite image mapping approach

Daisuke Yoneoka, Akifumi Eguchi, Shuhei Nomura, Takayuki Kawashima, Yuta Tanoue, Masahiro Hashizume, Motoi Suzuki

Scientific reports 14 ( 1 ) 25063 - 25063 2024.12

ISSN  2045-2322

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The COVID-19 pandemic has highlighted the importance of understanding environmental factors in disease transmission. This study aims to explore the spatial association between nighttime light (NTL) from satellite imagery and COVID-19 mortality. It particularly examines how NTL serves as a pragmatic proxy to estimate human interaction in illuminated nocturnal area, thereby impacting viral transmission dynamics to neighboring areas, which is defined as spillover effect. Analyzing 43,199 COVID-19 deaths from national mortality data during January 2020 and October 2022, satellite-derived NTL data, and various environmental and socio-demographic covariates, we employed the Spatial Durbin Error Model to estimate the direct and indirect effect of NTL on COVID-19 mortality. Higher NTL was initially directly linked to increased COVID-19 mortality but this association diminished over time. The spillover effect also changed: during the early 3rd wave (December 2020 - February 2021), a unit (nanoWatts/sr/cm2) increase in NTL led to a 7.9% increase in neighboring area mortality (p = 0.013). In contrast, in the later 7th wave (July - September 2022), dominated by Omicron, a unit increase in NTL resulted in an 8.9% decrease in mortality in neighboring areas (p = 0.029). The shift from a positive to a negative spillover effect indicates a change in infection dynamics during the pandemic. The study provided a novel approach to assess nighttime human activity and its influence on disease transmission, offering insights for public health strategies utilizing satellite imagery, particularly when direct data collection is impractical while the collection from space is readily available.

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Global, regional, and national stillbirths at 20 weeks' gestation or longer in 204 countries and territories, 1990–2021: findings from the Global Burden of Disease Study 2021

GBD 2021 Global Stillbirths Collaborators

The Lancet (Elsevier BV)  404 ( 10466 ) 1955 - 1988 2024.11

Accepted,  ISSN  01406736

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Background: Stillbirth is a devastating and often avoidable adverse pregnancy outcome. Monitoring stillbirth levels and trends—in a comprehensive manner that leaves no one uncounted—is imperative for continuing progress in pregnancy loss reduction. This analysis, completed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, methodically accounted for different stillbirth definitions with the aim of comprehensively estimating all stillbirths at 20 weeks or longer for 204 countries and territories from 1990 to 2021. Methods: We extracted data on stillbirths from 11 412 sources across 185 of 204 countries and territories, including 234 surveys, 231 published studies, 1633 vital statistics reports, and 10 585 unique location-year combinations from vital registration systems. Our final dataset comprised 11 different definitions, which were adjusted to match two gestational age thresholds: 20 weeks or longer (reference) and 28 weeks or longer (for comparisons). We modelled the ratio of stillbirth rate to neonatal mortality rate with spatiotemporal Gaussian process regression for each location and year, and then used final GBD 2021 assessments of fertility and all-cause neonatal mortality to calculate total stillbirths. Secondary analyses evaluated the number of stillbirths missed with the more restrictive gestational age definition, trends in stillbirths as a function of Socio-demographic Index, and progress in reducing stillbirths relative to neonatal deaths. Findings: In 2021, the global stillbirth rate was 23·0 (95% uncertainty interval [UI] 19·7–27·2) per 1000 births (stillbirths plus livebirths) at 20 weeks' gestation or longer, compared to 16·1 (13·9–19·0) per 1000 births at 28 weeks' gestation or longer. The global neonatal mortality rate in 2021 was 17·1 (14·8–19·9) per 1000 livebirths, corresponding to 2·19 million (1·90–2·55) neonatal deaths. The estimated number of stillbirths occurring at 20 weeks' gestation or longer decreased from 5·08 million (95% UI 4·07–6·35) in 1990 to 3·04 million (2·61–3·62) in 2021, corresponding to a 39·8% (31·8–48·0) reduction, which lagged behind a global improvement in neonatal deaths of 45·6% (36·3–53·1) for the same period (down from 4·03 million [3·86–4·22] neonatal deaths in 1990). Stillbirths in south Asia and sub-Saharan Africa comprised 77·4% (2·35 million of 3·04 million) of the global total, an increase from 60·3% (3·07 million of 5·08 million) in 1990. In 2021, 0·926 million (0·792–1·10) stillbirths, corresponding to 30·5% of the global total (3·04 million), occurred between 20 weeks' gestation and 28 weeks' gestation, with substantial variation at the country level. Interpretation: Despite the gradual global decline in stillbirths between 1990 and 2021, the overall number of stillbirths remains substantially high. Counting all stillbirths is paramount to progress, as nearly a third—close to 1 million in total—are left uncounted at the 28 weeks or longer threshold. Our findings draw attention to the differential progress in reducing stillbirths, with a high burden concentrated in countries with low development status. Scarce data availability and poor data quality constrain our capacity to precisely account for stillbirths in many locations. Addressing inequities in universal maternal health coverage, strengthening the quality of maternal health care, and improving the robustness of data systems are urgently needed to reduce the global burden of stillbirths. Funding: Bill & Melinda Gates Foundation.

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Changes in Healthcare Utilization in Japan in the Aftermath of the COVID-19 Pandemic: A Time Series Analysis of Japanese National Data Through November 2023

Yuta Tanoue, Alton Cao, Masahide Koda, Nahoko Harada, Cyrus Ghaznavi, Shuhei Nomura

Healthcare 12 ( 22 ) 2307 2024.11

Accepted,  ISSN  2227-9032

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Introduction: The COVID-19 pandemic precipitated substantial disruptions in healthcare utilization globally. In Japan, reduced healthcare utilization during the pandemic’s early phases had been documented previously. However, few studies have investigated the impact of the pandemic’s later stages (2022–2023) on healthcare utilization rates, particularly in the Japanese context. Methods: We employed a quasi-Poisson regression model, adapted from the FluMOMO framework, to analyze temporal trends in Japanese healthcare utilization throughout the pandemic until November 2023. We estimated inpatient and outpatient volumes and hospital length of stay by bed type (general and psychiatric). Results: In general hospital beds, inpatient volumes remained significantly below pre-pandemic levels for every month until November 2023, with a reduction of 7.8 percent in 2023 compared to pre-pandemic levels. Psychiatric inpatient volumes, which had been declining before the pandemic, continued this downward trend, with the average occupancy rate decreasing by approximately 5.3% to 81.3% in 2023 compared to pre-pandemic levels. Significantly reduced outpatient volumes for both general and psychiatric care, in addition to prolonged lengths of hospital stay for psychiatric beds, were observed sporadically for several months in 2022 and 2023, persisting beyond the cessation of state of emergency and quasi-state of emergency declarations. Conclusion: The COVID-19 pandemic fundamentally altered healthcare utilization patterns in Japan. We observed a sustained reduction in general and psychiatric inpatient volumes relative to pre-pandemic baselines nationwide. The prolonged impact on healthcare utilization patterns, persisting beyond emergency measures, warrants continued monitoring of service delivery.

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Changes in mortality during the COVID-19 pandemic in Japan: descriptive analysis of national health statistics up to 2022

Hirokazu Tanaka, Shuhei Nomura, Kota Katanoda

Journal of Epidemiology (Japan Epidemiological Association)   2024.10

Accepted,  ISSN  0917-5040

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Determinants of sodium intake knowledge and attitude: a cross-national analysis of socio-economic and health factors

Santosh Kumar Rauniyar, Yuta Tanoue, Cyrus Ghaznavi, Hitomi Hayabuchi, Toshihide Nishimura, Yukari Takemi, Shuhei Nomura

Public Health Nutrition 27 ( 1 ) e216 2024.10

Accepted,  ISSN  13689800

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Objective: The aim of this study is to conduct a comparative analysis across nations to: (1) identify the determinants influencing knowledge and attitudes related to sodium (Na) intake and (2) to analyse the association between knowledge and attitudes related to Na intake. Design: We utilised a secondary data from a cross-sectional study that was conducted across seven nations. Structural equation modelling (SEM) was utilised to assess the impact of socio-economic and health-related predictors on knowledge and attitudes pertaining to Na intake and further to investigate the relationship between knowledge and attitude. Setting: Indonesia, Brazil, Thailand, Japan, France, the UK and the USA. Participants: 7090 participants aged 15 years and above were included in the study. Results: SEM analysis showed a strong association between knowledge about Na intake and related attitude across all countries, particularly in the UK (2.65, 95 % CI 1.48-3.82), France (2.62, 1.45-3.79) and the USA (1.97, 1.21-2.73). In Brazil, Japan and France, individuals or family members having certain health conditions such as raised blood pressure, heart diseases, strokes or other diseases exhibited a positive attitude towards reducing Na intake. Conversely, socio-economic factors like education and income demonstrated the complexity of influences on knowledge and attitudes about Na intake. Conclusion: The study underscores the need for tailored public health interventions to reduce excessive Na consumption, considering the diverse cultural, social and economic factors. It highlights the complex determinants of knowledge and attitudes towards Na intake, calling for further research in varied populations.

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Analysis of factors associated with public attitudes towards salt reduction: a multicountry cross-sectional survey

Yuta Tanoue, Santosh Kumar Rauniyar, Manae Uchibori, Cyrus Ghaznavi, Hana Tomoi, Mami Ueta, Prapichaya Prommas, Alton Cao, Daisuke Yoneoka, Takayuki Kawashima, Akifumi Eguchi, Shuhei Nomura

BMJ Open 14 ( 10 ) e086467 2024.10

Accepted,  ISSN  2044-6055

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<jats:sec><jats:title>Objective</jats:title><jats:p>This paper provides an in-depth examination of public attitudes towards salt reduction across seven culturally diverse countries: the USA, the UK, France, Japan, Indonesia, Thailand, and Brazil.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Cross-sectional regression analysis with questionnaire data.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>An analysis of questionnaire study in seven countries.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>The study’s questionnaire collected responses from 7090 participants across seven countries with the mean age of respondents being 46.06 years (SD 16.96). The gender distribution encompassed 3473 men (49.12%), 3582 women (50.66%), 24 non-binary individuals (0.34%) and 11 who identified as ‘other’ (0.16%).</jats:p></jats:sec><jats:sec><jats:title>Primary and secondary outcome measures</jats:title><jats:p>Attitudes toward sodium reduction were measured on a seven-point Likert scale.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Regression analysis revealed significant associations between attitudes towards sodium reduction and various factors across countries. Gender was a significant factor in France, with women showing less awareness than men (coefficient −0.123, 95% CI −0.237 to −0.008). Age was a significant factor in Japan and Thailand, with older generations exhibiting stronger awareness. Occupation was a significant factor in France (grocery, 0.678, 0.229 to 1.127) and Japan (food service, 0.792, 0.300 to 1.283). In France (0.090, 0.033 to 0.146) and Brazil (0.092, 0.040 to 0.144), attitudes towards reducing sugar intake were positively associated with sodium reduction attitudes. Government interventions showed varying impacts, with positive associations in Thailand (0.004, 0.001 to 0.008) and negative associations in France (−0.003 –0.005 to −0.000).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Our study reveals a complex array of factors shaping attitudes towards sodium reduction across seven countries. These findings support the need for nuanced, country-specific approaches in formulating sodium reduction strategies. Future research should validate these findings, explore further determinants and understand how attitudes translate into dietary behaviours.</jats:p></jats:sec>

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Strengthening Public Health System Resilience to Disasters in Türkiye: Insights from a Scorecard Methodology

Ismail Tayfur, Perihan Şimşek, Abdülkadir Gunduz, Mayumi Kako, Shuhei Nomura, Benjamin Ryan

International Journal of Disaster Risk Reduction (Elsevier BV)  113   104869 - 104869 2024.10

Accepted,  ISSN  22124209

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Background: Türkiye is a country that faces many disasters, especially earthquakes and floods, which have serious short- and long-term consequences for public health. The importance of disaster risk reduction activities in building resilience before a disaster strikes is increasingly recognized. Furthermore, resilience assessment is considered to be the starting point for these activities. However, there is a substantial gap in the scientific evidence on systematic assessments of the resilience of the public health system and also a serious lack of activities to strengthen the system against disasters in Türkiye. Aim: Using a Scorecard methodology, the study aimed to systematically assess the resilience of the public health system in Türkiye by examining key indicators related to disaster risk management and preparedness, and subsequently to recommend priority actions. A systematic assessment of resilience can provide the scientific evidence needed to identify weaknesses in the system. Furthermore, identifying priority actions based on this evidence allows progress to be made towards strengthening the system. Methods: This mixed-methods study was conducted in two separate regions of Türkiye with the highest earthquake (Esenler/Istanbul) and flood risk (Ortahisar/Trabzon). Based on the Scorecard methodology, two-stage workshops (online and face-to-face) were held. During the online stage, qualitative data were collected by interviewing participants about their evaluation of the situation in the counties regarding the Scorecard indicators, and quantitative data were collected through scoring. In the face-to-face stage, strategies were developed to improve the resilience of the public health system. Quantitative data were expressed with numbers and percentages, and thematic analysis was utilized for qualitative data analysis. Results: The lowest scoring indicators were as follows (Esenler and Ortahisar, respectively): addressing mental health needs associated with disasters (2.17 ± 1.29; 2.27 ± 1.16), resilience of key healthcare facilities (2.22 ± 0.55; 2.91 ± 1.08), and protection and identification of ecosystem services (2.39 ± 1.04; 2.13 ± 1.49). In this study, participants recommended increasing the resilience of the public health infrastructure and improving human resources and ecosystem services to ensure the resilience of the public health system. Conclusions: The study found that the weakest areas in terms of public health system resilience were the seismic safety and infrastructure of health facilities, the capacity of disaster-related mental health services, and disaster-related ecosystem services. To improve the resilience of public health systems, it is essential to strengthen these areas of weakness and ensure collaboration between all stakeholders in the system. The identification of weaknesses in the study has guided the determination of priority actions to build a baseline of resilience. In addition, the results of the study have highlighted priority areas for investment to improve disaster response and the overall health of the population in the context of disasters.

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Forecasting the effects of smoking prevalence scenarios on years of life lost and life expectancy from 2022 to 2050: a systematic analysis for the Global Burden of Disease Study 2021

GBD 2021 Tobacco Forecasting Collaborators

The Lancet Public Health (Elsevier BV)  9 ( 10 ) e729 - e744 2024.10

Accepted,  ISSN  2468-2667

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Background: Smoking is the leading behavioural risk factor for mortality globally, accounting for more than 175 million deaths and nearly 4·30 billion years of life lost (YLLs) from 1990 to 2021. The pace of decline in smoking prevalence has slowed in recent years for many countries, and although strategies have recently been proposed to achieve tobacco-free generations, none have been implemented to date. Assessing what could happen if current trends in smoking prevalence persist, and what could happen if additional smoking prevalence reductions occur, is important for communicating the effect of potential smoking policies. Methods: In this analysis, we use the Institute for Health Metrics and Evaluation's Future Health Scenarios platform to forecast the effects of three smoking prevalence scenarios on all-cause and cause-specific YLLs and life expectancy at birth until 2050. YLLs were computed for each scenario using the Global Burden of Disease Study 2021 reference life table and forecasts of cause-specific mortality under each scenario. The reference scenario forecasts what could occur if past smoking prevalence and other risk factor trends continue, the Tobacco Smoking Elimination as of 2023 (Elimination-2023) scenario quantifies the maximum potential future health benefits from assuming zero percent smoking prevalence from 2023 onwards, whereas the Tobacco Smoking Elimination by 2050 (Elimination-2050) scenario provides estimates for countries considering policies to steadily reduce smoking prevalence to 5%. Together, these scenarios underscore the magnitude of health benefits that could be reached by 2050 if countries take decisive action to eliminate smoking. The 95% uncertainty interval (UI) of estimates is based on the 2·5th and 97·5th percentile of draws that were carried through the multistage computational framework. Findings: Global age-standardised smoking prevalence was estimated to be 28·5% (95% UI 27·9–29·1) among males and 5·96% (5·76–6·21) among females in 2022. In the reference scenario, smoking prevalence declined by 25·9% (25·2–26·6) among males, and 30·0% (26·1–32·1) among females from 2022 to 2050. Under this scenario, we forecast a cumulative 29·3 billion (95% UI 26·8–32·4) overall YLLs among males and 22·2 billion (20·1–24·6) YLLs among females over this period. Life expectancy at birth under this scenario would increase from 73·6 years (95% UI 72·8–74·4) in 2022 to 78·3 years (75·9–80·3) in 2050. Under our Elimination-2023 scenario, we forecast 2·04 billion (95% UI 1·90–2·21) fewer cumulative YLLs by 2050 compared with the reference scenario, and life expectancy at birth would increase to 77·6 years (95% UI 75·1–79·6) among males and 81·0 years (78·5–83·1) among females. Under our Elimination-2050 scenario, we forecast 735 million (675–808) and 141 million (131–154) cumulative YLLs would be avoided among males and females, respectively. Life expectancy in 2050 would increase to 77·1 years (95% UI 74·6–79·0) among males and 80·8 years (78·3–82·9) among females. Interpretation: Existing tobacco policies must be maintained if smoking prevalence is to continue to decline as forecast by the reference scenario. In addition, substantial smoking-attributable burden can be avoided by accelerating the pace of smoking elimination. Implementation of new tobacco control policies are crucial in avoiding additional smoking-attributable burden in the coming decades and to ensure that the gains won over the past three decades are not lost. Funding: Bloomberg Philanthropies and the Bill & Melinda Gates Foundation.

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Global, regional, and national burden of stroke and its risk factors, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

GBD 2021 Stroke Risk Factor Collaborators

The Lancet Neurology (Elsevier BV)  23 ( 10 ) 973 - 1003 2024.10

Accepted,  ISSN  14744422

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Background: Up-to-date estimates of stroke burden and attributable risks and their trends at global, regional, and national levels are essential for evidence-based health care, prevention, and resource allocation planning. We aimed to provide such estimates for the period 1990–2021. Methods: We estimated incidence, prevalence, death, and disability-adjusted life-year (DALY) counts and age-standardised rates per 100 000 people per year for overall stroke, ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage, for 204 countries and territories from 1990 to 2021. We also calculated burden of stroke attributable to 23 risk factors and six risk clusters (air pollution, tobacco smoking, behavioural, dietary, environmental, and metabolic risks) at the global and regional levels (21 GBD regions and Socio-demographic Index [SDI] quintiles), using the standard GBD methodology. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In 2021, stroke was the third most common GBD level 3 cause of death (7·3 million [95% UI 6·6–7·8] deaths; 10·7% [9·8–11·3] of all deaths) after ischaemic heart disease and COVID-19, and the fourth most common cause of DALYs (160·5 million [147·8–171·6] DALYs; 5·6% [5·0–6·1] of all DALYs). In 2021, there were 93·8 million (89·0–99·3) prevalent and 11·9 million (10·7–13·2) incident strokes. We found disparities in stroke burden and risk factors by GBD region, country or territory, and SDI, as well as a stagnation in the reduction of incidence from 2015 onwards, and even some increases in the stroke incidence, death, prevalence, and DALY rates in southeast Asia, east Asia, and Oceania, countries with lower SDI, and people younger than 70 years. Globally, ischaemic stroke constituted 65·3% (62·4–67·7), intracerebral haemorrhage constituted 28·8% (28·3–28·8), and subarachnoid haemorrhage constituted 5·8% (5·7–6·0) of incident strokes. There were substantial increases in DALYs attributable to high BMI (88·2% [53·4–117·7]), high ambient temperature (72·4% [51·1 to 179·5]), high fasting plasma glucose (32·1% [26·7–38·1]), diet high in sugar-sweetened beverages (23·4% [12·7–35·7]), low physical activity (11·3% [1·8–34·9]), high systolic blood pressure (6·7% [2·5–11·6]), lead exposure (6·5% [4·5–11·2]), and diet low in omega-6 polyunsaturated fatty acids (5·3% [0·5–10·5]). Interpretation: Stroke burden has increased from 1990 to 2021, and the contribution of several risk factors has also increased. Effective, accessible, and affordable measures to improve stroke surveillance, prevention (with the emphasis on blood pressure, lifestyle, and environmental factors), acute care, and rehabilitation need to be urgently implemented across all countries to reduce stroke burden. Funding: Bill & Melinda Gates Foundation.

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Progress and scenario-based projections of health service availability and coverage towards UHC in the post-conflict and post-pandemic Iraq: a Bayesian hierarchical regression approach

Hiroko Taniguchi, Md Mizanur Rahman, Ashraf Hussain, Shuhei Nomura, Ganan Devanathan, Masahiro Hashizume

BMJ Open (BMJ)  14 ( 9 ) e080492 - e080492 2024.09

Accepted,  ISSN  2044-6055

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Background

Two decades have passed since the beginning of the Iraq War in 2003. Iraq has long suffered from conflicts and instability, where the people have limited access to healthcare. The coronavirus disease (COVID-19) pandemic brought additional disruption to health service provision.

Objectives

At the midpoint towards universal health coverage (UHC) in 2030, this study aims to gain a better understanding of the trends of UHC progress in Iraq in the context of the conflicts and the COVID-19 pandemic and to indicate possible pragmatic options.

Design

This study employed Bayesian hierarchical regression models to estimate trends and projections of health service availability and coverage indicators up to 2030. Furthermore, for health service coverage, four scenarios were defined based on the availability of health services, and projections were made for each scenario up to 2030.

Setting

Our approach used the yearly data from the Ministry of Health and four nationally representative household surveys between 2000 and 2020. We evaluated the subnational-level progress in three health service availability indicators and 13 health service coverage indicators in 18 governorates in Iraq from 2000 to 2030.

Results

The findings from 2000 to 2020 revealed a lack of progress in the indicators of health facility and inpatient bed, and pronounced detrimental effects from major conflicts and the pandemic on all measured health service coverage indicators. Despite these setbacks, several health service coverage indicators demonstrated resilience and elasticity in their recovery. The projected trends for 2021 to 2030 indicated limited alternations in the health service availability. By 2030, five health service coverage indicators will achieve the designated 80% targets. A scenario-based analysis predicts improved coverage of antenatal care, and child immunisation and treatment if health service availability is bolstered to globally recommended standards. Under this scenario, several governorates—Anbar, Baghdad, Nainawa, Qadissiyah, Salahaddin, Thiqar and Wasit—presented improved health service coverage in more indicators.

Conclusion

Strengthened health service availability has the potential to significantly improve fragile health service coverage indicators and in more vulnerable governorates.

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Factors associated with lifetime use of commercial sex work services among Japanese men aged 20–49: findings from a quasi-representative national survey, 2022

Cyrus Ghaznavi, Peter Ueda, Shuhei Nomura, Masahiro Ishikane, Shunsuke Uno, Haruka Sakamoto

Sexually Transmitted Infections (BMJ)  100 ( 6 ) 371 - 380 2024.08

Accepted,  ISSN  13684973

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Objectives

Approximately half of Japanese men aged 20–49 years have purchased sexual services, but data concerning the use of commercial sex work (CSW) in Japan remain scarce.

Methods

We used online survey data from the National Inventory of Japanese Sexual Behavior conducted in 2022 (N=4000 Japanese men aged 20–49 years). We calculated the median number of paid sexual partners over the lifetime. We performed logistic regression analysis to determine the sociodemographic, anthropometric and attitudinal factors associated with any lifetime CSW use among men in Japan.

Results

The median number of paid sexual partners reported among men who had ever used CSW was 6 (IQR 3–17) across the lifetime; the corresponding value for those who had ever used CSW in the past year was 2 (IQR 1–4) over the last 12 months. In general, those reporting lifetime use of CSW were significantly more likely than their CSW-naïve counterparts to be older, be married, be heterosexual or bisexual, have higher income and have higher education. Those reporting higher self-rated attractiveness, high or low satisfaction with their sex lives, a desire to increase their frequency of sex and considering sex to be an important aspect of their lives were also found to have a higher likelihood of having used CSW.

Conclusions

High rates of CSW use in Japan likely reflect ease of access, low stigma with respect to use of sexual services and the diversity in the type of services offered. High-income, employed older men have more financial resources at their disposal to purchase services, which can be cost-prohibitive for part-time or unemployed young men with low incomes. These findings will serve as a launchpad for public health efforts directed at promoting safe sexual practices and improved sexually transmitted infection screening rates among users of CSW in Japan.

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Factors influencing parental COVID-19 vaccination willingness for children in Japan

Mami Ueta, Alton Cao, Michio Murakami, Hana Tomoi, Stuart Gilmour, Keiko Maruyama-Sakurai, Yoshihiro Takayama, Yoshitake Takebayashi, Masahiro Hashizume, Rauniyar Santosh Kumar, Hiroyuki Kunishima, Wataru Naito, Tetsuo Yasutaka, Satoshi Kaneko, Hiroaki Miyata, Shuhei Nomura

Vaccine: X (Elsevier BV)  19   100528 - 100528 2024.08

Accepted,  ISSN  2590-1362

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Objectives: This study aims to investigate the factors influencing parental willingness in COVID-19 vaccination for children in Japan in light of the introduction of pediatric vaccines. Methods: An online survey was conducted in February 2022, coinciding with the imminent start of pediatric COVID-19 vaccinations in Japan. It assessed attitudes toward vaccine uptake and included questions about health-related attributes, psychological considerations, and sources of COVID-19 information. Data from 2,419 respondents who had children under the age of 12 were analyzed using multinomial logistic regression to identify factors associated with parental willingness towards COVID-19 vaccination for children. The outcomes were “agree” (in favor of vaccination), “not sure” (undecided), with “disagree” (against vaccination) as the reference category. Results: Among participants supportive of vaccination (“agree” compared to the “disagree” reference), salient determinants included: gender (Men in reference to women: odds ratio [OR] 1.54; 95 % confidence interval [CI] 1.11–2.15), highest educational level (Junior College/Vocational in reference to under high school: OR 0.61; 95 % CI 0.40–0.93, Bachelor's /Master's/Doctoral degree in reference to under high school: OR 0.59; 95 % CI 0.42–0.84), perception of benefits of COVID-19 vaccination (Significant in reference to Insignificant: OR 2.04; 95 % CI 1.26–3.28), perception of risks of COVID-19 vaccination (Significant in reference to Insignificant: OR 0.28; 95 % CI 0.19–0.42, Neutral in reference to Insignificant: OR 0.48; 95 % CI 0.33–0.71), the number of referenced information sources utilized for COVID-19 was associated with attitudes towards children's vaccination (OR 1.02; 95 % CI 1.00–1.04). Conclusion: The study highlights the multifaceted factors influencing parents’ COVID-19 vaccination attitudes for their children, encompassing socioeconomic, health, psychological, and informational aspects. Factors like cautious information gathering, vaccine concerns and diverse referenced information sources impact willingness. To facilitate informed decision-making, essential measures include government risk communication, widespread vaccine information dissemination, and enhancing parents’ health information accessibility and evaluation skills are important.

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Trust in governments, public health institutions, and other information sources as determinants of COVID-19 vaccine uptake behavior in Japan

Alton Cao, Mami Ueta, Manae Uchibori, Michio Murakami, Hiroyuki Kunishima, Rauniyar Santosh Kumar, Prapichaya Prommas, Hana Tomoi, Stuart Gilmour, Haruka Sakamoto, Masahiro Hashizume, Wataru Naito, Tetsuo Yasutaka, Keiko Maruyama-Sakurai, Hiroaki Miyata, Shuhei Nomura

Vaccine (Elsevier BV)  42 ( 17 ) 3684 - 3692 2024.06

Accepted,  ISSN  0264410X

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Objectives: Trust in governments and public institutions as a determinant of public health outcomes has gained increased attention since the COVID-19 pandemic. Provided historically low confidence in vaccines in Japan, investigating the role of trust in information sources and actual COVID-19 vaccination uptake behavior will be invaluable for future vaccine promotion policymaking. Therefore, the objective of this study was to elucidate the determinants of COVID-19 vaccination uptake and evaluate the relationship between trust in different information sources and COVID-19 vaccination behavior in Japan. Methods: For this study, we leveraged a longitudinal series of web-based surveys of 19,174 individuals in Japan conducted between 2021 and 2022 which asked questions regarding a wide range of sociodemographic and psychographic characteristics related to the COVID-19 pandemic. Determinant analysis for vaccination (at least one dose of a COVID-19 vaccine) was conducted via multiple logistic regression, and odds ratios (OR) with 95% confidence intervals (CI) were estimated. Results: After adjustment for sociodemographic determinants of vaccine uptake, aggregate trust in the systems and institutions of vaccine approval (OR: 1.42, 95% CI: 1.30–1.56), and trust in information about the COVID-19 pandemic coming from government sources (OR: 1.27, 95% CI: 1.12–1.44) were found to be consistently powerful predictors of COVID-19 vaccination. Trust in media sources including traditional media (OR: 1.21, 95% CI: 1.07–1.36), and the internet (OR: 0.77, 95% CI: 0.66–0.89) had significant and opposing effects. Conclusions: Our findings support the broader hypothesis that trust in governments and public health institutions remains a powerful determinant for COVID-19 vaccine uptake in Japan. We also found that vaccination decision-making is a multifactorial process that includes the synthesis of trust in public institutions and media, and its interaction with psychosocial determinants such as prosociality and health literacy. We hope to apply this study's findings towards future vaccine programs for contagious diseases.

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Comparing the risks of environmental carcinogenic chemicals in Japan using the loss of happy life expectancy indicator

Michio Murakami, Kyoko Ono, Yoshitake Takebayashi, Masaharu Tsubokura, Shuhei Nomura

Environmental Research (Elsevier BV)  251   118637 - 118637 2024.06

Accepted,  ISSN  00139351

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In this study, we aimed to use the loss of happy life expectancy (LHpLE), an indicator that enables risk assessment considering wellbeing, to compare the risks of environmental carcinogenic chemicals in Japan. First, we surveyed Japanese people to determine their emotional happiness by age and sex and evaluated whether cancer incidence reduced emotional happiness. Questionnaires were administered to a general population panel and a panel of patients with cancer in 2022, recruiting a predetermined number of responses of 5000 and 850, respectively. Second, using the survey data, LHpLE was calculated for radon, arsenic, and fine particulate matter (aerodynamic diameter <2.5 μm; PM2.5) and compared to psychological distress, considering increased mortality and decreased emotional happiness due to these risks. We discovered no significant decrease in emotional happiness due to cancer incidence and no significant associations between emotional happiness and cancer type, history, or stage. LHpLE was calculated to be 6.4 × 10−3 years for radon, 2.6 × 10−3 years for arsenic, 1.1 × 10−2 years (2012 exposure) and 8.6 × 10−4 years (2020 exposure) for PM2.5, and 9.7 × 10−1 years for psychological distress. The fraction of losses caused by these carcinogenic chemicals to HpLE exceeded 10−5, suggesting that risk reduction for these chemicals is important in environmental policies. The LHpLE indicator allows for comparing different types of risks, such as environmental chemicals and psychological distress. This is the first study to compare chemical risks using the LHpLE indicator.

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The importance of methodological vigilance: Reevaluating suicide trends in Japan post‐2022

Masahide Koda, Nahoko Harada, Shuhei Nomura

Psychiatry and Clinical Neurosciences Reports (Wiley)  3 ( 2 )  2024.06

Last author, Accepted,  ISSN  2769-2558

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Active and passive smoking and breast cancer in Japan: a pooled analysis of nine population-based cohort studies

Wada K., Nagata C., Utada M., Sakata R., Kimura T., Tamakoshi A., Sugawara Y., Tsuji I., Sato R., Sawada N., Tsugane S., Oze I., Ito H., Kitamura T., Koyanagi Y.N., Lin Y., Matsuo K., Abe S.K., Inoue M., Tanaka S., Kimura T., Sugawara Y., Mizoue T., Nomura S., Takimoto H., Tanaka K., Charvat H., Hidaka A., Hirabayashi M., Iwasaki M., Kitamura Y., Mori N., Muto M., Naito M., Nakayama T., Nishino Y., Sadakane A., Saito E., Sasazuki S., Shimazu T., Shimizu H., Sugiyama K., Suzuki H., Tsubono Y., Wakai K., Yamagiwa Y., Yamaji T.

International Journal of Epidemiology 53 ( 3 )  2024.06

ISSN  03005771

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Background: Epidemiological studies have shown inconsistent results regarding the link between smoking and breast cancer risk, despite the biological plausibility of a positive association. Methods: Participants were 166  611 women from nine prospective cohort studies in Japan which launched in 1984-1994 and followed for 8-22 years. Information on smoking and secondhand smoke was obtained through self-administered baseline questionnaires. Breast cancer was defined as code C50 according to the International Classification of Diseases for Oncology, 3rd Edition or the International Classification of Diseases, 10th Revision. After adjusting for several potential confounders, relative risks for breast cancer were calculated in the individual studies according to the current or previous status of active and passive smoking using Cox regression, followed by a summary estimate of hazard ratios using random-effects meta-analyses. Results: Of the 60  441 participants who reported being premenopausal and 106  170 who reported being postmenopausal at baseline, 897 and 1168 developed breast cancer during follow-up, respectively. Compared with never smokers, current smokers had a higher risk of developing breast cancer before the age of 50 years. In addition, ever smokers who started smoking at 30 years of age or younger, or who started smoking before first childbirth, had a higher risk of developing breast cancer before the age of 50 years. No association between adulthood or childhood exposure to secondhand smoke and breast cancer was observed. Conclusion: Smoking may increase the risk of premenopausal breast cancer, and smoking earlier in life might be especially harmful. The impact of secondhand smoke needs further investigation.

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