論文 - 野村　周平

Estimated Global Proportions of Individuals with Persistent Fatigue, Cognitive, and Respiratory Symptom Clusters Following Symptomatic COVID-19 in 2020 and 2021

Vos T., Hanson S.W., Abbafati C., Aerts J.G., Al-Aly Z., Ashbaugh C., Ballouz T., Blyuss O., Bobkova P., Bonsel G., Borzakova S., Buonsenso D., Butnaru D., Carter A., Chu H., De Rose C., Diab M.M., Ekbom E., Tantawi M.E., Fomin V., Frithiof R., Gamirova A., Glybochko P.V., Haagsma J.A., Haghjooy Javanmard S., Hamilton E.B., Harris G., Heijenbrok-Kal M.H., Helbok R., Hellemons M.E., Hillus D., Huijts S.M., Hultström M., Jassat W., Kurth F., Larsson I.M., Lipcsey M., Liu C., Loflin C.D., Malinovschi A., Mao W., Mazankova L., McCulloch D., Menges D., Mohammadifard N., Munblit D., Nekliudov N.A., Ogbuoji O., Osmanov I.M., Peñalvo J.L., Petersen M.S., Puhan M.A., Rahman M., Rass V., Reinig N., Ribbers G.M., Ricchiuto A., Rubertsson S., Samitova E., Sarrafzadegan N., Shikhaleva A., Simpson K.E., Sinatti D., Soriano J.B., Spiridonova E., Steinbeis F., Svistunov A.A., Valentini P., Van De Water B.J., Van Den Berg-Emons R., Wallin E., Witzenrath M., Wu Y., Xu H., Zoller T., Adolph C., Albright J., Amlag J.O., Aravkin A.Y., Bang-Jensen B.L., Bisignano C., Castellano R., Castro E., Chakrabarti S., Collins J.K., Dai X., Daoud F., Dapper C., Deen A., Duncan B.B., Erickson M., Ewald S.B., Ferrari A.J., Flaxman A.D., Fullman N., Gamkrelidze A., Giles J.R., Guo G., Hay S.I., He J.

JAMA （American Medical Association (AMA)）  328 （ 16 ） 1604 - 1615 2022年10月

査読有り,  ISSN  00987484

　概要を見る

Importance: Some individuals experience persistent symptoms after initial symptomatic SARS-CoV-2 infection (often referred to as Long COVID). Objective: To estimate the proportion of males and females with COVID-19, younger or older than 20 years of age, who had Long COVID symptoms in 2020 and 2021 and their Long COVID symptom duration. Design, Setting, and Participants: Bayesian meta-regression and pooling of 54 studies and 2 medical record databases with data for 1.2 million individuals (from 22 countries) who had symptomatic SARS-CoV-2 infection. Of the 54 studies, 44 were published and 10 were collaborating cohorts (conducted in Austria, the Faroe Islands, Germany, Iran, Italy, the Netherlands, Russia, Sweden, Switzerland, and the US). The participant data were derived from the 44 published studies (10501 hospitalized individuals and 42891 nonhospitalized individuals), the 10 collaborating cohort studies (10526 and 1906), and the 2 US electronic medical record databases (250928 and 846046). Data collection spanned March 2020 to January 2022. Exposures: Symptomatic SARS-CoV-2 infection. Main Outcomes and Measures: Proportion of individuals with at least 1 of the 3 self-reported Long COVID symptom clusters (persistent fatigue with bodily pain or mood swings; cognitive problems; or ongoing respiratory problems) 3 months after SARS-CoV-2 infection in 2020 and 2021, estimated separately for hospitalized and nonhospitalized individuals aged 20 years or older by sex and for both sexes of nonhospitalized individuals younger than 20 years of age. Results: A total of 1.2 million individuals who had symptomatic SARS-CoV-2 infection were included (mean age, 4-66 years; males, 26%-88%). In the modeled estimates, 6.2% (95% uncertainty interval [UI], 2.4%-13.3%) of individuals who had symptomatic SARS-CoV-2 infection experienced at least 1 of the 3 Long COVID symptom clusters in 2020 and 2021, including 3.2% (95% UI, 0.6%-10.0%) for persistent fatigue with bodily pain or mood swings, 3.7% (95% UI, 0.9%-9.6%) for ongoing respiratory problems, and 2.2% (95% UI, 0.3%-7.6%) for cognitive problems after adjusting for health status before COVID-19, comprising an estimated 51.0% (95% UI, 16.9%-92.4%), 60.4% (95% UI, 18.9%-89.1%), and 35.4% (95% UI, 9.4%-75.1%), respectively, of Long COVID cases. The Long COVID symptom clusters were more common in women aged 20 years or older (10.6% [95% UI, 4.3%-22.2%]) 3 months after symptomatic SARS-CoV-2 infection than in men aged 20 years or older (5.4% [95% UI, 2.2%-11.7%]). Both sexes younger than 20 years of age were estimated to be affected in 2.8% (95% UI, 0.9%-7.0%) of symptomatic SARS-CoV-2 infections. The estimated mean Long COVID symptom cluster duration was 9.0 months (95% UI, 7.0-12.0 months) among hospitalized individuals and 4.0 months (95% UI, 3.6-4.6 months) among nonhospitalized individuals. Among individuals with Long COVID symptoms 3 months after symptomatic SARS-CoV-2 infection, an estimated 15.1% (95% UI, 10.3%-21.1%) continued to experience symptoms at 12 months. Conclusions and Relevance: This study presents modeled estimates of the proportion of individuals with at least 1 of 3 self-reported Long COVID symptom clusters (persistent fatigue with bodily pain or mood swings; cognitive problems; or ongoing respiratory problems) 3 months after symptomatic SARS-CoV-2 infection.

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Characterising reasons for reversals of COVID-19 vaccination hesitancy among Japanese people: One-year follow-up survey

Nomura S., Eguchi A., Yoneoka D., Murakami M., Ghaznavi C., Gilmour S., Kaneko S., Kawashima T., Kunishima H., Naito W., Sakamoto H., Maruyama-Sakurai K., Takahashi A., Takayama Y., Tanoue Y., Yamamoto Y., Yasutaka T., Miyata H.

The Lancet Regional Health - Western Pacific （Elsevier BV）  27   100541 - 100541 2022年10月

査読有り,  ISSN  2666-6065

　概要を見る

Background: Vaccine hesitancy is a global public health threat. We present unique data that characterises those who experienced reversals of COVID-19 vaccination hesitancy in Japan. Methods: We administered a questionnaire on vaccination intention among 30053 Japanese adults aged 20 years or older before the COVID-19 vaccination was available to the general population (first survey) and conducted a follow-up survey on vaccination status one year later in February 2022 (second survey). Those who responded in the first survey that they did not intend to be vaccinated or were unsure and then responded in the second survey that they were vaccinated or intend to be vaccinated were asked about the reasons for their change of heart. Based on previous literature and expert opinion, 31 reasons for changing vaccination intention were compiled and respondents were asked to choose which among them applied to themselves, with multiple responses possible. Based on the results of those responses, each individual was then clustered using the Uniform Manifold Approximation and Projection (UMAP) dimensionality reduction technique and Ordering Points To Identify the Clustering Structure (OPTICS) algorithm. We then identified unique characteristics among each of the sub-populations (clusters). Findings: In the second survey we received 19195 responses (response rate 63.9%), of which 8077 responded ‘no’ or ‘not sure’ in the first survey regarding their intention to be vaccinated. Of these, 5861 responded having received or intending to receive the vaccine (72.6%). We detected six and five sub-populations (clusters) among the ‘no’ group and ‘not sure’ group, respectively. The clusters were characterized by perceived benefits of vaccination, including the COVID-19 vaccine, awareness of the COVID-19 vaccination status of those close to them, recognition of the social significance of COVID-19 vaccination for the spread of infection, and dispelled concerns about short-term adverse reactions and the safety of the COVID-19 vaccine. Work and personal relationship reasons were also found to be a unique overarching reason for vaccination changes of heart only among those who did not intend to vaccinate. Interpretation: Those who changed their intention to accept COVID-19 vaccination as well as their unique characteristics as detailed in this study will be important entry points when discussing how to promote vaccination to those who are hesitant to vaccinate in the future. Funding: The present work was supported in part by a grant from the Kanagawa Prefectural Government of Japan and by AIST government subsidies.

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Factors associated with reversals of COVID-19 vaccination willingness: Results from two longitudinal, national surveys in Japan 2021-2022

Ghaznavi C., Yoneoka D., Kawashima T., Eguchi A., Murakami M., Gilmour S., Kaneko S., Kunishima H., Naito W., Sakamoto H., Maruyama-Sakurai K., Takahashi A., Takayama Y., Tanoue Y., Yamamoto Y., Yasutaka T., Miyata H., Nomura S.

The Lancet Regional Health - Western Pacific （Elsevier {BV}）  27   100540 - 100540 2022年10月

査読有り,  ISSN  2666-6065

　概要を見る

Background: Research characterizing changes of heart with respect to vaccine intention is scarce, and very little research considers those who were initially vaccine willing but became hesitant. Here, we sought to assess the factors related to reversals of vaccine willingness. Methods: We conducted a longitudinal, national survey on vaccination intention among Japanese adults aged 20 years or older, with the first questionnaire performed in February-March 2021 (N = 30,053) and the follow-up in February 2022 (N = 19,195, response rate 63.9%). The study population comprised those who reported vaccine willingness in the first survey, with the outcome variable being development of vaccine hesitancy at follow-up. We performed a regression analysis of vaccination status using sociodemographic, health-related, psychologic/attitudinal, and information-related variables as predictors. We used the sparse group minimax concave penalty (MCP) to select the optimum group of covariates for the logistic regression. Findings: Of 11,118 (57.9%) respondents who previously expressed interest in vaccination, 10,684 (96.1%) and 434 (3.9%) were in the vaccine willing and hesitant groups, respectively. Several covariates were found to significantly predict vaccine hesitancy, including marital status, influenza vaccine history, COVID-19 infection/testing history, engagement in COVID-19 preventive measures, perceived risks/benefits of the COVID-19 vaccine, and attitudes regarding vaccination policies and norms. The use of certain information sources was also associated with vaccine hesitancy. Interpretation: Sociodemographic, health-related, psychologic/attitudinal, and information-related variables predicted the development of vaccine hesitancy among those with prior willingness. Most of these predictors were also associated with vaccination status. Funding: The present work was supported in part by a grant from the Kanagawa Prefectural Government of Japan and by AIST government subsidies.

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Effect of the Tokyo 2020 Summer Olympic Games on COVID-19 incidence in Japan: A synthetic control approach

Yoneoka D., Eguchi A., Fukumoto K., Kawashima T., Tanoue Y., Tabuchi T., Miyata H., Ghaznavi C., Shibuya K., Nomura S.

BMJ Open 12 （ 9 ） e061444 2022年09月

査読有り,  ISSN  2044-6055

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Background The Tokyo 2020 Summer Olympic Games (23 July-8 August 2021) were held in the middle of Japan's fifth wave of COVID-19, when the number of cases was on the rise, and coincided with the fourth state of emergency implemented by the host city, Tokyo. Aim This study aimed to assess whether the hosting of the Games was associated with a change in the number of COVID-19 cases in Japan using a synthetic control method. Methods A weighted average of control countries with a variety of predictors was used to estimate the counterfactual trajectory of daily COVID-19 cases per 1 000 000 population in the absence of the Games in Japan. Outcome and predictor data were extracted using official and open sources spanning several countries. The predictors comprise the most recent country-level annual or daily data accessible during the Games, including the stringency of the government's COVID-19 response, testing capacity and vaccination capacity; human mobility index; electoral democracy index and demographic, socioeconomic, health and weather information. After excluding countries with missing data, 42 countries were ultimately used as control countries. Results The number of observed cases per 1 000 000 population on the last day of the Games was 109.2 (7-day average), which was 115.7% higher than the counterfactual trajectory comprising 51.0 confirmed cases per 1 000 000 population. During the Olympic period (since 23 July), the observed cumulative number of cases was 61.0% higher than the counterfactual trajectory, comprising 143 072 and 89 210 confirmed cases (p=0.023), respectively. The counterfactual trajectory lagged 10 days behind the observed trends. Conclusions Given the increasing likelihood that new emerging infectious diseases will be reported in the future, we believe that the results of this study should serve as a sentinel warning for upcoming mega-events during COVID-19 and future pandemics.

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Eliciting national and subnational sets of disability weights in mainland China: Findings from the Chinese disability weight measurement study

Liu X., Wang F., Yu C., Zhou M., Yu Y., Qi J., Yin P., Yu S., Zhou Y., Lin L., Liu Y., Wang Q., Zhong W., Huang S., Li Y., Liu L., Liu Y., Ma F., Zhang Y., Tian Y., Yu Q., Zeng J., Pan J., Zhou M., Kang W., Zhou J.Y., Yu H., Liu Y., Li S., Yu H., Wang C., Xia T., Xi J., Ren X., Xing X., Cheng Q., Fei F., Wang D., Zhang S., He Y., Wen H., Liu Y., Shi F., Wang Y., Sun P., Bai J., Wang X., Shen H., Ma Y., Yang D., Mubarik S., Cao J., Meng R., Zhang Y., Guo Y., Yan Y., Zhang W., Ke S., Zhang R., Wang D., Zhang T., Nomura S., Hay S.I., Salomon J.A., Haagsma J.A., Murray C.J.L., Vos T.

The Lancet Regional Health - Western Pacific （Elsevier {BV}）  26   100520 - 100520 2022年09月

査読有り,  ISSN  2666-6065

　概要を見る

Background: The disability weight (DW) quantifies the severity of health states from disease sequela and is a pivotal parameter for disease burden calculation. We conducted a national and subnational DW measurement in China. Methods: In 2020–2021, we conducted a web-based survey to assess DWs for 206 health states in 31 Chinese provinces targeting health workers via professional networks. We fielded questions of paired comparison (PC) and population health equivalence (PHE). The PC data were analysed by probit regression analysis, and the regression results were anchored by results from the PHE responses on the DW scale between 0 (no loss of health) and 1 (health loss equivalent to death). Findings: We used PC responses from 468,541 respondents to estimate DWs of health states. Eight of 11 domains of health had significantly negative coefficients in the regression of the difference between Chinese and Global Burden of Disease (GBD) DWs, suggesting lower DW values for health states with mention of these domains in their lay description. We noted considerable heterogeneity within domains, however. After applying these Chinese DWs to the 2019 GBD estimates for China, total years lived with disability (YLDs) increased by 14·9% to 177 million despite lower estimates for musculoskeletal disorders, cardiovascular diseases, mental disorders, diabetes and chronic kidney disease. The lower estimates of YLDs for these conditions were more than offset by higher estimates of common, low-severity conditions. Interpretation: The differences between the GBD and Chinese DWs suggest that there might be some contextual factors influencing the valuation of health states. While the reduced estimates for mental disorders, alcohol use disorder, and dementia could hint at a culturally different valuation of these conditions in China, the much greater shifts in YLDs from low-severity conditions more likely reflects methodological difficulty to distinguish between health states that vary a little in absolute DW value but a lot in relative terms. Funding: This work was supported by the National Natural Science Foundation of China [grant number 82173626], the National Key Research and Development Program of China [grant numbers 2018YFC1315302], Wuhan Medical Research Program of Joint Fund of Hubei Health Committee [grant number WJ2019H304], and Ningxia Natural Science Foundation Project [grant number 2020AAC03436].

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Excess deaths from non-COVID-19-related causes in Japan and 47 prefectures from January 2020 through May 2021 by place of death

Nomura S., Eguchi A., Ghaznavi C., Tanoue Y., Kawashima T., Yoneoka D., Yamasaki L., Suzuki M., Hashizume M.

SSM - Population Health （Elsevier BV）  19   101196 - 101196 2022年09月

ISSN  2352-8273

　概要を見る

Excess deaths, including all-causes mortality, were confirmed for the first time in Japan in April 2021. However, little is known about the indirect effects of COVID-19 on the number of non-COVID-19-related deaths. We then estimated the excess deaths from non-COVID-19-related causes in Japan and its 47 prefectures from January 2020 through May 2021 by place of death. Vital statistical data on deaths were obtained from the Ministry of Health, Labour and Welfare. Using quasi-Poisson regression models, we estimated the expected weekly number of deaths due to all-causes excluding COVID-19 (non-COVID-19) and due to respiratory disease, circulatory disease, malignant neoplasms, and senility. Estimates were made separately for deaths in all locations, as well as for deaths in hospitals and clinics, in nursing homes and elderly care facilities, and at home. We defined a week with excess deaths as one in which the observed number of deaths exceeded the upper bound of the two-sided 95% prediction interval. Excess death was expressed as a range of differences between the observed and expected number of deaths and the 95% upper bound of the two-sided predictive interval. The excess percentage was calculated as the number of excess deaths divided by the expected number of deaths. At the national level, excess deaths from non-COVID-19-related all-causes were observed during April 19 to May 16, 2021. The largest excess percentage was 2.73–8.58% (excess deaths 689–2161) in the week of May 3–9. Similar trends were observed for all four cause categories. The cause-of-death categories which contributed to the excesses showed heterogeneity among prefectures. When stratified by place of death, excess mortality tended to be observed in nursing homes and elderly care facilities for all categories, in hospitals and clinics for circulatory disease, and at home for respiratory disease, malignant neoplasms, and senility. A caution is necessary that for the lastest three months (March–May 2021), adjusted data were used to account for possible reporting delays.

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Decreased incidence followed by comeback of pediatric infections during the COVID-19 pandemic in Japan

Ghaznavi C., Sakamoto H., Kawashima T., Horiuchi S., Ishikane M., Abe S.K., Yoneoka D., Eguchi A., Tanoue Y., Hashizume M., Nomura S.

World Journal of Pediatrics （Springer Science and Business Media {LLC}）  18 （ 8 ） 564 - 567 2022年08月

査読有り,  ISSN  17088569

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Changes in Health Care Access during the COVID-19 Pandemic: Estimates of National Japanese Data, June 2020–October 2021

Tanoue Y., Ghaznavi C., Kawashima T., Eguchi A., Yoneoka D., Nomura S.

International Journal of Environmental Research and Public Health （MDPI AG）  19 （ 14 ） 8810 - 8810 2022年07月

ISSN  16617827

　概要を見る

The COVID-19 pandemic has disrupted health care access around the world, both for inpatients and outpatients. We applied a quasi-Poisson regression to national, monthly data on the number of outpatients, number of inpatients, length of average hospital stay, and the number of new hospitalizations from March 2015 to October 2021 to assess how these outcomes changed between June 2020 to October 2021. The number of outpatient visits were lower-than-predicted during the early phases of the pandemic but normalized by the fall of 2021. The number of inpatients and new hospitalizations were lower-than-predicted throughout the pandemic, and deficits in reporting continued to be observed in late 2021. The length of hospital stays was within the predicted range for all beds, but when stratified by bed type, was higher than predicted for psychiatric beds, lower-than-predicted for tuberculosis beds, and showed variable changes in long-term care insurance beds. Health care access in Japan was impacted by the COVID-19 pandemic.

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Attributable risk of household solid fuel use and second-hand smoke associated with under-5 mortality in 46 low- and lower-middle-income countries, 2010–2020

Lwin K.S., Nomura S., Swe K.T., Gilmour S., Alam M.A., Hashizume M.

International Journal of Hygiene and Environmental Health （Elsevier {BV}）  243   113986 - 113986 2022年06月

査読有り,  ISSN  14384639

　概要を見る

Background: Household solid fuel use (including indoor and outdoor) and second-hand smoke (SHS) are considered to be major contributors of under-5 mortality (U5M) in low- and lower-middle-income countries (LMICs). This study provides a comprehensive assessment of their odds ratios and attributable mortality in LMICs. Methods: We used the Demographic Health Surveys data for under-5 children in 46 LMICs (n = 778,532) from 2010 to 2020. Mixed effect multilevel logistic regressions were conducted to estimate the pooled adjusted odds ratio (aOR) for U5M due to solid fuel use, SHS and their combination compared to no exposure to them in 46 LMICs. The attributable mortality of solid fuel use, SHS, and their combination were assessed for each LMIC. Findings: The pooled aOR of solid fuel use and SHS for U5M was estimated to be 1.27 (95% Confidence Interval (CI): 1.19–1.36) and 1.13 (95%CI: 1.06–1.25), respectively, whereas those of their combination was 1.40 (95%CI: 1.31–1.50). U5M attributable to indoor and outdoor solid fuel use was the highest in Myanmar (18.0%) and the Gambia (16.5%), respectively, while those attributable to SHS was the highest in Indonesia (9.8%). U5M attributable to the combination of solid fuel use and SHS was the highest in Timor-Leste (22.7%). Interpretation: The combined effect of exposure to solid fuel and SHS had a higher risk of U5M than the individual risk. The use of clean fuel and tobacco control measures should be integrated with other child health promotion policies. Funding: This research was partially supported by a research grant from the Ministry of Education, Culture, Sports, Science and Technology of Japan (21H03203)

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Factors associated with the risk perception of COVID-19 infection and severe illness: A cross-sectional study in Japan

Adachi M., Murakami M., Yoneoka D., Kawashima T., Hashizume M., Sakamoto H., Eguchi A., Ghaznavi C., Gilmour S., Kaneko S., Kunishima H., Maruyama-Sakurai K., Tanoue Y., Yamamoto Y., Miyata H., Nomura S.

SSM - Population Health （Elsevier {BV}）  18   101105 - 101105 2022年06月

査読有り,  ISSN  2352-8273

　概要を見る

Understanding COVID-19 risk perception may help inform public health messaging aimed at encouraging preventive measures and improving countermeasures against the pandemic. We conducted an online survey of 29,708 Japanese adults in February 2021 and estimated the associations between COVID-19 risk perception and a broad array of individual factors. Two logistic regressions were constructed to estimate factors associated with the risk perception of COVID-19 (defined as responding that one might become infected within the next 6 months), and of severe illness among those who responded that they might become infected (defined as responding that one would become severely ill). After adjusting for covariates, those with a higher perceived risk of the COVID-19 vaccine had higher odds of risk perception for both infection and severe illness. Interestingly, those with higher odds of risk perception of being infected were more likely to report obtaining their information from healthcare workers whereas those with lower odds were more likely to report obtaining their information from the Internet or the government; those with lower odds of risk perception of being severely ill were more likely to report obtaining their information from the Internet. The higher the trust level in the government as a COVID-19 information source, the lower the odds of both risk perception of being infected and becoming severely ill. The higher the trust levels in social networking services as a COVID-19 information source, the higher the odds of risk perception of becoming severely ill. Public health messaging should address the factors identified in our study.

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Pre- and post-COVID-19 all-cause mortality of Japanese citizens versus foreign residents living in Japan, 2015–2021

Ghaznavi C., Eguchi A., Tanoue Y., Yoneoka D., Kawashima T., Suzuki M., Hashizume M., Nomura S.

SSM - Population Health （Elsevier BV）  18   101114 - 101114 2022年06月

査読有り,  ISSN  2352-8273

　概要を見る

Immigrants in Japan face multiple health care challenges. There is limited research addressing how all-cause mortality differs between foreign residents and Japanese citizens, including the impact of the COVID-19 pandemic. We assessed whether all-cause mortality rates between Japanese citizens and foreign residents living in Japan differ, and whether these differentials changed after the start of the COVID-19 pandemic. We conducted a cross-sectional analysis using vital statistical data of all deaths among citizens and foreign residents that occurred within Japanese borders aggregated every 6 months between January 1, 2015 and June 30, 2021. Data were used to calculate sex-, region-, and 20-year age group-specific standardized mortality rates using the direct method based on the population distribution of Japanese citizens in 2021 by sex, region, and 20-year age groups. Chi-squared tests and linear regression were used to assess whether the pandemic was associated with changes in mortality rates among groups and changes in the mortality differentials between citizens and non-citizens, respectively. All-cause mortality increased monotonically with age for men and women. Men had higher mortality than women, regardless of age or nationality. All-cause mortality is lower among immigrants than Japanese citizens between the ages of 20–59, but higher under the age of 20 and over the age of 59. The pandemic was associated with significant changes in mortality in most groups, but no statistically significant changes in the mortality differentials between immigrants and Japanese citizens were detected. Young immigrants are generally healthier than their Japanese counterparts, in line with the healthy migrant hypothesis. Younger migrants are at higher risk of mortality, possibly due to increased vulnerability to psychologic stress. Older migrant mortality converged with citizen mortality, consistent with acculturation that occurs with longer duration of residence. The pandemic did not exacerbate health inequities for foreign residents with respect to mortality.

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Changes in marriage, divorce and births during the COVID-19 pandemic in Japan

Ghaznavi C., Kawashima T., Tanoue Y., Yoneoka D., Makiyama K., Sakamoto H., Ueda P., Eguchi A., Nomura S.

BMJ Global Health 7 （ 5 ） e007866 2022年05月

査読有り,  ISSN  2059-7908

　概要を見る

Introduction Marriage, divorce and fertility are declining in Japan. There is concern that the COVID-19 pandemic may have accelerated the decrease in marriages and births while increasing the number of divorces. Changes in partnership behaviours and fertility have significant implications for mental health, well-being and population demographics. Methods Japanese vital statistical data were collected for December 2011-May 2021. We used the Farrington algorithm on the daily numbers of marriages, divorces and births (per month) in order to determine whether any given month between January 2017 and May 2021 had a significant excess or deficit. Analyses were conducted at the national and regional levels. Results During the pandemic, significant deficits in the national number of marriages were noted in January 2020, April 2020, May 2020, July 2020, September 2020 and April 2021. Regional marriage patterns reflected national trends. Divorces were noted to be in deficit during April 2020, May 2020 and May 2021 at the country level. Regional analyses mirrored national divorce trends with the exception of Shikoku, which showed no deficits during the pandemic. Significant deficits in the number of total births were noted in December 2020, January 2021 and February 2021. Regionally, birth deficits were concentrated in Chubu, Kansai and Kanto. After the start of the pandemic, no significant excesses in marriages, divorces or births were noted at the national or regional level. Conclusions Marriages and divorces declined during the pandemic in Japan, especially during state of emergency declarations. There were decreased births between December 2020 and February 2021, approximately 8-10 months after the first state of emergency, suggesting that couples altered their pregnancy intention in response to the pandemic. Metropolitan regions were more affected by the pandemic than their less metropolitan counterparts.

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Assessment of Traffic Accidents in Japan during the COVID-19 Pandemic vs. Previous Years: A Preliminary Report

Shimizu K., Ueda P., Ghaznavi C., Sakamoto H., Nomura S.

Healthcare (Switzerland) （{MDPI} {AG}）  10 （ 5 ） 860 - 860 2022年05月

査読有り,  ISSN  2227-9032

　概要を見る

Beginning in April 2020, social distancing measures were implemented to mitigate the COVID-19 pandemic in Japan. We assessed whether traffic accident rates had decreased from April 2020 to December 2021 as compared with previous years. The analysis included 2,934,477 traffic accidents, and the trend of decreasing rates of traffic accidents in recent years and seasonal fluctuations in traffic accidents were considered. The yearly change in the traffic accident rate between 2015 and 2019 was estimated, and the traffic accident rate in 2020 and 2021 was predicted. This was followed by the comparison of observed vs. predicted traffic accident rate. In 2020, the observed vs. expected rates of traffic accidents were lower in April to December 2020, and the rate of traffic accidents in Japan was 30–40% lower in April–May 2020 than would be expected based on trends from previous years. In 2021, rates of traffic accidents remained lower than expected between January and November, but the magnitude of decrease was not as pronounced. These findings could be explained by social distancing policies, including the declaration of the state of emergency, and the relaxation of public health and social measures over time.

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Japan's development assistance for health: Historical trends and prospects for a new era

Nomura S., Yamasaki L., Shimizu K., Ghaznavi C., Sakamoto H.

The Lancet Regional Health - Western Pacific （Elsevier {BV}）  22   100403 - 100403 2022年05月

ISSN  2666-6065

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The year 2020 marked an important turning point in Japan's global health policy. While the global health community has been suffering serious damage to sustainable health financing due to the COVID-19 pandemic, an independent commission on Japan's Strategy on Development Assistance for Health (DAH) launched an ambitious policy recommendation to double the amount of Japan's DAH during the post-COVID-19 era. This paper examines historical trends in DAH in Japan over the past 30 years based on published literature and comprehensive DAH tracking data and highlights priority areas for discussion on how DAH can be advanced to ensure equitable and efficient use of limited resources to support the achievement of the Sustainable Development Goals, including universal health coverage and pandemic preparedness, in low- and middle-income countries. Priority areas for discussion include: how and where to focus DAH for equitable health gains; how to provide DAH to support health system strengthening, including pandemic preparedness; and clarifying the role of DAH in global health functions.

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Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020–21

Wang H., Paulson K.R., Pease S.A., Watson S., Comfort H., Zheng P., Aravkin A.Y., Bisignano C., Barber R.M., Alam T., Fuller J.E., May E.A., Jones D.P., Frisch M.E., Abbafati C., Adolph C., Allorant A., Amlag J.O., Bang-Jensen B., Bertolacci G.J., Bloom S.S., Carter A., Castro E., Chakrabarti S., Chattopadhyay J., Cogen R.M., Collins J.K., Cooperrider K., Dai X., Dangel W.J., Daoud F., Dapper C., Deen A., Duncan B.B., Erickson M., Ewald S.B., Fedosseeva T., Ferrari A.J., Frostad J.J., Fullman N., Gallagher J., Gamkrelidze A., Guo G., He J., Helak M., Henry N.J., Hulland E.N., Huntley B.M., Kereselidze M., Lazzar-Atwood A., LeGrand K.E., Lindstrom A., Linebarger E., Lotufo P.A., Lozano R., Magistro B., Malta D.C., Månsson J., Mantilla Herrera A.M., Marinho F., Mirkuzie A.H., Misganaw A.T., Monasta L., Naik P., Nomura S., O'Brien E.G., O'Halloran J.K., Olana L.T., Ostroff S.M., Penberthy L., Reiner R.C., Reinke G., Ribeiro A.L.P., Santomauro D.F., Schmidt M.I., Shaw D.H., Sheena B.S., Sholokhov A., Skhvitaridze N., Sorensen R.J.D., Spurlock E.E., Syailendrawati R., Topor-Madry R., Troeger C.E., Walcott R., Walker A., Wiysonge C.S., Worku N.A., Zigler B., Pigott D.M., Naghavi M., Mokdad A.H., Lim S.S., Hay S.I., Gakidou E., Murray C.J.L.

The Lancet （Elsevier {BV}）  399 （ 10334 ） 1513 - 1536 2022年04月

査読有り,  ISSN  01406736

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Background: Mortality statistics are fundamental to public health decision making. Mortality varies by time and location, and its measurement is affected by well known biases that have been exacerbated during the COVID-19 pandemic. This paper aims to estimate excess mortality from the COVID-19 pandemic in 191 countries and territories, and 252 subnational units for selected countries, from Jan 1, 2020, to Dec 31, 2021. Methods: All-cause mortality reports were collected for 74 countries and territories and 266 subnational locations (including 31 locations in low-income and middle-income countries) that had reported either weekly or monthly deaths from all causes during the pandemic in 2020 and 2021, and for up to 11 year previously. In addition, we obtained excess mortality data for 12 states in India. Excess mortality over time was calculated as observed mortality, after excluding data from periods affected by late registration and anomalies such as heat waves, minus expected mortality. Six models were used to estimate expected mortality; final estimates of expected mortality were based on an ensemble of these models. Ensemble weights were based on root mean squared errors derived from an out-of-sample predictive validity test. As mortality records are incomplete worldwide, we built a statistical model that predicted the excess mortality rate for locations and periods where all-cause mortality data were not available. We used least absolute shrinkage and selection operator (LASSO) regression as a variable selection mechanism and selected 15 covariates, including both covariates pertaining to the COVID-19 pandemic, such as seroprevalence, and to background population health metrics, such as the Healthcare Access and Quality Index, with direction of effects on excess mortality concordant with a meta-analysis by the US Centers for Disease Control and Prevention. With the selected best model, we ran a prediction process using 100 draws for each covariate and 100 draws of estimated coefficients and residuals, estimated from the regressions run at the draw level using draw-level input data on both excess mortality and covariates. Mean values and 95% uncertainty intervals were then generated at national, regional, and global levels. Out-of-sample predictive validity testing was done on the basis of our final model specification. Findings: Although reported COVID-19 deaths between Jan 1, 2020, and Dec 31, 2021, totalled 5·94 million worldwide, we estimate that 18·2 million (95% uncertainty interval 17·1–19·6) people died worldwide because of the COVID-19 pandemic (as measured by excess mortality) over that period. The global all-age rate of excess mortality due to the COVID-19 pandemic was 120·3 deaths (113·1–129·3) per 100 000 of the population, and excess mortality rate exceeded 300 deaths per 100 000 of the population in 21 countries. The number of excess deaths due to COVID-19 was largest in the regions of south Asia, north Africa and the Middle East, and eastern Europe. At the country level, the highest numbers of cumulative excess deaths due to COVID-19 were estimated in India (4·07 million [3·71–4·36]), the USA (1·13 million [1·08–1·18]), Russia (1·07 million [1·06–1·08]), Mexico (798 000 [741 000–867 000]), Brazil (792 000 [730 000–847 000]), Indonesia (736 000 [594 000–955 000]), and Pakistan (664 000 [498 000–847 000]). Among these countries, the excess mortality rate was highest in Russia (374·6 deaths [369·7–378·4] per 100 000) and Mexico (325·1 [301·6–353·3] per 100 000), and was similar in Brazil (186·9 [172·2–199·8] per 100 000) and the USA (179·3 [170·7–187·5] per 100 000). Interpretation: The full impact of the pandemic has been much greater than what is indicated by reported deaths due to COVID-19 alone. Strengthening death registration systems around the world, long understood to be crucial to global public health strategy, is necessary for improved monitoring of this pandemic and future pandemics. In addition, further research is warranted to help distinguish the proportion of excess mortality that was directly caused by SARS-CoV-2 infection and the changes in causes of death as an indirect consequence of the pandemic. Funding: Bill & Melinda Gates Foundation, J Stanton, T Gillespie, and J and E Nordstrom

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Salaries, degrees, and babies: Trends in fertility by income and education among Japanese men and women born 1943–1975—Analysis of national surveys

Ghaznavi C., Sakamoto H., Yamasaki L., Nomura S., Yoneoka D., Shibuya K., Ueda P.

PLoS ONE （Public Library of Science ({PLoS})）  17 （ 4 April ） e0266835 2022年04月

査読有り,  ISSN  1932-6203

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Background While fertility rates have decreased during the second half of the 20th century in Japan, little is known regarding trends in the number of children that men and women have across birth cohorts and whether these differ by education and income. Methods We used data from four rounds of the National Fertility Survey (1992, 2005, 2010 and 2015) and included men and women aged 40–49 years (16728 men and 17628 women). By 5-year birth cohorts, we assessed the distribution of number of children (0, 1, 2 and 3 or more) and total fertility (the mean number of children) at completed fertility (age 45–49 or 40–44 years depending on birth cohort). We assessed trends in these fertility outcomes in men and women separately, and by education (no university education; university education) for men and women and by reported annual income (0 to <3 000 000 JPY; 3 000 000 to <6 000 000 JPY; ≥6 000 000 JPY) for men. Results When comparing those born in 1943–1948 with those born in 1971–1975, the proportion with no children had increased from 14.3 to 39.9% for men and from 11.6 to 27.6% for women. This increase coincided with a decrease in the proportions of individuals with 2 or more children. Total fertility had decreased from 1.92 to 1.17 among men and from 1.96 to 1.42 among women. For men, those with a university degree were more likely to have children than those without a university degree in all birth cohorts except 1943–1947. Men with higher income were more likely to have children across birth cohorts. While the proportion who had children had decreased in all income groups, the decrease was steeper among those in the lowest income group. Among women born 1956–1970, those with a university degree were less likely to have children than those without a university degree; this difference was no longer seen among those born 1971–1975. For both men and women, trends in having children and total fertility across birth cohorts did not differ by educational status. Conclusions The decline in the total fertility rate in Japan can be attributed to both an increasing proportion of the population who have no children and a lower number of children among those who have children. Men with lower education and income were less likely to have children and the disparity in the number of children that men have by income had increased in more recent birth cohorts. Among women, higher education was associated with lower fertility, although this pattern was no longer observed among those born in 1971–1975.

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Toward a third term of Health Japan 21 – implications from the rise in non-communicable disease burden and highly preventable risk factors

Nomura S., Sakamoto H., Ghaznavi C., Inoue M.

The Lancet Regional Health - Western Pacific （Elsevier BV）  21   100377 - 100377 2022年04月

査読有り,  ISSN  2666-6065

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In 2000, the Japanese government launched the National Health Promotion Movement known as Health Japan 21 (HJ21), a 13-year national health promotion policy (2000–2012) aimed at preventing and controlling non-communicable diseases (NCDs) and their underlying risk factors. After the revision in 2013 (2013–2023), the target NCDs and risk factors are being reviewed and a new strategy for the third term of HJ21 is going to be discussed. Using the latest findings from the Global Burden of Disease Study 2019, this paper highlights NCDs that continue to increase health losses and preventable metabolic and behavioural risk factors. These NCDs and risk factors are associated with an increased risk of serious illness and death from the novel coronavirus disease (COVID-19). The third term of HJ21 will be formulated during the continuing threat of acute health crises like the current COVID-19 pandemic and thus offers an important opportunity to renew public health efforts to halt the growing burden of NCDs in Japan. This article may serve as one of the roadmaps for the formulation of the third term of HJ21.

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Long-Term Mental Health Support after Natural Hazard Events: A Report from an Online Survey among Experts in Japan

Kayano R., Lin M., Shinozaki Y., Nomura S., Kim Y.

International Journal of Environmental Research and Public Health （{MDPI} {AG}）  19 （ 5 ） 3022 - 3022 2022年03月

査読有り,  ISSN  16617827

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This paper aims to provide preliminary evidence on the degree of consensus on the approach to long-term mental health and psychosocial support after a natural hazard event. We conducted an online survey among mental health experts in Japan. The questionnaire was divided into five categories: (A) terminology setting definition of “long-term”, (B) priority in activity for long-term mental health support, (C) system and preparedness for better support, (D) transition from acute support to long-term support, and (E) actions to improve preparedness for future disasters. Invitations to participate in the survey were sent by e-mail in November 2017 to mental health experts in Japan, who had participated in workshops related to disaster mental health or trauma care organized by the National Institute of Mental Health over the last 15 years. Out of 1385 experts who received the invitation, a total of 305 participants responded to the survey. Participants were for the most part in agreement regarding focuses and required preparedness and actions for long-term support. There was still low consensus especially on defining the timeframe “long-term”. The acute phase and long-term phase were identified as being different in dimension rather than category. Although caution is necessary around the representativeness of these findings, they will provide important scientific evidence for the development of future plans for a qualitative improvement in long-term mental health support.

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Global, regional, and national burden of diseases and injuries for adults 70 years and older: systematic analysis for the Global Burden of Disease 2019 Study

GBD 2019 Ageing Collaborators

BMJ 2022年03月

査読有り,  ISSN  1756-1833

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<jats:title>Abstract</jats:title><jats:sec><jats:title>Objectives</jats:title><jats:p>To use data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019) to estimate mortality and disability trends for the population aged ≥70 and evaluate patterns in causes of death, disability, and risk factors.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Systematic analysis.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>Participants were aged ≥70 from 204 countries and territories, 1990-2019.</jats:p></jats:sec><jats:sec><jats:title>Main outcomes measures</jats:title><jats:p>Years of life lost, years lived with disability, disability adjusted life years, life expectancy at age 70 (LE-70), healthy life expectancy at age 70 (HALE-70), proportion of years in ill health at age 70 (PYIH-70), risk factors, and data coverage index were estimated based on standardised GBD methods.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Globally the population of older adults has increased since 1990 and all cause death rates have decreased for men and women. However, mortality rates due to falls increased between 1990 and 2019. The probability of death among people aged 70-90 decreased, mainly because of reductions in non-communicable diseases. Globally disability burden was largely driven by functional decline, vision and hearing loss, and symptoms of pain. LE-70 and HALE-70 showed continuous increases since 1990 globally, with certain regional disparities. Globally higher LE-70 resulted in higher HALE-70 and slightly increased PYIH-70. Sociodemographic and healthcare access and quality indices were positively correlated with HALE-70 and LE-70. For high exposure risk factors, data coverage was moderate, while limited data were available for various dietary, environmental or occupational, and metabolic risks.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Life expectancy at age 70 has continued to rise globally, mostly because of decreases in chronic diseases. Adults aged ≥70 living in high income countries and regions with better healthcare access and quality were found to experience the highest life expectancy and healthy life expectancy. Disability burden, however, remained constant, suggesting the need to enhance public health and intervention programmes to improve wellbeing among older adults.</jats:p></jats:sec>

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Reduced mortality during the COVID-19 outbreak in Japan, 2020: A two-stage interrupted time-series design

Onozuka D., Tanoue Y., Nomura S., Kawashima T., Yoneoka D., Eguchi A., Ng C.F.S., Matsuura K., Shi S., Makiyama K., Uryu S., Kawamura Y., Takayanagi S., Gilmour S., Hayashi T.I., Miyata H., Sera F., Sunagawa T., Takahashi T., Tsuchihashi Y., Kobayashi Y., Arima Y., Kanou K., Suzuki M., Hashizume M.

International Journal of Epidemiology （Oxford University Press (OUP)）  51 （ 1 ） 75 - 84 2022年02月

ISSN  03005771

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Coronavirus disease 2019 (COVID-19) continues to be a major global health burden. This study aims to estimate the all-cause excess mortality occurring in the COVID-19 outbreak in Japan, 2020, by sex and age group. Methods: Daily time series of mortality for the period January 2015-December 2020 in all 47 prefectures of Japan were obtained from the Ministry of Health, Labour and Welfare, Japan. A two-stage interrupted time-series design was used to calculate excess mortality. In the first stage, we estimated excess mortality by prefecture using quasi-Poisson regression models in combination with distributed lag non-linear models, adjusting for seasonal and long-term variations, weather conditions and influenza activity. In the second stage, we used a random-effects multivariate meta-analysis to synthesize prefecture-specific estimates at the nationwide level. Results: In 2020, we estimated an all-cause excess mortality of -20 982 deaths [95% empirical confidence intervals (eCI): -38 367 to -5472] in Japan, which corresponded to a percentage excess of -1.7% (95% eCI: -3.1 to -0.5) relative to the expected value. Reduced deaths were observed for both sexes and in all age groups except those aged <60 and 70-79 years. Conclusions: All-cause mortality during the COVID-19 outbreak in Japan in 2020 was decreased compared with a historical baseline. Further evaluation of cause-specific excess mortality is warranted.

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