Hiroshi Hirai

Iwate University, Morioka, Iwate, Japan

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Publications (51)80.26 Total impact

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    ABSTRACT: Many studies have suggested a U-shaped curve for the association between body size and mortality risks, i.e., mortality risks increase in those who are both overweight and underweight. The strength of the associations may vary according to socioeconomic statuses (SES), as they determine levels of access to healthcare and psychosocial stresses. We investigated the modifying effects of SES on the relationship between body mass index (BMI) and mortality. We used prospective cohort data of participants in the Aichi Gerontological Evaluation Study in 2003 (n=14,931), who were 65 years or older and physically and cognitively independent at baseline, and residing in eight municipalities in Japan. Data on all-causes mortality and mortality from cancer, cardiovascular disease, and respiratory disease was obtained from municipal government registries. Proportional hazard regression analyses showed that, among men, the associations between overweight (BMI ≥ 25 kg/m(2)) and higher mortality risks by any cause were stronger among lower income groups. Even adjusting for multiple confounding factors, hazard ratios (95% confidence intervals) for mortality by all causes among low income group (household income < 1.5 million yen) were 1.96 (1.02-3.73) for overweight compared to BMIs between 23.0 and 24.9, whereas they were 0.94 (0.57-1.38) among men in high income group (income > 3 million yen). The modifying effects of income were not marked among women. Household income, which may directly reflect accessibility to healthcare and psychosocial stress among older Japanese men, may be an important modifying factor in the health risks attributable to overweight. Copyright © 2015. Published by Elsevier Inc.
    Preventive Medicine 05/2015; 77. DOI:10.1016/j.ypmed.2015.05.015 · 2.93 Impact Factor
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    ABSTRACT: The purpose of this study is to investigate healthcare access disparity that will cause delayed and unmet healthcare needs for the elderly, and to examine health inequality and healthcare cost burden for the elderly. To produce clear policy applications, this study adapts a modified PRECEDE-PROCEED model for framing theoretical and experimental approaches. Data were collected from a large collection of the Community Tracking Study Household Survey 2003-2004 of the USA. Reliability and construct validity are examined for internal consistency and estimation of disparity and inequality are analyzed by using probit/ols regressions. The results show that predisposing factors (e.g., attitude, beliefs, and perception by socio-demographic differences) are negatively associated with delayed healthcare. A 10% increase in enabling factors (e.g., availability of health insurance coverage, and usual sources of healthcare providers) are significantly associated with a 1% increase in healthcare financing factors. In addition, information through a socio-economic network and support system has a 5% impact on an access disparity. Income, health status, and health inequality are exogenously determined. Designing and implementing easy healthcare accessibility (healthcare system) and healthcare financing methods, and developing a socio-economic support network (including public health information) are essential in reducing delayed healthcare and health inequality.
    International Journal of Environmental Research and Public Health 02/2015; 12(2):1745-72. DOI:10.3390/ijerph120201745 · 1.99 Impact Factor
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    ABSTRACT: Objectives No clear evidence for a cut-off point for social isolation has been established so far. The purpose of this study was to evaluate the criteria for social isolation based on associations with objective health outcomes in a 10-year follow-up study.Methods We performed a prospective study of functionally independent residents aged 65 years or older who lived in six municipalities as part of the Aichi Gerontological Evaluation Study (response rate: 50.4%) that began in 2003. Data on the onset of functional disability, dementia, and death were obtained from municipal databases of the public long-term care insurance system. A total of 12,085 participants were followed up for up to 10 years. We used frequencies of face-to-face and non-face-to-face contact with non-resident children, relatives and friends, or neighbors as indicators of social isolation. The overall frequency of contact with others was categorized from "less than once a month" to "frequently, every day."Results Cox's proportional hazard model revealed that, after controlling for sex, age, education level, marital status, equivalent household income, need for medical care, self-recognition of forgetfulness, and residential area, the hazard ratios for functional disability (over long-term care level 2), dementia, and premature death increase in those with contact frequency of "less than once a month" were 1.37 (95% confidence interval [CI]: 1.16-1.61), 1.45 (95% CI: 1.21-1.74), and 1.34 (95% CI: 1.16-1.55), respectively. The "from once a month to once a week" frequency was also associated with these health indicators, although the "more than once a week" frequency was not significantly associated with any measured outcome. The prevalence of "less than once a month" contact was 7.4% (men=10.2%, women=4.7%), and this was 15.8% (men=21.2%, women=10.6%) when including those with "less than once a week" contact.Conclusion These findings suggest that "less than once a week" or "less than once a month" contact with non-cohabitant others are valid operational definitions of social isolation that are closely associated with premature death and other health indicators.
    [Nippon kōshū eisei zasshi] Japanese journal of public health 01/2015; 62(3):95-105. DOI:10.11236/jph.62.3_95
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    ABSTRACT: Background: after the Great East Japan Earthquake in 2011, inactivity and the homebound status of older victims in affected areas have been a serious public health concern owing to the victims' prolonged existence as evacuees in mountainous areas. Objective: to evaluate the association between distances to retail stores and risks of being homebound. Design: secondary analysis of cross-sectional interview survey data with a geographical information analysis. Setting: Rikuzentakata, Iwate, a municipality seriously damaged by the 2011 earthquake and tsunami. Subjects: all Rikuzentakata residents aged 65 or older except for those living in temporary housing (n = 2,327). Methods: we calculated road distances between each residential address and retail stores, hawker sites and shopping bus stops, accounting for the extra load caused by walking on slopes. The prevalence ratio of being homebound adjusted for age, source of income and morbidity by road distance was estimated using Poisson regression with a generalised estimating equation. Results: those living at distances of 1,200 m or more were 1.78 (95% confidence intervals, 1.03-3.08) times more likely to be homebound (going out only every 4 or more days a week) among men and 1.85 (1.13-3.02) among women, compared with those residing in places <400 m from retail stores or shopping bus stops. The distances were reduced by new hawker and shopping bus services, but the improvements varied greatly across the districts. Conclusions: access to daily needs is essential to prevent homebound status. Post-disaster community diagnosis in terms of the built environment is important for strategic community restoration.
    Age and Ageing 10/2014; 44(3). DOI:10.1093/ageing/afu146 · 3.11 Impact Factor
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    ABSTRACT: Background: We examined the relationship between incident functional disability and social participation from the perspective of number of types of organizations participated in and type of social participation in a prospective cohort study. Method: The study was based on the Aichi Gerontological Evaluation Study (AGES) Cohort Study data. We followed 13,310 individuals aged 65 years or older for 4 years. Analysis was carried out on 12,951 subjects, excluding 359 people whose information on age or sex was missing. Social participation was categorized into 8 types. Results: Compared to those that did not participate in any organizations, the hazard ratio (HR) was 0.83 (95% CI: 0.73-0.95) for participation in one, 0.72 (0.61-0.85) for participation in two, and 0.57 (0.46-0.70) for participation in three or more different types of organizations. In multivariable adjusted models, participation in the following types of organization was protective for incident disability: local community organizations (HR = 0.85, 95% CI: 0.76-0.96), hobby organizations (HR = 0.75, 95% CI: 0.64-0.87), and sports organizations (HR = 0.64, 95% CI: 0.54-0.81). Conclusion: Social participation may decrease the risk of incident functional disability in older people in Japan. This effect may be strengthened by participation in a variety of different types of organizations. Participating in a local community, hobby, or sports group or organization may be especially effective for decreasing the risk of disability.
    PLoS ONE 06/2014; 9(6):e99638. DOI:10.1371/journal.pone.0099638 · 3.53 Impact Factor
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    ABSTRACT: To evaluate the impact of satisfied isolation on the onset of functional disability of older Japanese adults, we performed a prospective data analysis. We collected baseline information in 2003 from 13,310 functionally independent residents aged 65 years or older who lived in six municipalities in Aichi prefecture. The onset of functional disability was obtained from municipal databases of the public long-term care insurance system. All participants were followed for up to 4 years. Respondents who had face-to-face and non-face-to-face contacts once or twice per month or less were considered as isolated. We distinguished the isolated person who were satisfied their life or not; 74.1% of isolated older people were categorized as satisfied isolation. Cox’s proportional hazard model revealed that the isolated older people were 1.34 (95%CI: 1.18-1.53) times more likely to develop functional disability. Although the interaction effect between isolation and life satisfaction was not statistically significant, satisfied isolation was associated with 1.27 (95%CI: 1.02-1.58) times higher risk of functional disability than those who were not isolated in older men. Satisfied isolation was also attributable to 11,000 functional disability annually for the older Japanese population.
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    ABSTRACT: Social participation has been linked to healthy aging and the maintenance of functional independence in older individuals. However, causality remains tenuous because of the strong possibility of reverse causation (healthy individuals selectively participate in social activities). We describe a quasi-experimental intervention in one municipality of Japan designed to boost social participation as a way of preventing long-term disability in senior citizens through the creation of 'salons' (or community centers). In this quasi-experimental intervention study, we compared 158 participants with 1391 non-participants in salon programs, and examined the effect of participation in the salon programs on self-rated health. We conducted surveys of community residents both before (in 2006) and after (in 2008) the opening of the salons. Even with a pre/post survey design, our study could be subject to reverse causation and confounding bias. We therefore utilized an instrumental variable estimation strategy, using the inverse of the distance between each resident's dwelling and the nearest salon as the instrument. After controlling for self-rated health, age, sex, equivalized income in 2006, and reverse causation, we observed significant correlations between participation in the salon programs and self-rated health in 2008. Our analyses suggest that participation in the newly-opened community salon was associated with a significant improvement in self-rated health over time. The odds ratio of participation in the salon programs for reporting excellent or good self-rated health in 2008 was 2.52 (95% CI 2.27-2.79). Our study provides novel empirical support for the notion that investing in community infrastructure to boost the social participation of communities may help promote healthy aging.
    Social Science [?] Medicine 10/2013; 94:83-90. DOI:10.1016/j.socscimed.2013.05.006 · 2.56 Impact Factor
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    ABSTRACT: We sought to examine prospectively the difference in the association between incident functional disability and exercise with or without sports organization participation. The study was based on the Aichi Gerontological Evaluation Study (AGES) Cohort Study data. In October 2003, self-reported questionnaires were mailed to 29,374 non-disabled Japanese individuals aged 65 years or older. Of these, 13,310 individuals were introduced to the Study, and they were followed for 4 years. Analysis was carried out on 11,581 subjects who provided all necessary information for the analysis. Analysis was carried out on incident functional disability by 4 groups of different combinations of performance of exercise and participation in a sports organization Active Participant (AP), Exercise Alone (EA), Passive Participant (PP) and Sedentary (S). Compared to the AP group, the EA group had a hazard ratio (HR) of 1.29 (1.02-1.64) for incident functional disability. No significant difference was seen with the PP group, with an HR of 1.16 (0.76-1.77). When a measure of social networks was added to the covariates, the HR of the EA group dropped to 1.27 (1.00-1.61), and significant differences disappeared. In contrast, it showed hardly any change when social support was added. The results suggested that, even with a regular exercise habit, incident functional disability may be better prevented when a person participates in a sports organization than when he/she does not. In addition, participation in a sports organization correlates positively with social networks, which may lead to a small decrease in incident functional disability.
    PLoS ONE 11/2012; 7(11):e51061. DOI:10.1371/journal.pone.0051061 · 3.53 Impact Factor
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    ABSTRACT: We examined the relationship between income, mortality, and loss of years of healthy life in a sample of older persons in Japan. We analyzed 22,829 persons aged 65 or older who were functionally independent at baseline as a part of the Aichi Gerontological Evaluation Study (AGES). Two outcome measures were adopted, mortality and loss of healthy life. Independent variables were income level and age. The occurrence of mortality and need for care during these 1,461 days were tracked. Cox regressions were used to calculate the hazard ratio for mortality and loss of healthy life by income level. We found that people with lower incomes were more likely than those with higher incomes to report worse health. For the overall sample, using the governmental administrative data, the hazard ratios of mortality and loss of healthy life-years comparing the lowest to the highest income level were 3.50 for men and 2.48 for women for mortality and 3.71 for men and 2.27 for women for loss of healthy life. When only those who responded to questions about income on the mail survey were included in the analysis, the relationships became weaker and lost statistical significance.
    Current Gerontology and Geriatrics Research 09/2012; 2012:701583. DOI:10.1155/2012/701583
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    ABSTRACT: BACKGROUND: Recent increases in numbers of older people have been accompanied by increases in those with functional disability. No study has examined the association between community social capital and the onset of functional disability. METHODS: The association between community social capital and the onset of functional disability was examined using data from the Aichi Gerontological Evaluation Study, a prospective cohort established in 2003 in Japan. Perceptions of community social capital (indicators of social cohesion such as trust of others and extent of social participation) in 6953 men and 7636 women aged 65 years or older were surveyed. Multilevel survival analysis using the discrete-time hazard model was applied. RESULTS: During 4-year follow-up, onset of functional disability occurred in 759 men and 1146 women. Women living in communities with higher mistrust had 1.68 (95% CI 1.14 to 2.49) times higher OR of onset of disability, even after adjusting for covariates. Mediators did not substantially change this association. Lack of social participation seemed to affect the health of women, though the effect was marginal (OR for covariates adjusted model =1.12 (95% CI 0.96 to 1.31)). There were no significant ORs among men. CONCLUSIONS: Lower community social capital was associated with higher incidence of onset of functional disability among older women but not among men. Community-based interventions to promote social capital may be useful for preventing functional disability of older Japanese women.
    Journal of epidemiology and community health 07/2012; 67(1). DOI:10.1136/jech-2011-200307 · 3.29 Impact Factor
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    ABSTRACT: To examine if self-reported number of teeth, denture use and chewing ability are associated with incident falls. Longitudinal cohort study (the Aichi Gerontological Evaluation Study). 5 Japanese municipalities. 1763 community-dwelling individuals aged 65 years and older without experience of falls within the previous year at baseline. Self-reported history of multiple falls during the past year at the follow-up survey about 3 years later. Baseline data on the number of teeth present and/or denture use and chewing ability were collected using self-administered questionnaires. Logistic regression analyses controlled for sex, age, functional disability during follow-up period, depression, self-rated health and educational attainment. 86 (4.9%) subjects reported falls at the follow-up survey. Logistic regression models fully adjusted for all covariates showed that subjects having 19 or fewer teeth but not using dentures had a significantly increased risk for incident falls (OR 2.50, 95% CI 1.21 to 5.17, p=0.013) compared with those having 20 or more teeth. Among subjects with 19 or fewer teeth, their risk of falls was not significantly elevated so long as they wore dentures (OR 1.36, 95% CI 0.76 to 2.45, p=0.299). No significant association was observed between chewing ability and incident falls in the fully adjusted model. Having 19 or fewer teeth but not using dentures was associated with higher risk for the incident falls in older Japanese even after adjustment for multiple covariates. Dental care to prevent tooth loss and denture treatment for older people might prevent falls, although the authors cannot exclude the possibility that the association is due to residual confounding.
    BMJ Open 07/2012; 2(4). DOI:10.1136/bmjopen-2012-001262 · 2.06 Impact Factor
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    ABSTRACT: To evaluate the gender-specific impact of social exclusion on the mortality of older Japanese adults, we performed a prospective data analysis using the data of the Aichi Gerontological Evaluation Study (AGES). In AGES, we surveyed functionally independent residents aged 65 years or older who lived in six municipalities in Aichi prefecture, Japan. We gathered baseline information from 13,310 respondents in 2003. Information on mortality was obtained from municipal databases of the public long-term care insurance system. All participants were followed for up to 4 years. We evaluated social exclusion in terms of the combination of social isolation, social inactivity, and relative poverty. Cox's proportional hazard model revealed that socially excluded older people were at significantly increased risk (9-34%) for premature mortality. Those with simultaneously relative poverty and social isolation and/or social inactivity were 1.29 times more likely to die prematurely than those who were not socially excluded. Women showed stronger overall impact of social exclusion on mortality, whereas relative poverty was significantly associated with mortality risks for men. If these associations are truly causal, social exclusion is attributable to 9000-44,000 premature deaths (1-5%) annually for the older Japanese population. Health and social policies to mitigate the issue of social exclusion among older adults may require gender-specific approaches.
    Social Science [?] Medicine 05/2012; 75(5):940-5. DOI:10.1016/j.socscimed.2012.04.006 · 2.56 Impact Factor
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    ABSTRACT: The story of Roseto, Pennsylvania, USA, is one of the most widely cited studies of the putative influence of community social cohesion on population health. However, few contemporary studies of community-based "social capital" on health have addressed "communities" as unique places with unique histories outside of a Western context. In the present study, we focus on a specific region of Japan (which we call the M-region to preserve anonymity). Using survey data and qualitative interviews, we discuss the historical and contextual origins of the high social capital in the M-region that could account for its relatively good health profile. The analysis of survey data suggested that the residents of M-region have higher norms of reciprocity and participate more in horizontal organizations (including volunteer group, citizen or consumer group, sports group or club, and hobby group), and it also indicated better health status and behaviors in some outcomes among the residents of M-region. Based on qualitative interviews, the origins of social capital in the M-region appeared to be rooted in the strong sense of solidarity fostered by the fact that many of the residents were recruited into the region by the same local employer (a steel manufacturing company). Our study points to the need to ground studies of community-based "social capital" and health on detailed knowledge of the historical context of specific places.
    Social Science [?] Medicine 04/2012; 75(1):225-32. DOI:10.1016/j.socscimed.2012.03.017 · 2.56 Impact Factor
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    ABSTRACT: Studies have shown that people with cognitive impairment have poor dental health. However, the direction of causality remains unknown. This prospective cohort study aimed to determine the association between four self-reported dental health variables and dementia onset in older Japanese people. Analysis was conducted on 4425 residents 65 years or older. Four self-reported dental health variables included the number of teeth and/or use of dentures, ability to chew, presence/absence of a regular dentist, and taking care of dental health. Data were collected using self-administered questionnaires given in 2003. Records of dementia onset during 2003 to 2007 were obtained from municipalities in charge of the public long-term care insurance system. Age, income, body mass index, present illness, alcohol consumption, exercise, and forgetfulness were used as covariates. Dementia onset was recorded in 220 participants. Univariate Cox proportional hazards models showed significant associations between the dental health variables and dementia onset. In models fully adjusted for all covariates, hazard ratios (95% confidence intervals) of dementia onset of respondents were as follows: 1.85 (1.04-3.31) for those with few teeth and without dentures; 1.25 (0.81-1.93) for those who could not chew very well; 1.44 (1.04-2.01) for those who did not have a regular dentist; and 1.76 (0.96-3.20) for those who did not take care of their dental health. Few teeth without dentures and absence of a regular dentist, not poor mastication and poor attitudes toward dental health, were associated with higher risk of dementia onset in the older Japanese cohort even after adjustment for available covariates.
    Psychosomatic Medicine 03/2012; 74(3):241-8. DOI:10.1097/PSY.0b013e318246dffb · 4.09 Impact Factor
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    ABSTRACT: Why are some communities more cohesive than others? The answer to the puzzle has two parts: (a) due to variations in the attributes of residents, and/or (b) due to variations in the attributes of places. However, few studies have sought to examine the community-level determinants of social capital. In the present study, we examined the associations between social capital and different area characteristics: (1) neighborhood walkability, (2) date of community settlement, and (3) degree of urbanization. We based our analysis on 9414 respondents from the Aichi Gerontological Evaluation Study (AGES), conducted in 2003. No significant positive association was found between the walkability score and any of the social capital indices. In contrast, community age and degree of urbanization were associated with many of the social capital indicators, even after controlling for characteristics of the residents. Community social capital thus appears to be more consistently linked to the broader historical and geographic contexts of neighborhoods, rather than to the proximal built environment (as measured by walkability).
    Health & Place 03/2012; 18(2):229-39. DOI:10.1016/j.healthplace.2011.09.015 · 2.44 Impact Factor
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    ABSTRACT: Studies have reported that the predictive ability of self-rated health (SRH) for mortality varies by sex/gender and socioeconomic group. The purpose of this study is to evaluate this relationship in Japan and explore the potential reasons for differences between the groups. The analyses in the study were based on the Aichi Gerontological Evaluation Study's (AGES) 2003 Cohort Study in Chita Peninsula, Japan, which followed the four-year survival status of 14,668 community-dwelling people who were at least 65 years old at the start of the study. We first examined sex/gender and education-level differences in association with fair/poor SRH. We then estimated the sex/gender- and education-specific hazard ratios (HRs) of mortality associated with lower SRH using Cox models. Control variables, including health behaviors (smoking and drinking), symptoms of depression, and chronic co-morbid conditions, were added to sequential regression models. The results showed men and women reported a similar prevalence of lower SRH. However, lower SRH was a stronger predictor of mortality in men (HR = 2.44 [95% confidence interval (CI): 2.14-2.80]) than in women (HR = 1.88 [95% CI: 1.44-2.47]; p for sex/gender interaction = 0.018). The sex/gender difference in the predictive ability of SRH was progressively attenuated with the additional introduction of other co-morbid conditions. The predictive ability among individuals with high school education (HR = 2.39 [95% CI: 1.74-3.30]) was similar to that among individuals with less than a high school education (HR = 2.14 [95% CI: 1.83-2.50]; p for education interaction = 0.549). The sex/gender difference in the predictive ability of SRH for mortality among this elderly Japanese population may be explained by male/female differences in what goes into an individual's assessment of their SRH, with males apparently weighting depressive symptoms more than females.
    PLoS ONE 01/2012; 7(1):e30179. DOI:10.1371/journal.pone.0030179 · 3.53 Impact Factor
  • Iryo To Shakai 01/2012; 22(1):19-30. DOI:10.4091/iken.22.19
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    ABSTRACT: To determine the association between dental health status and onset of functional disability in older Japanese people. Prospective cohort study. Six Japanese municipalities. Four thousand four hundred twenty-five community-dwelling individuals aged 65 and over. The outcome measure was the onset of functional disability based on public records of people receiving long-term care insurance benefits, determined through a standardized multistep assessment of functional and cognitive impairment including a personal interview and an examination by a physician. Disability data were analyzed for 4,425 respondents during 2003 to 2007. Self-reported number of remaining teeth and eating ability were used as measures of dental health status. Age, sex, body mass index, self-rated health, present illness, smoking, alcohol, exercise, and equivalent income were used as covariates. In the age- and sex-adjusted Cox proportional hazard models, there were significant associations between number of remaining teeth, eating ability, and onset of disability. After adjusting for sociodemographic, behavioral, and health status variables, respondents with 19 or fewer teeth had a significant 1.21 (95% confidence interval = 1.06-1.40) times higher hazard ratio for the onset of functional disability. In contrast, eating ability was not significantly associated with the onset of disability. Poor dental status was associated with a higher risk of onset of functional disability in older Japanese people. Sociodemographic, behavioral, and health status covariates explained the association between eating ability and onset of disability.
    Journal of the American Geriatrics Society 12/2011; 60(2):338-43. DOI:10.1111/j.1532-5415.2011.03791.x · 4.22 Impact Factor
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    ABSTRACT: Objectives: This prospective cohort study attempted to examine the associations between subjective levels of happiness and risks of loss of healthy life expectancy among Japanese men and women who is over 65 years old, living in the community settings. Methods: Study subjects were 8,248 (4016 men and 4232 women) aged Japanese free from dementia nor disabled conditions at baseline 2003, included in Aichi Gerontological Evaluation Study (AGES). Loss of healthy life expectancy (HLE) was assessed through public long-term care insurance databases and national resident registry. Sex-specific age and multivariable adjusted hazard ratios (HRs) were calculated according to the perceived levels of happiness from Cox proportional hazard models to estimate the risks of loss of HLE. Additionally, one-to-one nearest neighbor propensity score matching analysis were also carried out using a logit model. Result: Among followed up period for 4 years in median, a total of 490 loss of HLE were documented. The multivariable hazard ratios (HRs) of loss of HLE was calculated, and to compare with the highest levels of happiness to those in the lowest were 0.70 (95%CI:0.58-0.86), p for trend p=0.03 in total population. The hazard ratios and the 95% CIs calculated in the matching technique were not grossly different. Conclusion: A higher levels of happiness was found to be associated with lower risks of loss of HLE in the later stage of life, suggesting a protective role of positive psychological conditions on health.
    139st APHA Annual Meeting and Exposition 2011; 10/2011

Publication Stats

338 Citations
80.26 Total Impact Points

Institutions

  • 2011–2015
    • Iwate University
      • Department of Civil and Environmental Engineering
      Morioka, Iwate, Japan
  • 2007–2012
    • Nihon Fukushi University
      Koromo, Aichi, Japan
  • 2008
    • Osaka University of Commerce
      Ōsaka, Ōsaka, Japan
    • Hamamatsu University School Of Medicine
      Hamamatu, Shizuoka, Japan