Introduction: Income is hypothesized to affect health not just through material pathways (i.e. the ability to purchase health-enhancing goods) but also through psychosocial pathways (e.g. social comparisons with others). Two concepts relevant to the psychosocial effects of income are: relative deprivation (for example expressed by the Yitzhaki Index, measuring the magnitude of difference in income among individuals) and Income Rank. This study examined whether higher relative deprivation and lower Income Rank are associated with depressive symptoms in an older population independently of absolute income. Method: Using cross-sectional data of 83,100 participants (40,038 men and 43,062 women) in the Japan Gerontological Evaluation Study (JAGES), this study applied multiple logistic regression models to calculate the odds ratios (OR) of depression associated with relative deprivation/Income Rank. The Japanese Geriatric Depression Scale (GDS-15) was used to assess depressive symptoms, and subjects with a score of ≥5 were categorized as depressed. Reference groups for calculating Yitzhaki Index and Income Rank were constructed based on same gender, age-group, and municipality of residence. Results: The findings indicated that after controlling for demographic factors, each 100,000 yen increase in relative deprivation and 0.1 unit decrease in relative rank was associated with a 1.07 (95% CI: 1.07, 1.08) and a 1.15 (95% CI: 1.14, 1.16) times higher odds of depression, respectively, in men. The corresponding ORs in women were 1.05 (95% CI: 1.05, 1.06) and 1.12 (95% CI: 1.11, 1.13), respectively. After adjustment for other covariates and stratification by income quartiles, the results remained statistically significant. Women in the highest income quartile appeared to be more susceptible to the adverse mental health effects of low Income Rank, while among men the associations were reversed, low Income Rank appeared more toxic for the poor. Conclusion: Concepts of relative income appear to be relevant for mental health over and above the effects of absolute income.

Supplemental Digital Content is available in the text.

No abstract

We examined potential associations of sport club participation during adolescence and sports-related physical activity during adulthood with mortality from cardiovascular diseases (CVD) in a Japanese population. Between 1988 and 1990, 29,526 men and 41,043 women aged 40-79 years responded to a questionnaire including questions about the frequency of sports participation at baseline and sport club participation during junior/senior high school. Subjects were followed-up until the end of 2009, and 4230 cardiovascular deaths (870 CHD, 1859 stroke) were identified. Cox proportional-hazard regression models were used to estimate hazard ratios (HR). During the first-two thirds of the follow-up - where the proportional hazards assumption was met - the multivariate-adjusted HR (95% confidence interval) for total CVD mortality was 0.77 (0.61-0.98) among men and 0.82 (0.61-1.10) among women who were physically active at baseline (≥5 h/week versus 1-2 h/week). The corresponding HRs for coronary heart disease (CHD) mortality were 0.65 (0.39-1.07) and 0.40 (0.17-0.91), respectively. The combined associations of sports participation during adulthood and adolescence were also examined. Among men who participated in sports for ≥5 h/week at baseline, the multivariate-adjusted HR for those who also engaged in sport club activities during adolescence was 0.89 (0.61-1.30) for total CVD mortality and 0.24 (0.08-0.71) for CHD mortality when compared to non-participants. Among women, no statistically significant differences were found between sport club participants and non-participants. In conclusion, participating in sport clubs during adolescence might lead to a more pronounced risk-reduction for CHD mortality among men who also participate in sport activities during adulthood.

The strength of social connections in the community (“social capital”) is hypothesized to be a crucial ingredient in disaster resilience. We examined whether community-level social capital is correlated with the ability to maintain functional capacity among older residents who experienced the 2011 Great East Japan Earthquake and Tsunami. The baseline of our cohort (mean age 74 years) was established in 2010, seven months before the disaster in Iwanuma, a Japanese city located 80-km from the epicenter. Disaster related personal experiences (e.g., housing damage/relocation) were assessed through a follow-up survey (n=3594; follow-up rate: 82.1%) conducted in 2013, two and a half years after the earthquake. Multiple membership multilevel models were used to evaluate the associations between functional capacity – measured by the Instrumental Activities of Daily Living scale – and three sub-scales of community-level social capital; social cohesion, social participation, and reciprocity. Community-level social participation was associated with a lower risk of functional decline after disaster exposure. The average level of social participation in the community also mitigated the adverse impact of housing damage on functional status, suggesting a buffering mechanism.

BackgroundThe objective of this study was to examine long-term trends in rates of ischaemic heart disease (IHD) mortality, a leading cause of mortality in Hungary. The study examined the effects of age, period, and cohort on IHD mortality rates and compared mortality rates between the capital (Budapest) and non-capital counties.MethodsData on IHD deaths and population censuses were obtained from the Hungarian Central Statistical Office. Age-period-cohort analysis utilized nine age-group classes for ages 40 to 84 years, eight time periods from 1970 to 2009, and 16 birth cohorts from 1886 to 1969.ResultsAge-adjusted IHD mortality rates for men and for women generally increased from 1970 to 1993 and from 1980 to 1999, respectively, decreasing thereafter for both sexes. IHD mortality rates for men and for women from Budapest were lower from 1991 and from 1970, respectively, than corresponding rates in non-capital counties, with the difference increasing after 1999. Age had a more significant influence on mortality rates for women than for men. The period effect increased from 1972 to 1982 and decreased thereafter for men, while the period effect decreased consistently for women from 1972 to 2007. The decline in period effect for both sexes was larger for individuals from the capital than for those from non-capital counties. The cohort effect for both sexes declined from birth years 1890 to 1965, with a steeper decline for individuals from the capital than for those from non-capital counties.ConclusionsThe findings indicate a need for programs in Hungary for IHD prevention, especially for non-capital counties.

Stroke is the first and fourth leading cause of death in China and Japan, respectively. Physical inactivity was suggested to be one of the most important risk factors for stroke mortality. therefore, this study aimed to assess long-term trends in stroke mortality attributable to low physical activity (LpA) in China and Japan during the period 1990-2016. Mortality data were obtained from the Global Burden of Disease Study 2016 (GBD 2016) and were analyzed with an age-period-cohort method. The agestandardized mortality rates (ASMRs) showed declining trends for LpA-attributable stroke mortality. the overall net drift per year was −1.3% for Chinese men, −2.9% for Chinese women, −3.9% for Japanese men, and −5.6% for Japanese women. In both countries, the local drift values were below zero in all age groups. the longitudinal age curves of LpA-attributable stroke mortality were higher in men than in women in all age groups. the period and cohort rate ratios showed similar downward patterns for both sexes, with a faster decline for women than for men. However, the physically active population is still small in both countries. therefore, policymakers should further promote physical activity as one of the most recommended effective strategies in stroke prevention.Stroke is a significant public health problem worldwide 1 . Even though in the past two decades, between 1990 and 2010, stroke mortality showed declining trends, it is still the first leading cause of death in China 2 , and the fourth in Japan 3 . Also, while the stroke mortality rate per 100,000 population decreased from 27.9 to 18.8 in Japan, the corresponding rates in China were 110.7 and 80.2, respectively 4 . To close the health gap between the two countries, it is crucial to identify controllable risk factors that led to a more substantial decrease in stroke mortality in Japan compared to China and to plan more effective prevention strategies and health-care management.Previous case-control and cohort studies showed an inverse association between physical activity (PA) and the risk of stroke morbidity or mortality 5-8 . The Physical Activity Guidelines Advisory Committee reported that PA was associated with a 25-30% reduction in stroke risk 9 . Also, a nationwide cohort study in Korea identified lack of moderate-to vigorous-intensity PA as the second most important risk factor for stroke after high blood pressure 10 .However, while several studies examined stroke mortality attributable to low physical activity (LPA), according to our knowledge, none of them had investigated age-specific mortality rates or explored the mechanisms that can justify the observed lifelong trends. Accordingly, comparing China and Japan, this study assessed the temporal trends and the autonomous impacts of birth cohort, chronologic age and time period on LPA-attributable stroke mortality between 1990 and 2016, utilizing an age-period-cohort model (APC) of estimable functions which were then processed by Microsoft Excel 2016 and employing data from the 2016 Global Burden of Disease ...

IMPORTANCE Trust is a core component of social cohesion, facilitating cooperation and collective action in the face of adversity and enabling survivors to remain resilient. Residential stability is an important prerequisite of developing trusting relations among community members. However, little is known about whether the movement of internally displaced persons (IDPs) after a disaster might change community relations. OBJECTIVE We explored perceived changes in trust within 1 community directly impacted by the 2011 Great East Japan Earthquake and Tsunami. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study examined survey data from 3594 residents of Iwanuma City, Japan, aged 65 years or older. Data were obtained from the Iwanuma Study-part of the Japan Gerontological Evaluation Study, a nationwide cohort study established in 2010-approximately 7 months before the disaster. All Iwanuma City residents age 65 years or older (8576 residents) were eligible to participate in 2010. The response rate was 59.0% (5058 residents). A follow-up survey was conducted in 2013, approximately 2.5 years after the disaster. Of the 4380 remaining participants who answered the baseline survey, 3594 were recontacted (follow-up rate, 82.1%). Data analysis was performed from July 1, 2019, to January 9, 2020. EXPOSURES The number of temporarily relocated Iwanuma City survivors within 100 m and 250 m of a nonrelocated resident's home address. MAIN OUTCOMES AND MEASURES Perceived changes in particularized trust (ie, trusting people from the same community) and generalized trust (trusting people from other communities) measured on a 5-point Likert scale. RESULTS Among 3250 nonrelocated residents (1808 [55.6%] women; mean [SD] age, 76.5 [6.2] years) of Iwanuma City included in the analytic sample, multivariable-adjusted multinomial logistic regression analyses found that each standard deviation increase in the influx of internally displaced persons (1 SD = 11 IDPs) within 250 m of a resident's home address was associated with higher odds of a decrease in the resident's particularized and generalized trust (odds ratio, 1.17; 95% CI, 1.04-1.32). CONCLUSIONS AND RELEVANCE The influx of IDPs in the host community appeared to be associated with an erosion of trust among locals. To avoid the erosion of social cohesion after a disaster, it may be crucial to provide opportunities for social interaction between old and new residents of communities.