Comorbidity Disease Pattern in Japanese Elderly Population: A Network-Based Analysis

Objective To explore the prevalence of anemia, iron deficiency and iron deficient anemia (IDA), and to identify their risk factors in 3 to 6 months infants in Dongcheng District of Beijing. Methods All the 845 infants aged 3 to 6 months who received bacille calmette guerin (BCG) vaccine during December 2010 and October 2011 in Hepingli Hospital of Beijing were invited to complete the investigation.Data (months, gender, birth weight, birth height, etc) were collected through a questionnaire survey.Infants were tested for hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), serum ferritin (SF) and zinc protoporphyrin (ZPP) and mothers underwent measurement for Hb, SF and serum iron (SI). Descriptive epidemiology and non-conditional logistic regression model were used to analyze the prevalence of nutritional anemia. Results The prevalence of anemia, iron deficiency and IDA was 12.06%, 7.38% and 2.11%, respectively.Non-conditional logistic regression analysis showed that the associated factor of anemia in infants was month age (vs. 3-4 months age group, 4-5 months age group: odds ratio (OR)=0.496, 95% confidence interval (CI) 0.272-0.905; 5-6 months age group: OR=0.494, 95% CI 0.234-1.043). The factors associated with iron deficiency were month age (vs. 3-4 months age group, 4-5 months age group: OR=0.539, 95% CI 0.266-1.088; 5-6 months age group: OR=0.334, 95% CI 0.125-0.891)and time of first breast-feeding (vs. the first day, the second day: OR=2.359, 95% CI 1.191-4.675; the third day: OR=1.154, 95% CI 0.450-2.963). Conclusions Our data show that iron nutrition in 3 to 6 months-old infants in Dongcheng District of Beijing was in good situation.The influencing factors of iron nutrition in infants may be month age and the time of first breast feeding. Key words: Infant; Anemia, iron-deficiency; Logistic models

Worldwide, iron deficiency, and consequent iron-deficiency anaemia, remains the most common nutritional disorder. Iron-deficiency anaemia mostly affects young children and women of reproductive age, especially in Asia and Africa. Iron deficiency may contribute to disability directly or indirectly as a risk factor for other causes of death, and may rarely contribute to death. To estimate the changing burden of disease attributable to iron deficiency in males and females (all ages) for the years 2000, 2006 and 2012 in South Africa (SA). The comparative risk assessment methodology developed by the World Health Organization (WHO) and the Global Burden of Diseases, Injuries, and Risk Factors Studies was used to estimate the burden attributable to iron deficiency in SA for the years 2000, 2006 and 2012. We attributed 100% of the estimated iron-deficiency anaemia burden across all age groups by sex to iron deficiency. For maternal conditions, the attributable burden to iron deficiency was calculated using the counterfactual method and applied to all women of reproductive age. The population attributable fraction calculated for these selected health outcomes was then applied to local burden estimates from the Second SA National Burden of Disease Study (SANBD2). Age-standardised rates were calculated using WHO world standard population weights and SA mid-year population estimates. There was a slight decrease in the prevalence of iron-deficiency anaemia in women of reproductive age from ~11.9% in 2000 to 10.0% in 2012, although the prevalence of anaemia fluctuated over time (25.5% - 33.2%), with a peak in 2006. There has been a gradual decline in the number of deaths from maternal conditions attributable to iron deficiency in SA between 2000 (351 deaths (95% uncertainty interval (UI) 248 - 436)) and 2012 (307 deaths (95% UI 118 - 470)), with a peak in 2006 (452 deaths (95% UI 301 - 589)). Furthermore, our analysis showed a 26% decrease between 2000 and 2012 in the age-standardised burden rates from maternal conditions (truncated to 15 - 49 years) attributable to iron deficiency. Between 2000 and 2012, the age-standardised disability-adjusted life year (DALY) rate from iron-deficiency anaemia attributable to iron deficiency markedly decreased by 33% in males, and increased by 3% in females of all ages. Approximately 1.1 - 1.4% of all DALYs in SA from 2000 to 2012 were attributable to iron deficiency. Iron-deficiency anaemia prevalence can be markedly reduced if iron deficiency is eliminated. Hence it is essential to encourage, reappraise and strengthen the measures that have been put in place to address iron deficiency, especially in women of reproductive age and children.

Background:CAD is a rare form of autoimmune hemolytic anemia with a prevalence in Northern Europe of 16 cases per 1 million inhabitants (Berentsen S. Semin Hematol 2018). Ig M autoantibodies bind to red blood cells and trigger hemolysis via activation of the classical complement pathway. Although clinical and epidemiological studies are limited, recent evidence indicates that CAD patients in Europe and North America have an increased risk of thromboembolic events (TE) (Bylsma LC, et al. EHA 2018; Broome C, et al. Blood 2017). The 1‐year case‐fatality of TE has been reported as 23% (Tagalakis V, et al. Am J Med 2013). There are no studies evaluating the clinical course and risk of TE in CAD patients in Japan or other Asian populations.Aims:To describe clinical characteristics, treatment patterns, and risk of TE in CAD patients in Japan.Methods:Patients were retrospectively identified from 2008 to 2017 using a hospital‐based administrative claims database (Medical Data Vision), representing approximately 300 hospitals and 20 million patients in Japan. CAD cohort inclusion required age ≥18 years and CAD diagnosis (Japanese Disease Code 2830009) entry on ≥3 separate occasions within the study period. The first CAD diagnostic code entry was used as the index date. Patients in the comparison cohort had no history of CAD and were matched 10:1 to patients in the CAD group by age, sex, year and season of diagnosis, follow‐up time, and comorbidities using the Charlson Comorbidity Index. Conditional logistic regression was used to adjust for these variables when comparing cohorts.Results:344 CAD patients were identified with a slight female preponderance (53.2%), mean age of 66.8 years and 18.9‐month mean duration of follow‐up. The most frequently used treatment was steroids (34.2%). Other treatments included cytotoxic chemotherapy (6.9%), rituximab (5.9%), and immunosuppressants (5.9%). A total of 3440 patients with matching characteristics were included in the control group to compare the risk of TE among cohorts. Overall, CAD patients had an increased rate of TE versus patients without CAD (34.8% vs 17.9%, respectively; P < 0.0001) (Figure). The rate of arterial and venous TE was also higher in CAD versus non‐CAD cohorts (25.0% vs 4.6% and 8.4% vs 4.0%, respectively; P < 0.0001 for both analyses). Most cases of arterial TE in CAD patients corresponded to myocardial infarctions (87.2%). There was no difference in cerebral TE among the CAD and non‐CAD groups (10.4% vs 11.9%, respectively). The overall odds ratio (OR [95% confidence interval]) for development of TE in the CAD cohort versus non‐CAD cohort was 2.81 (2.18–3.61). Corresponding ORs for arterial and venous TE were 8.59 (6.16–11.98) and 2.37 (1.56–3.62), respectively.Summary/Conclusion:This study is the first to evaluate the clinical characteristics, treatment practices, and TE risk of CAD patients in Japan. Our results indicate that the CAD treatment approach used in Japan (ie, predominantly with steroids) differs from that reported for other countries. However, in accordance with recent reports from non‐Asian populations, this study demonstrates an increased risk of TE in the Japanese population. Interestingly, the rate of arterial TE was higher in Japan, which was mostly attributed to the high prevalence of myocardial infarctions in our CAD cohort. Japanese healthcare providers should be aware of these risks to properly monitor their CAD patients. Prospective studies are needed to further evaluate these findings.image

IntroductionTo describe clinical characteristics of patients in Japan with coronavirus disease 19 (COVID-19) and pre-existing rheumatic disease and examine the possible risk factors associated with severe COVID-19.MethodsAdults with rheumatic disease and a COVID-19 diagnosis who were registered in the COVID-19 Global Rheumatology Alliance (C19-GRA) physician-reported registry from Japan between 15 May 2020 and 12 May 2021 were included. Multivariable logistic regression models were used to assess factors associated with severe COVID-19 progression, defined as death or requiring oxygen inhalation.ResultsIn total, 222 patients were included in the study. Rheumatoid arthritis (48.2%), gout (14.4%), and systemic lupus erythematosus (8.1%) were the most common types of rheumatic disease, 55.1% of patients were in remission and 66.2% had comorbid disease. Most patients were hospitalised (86.9%) for COVID-19, 43.3% received oxygen, and 9.0% died. Older age (≥ 65 years), corticosteroid use, comorbid diabetes, and lung diseases are associated with higher risk for severe COVID-19 progression (odds ratio (OR) 3.52 [95% confidence interval (CI) 1.69–7.33], OR 2.68 [95% CI 1.23–5.83], OR 3.56 [95% CI 1.42–8.88], and OR 2.59 [95% CI 1.10–6.09], respectively).ConclusionsThis study described clinical characteristics of COVID-19 patients with rheumatic diseases in Japan. Several possible risk factors for severe COVID-19 progression were suggested.Key points• Clinical characteristics of 222 adult patients in Japan with coronavirus disease 19 (COVID-19) and pre-existing rheumatic diseases were described.• Most patients were hospitalised (86.9%) for COVID-19 in Japan, 43.3% received oxygen, and 9.0% died.• The COVID-19 characteristics of patients with rheumatic diseases did not show any obvious different pattern from those of the general population in Japan.• In this study, older age (≥ 65 years), corticosteroid use, comorbid diabetes, and lung diseases are associated with higher risk for severe COVID-19 progression.Supplementary informationThe online version contains supplementary material available at 10.1007/s10067-022-06305-w.

In Japan, with the largest percentage of population aged 65years or over, a dementia strategy is needed not only from a medical perspective, but also from a social policy viewpoint. This study aimed to verify the association between socioeconomic factors and cognitive decline among Japanese elderly people. Cognitive decline was assessed over a 15-year follow-up period using memory tests or through identifying missing/proxy responses to survey questions due to cognitive dysfunction. I analysed 1886 men and 2102 women in Japan, using competing risk models for cognitive decline, to consider survival effects. Survival effects have not been considered so far although those who live longer may be more likely to experience cognitive decline. Men with higher income had a lower risk of cognitive decline (sub-hazard ratio [SHR]: 0.997, 95% confidence interval (CI): 0.995-0.999). Women with higher education had a lower risk of cognitive decline: 8 to 9years (SHR: 0.646, 95% CI: 0.457-0.914) and ≥12years (SHR: 0.360, 95% CI: 0.164-0.794) than women with 0 to 7years of education. This study suggests that cognitive decline among the elderly Japanese population is associated with socioeconomic factors, such as income and education, even after taking survival effects into account.

The aim of this study is to evaluate the ability of soluble urokinase plasminogen activator receptor (suPAR) and modified suPAR with National Early Warning Score (NEWS) for detecting mortality in elderly emergency patients who are older than 70 years. This is a secondary analysis of our previous study, which was a single-center prospective pilot study, carried out for 21 months in the emergency department of a secondary emergency institution in Japan. This study was carried out between September 16, 2020, and June 21, 2022. The study included all patients without trauma aged 70 years or older who presented to the emergency department. Discrimination was assessed by plotting the receiver-operating characteristic curve and calculating the area under the receiver-operating characteristic curve (AUC). During the study period, 47 eligible older patients were included, among which 8 (17.0%) patients died. The median suPAR was significantly lower in the survivor's group than in the nonsurvivor's group (P < 0.01). For suPAR, the AUC for the prediction of mortality was 0.805 (95% confidence interval 0.633-0.949, P < 0.001). The AUC of modified suPAR with NEWS for mortality was higher than that of suPAR [0.865 (95% confidence interval 0.747-0.958, P < 0.001)]. Our single-center study has demonstrated the high utility of modified suPAR with NEWS as a predictive tool of mortality in elderly emergency patients. Evidence from multicenter studies is needed for introducing modified suPAR with NEWS in the emergency department setting.

We identified and genetically characterized seven fluoroquinolone-resistant Streptococcus pneumoniae strains among 293 clinical strains isolated from 1999 to 2001 in Japan. The resistant strains were isolated only from adults, and 7 of 31 isolates (22.6%) were from patients more than 20 years old. Resistant strains were not found in 262 isolates from children under age 10.

Background: The aim of the present study was to elucidate the prevalence of cervical spine injury and its age distribution, and the causes and mortality rate in Japan using the Japan Trauma Data Bank. Methods: Patients coded as having a cervical spine injury were extracted from the Japan Trauma Data Bank from 2004 to 2013, which consisted of a total of 152,722 patients. The number of patients, their age distribution and causes of injury were analyzed amongst the patients with Abbreviated Injury Score (AIS) coding associated with cervical spine injuries. Next, we extracted data for patients with an AIS coding of cervical spine injuries as a main disease, excluding patients with multiple trauma. We compared the mortality rate between aged and non-aged patients. Results: The total number of patients with an AIS code of cervical spine injuries was 12,116. The peak age range for cervical injury was 60–69 years. The most common causes of cervical spine injuries were falls from a height and traffic accidents. The number of patients with an AIS code of cervical spine injuries as a main disease was 8982. The total number of patients who died from a cervical spine injury was 668. Mortality rate tended to be higher in the older patients. Conclusions: The present results showed that the peak age range for cervical injury was 60–69 years. The mortality rate tended to be higher in patients over 70 years old.

Background Medication regimen complexity includes various aspects of a regimen, including the dosage form, number of medications and need for additional information for use. Complicated medication regimens cause non-adherence to prescribed medications, making it essential to evaluate medication regimen complexity in older adults to improve adherence to prescribed medications and clinical outcomes. The medication regimen complexity index is currently the most widely used scale for quantifying regimen complexity; however, it has yet to be adopted in Japan. Objective This study aimed to translate the medication regimen complexity index to Japanese and assess its reliability and validity for application in elderly patients in Japan. Setting This study was conducted in a clinic that provides home medical care to patients in the southern part of Ibaraki prefecture, Japan. Method The validation process consisted of translation of the original English version of the medication regimen complexity index to Japanese followed by back-translation to English, comparison of the back-translated and original versions, pilot testing, and assessment of the Japanese version by two raters using the medication regimens of 72 patients with chronic diseases. Main outcome measure The psychometric properties of the index were evaluated according to inter-rater and test-retest reliability, and convergent and discriminant validity. Results The mean age of the 72 patients was 84.3years. The scale showed high inter-rater reliability (intraclass correlation coefficient 0.946) and test-retest reliability (intraclass correlation coefficient 0.991) for total scores. The number of medications was positively correlated with total medication regimen complexity index score (rs=0.930, P < 0.001). There were no statistically significant differences between age, sex and Charlson Comorbidity Index and medication regimen complexity index score (P > 0.05). Conclusions The Japanese version of the medication regimen complexity index is a reliable and valid tool for assessing the complexity of medication regimen in Japanese elderly patients.

Delusion of theft and phantom intruder delusion are among the most frequent delusions in dementia. The purpose of this study was to clarify the clinical characteristics of patients with these symptoms. The authors conducted a questionnaire survey; items included age, gender, dementia diagnosis, cognitive function, and activities of daily living. Other clinical characteristics were evaluated using the quality of life questionnaire for dementia. A total of 217 patients with dementia were rated. Frequencies of delusion of theft were as follows: frequent, 7%; sometimes, 11%; rare, 16%; and none, 66%. Frequencies of phantom intruder delusion were as follows: frequent, 4%; sometimes, 10%; rare, 9%; and none, 77%. Comparison between positive and negative groups with these symptoms revealed that positive groups had higher scores in 2 of 6 domains of the quality of life questionnaire for dementia, namely, negative affect and actions, and restlessness. The positive group with delusion of theft had higher scores in cognitive function and activities of daily living than did the negative group. These results suggest that negative affect and action and restlessness might be related to delusion of theft or phantom intruder delusion and that delusion of theft frequently occurs in the early stage of dementia.

Today, approximately 25% of the Japanese population is over 60 years of age, and about 70% of patients who visit the Pain Relief Center, the University of Tokyo Hospital, are elderly (≥ 60 years). The main diseases causing pain in elderly patients include lower back pain and leg pain, post‐herpetic neuralgia, trigeminal neuralgia, and cancer. At our pain clinic, these painful conditions are treated with a variety of treatment modalities, including nerve block, sympathetic blockade, phototherapy, acupuncture, epiduroscopy, and pharmacologic treatment such as systemic and/or topical NSAIDs, opioids, antidepressants, anticonvulsants, vasoactive drugs, and local as well as general anesthetics. This paper briefly describes methods of pain control for these diseases, especially focusing on recently developed treatment modalities.

To evaluate whether the traditional Chinese herbal medicine banxia houpu tang (BHT, formula magnolia et pinelliae) prevents aspiration pneumonia and pneumonia-related mortality in elderly people. A prospective, observer-blinded, randomized, controlled trial. Two long-term care hospitals for handicapped elderly patients in Japan from March 2005 to February 2006. One hundred four elderly patients (31 men and 73 women; mean age+/-standard deviation 83.5+/-7.8) with dementia and cerebrovascular disease, Alzheimer's disease, or Parkinson's disease. Ninety-five participants (mean age 84.0, M:F=28:67) were randomly assigned to the BHT treatment group (n=47) or the control group (n=48) and took BHT or placebo for 12 months. The occurrence of pneumonia, mortality due to pneumonia, and the daily amount of self-feeding. Complete data were available for analysis on 92 of the 95 subjects randomized. Four patients in the BHT group developed pneumonia, and one of them died as a result. Fourteen patients in the control group developed pneumonia, and six of them died as a result. There was a significant difference between the two groups in pneumonia onset (P=.008), and a tendency toward significance in pneumonia-related mortality (P=.05). The relative risk of pneumonia in the BHT group compared with the control group was 0.51 (95% confidence interval (CI)=0.27-0.84, P=.008) and that of death from pneumonia was 0.41 (95% CI=0.10-1.03, P=.06) according to the Cox proportional hazards model. No adverse events were observed from treatment with BHT. The BHT group was able to maintain self-feeding better than the control group (P=.006). Treatment with BHT reduced the risk of pneumonia and pneumonia-related mortality in elderly patients with dementia.

BackgroundThis study aimed to estimate the economic burden of community-acquired pneumonia (CAP) among elderly patients in Japan. In addition, the study evaluated the relationship between total treatment cost and CAP risk factors.MethodsAn administrative database was searched for elderly patients (≥ 65 years old) who had pneumonia (ICD-10 code: J12–J18) and an antibiotic prescription between 1 June 2014 and 31 May 2015. The all-cause total healthcare costs of outpatient and inpatient CAP episodes were calculated.ResultsThis study evaluated data from 29,619 patients with CAP who experienced 14,450 outpatient CAP episodes and/or 20,314 inpatient CAP episodes. The mean ages were 77.5 ± 8.0 years and 81.5 ± 8.2 years among the outpatient and inpatient groups, respectively. The median treatment costs were US$346 (interquartile range: $195–551) per outpatient episode and US$4851 (interquartile range: $3313–7669) per inpatient episode. More severe cases had increased treatment costs at the treating hospitals. Male sex, diabetes, chronic obstructive pulmonary disease, and liver dysfunction were associated with increased total treatment costs, while dementia, dialysis, and rheumatism were associated with high costs of treating a CAP episode.ConclusionsThe economic burden of CAP might be decreased by reducing the number of hospitalizations for mild CAP and the incidence of severe CAP. Therefore, preventative care (e.g. oral hygiene or pneumococcus vaccination) is recommended for patients with related risk factors, such as male sex, older age, diabetes, chronic obstructive pulmonary disease, liver dysfunction, rheumatism, dementia, or dialysis.

Association between Iron Deficiency Anemia and Thrombosis, a Population Based Study

Iron deficiency, and specifically iron deficiency anaemia, remains one of the most severe and important nutritional deficiencies in the world today. To estimate the prevalence and associated factors for iron deficiency anaemia among pre-school children in Lagos. The study was conducted from December 2009 to February 2010 at the outpatient clinics of Lagos State University Teaching Hospital, Lagos. Serum iron, total iron binding capacity, transferrin saturation and serum ferritin were assayed in subjects. The primary outcome measured was iron deficiency anaemia established based on the following criteria: hemoglobin <11.0 g/dl1 plus 2 or more of the following: MCV <70fl, transferrin saturation <10% or serum ferritin <15ng/dL. Statistical analysis included Pearson Chi square analysis and logistic regression analysis. A total of 87 apparently healthy subjects were recruited. Only one subject had iron depletion and this child belonged to the ≤ 2 years age category. None of the recruited subjects had iron deficiency without anaemia. Nine of the study subjects (10.11%) had iron deficiency anaemia. The prevalence of iron deficiency anaemia was significantly higher among younger age group than in the older age group (19.1% Vs 2.1%, p = 0.022). The prevalence of iron deficiency anaemia was significantly higher among subjects with weight-for-age, and weight-for-height Z scores below two standard scores (83.3% and 75.0% respectively, p = <0.001 and 0.001 respectively). The overall prevalence of iron deficiency anaemia among study subjects was 10.11%. Iron deficiency anaemia was more common in children aged two years and below. Weight-for-age and weight-for-height Z scores below minus two standard scores were strongly associated with iron deficiency anaemia.