Specific Health Checkups Research Articles

Longitudinal association between posterior occlusal contact and dementia development in a large retrospective cohort study using a Japanese claims database.

This study examines the association between posterior occlusal contact and the risk of dementia development in the Japanese population, utilizing Eichner classification to evaluate occlusal status. Data from Japanese health insurance claims were analyzed for the period from April 2016 to March 2022. Participants had undergone specific health checkups, had no prior history of dementia, and were classified according to their dental occlusal contact. Dementia diagnoses were determined using ICD-10 codes, and participants were divided into three groups-A, B, and C-based on the Eichner classification, which indicates the extent of occlusal contact. Over an average follow-up period of 35.6 months, 691 dementia were identified among 931,309 participants. Those diagnosed with dementia were more likely to belong to Eichner B and C groups, signifying reduced occlusal contact. After adjusting for covariates, the hazard ratios (95% confidence intervals) for Eichner B and C were 1.73 (1.31-2.28) and 2.10 (1.35-3.26), respectively. Sensitivity analyses confirmed these findings in adults aged 60-75. These findings suggest that reduced posterior occlusal contact correlates with an increased risk of dementia. Since the study is limited to participants under the age of 75, further research is required to determine its generalizability to older populations.

Factors Associated with Heart Disease in Japan: Multivariate Analysis Based on Specific Health Checkups

The global population affected by heart failure is projected to reach 30 million. The number of deaths due to heart disease has surged, rising from 2 million in 2000 to 8.9 million in 2019. In Japan, the prevalence of heart failure is rapidly increasing, with the number expected to reach 1.3 million by 2030. Primary prevention is crucial to prevent heart disease. We explored the associations of heart disease incidence with findings from checkups performed a decade ago. A multivariate logistic regression analysis revealed that individuals who reported a history of stroke, history of chronic renal failure, or weight gain ≥ 10 kg since age 20 in the questionnaire-based health checkup are at high risk for developing heart disease. Additionally, those with biochemical test results from 10 years ago indicating the use of antihypertensive drugs, use of insulin injections or hypoglycemic medications, systolic hypertension, and abnormal creatinine levels also exhibited a significantly higher risk of heart disease. Conversely, individuals who identified as female, walked faster than people of the same age, drank alcohol daily, and felt refreshed upon awakening in the questionnaire-based health checkup were protected from heart disease.

Association of body indices with mortality in older population: Japan Specific Health Checkups (J-SHC) Study.

Obesity indices reflect not only fat mass but also muscle mass and nutritional status in older people. Therefore, they may not accurately reflect prognosis. This study aimed to investigate associations between a body shape index (ABSI), body mass index (BMI), and mortality in the general older population. This nationwide observational longitudinal study included individuals aged between 65 and 74 years who underwent annual health checkups between 2008 and 2014. Exposures of interest were ABSI and BMI, and the primary outcome was all-cause mortality. Association between the ABSI and BMI quartile (Q1-4) and mortality was assessed using Cox regression analysis. A restricted cubic spline was also used to investigate nonlinear associations. The missing values were imputed using multiple imputation by chained equations. Among 315,215 participants, 5074 died during a median follow-up period of 42.5 (interquartile range: 26.2-59.3) months. Compared with ABSI Q1, ABSI Q3 and Q4 were associated with increased risk of mortality, with the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of 1.13 (1.05-1.22) and 1.23 (1.13-1.35), respectively. Compared with BMI Q3, BMI Q1 and Q2 were associated with an increased risk of mortality, with aHRs and 95% CIs of 1.51 (1.39-1.65) and 1.12 (1.03-1.22), respectively. The impacts of these indices were greater in male than in female. The heatmap of the aHR for mortality by continuous ABSI and BMI showed that higher ABSI was consistently associated with higher mortality risk regardless of BMI, and that the combination of low BMI and high ABSI was strongly associated with increased mortality risk. High ABSI and low BMI are additively associated with the risk of all-cause mortality in the general older population in Japan. Combination of ABSI and BMI is useful for evaluating mortality risk in older people.

Contemporary use of beta-blockers in the outpatient treatment of heart failure with atrial fibrillation

Abstract Background Evidence of the effectiveness of β-blockers in heart failure (HF) and atrial fibrillation (AF) in a contemporary cohort is controversial. This study investigated the association between the use of β-blockers and prognosis in outpatients across a broad spectrum of HF with AF. Methods Patients hospitalized with the first episode of acute HF were identified from the National Database of Health Insurance Claims and Specific Health Checkups of Japan between 2014 and 2021. Associations of β-blocker use at discharge and prognosis were compared by propensity score matching among the AF or non-AF group. A multilevel mixed-effects survival model was used with hazard ratio (HR) and 95% confidence interval (CI). Results Among 428,650 patients discharged with HF in 4,433 hospitals, 175,174 (40.9%) were ≥85 years old, 151,873 (35.4%) had complicated AF, and 236,457 (55.2%) were β-blocker users. In a matched AF group, β-blocker use was associated with a lower composite outcome of all-cause mortality or HF rehospitalization (HR [95% CI], 0.95 [0.93–0.97]). A similar result was obtained in a matched non-AF group (0.95 [0.94–0.96]). In addition, the HRs in patients aged ≥85 years and female patients were 1.00 [0.98–1.02] and 1.01 [0.98–1.03] in the AF group and 1.03 [1.01–1.05] and 0.98 [0.97–1.00] in the non-AF group, respectively (Figure). Conclusions The favorable prognostic associations of β-blocker use were observed regardless of AF in outpatients across a broad spectrum of HF in a superaged society. However, β-blocker use may not be effective in older or female patients.

Current situation and trends of radiation therapy in Japan based on the National Database Open Data.

This study aimed to visualize the current situation and trends in radiation therapy in Japan using open data from the Japanese National Database of Health Insurance Claims and Specific Health Checkups (NDB). We downloaded the NDB open data from the website of Japan's Ministry of Health, Labor and Welfare and used Python libraries to analyze the receipt data related to radiation therapy from fiscal year 2014 to 2022. The number of radiation therapy plans peaked in 2019, temporarily declined and subsequently showed a gradual increase. Conversely, the total points associated with radiation therapy have consistently increased without any decline. The use of high-precision radiation therapies such as intensity-modulated radiation therapy (IMRT) has increased over time. Significant regional differences exist, with the Chubu and Kyushu regions showing higher total points and receipts per certified radiation oncologist. A correlation was observed between the number of IMRT plans per population and the number of certified radiation oncologists. Males exhibited a sharp peak in their early 70s, while females demonstrated a mild peak from their 40s to 80s. In recent years, the points for males in their early 70s have rapidly increased. We used the NDB open data to illustrate the current situation and trends in radiation therapy in Japan, highlighting reduced costs and workloads. This study underscored the regional differences in radiation therapy and emphasized the need to discuss strategies for meeting future demand.

Stroke Research Using Administrative Claims Database in Japan: A Narrative Review.

Although administrative claims databases have recently been used for clinical research in Japan, no detailed description of their utilization in stroke research is available. We reviewed stroke studies using the Diagnosis Procedure Combination (DPC), the National Database of Health Insurance Claims and Specific Health Checkups (NDB), and several commercial databases sourced from social health insurance associations, focusing on their applications and limitations. Original articles on stroke published by April 2024 using the DPC, NDB, and commercial databases were identified in Ovid MEDLINE. The characteristics of each database were compared in terms of comprehensiveness, traceability, baseline information, and outcome assessment in stroke research. A total of 114 studies were included (83 for DPC, 6 for NDB, and 25 for commercial databases). The number of stroke studies using administrative databases in Japan is still approximately 10 per year, although there is a slowly increasing trend. The DPC database was utilized for short-term outcome studies because of its detailed baseline and outcome information, although the inability to track patients once they changed facilities limits their use in long-term studies. The NDB database is potentially useful for long-term studies because of its comprehensiveness and traceability, but difficulties in data access restrict its usage. The most commonly used commercial database utilizes baseline information on lifestyle and blood test data, although the lack of coverage for those over 75 years old may limit its generalizability. Administrative claims databases are beginning to be used in stroke research in Japan but are not yet fully utilized. Researchers need to understand their applications and limitations.

Clinical epidemiology of the endoscopic, laparoscopic, and surgical resection of malignant gastric tumors in Japan, 2014-2021: a retrospective study using open data from a national claims database.

Gastric cancer is a common malignancy with a high incidence in East Asia. Gastric resection ranges from endoscopic resection to open total gastrectomy. However, nationwide data are lacking. This observational study analyzed data from the publicly accessible National Database of Health Insurance Claims and Specific Health Checkups, which includes most national health insurance claims data in Japan. Trends in the types of resection performed for malignant gastric tumors between 2014 and 2021, patients' age and sex distributions, and regional disparities were investigated. The annual number of resections was highest in 2015 (109,000) and lowest in 2020 (90,000) after the COVID-19 pandemic. The proportion of endoscopic resections increased from 47% in 2014 to 57% in 2021 while that of total gastrectomies decreased from 17 to 10%. In 2021, 70% of patients who underwent resection were men. That year, 83.8% of all patients who underwent any type of gastric resection and 87.1% of those who underwent endoscopic submucosal dissection were aged ≥ 65years. The annual incidence of gastric resection per million population was highest in Tottori (n = 1236) and lowest in Okinawa (n = 251). The proportion of endoscopic resections was highest in Miyagi (66%) and lowest in Aichi (45%) and that of open surgery was highest in Aomori (36%) and lowest in Wakayama (5%). Gastric malignancy is increasingly treated by endoscopic submucosal dissection rather than open total gastrectomy. However, regional disparities remain in resection type. Standardization of treatment and a more even distribution of specialists are needed.

Correlation between prescription volumes of generic antiepileptic drugs and the number of clinical epileptologists across prefectural regions in Japan: A descriptive study using a national claims database

PurposeAlthough generic drugs are essential in reducing medical costs, their use in epilepsy therapy remains a subject of ongoing debate. In this study, we analysed prescription trends of generic drugs using data from the National Database of Health Insurance Claims and Specific Health Checkups (NDB) Open Data Japan. MethodsThe number of generic drug prescriptions from 2017–2021 was extracted from the NDB Open Data Japan, with data for each medication stratified by prefectural region, sex, and age, allowing for the analysis of the impact of each factor. We analysed the correlation between the prescription volumes of generic antiseizure medications (ASMs) and the number of clinical epileptologists registered with the Japan Epilepsy Society per 100,000 population. ResultsIn 2021, the prescription volume of generic ASMs was 49 %, whereas that for other pharmacological agents was between 70–80 %. Notably, for children < 15 years of age, generics made up approximately 20 % of prescriptions, which was significantly less than that in other age groups. Analysis by prefecture revealed a negative correlation between prescription volumes of ASMs and the number of clinical epileptologists across prefectural regions in Japan (R = −0.47, p < 0.01). ConclusionOur findings indicate that the higher the proportion of clinical epileptologists in each prefecture, the lower the number of prescribed generic ASMs. Clinical epileptologists in Japan therefore prescribe antiseizure agents in accordance with the Japanese epilepsy treatment guidelines that do not recommend the use of generic agents.

Prevalence, incidence, and recovery of metabolic syndrome after the fukushima nuclear power plant disaster: A 10-year longitudinal study

After the 2011 Fukushima nuclear power plant accident, the prevalence of metabolic syndrome sharply increased in municipalities near the nuclear power plant, where a massive evacuation of community residents occurred (the evacuation area). However, after the initial increase, the rate of increase in metabolic syndrome in the evacuation area was slower than that in the surrounding area (non-evacuation area). In this study, we compared the incidence of and recovery from metabolic syndrome as well as its prevalence between evacuation and non-evacuation areas during the 10 years after the accident to explore whether the slower increase in metabolic syndrome after the initial increase in the evacuation area stemmed from suppressed incidence or from fast recovery. We analyzed specific health check-up data of community residents aged 40–74 in Fukushima Prefecture from fiscal year (FY) 2012 to FY 2021 (N = 710,201). To explore the prevalence of metabolic syndrome, we examined the associations of time, residential area, and their interaction with metabolic syndrome using mixed-model repeated measures. We used data from those without metabolic syndrome in FY 2012 to investigate the incidence. We similarly examined the associations of time, residential area, and their interaction with metabolic syndrome using FY 2013 to FY 2021 data. To explore recovery, we used the data of those with metabolic syndrome in FY 2012 and repeated the same procedure. The rate of increase in the prevalence and incidence of metabolic syndrome was slower in the evacuation area than in the non-evacuation area. On the other hand, as for the recovery, the time trend of metabolic syndrome did not differ between the two areas. The slower increase in metabolic syndrome in the evacuation area was partly explained by the slower incidence in the evacuation area but not by recovery.

Delayed global standardization and prefectural disparities in systematic lupus erythematosus treatment in Japan: a nationwide study using the National Database of Health Insurance Claims and Specific Health Checkups of Japan.

To evaluate the status of the global standardization of, and prefectural differences in, systematic lupus erythematosus (SLE) treatments in Japan. The Japanese National Database of Health Insurance Claims and Specific Health Checkups (NDB Japan) was used. A patient with SLE was defined as having a disease with ICD10 code M321 or M329 between April 2019 and March 2020, for which oral corticosteroids (OCS), immunosuppressive agents or biologic agents were prescribed at least once during a given month. SLE treatments were evaluated by treatment center type and prefecture. In total, 74,277 patients met the definition of SLE. The SLE prevalence was 60 per 100,000 (range: 47 - 102 per 100,000 by prefecture). Nationwide, 79.4% of the patients (range: 52.1% - 93.3% by prefecture) visited a specialized treatment center (STC); 37.4% (range: 26.4% - 51.3% by prefecture) received only OCS, with fewer of these patients visiting a STC than a non-STC (34.8% and 49.7%, p<0.001); and 21.4% (range: 10.7% - 35.0%) received HCQ, with more of these patients visiting a STC than a non-STC (23.0% and 13.5%; p<0.001). NDB Japan demonstrated delayed global standardization of, and prefectural disparity in, SLE treatments in Japan.

Shifting paradigms in endoscopic sinus surgery: a comprehensive analysis from Japan’s national database

Background In 2013, Japan established a standardized classification system for categorizing endoscopic sinus surgery (ESS) into types I–V, yet no evaluation has been conducted thereof. Objective We assessed the ESS trends and status in Japan, focusing on outpatient and inpatient surgeries. Material and Methods This descriptive retrospective cohort study used Japan’s National Database of Health Insurance Claims and Specific Health Checkups between 2014 and 2021. The distribution of ESS types I–V and outpatient and inpatient surgeries was analysed, along with age groups and regional differences, focusing on ESS type III. Results Overall, 427,813 ESS procedures were performed, with types III and IV being most common. Outpatient ESS type III increased substantially compared to inpatient surgeries. Younger individuals favoured outpatient ESS type III over inpatient surgeries, with substantial regional variations across prefectures. Conclusions and Significance The adoption of a standardized ESS classification in Japan has facilitated a detailed understanding of surgical trends. The shift toward outpatient surgeries, especially for type III ESS, aligns with global trends toward minimally invasive procedures and reflects changing patient preferences and healthcare delivery practices. Consequently, continuous monitoring and research are crucial for adapting surgical practices to the evolving healthcare needs and patient expectations.

Assessment of cancer risk associated with 7-nitroso-3-(trifluoromethyl)-5,6,7,8-tetrahydro[1,2,4] triazolo-[4,3-a]pyrazine-contaminated sitagliptin use: A retrospective cohort study.

A recent US Food and Drug Administration report highlighted concerns over nitrosamine (7-nitroso-3-(trifluoromethyl)-5,6,7,8-tetrahydro[1,2,4] triazolo-[4,3-a]pyrazine [NTTP]) impurities in sitagliptin, prompting investigations into its safety profile. The present study aimed to determine if the use of NTTP-contaminated sitagliptin, in comparison with other dipeptidyl peptidase-4 (DPP-4) inhibitors, is associated with an increased cancer risk. This retrospective cohort study secondarily used the National Database of Health Insurance Claims and Specific Health Checkups of Japan, encompassing data on >120 million individuals. The study involved patients who initiated DPP-4 inhibitor therapy (sitagliptin or other DPP-4 inhibitors) and continued its exclusive use for 3 years. Sitagliptin users were compared with other DPP-4 inhibitor users for assessing the occurrence of cancers, as defined by diagnosis codes. Further analyses focused on specific types of cancer, using either diagnosis codes or a combination of diagnosis and procedure codes. We also carried out various sensitivity analyses, including those with different exposure periods. Sitagliptin users (149,120 patients, 388,356 person-years) experienced 9,643 cancer incidences (2,483.0/100,000 person-years) versus 12,621 incidences (2,504.4/100,000 person-years) among other DPP-4 inhibitor users (199,860 patients, 503,952 person-years), yielding a minimal difference (incidence rate ratio 0.99, 95% confidence interval 0.97-1.02). A multiple Cox proportional hazards model showed no significant association between sitagliptin use and overall cancer incidence (hazard ratio 1.01, 95% confidence interval 0.98-1.04). Findings were also consistent across cancer types and sensitivity analyses. We observed no evidence to suggest an increased cancer risk among patients prescribed NTTP-contaminated sitagliptin, although continued investigation is needed.

Impact of Collagenase Injection on Dupuytren Disease Treatment in Japan: A Comprehensive Survey of Trends.

Collagenase Clostridium histolyticum (CCH) injection, an effective enzymatic fasciotomy treatment for Dupuytren disease (DD), was abruptly withdrawn from the healthcare market outside the United States in 2020. The impact on patients, physicians and hospitals of this helpful surgical alternative no longer being available has been little studied. To investigate the impact of the withdrawal of CCH in Japan, we used the National Database Open Data Japan from 2014 to 2020. Published by the government, it contains summary data of the National Database of Health Insurance Claims and Specific Health Checkups of Japan. We extracted the numbers of CCH injections with Xiaflex, the product name in Japan, and surgeries identified by "Dupuytren contracture surgery codes." Each treatment was further parsed into one of 12 predefined regions in which it had taken place and by whether it had been delivered on an inpatient or outpatient basis. From its introduction in 2015, the number of DD patients treated with CCH increased in each successive year, reaching a peak in 2019, while the number of surgeries decreased with time. After the withdrawal in 2020, the number of surgeries increased to 1.5 times the 2019 number notwithstanding the impact of COVID-19, but the total number of patients treated decreased by 43%. In the initial regional analysis, CCH accounted for approximately 40% of all DD treatments in the less populous areas, with the exception of the Tohoku region, and more than 50% in the other regions. By 2019, the share of CCH treatment had increased in all regions. There was no significant correlation between the number of hand surgeons authorized to use CCH and the number of CCH cases within each region. CCH increased treatment options for patients and surgeons. The withdrawal of this valuable pharmaceutical resulted in an increase in the number of surgeries amidst a decrease in the total number of treatments and lost opportunities for patients.

Impact of new antifungal medications on onychomycosis prescriptions and costs in Japan: A nationwide claims database study.

Onychomycosis, a fungal nail infection, is a common dermatological condition in Japan, with a prevalence of approximately 5%-10%. Despite the introduction of new antifungal medications and updated treatment guidelines published in 2019, data on real-world prescription trends and the associated medical costs are limited. This study aimed to investigate the prescription patterns and medical costs of topical and oral antifungal medications for onychomycosis in Japan from fiscal years 2014 to 2021 using the National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data. We analyzed the annual prescription volumes and medical costs of four antifungal medications: efinaconazole, luliconazole, fosravuconazole, and terbinafine. The prescription volume of efinaconazole, a topical medication launched in 2014, rapidly increased and dominated the market share. Fosravuconazole, an oral medication introduced in 2018, showed an increasing trend, coinciding with a decline in efinaconazole prescriptions. Terbinafine, a well-established oral medication, experienced a substantial decrease in prescription volume. The sex- and age-adjusted prescription volume per 100 000 population was higher among older adults, particularly for efinaconazole. The total medical costs for onychomycosis treatment more than doubled in fiscal year 2015 compared with that for 2014, mainly driven by efinaconazole prescriptions, and exceeded 30 billion Japanese yen in fiscal years 2019-2021. The costs slightly decreased in fiscal years 2020 and 2021, possibly due to the introduction of fosravuconazole. The predominance of topical prescriptions, especially in older adults, raises concerns regarding adherence to the Japanese guidelines that recommend oral antifungals as the first-line treatment for onychomycosis. The substantial increase in medical costs also highlights the economic burden of onychomycosis and the need for cost-effective treatment strategies. This study provides valuable insights into the real-world prescription trends and medical costs of onychomycosis treatment in Japan, suggesting an opportunity to assess potential gaps between guideline recommendations and clinical practice.

Survey of pharyngeal foreign bodies in Japan: An ecological study using the nationwide claims data

ObjectivePharyngeal foreign bodies (PFBs) are a prevalent disease affected by food culture and dietary habits, with fish bones as the leading cause. Most studies were limited to specific regions, and a nationwide survey was not conducted in Japan. In this ecological study, we aimed to conduct a nationwide analysis of outpatient PFB cases in Japan over three years, focusing on seasonal trends, sex- and age-stratified cases, and regional differences. MethodsWe used the National Database of Health Insurance Claims and Specific Health Checkups of Japan open data from April 2019 to March 2022. The case data were analyzed by month, age, sex, and prefecture. Additionally, we calculated the standardized claim ratios (SCRs) for each prefecture and investigated the association between dietary habits, food culture, and SCR of PFBs using a two-level linear regression model. ResultsWe analyzed a total of 164,337 outpatient PFB cases in Japan, revealing an average incidence rate of 45.6 per 100,000 persons. The seasonal trend revealed a peak in July each year from 2019 to 2021, confirming seasonality in PFB incidents. Children reported a higher incidence rate. Living west of Japan and expenditure on fish and shellfish had a strongly positive association with the SCR of PFBs. ConclusionOur nationwide survey reveals that, even within Japan, there were regional variations influenced by food culture and dietary habits. The data showed that PFB incidence was higher among children, highlighting the need for preventive education. Level of evidenceLevel 3.

Temporal trends and regional variations in operative vaginal deliveries in Japan: A national representative cohort study.

To analyze temporal trends and regional variations in operative vaginal delivery (OVD) in Japan. Using the National Database of Health Insurance Claims and Specific Health Checkups of Japan from 2014 to 2021, we identified the numbers of vacuum and forceps deliveries. We analyzed annual totals and proportions of OVDs and calculated the mean age of women undergoing these deliveries. We also predicted trends in OVD for the next 20 years and compared geographical differences in the proportions of forceps deliveries among OVDs. During the observation period, out of 7 368 814 total births, 8.4% were through OVD, including 7.6% by vacuum and 0.8% by forceps. Both delivery methods showed an increasing trend from 2014 to 2021: vacuum deliveries rose from 7.0% to 8.7%, and forceps deliveries increased from 0.6% to 1.0%. Notably, the proportion of forceps deliveries in OVD increased from 8.1% to 10.5%. The mean age was higher for forceps deliveries than vacuum deliveries. According to our predictions, vacuum deliveries may continue to increase, but forceps deliveries may stabilize. The proportion of forceps deliveries among OVDs ranged from 0% to 38% across Japanese prefectures. This study shows an increase in the use of OVD in Japan from 2014 to 2021. There are large regional differences in the choice between vacuum and forceps deliveries. These findings can help us understand the practice of OVD in Japan.

Neurectomy for allergic rhinitis in Japan: Increasing trends and surgeon preferences

ObjectiveThere is no consensus on the optimal surgical technique for allergic rhinitis (AR). Furthermore, the appropriateness of surgical intervention in children and older individuals remains debatable. This study aimed to analyze trends and patterns in the surgical management of AR in Japan, focusing on parasympathetic neurectomy. MethodsUsing the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), we conducted a comprehensive review of procedures performed between April 2014 and March 2022. In addition, a cross-sectional survey targeting otolaryngologists across Japan was conducted to gather insights into surgical preferences and practices. ResultsThe NDB data showed an increasing trend in neurectomies, with the most frequent age group being 25–29 years; the procedure was also performed in pediatric and older patients. The survey among otolaryngologists indicated that 58.2 % of surgeons preferred peripheral branch neurectomy of the posterior nasal nerve. The findings of this study also indicated a cautious approach toward conducting these procedures in children, with 51.2 % of surgeons considering patients less than 18 years of age unsuitable for the procedure. ConclusionThis study highlighted a shift toward simple and minimally invasive surgical methods, such as peripheral branch neurectomy, in Japan. However, further research is needed to understand the long-term outcomes and refine the surgical techniques. The findings of this study also emphasized the need for age-specific considerations when treating pediatric and older patients with AR.

Associations of the staffing structure of intensive care units and high care units on in-hospital mortality among patients with sepsis: a cross-sectional study of Japanese nationwide claims data

ObjectiveThe objective was to analyse the associations of intensive care unit (ICU) and high care unit (HCU) organisational structure on in-hospital mortality among patients with sepsis in Japan’s acute care...

Current status and usefulness of therapeutic drug monitoring implementation of theophylline in elderly patients based on a nationwide database study and modeling approach.

Theophylline is used in the treatment of chronic obstructive pulmonary disease but readily causes symptoms of intoxication and exhibits high risks in elderly patients. However, there have only been a few recent reports on the significance of therapeutic drug monitoring (TDM) implementation, especially in elderly patients. To examine the usefulness of theophylline TDM, we evaluated the current status of prescriptions containing theophylline and its side effects and assessed the influence of aging, sex, drug formulation, and concurrent drugs use on theophylline exposure using data from various nationwide databases and a pharmacokinetic modeling approach. We utilized sampling data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Using the data of patients aged ≥80 years, we conducted an association analysis of theophylline and concurrent drugs. The transition in plasma theophylline concentration levels of elderly patients was estimated based on a previously reported physiological-based pharmacokinetic model. Altogether, 3973 patients using theophylline were registered in our dataset, and about 50% were over 70 years old and used theophylline. Therapeutic drug monitoring implementation was confirmed in only 1.13% of patients. The association analysis confirmed a frequent co-occurrence with allopurinol and famotidine, which increase theophylline exposure, in elderly patients aged ≥80 years. The physiologically based pharmacokinetic model indicated that theophylline trough concentrations were 1.65-fold higher in elderly patients aged 80 years compared to those aged 30 years and 1.35-fold higher in females compared to males. This study effectively combined information on the nationwide health care database and modeling approach, indicating the importance of proactive TDM and dose justification for female and elderly patients.

Children with medical complexity receiving home healthcare devices in Japan: a retrospective cohort study

BackgroundLimited evidence exists regarding children receiving home healthcare devices (HHDs). This study aimed to describe the range and type of HHD use by children with chronic medical conditions in Japan...