Impact of Hypertension, Diabetes and Dyslipidemia on Ischemic Heart Disease among Japanese: A Case-Control Study Based on National Health Insurance Medical Claims

Aim Although the important role of conventional risk factors (cigarette smoking, hypertension, diabetes and dyslipidemia) inthe pathogenesis of ischemic heart disease (IHD) has been established, how frequently IHD is preceded by exposure to conventionalrisk factors remains controversial. The present study aimed to identify the prevalence of hypertension, diabetes anddyslipidemia among patients with IHD and examine associations between each of them with IHD in a Japanese population.Methods Data were collected from health insurance claims in May 2010 for National Health Insurance beneficiaries aged 40-79 years in Nagasaki Prefecture, Japan. One sex- and age-matched control was randomly selected for each of 42,236 patientswith IHD (International Classification of Diseases, 10th Revision code: I20-25). The prevalence of hypertension, diabetes anddyslipidemia and the number of these risk factors were compared between the patients and controls. Associations betweenrisk factors and IHD were examined using a conditional logistic regression model.Results Over 90% of patients with IHD had at least one of hypertension, diabetes or dyslipidemia. The odds of IHD were 4.5-fold (95% confidence interval [CI]: 4.3, 4.7), 4.2-fold (95% CI: 3.9, 4.6) and 5.3-fold (95% CI: 4.9, 5.7) higher for patients withhypertension, diabetes and dyslipidemia, respectively, compared with patients without any of these risk factors. Patients withseveral risk factors were at increased risk for IHD.Conclusion Comprehensive risk reduction strategies that encourage a healthy lifestyle and diet and promote the recognition,evaluation and management of conventional risk factors are important to prevent IHD

Optimization of Elderly Influenza and Pneumococcal Immunization Programs in Beijing, China Using Health Economic Evaluations: A Modeling Study

(1) Background: Currently, residents ≥ 60 and ≥65 years old in Beijing, China, are eligible for free influenza and pneumococcal polysaccharide vaccines (PPSV23), respectively. The present study aimed to assess the cost-effectiveness of current and alternative strategies of dual influenza and PPSV23 vaccination among the elderly in Beijing. (2) Methods: We developed a Markov state-transition model to compare the costs and the quality-adjusted life years (QALYs) associated with four influenza and PPSV23 vaccination strategies among the elderly in Beijing. The strategies were as follows: (1) no vaccination; (2) only flu vaccine for people ≥ 60 years old; (3) flu vaccine for people ≥ 60 years old and PPSV23 for people ≥ 65 years old; and (4) dual influenza vaccines and PPSV23 for people ≥ 60 years old. Incremental costs and QALYs were quantified to determine the optimal option. If dominant strategies emerged, the Chinese gross domestic product per capita in 2021 (80,976 CNY) was used as the willingness-to-pay (WTP) threshold to covert QALYs into the monetary equivalent. (3) Results: The current program saved costs and increased QALYs compared to no vaccination or flu vaccine-only strategies. However, extending free PPSV23 to people ≥ 60 years old saved 0.35 CNY additionally while increasing QALYs marginally compared with the current policy. Results were robust in all sensitivity analyses. (4) Conclusion: Beijing’s current dual influenza and pneumococcal vaccination program was cost-effective among the elderly compared with the preceding policies of no vaccination and flu-only immunization programs. However, the program can further save money while enhancing the population health by extending PPSV23 to all people ≥ 60 years old

Association of Age, Obesity, Joint Pain, and Chewing Ability with Chair Stand Difficulty among Community-dwelling Elderly People in Nagasaki, Japan

Difficulty in standing up from a chair is associated with weakness of the muscles of the lower extremity and is an important factor that indicates frailty in elderly people. Little is known about the factors that influence this difficulty among the elderly. To elucidate these factors, we studied 323 community-dwelling people from Nagasaki Prefecture, Japan, who were aged 65 years and over. The body weight and height of the subjects were measured, and their body mass index (BMI) was calculated. Obesity was defined as BMI ? 25 (kg/m2). The subjects were asked whether they experienced any difficulty in standing up from a chair (chair stand difficulty). Information on comorbidities, back pain, pain in any joint, and chewing ability was collected. The proportion of people who experienced chair stand difficulty increased with age (p = 0.061 for men and p = 0.005 for women). The results of multiple logistic regression analysis showed that older age (odds ratio (OR): 2.16; 95% confidence interval (CI): 1.22-3.71), obesity (OR: 3.00; 95% CI: 1.47-6.14), pain in any joint (OR: 2.73; 95% CI: 1.42-5.26), and poor chewing ability (OR: 2.65; 95% CI: 1.33-5.28) were significantly associated with chair stand difficulty. Intervention to reduce the risk of frailty among the elderly would be decided on the basis of physical factors such as obesity, musculoskeletal pain, and chewing ability