Municipal health expectancy in Japan: decreased healthy longevity of older people in socioeconomically disadvantaged areas

BACKGROUND: Little is known about small-area variation in healthy longevity of older people and its socioeconomic correlates. This study aimed to estimate health expectancy at 65 years (HE65) at the municipal level in Japan, and to examine its relation to area socio-demographic conditions. METHODS: HE65 of municipalities (N = 3361) across Japan was estimated by a linear regression formula with life expectancy at 65 years and the prevalence of those certificated as needing nursing care. The relation between HE65 and area socio-demographic indicators was examined using correlation coefficients. RESULTS: The estimated HE65 (years) ranged from 13.13 to 17.39 for men and from 14.84 to 20.53 for women. HE65 was significantly positively correlated with the proportion of elderly and per capita income, and negatively correlated with the percentage of households of a single elderly person, divorce rate, and unemployment rate. These relations were stronger in large municipalities (with a population of more than 100,000) than in small and medium-size municipalities. CONCLUSION: A decrease in healthy longevity of older people was associated with a higher percentage of households of a single elderly person and divorce rate, and lower socioeconomic conditions. This study suggests that older people in urban areas are susceptible to socio-demographic factors, and a social support network for older people living in socioeconomically disadvantaged conditions should be encouraged

Prediction of docetaxel monotherapy-induced neutropenia based on the monocyte percentage

We retrospectively reviewed the medical records of 32 chemonaïve patients with either breast, lung or prostate cancer, who were treated with docetaxel (DOC) monotherapy, and evaluated whether the proportion of peripheral blood monocytes was capable of predicting the occurrence of neutropenia following chemotherapy. In the granulocyte-colony stimulating factor (G-CSF) non‑administration group, the monocyte percentage was inversely correlated with the decrease in neutrophils (P=0.01; corrected correlation coefficient, -0.71). The neutrophil count decreased by ≥30% in 7 of 8 patients with <5% monocytes, whereas it decreased by >30% in 1 of 6 patients with ≥5% monocytes (P=0.01). Three of 8 patients with <5% monocytes experienced grade 4 neutropenia, while in the group with ≥5% monocytes, 1 of 6 patients experienced grade 4 neutropenia. The frequency of grade 3 or 4 neutropenia was lower in patients with ≥5% monocytes than in patients with <5% monocytes, but the difference was not significant (P=0.41). Following G-CSF administration, grade 3 or 4 neutropenia had the tendency of lasting longer in patients with <5% monocytes than in those with ≥5% monocytes; however, the monocyte percentage was not correlated with the grade of neutropenia (P=0.34). The monocyte percentage following chemotherapy was inversely correlated with the decrease in neutrophils. The percentage of monocytes that are available in clinical practice may be predictive of neutropenia following chemotherapy. Our findings suggest that patients with <5% monocytes following DOC monotherapy are at risk of severe neutropenia and should be carefully monitored