Assessment of suicide in Japan during the COVID-19 pandemic vs previous years

Importance: There are concerns that suicide rates may have increased during the coronavirus disease 2019 (COVID-19) pandemic. Objective: To assess whether suicide rates in Japan increased in April through November 2020 compared with previous years. Design, Setting, and Participants: This cross-sectional study used national data obtained from the Ministry of Health, Labor and Welfare from 2016 to 2020 on the monthly number of individuals who died of suicide in Japan from January to November of 2016 to 2020. Exposure: 2020 vs previous years. Main Outcomes and Measures: The main outcome was monthly suicide rates, calculated as the number of individuals who died of suicide divided by the total population. A difference-in-difference regression model was used to estimate the change in monthly suicide rates in April to November 2020 vs these months in 2016 to 2019. Results: Analyses included 90 048 individuals (61 366 [68.1%] men) who died of suicide from 2016 to 2020. The difference-in-difference analysis of men showed that there was no increase in suicide rates from April through September 2020 compared with these months in 2016 to 2019, but that suicide rates were increased in October (difference-in-difference, 0.40 [95% CI, 0.14 to 0.67] suicide deaths per 100 000 population) and November (difference-in-difference, 0.34 [95% CI, 0.07 to 0.60] suicide deaths per 100 000 population). Among women, suicide rates in 2020 compared with 2016 to 2019 increased in July (difference-in-difference, 0.24 [95% CI, 0.09 to 0.38] suicide deaths per 100 000 population), August (difference-in-difference, 0.30 [95% CI, 0.16 to 0.45] suicide deaths per 100 000 population), September (difference-in-difference, 0.29 [95% CI, 0.15 to 0.44] suicide deaths per 100 000 population), October (difference-in-difference, 0.62 [95% CI, 0.48 to 0.77] suicide deaths per 100 000 population), and November (difference-in-difference, 0.29 [95% CI, 0.15 to 0.44] suicide deaths per 100 000 population). In secondary analyses in which the suicide rates of 2020 were compared with the expected rates based on trends from 2011 to 2019, the increases in suicide rates were most pronounced among men aged younger than 30 years (eg, November: observed vs expected rate ratio [RR], 1.48 [95% CI, 1.26-1.71]) and women aged younger than 30 years (eg, October: observed vs expected RR, 2.14 [95% CI, 1.76 to 2.52]) and 30 to 49 years (eg, October: observed vs expected RR, 2.30 [95% CI, 2.01 to 2.58]). Conclusions and Relevance: These findings suggest that compared with previous years, suicide rates in Japan in 2020 increased in October and November for men and in July through November for women

Tracking sectoral allocation of official development assistance: a comparative study of the 29 Development Assistance Committee countries, 2011–2018

Background: Official development assistance (ODA) is one of the most important means for donor countries to foster diplomatic relations with low- and middle-income countries and contribute to the welfare of the international community. Objective: This study estimated the sectoral allocation of gross disbursements of ODA of the 29 Development Assistance Committee (DAC) member countries of the Organisation for Economic Co-operation and Development (OECD) for the duration of 2011 to 2018, by aid type (bilateral, multilateral, and both aids). Methods: Data from the OECD iLibrary were used. The sector definition was based on the OECD sector classification. For core funding to multilateral agencies that do not specialize in each aid sector, we estimated ODA and its flows based on the OECD methodology for calculating imputed multilateral ODA. Results: For all 29 countries, during the period of 2014–2018 where data were available for all the countries, the sector with the highest average annual ODA contribution was health at 20.34 billion USD (13.21%), followed by humanitarian aid at 18.04 billion (11.72%). Humanitarian aid has increased in the sectoral share rankings in both bilateral and multilateral aid, and the sectoral share for refugees in donor countries has increased in bilateral aid. While the 29 countries show relatively similar trends for sectoral shares, some countries and sectors display unique trends. For instance, infrastructure and energy sectors in bilateral aid of Japan are particularly high accounts for 48.48% of the total bilateral ODA of the country in 2018. Conclusions: This paper evaluated ODA trends by major donors of DAC countries in the pre-COVID-19 pandemic periods. We hope that our estimates will contribute to the review of the strategic decision-making and the effective implementation of future ODA policy discussions in the DAC countries while ensuring transparency

Assessment of traffic accidents in Japan during the COVID-19 pandemic vs. previous years: a preliminary report

Beginning in April 2020, social distancing measures were implemented to mitigate the COVID-19 pandemic in Japan. We assessed whether traffic accident rates had decreased from April 2020 to December 2021 as compared with previous years. The analysis included 2,934,477 traffic accidents, and the trend of decreasing rates of traffic accidents in recent years and seasonal fluctuations in traffic accidents were considered. The yearly change in the traffic accident rate between 2015 and 2019 was estimated, and the traffic accident rate in 2020 and 2021 was predicted. This was followed by the comparison of observed vs. predicted traffic accident rate. In 2020, the observed vs. expected rates of traffic accidents were lower in April to December 2020, and the rate of traffic accidents in Japan was 30–40% lower in April–May 2020 than would be expected based on trends from previous years. In 2021, rates of traffic accidents remained lower than expected between January and November, but the magnitude of decrease was not as pronounced. These findings could be explained by social distancing policies, including the declaration of the state of emergency, and the relaxation of public health and social measures over time

The herbivore\u27s dilemma: Trends in and factors associated with heterosexual relationship status and interest in romantic relationships among young adults in Japan-Analysis of national surveys, 1987-2015

BACKGROUND: It has been suggested that an increasing proportion of young adults in Japan have lost interest in romantic relationships, a phenomenon termed herbivorization . We assessed trends in heterosexual relationship status and self-reported interest in heterosexual romantic relationships in nationally representative data. METHODS: We used data from seven rounds of the National Fertility Survey (1987-2015) and included adults aged 18-39 years (18-34 years in the 1987 survey; sample size 11,683-17,675). Current heterosexual relationship status (married; unmarried but in a relationship; single) was estimated by sex, age group and survey year, with singles further categorized into those reporting interest vs. no interest in heterosexual romantic relationships. Information about same-sex relationships were not available. RESULTS: Between 1992 and 2015, the age-standardized proportion of 18-39-year-old Japanese adults who were single had increased steadily, from 27.4 to 40.7% among women and from 40.3 to 50.8% among men. This increase was largely driven by decreases in the proportion of married women aged 25-39 years and men aged 30-39 years, while those in a relationship had increased only slightly for women and remained stable for men. By 2015, the proportion of single women was 30.2% in those aged 30-34 years and 24.4% in those aged 35-39 years. The corresponding numbers for men were 39.3% and 32.4%. Around half of the singles (21.4% of all women and 25.1% of all men aged 18-39 years) reported that they had no interest in heterosexual romantic relationships. Single women and men who reported no interest in romantic relationships had lower income and educational levels and were less likely to have regular employment compared to those who reported such an interest. CONCLUSIONS: In this analysis of heterosexual relationships in nationally representative data from Japan, singlehood among young adults had steadily increased over the last three decades. In 2015 around one in four women and one in three men in their thirties were unmarried and not in a heterosexual relationship. Half of the singles reported no interest in romantic relationships and these women and men had lower income and educational levels and were less likely to have regular employment

Fish in the sea: Number, characteristics, and partner preferences of unmarried Japanese adults - analysis of a national survey

BACKGROUND: A large proportion of adults in Japan remain unmarried even though they intend to marry during their lifetime. To provide data for policy makers and those searching for partners in the Japanese marriage market, we estimated the number and characteristics of unmarried women and men with marriage intention and assessed their partner preferences. Based on the findings, we hypothesized regarding potential mismatches between the individuals available in the marriage market and the type of partners they are looking for. METHODS: We used data from the National Fertility Survey (2015), a nationally representative survey in Japan, and included 20,344 participants aged 18-49 years, of which 6,568 were unmarried with marriage intention. We estimated the total number of unmarried women and men who intend to marry, extrapolated their characteristics to the Japanese population, and assessed their partner preferences, as well as their ideal age of marriage and the ideal age of their partner. RESULTS: In 2015, there were 8.48 million unmarried women and 9.83 million unmarried men aged 18-49 years with marriage intention in Japan. Surpluses of around 600,000 men were observed in non-densely inhabited areas (men-to-women ratio: 1.31) and in the Kanto region (1.23). Most of the women and men in the marriage market had annual incomes lower than 3,000,000 JPY (28,000 USD) and only 263,000 women (3%) and 883,000 men (9%) had an income of 5,000,000 JPY (47,000 USD) or more; 167,000 men (2%) had an income of 7,000,000 JPY (66,000 USD) or more, with roughly three-quarters of them having a university degree. When asked about eight items that one may consider in a potential partner, the proportion of women listing an item as important tended to be larger than those of men across all items (education, occupation, finances, personality, mutual hobbies, cooperation/understanding regarding one\u27s work, and attitude towards/skills in housework and childrearing) except appearance. The largest differences were observed for finances (proportion of women vs. men listing the item as important or would consider: 94.0% vs. 40.5%, p\u3c0.001), occupation (84.9% vs. 43.9%, p\u3c0.001), and education (53.9% vs. 28.7%, p\u3c0.001). While women, on average, preferred men who were around 1-3 years older than themselves, men preferred women around their own age until the age of 26 years, at which point men preferred women who were younger than themselves, with the preferred age difference increasing substantially with age. As such, the number of men preferring a younger partner was larger than the number of women who preferred an older partner. CONCLUSIONS: By providing data on the number, characteristics and partner preferences of individuals in the marriage market, our study could inform decisions for those searching for marriage partners in Japan. Moreover, we hypothesize that mismatches in geographical location, the supply-demand disparity for partners with higher income, and age preferences could partly explain the large number of Japanese women and men who remain unmarried despite intending to get married. Further studies are needed to assess if, and to what extent, the identified mismatches may affect marriage rates

Salaries, degrees, and babies: Trends in fertility by income and education among Japanese men and women born 1943-1975-Analysis of national surveys

BACKGROUND: While fertility rates have decreased during the second half of the 20th century in Japan, little is known regarding trends in the number of children that men and women have across birth cohorts and whether these differ by education and income. METHODS: We used data from four rounds of the National Fertility Survey (1992, 2005, 2010 and 2015) and included men and women aged 40-49 years (16728 men and 17628 women). By 5-year birth cohorts, we assessed the distribution of number of children (0, 1, 2 and 3 or more) and total fertility (the mean number of children) at completed fertility (age 45-49 or 40-44 years depending on birth cohort). We assessed trends in these fertility outcomes in men and women separately, and by education (no university education; university education) for men and women and by reported annual income (0 to \u3c3 000 000 JPY; 3 000 000 to \u3c6 000 000 JPY; ≥6 000 000 JPY) for men. RESULTS: When comparing those born in 1943-1948 with those born in 1971-1975, the proportion with no children had increased from 14.3 to 39.9% for men and from 11.6 to 27.6% for women. This increase coincided with a decrease in the proportions of individuals with 2 or more children. Total fertility had decreased from 1.92 to 1.17 among men and from 1.96 to 1.42 among women. For men, those with a university degree were more likely to have children than those without a university degree in all birth cohorts except 1943-1947. Men with higher income were more likely to have children across birth cohorts. While the proportion who had children had decreased in all income groups, the decrease was steeper among those in the lowest income group. Among women born 1956-1970, those with a university degree were less likely to have children than those without a university degree; this difference was no longer seen among those born 1971-1975. For both men and women, trends in having children and total fertility across birth cohorts did not differ by educational status. CONCLUSIONS: The decline in the total fertility rate in Japan can be attributed to both an increasing proportion of the population who have no children and a lower number of children among those who have children. Men with lower education and income were less likely to have children and the disparity in the number of children that men have by income had increased in more recent birth cohorts. Among women, higher education was associated with lower fertility, although this pattern was no longer observed among those born in 1971-1975

COVID-19 and heat illness in Tokyo, Japan: implications for the summer Olympic and Paralympic Games in 2021

The 2020 summer Olympic and Paralympic Games in Tokyo were postponed to July– September 2021 due to the coronavirus disease 2019 (COVID-19) pandemic. While COVID-19 has emerged as a monumental health threat for mass gathering events, heat illness must be acknowl-edged as a potentially large health threat for maintaining health services. We examined the number of COVID-19 admissions and the Tokyo rule for emergency medical care, in Tokyo, from March to September 2020, and investigated the weekly number of emergency transportations due to heat illness and weekly averages of the daily maximum Wet Bulb Globe Temperature (WBGT) in Tokyo in the summer (2016–2020). The peak of emergency transportations due to heat illness overlapped the resurgence of COVID-19 in 2020, and an increase of heat illness patients and WBGT has been observed. Respect for robust science is critical for the decision-making process of mass gathering events during the pandemic, and science-based countermeasures and implementations for COVID-19 will be warranted. Without urgent reconsiderations and sufficient countermeasures, the double burden of COVID-19 and heat-related illnesses in Tokyo will overwhelm the healthcare provision system, and maintaining essential health services will be challenging during the 2021 summer Olympic and Paralympic Games

Genotype prevalence and age distribution of human papillomavirus from infection to cervical cancer in Japanese women: A systematic review and meta-analysis

Background: National HPV vaccination coverage in Japan is less than one percent of the eligible population and cervical cancer incidence and mortality are increasing. This systematic review and meta-analysis aimed to provide a comprehensive estimate of HPV genotype prevalence for Japan. Methods: English and Japanese databases were searched to March 2021 for research reporting HPV genotypes in cytology and histology samples from Japanese women. Summary estimates were calculated by disease stage from cytology only assessment – Normal, ASCUS, LSIL, HSIL and from histological assessment – CIN1, CIN2, CIN3/AIS, ICC (ICC-SCC, and ICC-ADC), and other. A random-effects meta–analysis was used to calculate summary prevalence estimates of any-HPV, high-risk (HR) and low-risk (LR) vaccine types, and vaccine genotypes (bivalent, quadrivalent, or nonavalent). This study was registered with PROSPERO: CRD42018117596. Results: A total of 57759 women with normal cytology, 1766 ASCUS, 3764 LSIL, 2017 HSIL, 3130 CIN1, 1219 CIN2, 869 CIN3/AIS, and 4306 ICC (which included 1032 ICC-SCC, and 638 ICC-ADC) were tested for HPV. The summary estimate of any-HPV genotype in women with normal cytology was 15·6% (95% CI: 12·3–19·4) and in invasive cervical cancer (ICC) was 85·6% (80·7–89·8). The prevalence of HR-HPV was 86·0% (95% CI: 73·9–94·9) for cytological cases of HSIL, 76·9% (52·1–94·7) for histological cases of CIN3/AIS, and 75·7% (68·0–82·6) for ICC. In women with ICC, the summary prevalence of bivalent vaccine genotypes was 58·5% (95% CI: 52·1–64·9), for quadrivalent genotypes was 58·6% (52·2–64·9) and for nonavalent genotypes was 71·5% (64·9–77·6), and of ICC cases that were HPV positive over 90% of infections are nonavalent vaccine preventable. There was considerable heterogeneity in all HPV summary estimates and for ICC, this heterogeneity was not explained by variability in study design, sample type, HPV assay type, or HPV DNA detection method, although studies published in the 1990s had lower prevalence estimates of any-HPV and HR HPV genotypes. Interpretations: HPV prevalence is high among Japanese women. The nonavalent vaccine is likely to have the greatest impact on reducing cervical cancer incidence and mortality in Japan

Early SNS-based monitoring system for the COVID-19 outbreak in Japan: a population-level observational study

Background: The World Health Organization declared the novel coronavirus outbreak (COVID-19) to be a pandemic on March 11, 2020. Large-scale monitoring for capturing the current epidemiological situation of COVID-19 in Japan would improve preparation for and prevention of a massive outbreak. Methods: A chatbot-based healthcare system named COOPERA (COvid-19: Operation for Personalized Empowerment to Render smart prevention And care seeking) was developed using the LINE app to evaluate the current Japanese epidemiological situation. LINE users could participate in the system either though a QR code page in the prefecture’s website, or a banner at the top of the LINE app screen. COOPERA asked participants questions regarding personal information, preventive actions, and non-specific symptoms related to COVID-19 and their duration. We calculated daily cross correlation functions between the reported number of infected cases confirmed by PCR and the symptom-positive group captured by COOPERA. Results: We analyzed 206,218 participants from three prefectures reported between March 5 and 30, 2020. The mean (standard deviation) age of participants was 44.2 (13.2). No symptoms were reported by 96.93% of participants, but there was a significantly positive correlation between the reported number of COVID-19 cases and self-reported fevers, suggesting that massive monitoring of fever might help to estimate the scale of the COVID-19 epidemic in real time. Conclusions: COOPERA is the first real-time system being used to monitor trends in COVID-19 in Japan, and provides useful insights to assist political decisions to tackle the epidemic