Regression analysis of trends in mortality from hepatocellular carcinoma in Japan, 1972-2001

Background In Japan, higher mortality rates from hepatocellular carcinoma (HCC) have been observed than in any other industrialized country and the reported numbers of deaths due to HCC have increased significantly in recent years. We assessed whether there was a real increase in mortality from HCC and which factors contributed to the recent increasing trends of the number of deaths from HCC. Methods Poisson regression models were used to analyse panel data for the period 1972-2001. Results In both sexes, age-standardized mortality rates from HCC increased significantly over the past three decades. Among males the annual percentage increase in age-adjusted mortality rates was approximately 1-3% during the period 1972-96. On the other hand, female mortality trends were less clear. The estimated birth cohort effects suggested that there was a peak in the mortality risk among the cohorts born during the period 1927-36, which corresponded to those aged between 50-64 years during the period 1987-96. This was the period when a large increase of both age-specific mortality rates among older age groups and age-standardized mortality rates were observed particularly among males. Conclusions This study shows that an upward trend of mortality from HCC in Japan was primarily due to the effects among birth cohorts born around 1930, which are consistent with the pattern of past exposure to hepatitis C virus. The cohort effects have contributed to a large increase in mortality from HCC in recent years and the number of deaths from HCC is expected to increase by 2010-1

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

Achieving MDG 4 in Sub-Saharan Africa: What Has Contributed to the Accelerated Child Mortality Decline in Ghana?

BACKGROUND: Recent analyses have suggested an accelerated decline in child mortality in Ghana since 2000. This study examines the long-term child mortality trends in the country, relates them to changes in the key drivers of mortality decline, and assesses the feasibility of the country's MDG 4 attainment. METHODOLOGY: Data from five Demographic and Health Surveys (DHS) between 1988 and 2008 and the Maternal Health Survey 2007 were used to generate two-year estimates of under-five mortality rates back to 1967. Lowess regression fitted past and future trends towards 2015. A modified Poisson approach was applied on the person-period data created from the DHS 2003 and 2008 to examine determinants of under-five mortality and their contributions to the change in mortality. A policy-modelling system assessed the feasibility of the country's MDG 4 attainment. FINDINGS: The under-five mortality rate has steadily declined over the past 40 years with acceleration since 2000, and is projected to reach between 45 and 69 per 1000 live births in 2015. Preceding birth interval (reference: 36+ months, relative risk [RR] increased as the interval shortened), bed net use (RR 0.71, 95% confidence interval [CI]: 0.52-0.95), maternal education (reference: secondary/higher, RR 1.71, 95% CI: 1.18-2.47 for primary), and maternal age at birth (reference: 17+ years, RR 2.13, 95% CI: 1.12-4.05) were primarily associated with under-five mortality. Increased bed-net use made a substantial contribution to the mortality decline. The scale-up of key interventions will allow the possibility of Ghana's MDG 4 attainment. CONCLUSIONS: National and global efforts for scaling up key child survival interventions in Ghana are paying off--these concerted efforts need to be sustained in order to achieve MDG 4

Global and regional estimates of cancer mortality and incidence by site: I. Application of regional cancer survival model to estimate cancer mortality distribution by site

BACKGROUND: The Global Burden of Disease 2000 (GBD 2000) study starts from an analysis of the overall mortality envelope in order to ensure that the cause-specific estimates add to the total all cause mortality by age and sex. For regions where information on the distribution of cancer deaths is not available, a site-specific survival model was developed to estimate the distribution of cancer deaths by site. METHODS: An age-period-cohort model of cancer survival was developed based on data from the Surveillance, Epidemiology, and End Results (SEER). The model was further adjusted for the level of economic development in each region. Combined with the available incidence data, cancer death distributions were estimated and the model estimates were validated against vital registration data from regions other than the United States. RESULTS: Comparison with cancer mortality distribution from vital registration confirmed the validity of this approach. The model also yielded the cancer mortality distribution which is consistent with the estimates based on regional cancer registries. There was a significant variation in relative interval survival across regions, in particular for cancers of bladder, breast, melanoma of the skin, prostate and haematological malignancies. Moderate variations were observed among cancers of colon, rectum, and uterus. Cancers with very poor prognosis such as liver, lung, and pancreas cancers showed very small variations across the regions. CONCLUSIONS: The survival model presented here offers a new approach to the calculation of the distribution of deaths for areas where mortality data are either scarce or unavailable

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

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

Trends in cause specific mortality across occupations in Japanese men of working age during period of economic stagnation, 1980-2005: retrospective cohort study

Objective To assess the temporal trends in occupation specific all causes and cause specific mortality in Japan between 1980 and 2005