Preventive impact of social participation on the onset of noncommunicable diseases among middle-aged adults

June 20, 2020
Takashi Oshio
Institute of Economic Research
Hitotsubashi University1

Non-communicable diseases (NCDs)

Social participation (SP)2

Motivation
 Social participation (SP) is known to have a favorable impact on
the health of older adults by reducing the risk of functional
disability, psychological distress, cognitive impairment, andmortality…
 …but the preventive impact of SP on non-communicablediseases (NCDs) among middle-aged adults is largely
understudied.

3Research purposeHence,we estimated Cox proportional hazards models to estimate thepreventive impact of SP adjusted for baseline covariates…
… using the dataset from a population-based, 10-wave
longitudinal survey that started with Japanese adults aged
50–59 years in 2005 (16,290 men and 17,248 women).

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Study sample
Longitudinal Survey of Middle-aged and Older Adults Nationwide, genuine panel data Ministry of Health, Labour and Welfare (MHLW) Conducted every year since 2005
 Data of 10 waves (2005-2014) used in this study Started with 34,240 individuals aged 50-59 (10 cohorts)
To capture the preventive impact of SP on health, we focused only
on the respondents who did not report its incidence at baseline.
5Six types of SP activities and their prevalence at baseline

Constructing a binary variable of SP:
1 if SP at baseline and 0 otherwise

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Six types of NCDs
 diagnosed with each by a medical doctor at the survey time:1) diabetes, 2) heart disease, 3) stroke, 4) hypertension,5) hyperlipidemia, and 6) cancer.
Covariates
Time-invariant individual attributes:
gender and educational attainment
Baseline variables:
age, household spending, current smoking,heavy alcohol consumption, and self-rated health7

Analytic strategy
1) Descriptive analysis
Concentrated on respondents who participated in all ten waves
Compared the probabilities of onset for each NCD between
those with at least one SP at baseline and those without it.
Ignored the potential attrition bias

82) Regression analysis
Estimated three Cox proportional hazards models to compute theHR for each NCD over 9 follow-up waves for men and women.
 Model 1 estimated the crude HR for each health outcome for
the SP group, unadjusted for covariates.
 Model 2 estimated the HR for each health outcome for the SPgroup, adjusted for covariates
 Model 3 replaced SP with the variable for the type of SP— “SP with others” or “SP alone”—in Model 2.
9RESULTS

Prevalence of NCDs at baseline

10Proportions of the onset of NCDs by Wave 1011

Diabetes: Kaplan-Meier survival (= no onset) estimates
between individuals with and without baseline SP12

Results of Models 1 and 2 for men
Model 1Model 2NoYes

Controlled for covariates
HR

95% CI

Diabetes

0.79(0.72, 0.88)

0.86 (0.77, 0.95)

Heart disease
StrokeHypertension

0.87
0.75
0.94(0.77, 0.99)(0.64, 0.89)(0.87, 1.00)

0.93 (0.82, 1.05)
0.83 (0.70, 0.99)
0.95 (0.88, 1.02)

Hyperlipidemia
Cancer1.14
0.93(1.05, 1.23)(0.81, 1.06)

1.07 (0.98, 1.16)
0.96 (0.84, 1.10)

13HR

95% CI

Results of Models 1 and 2 for women
Model 1Model 2No

Yes

Controlled for covariates
HR95% CI

HR

95% CI

Diabetes

0.68 (0.60, 0.76) 0.75 (0.66, 0.85)

Heart disease
StrokeHypertension

0.85 (0.73, 0.99) 0.92 (0.79, 1.07)
0.70 (0.58, 0.86) 0.78 (0.64, 0.97)
0.88 (0.81, 0.95) 0.91 (0.84, 0.99)

Hyperlipidemia
Cancer

1.30 (1.20, 1.41) 1.27 (1.17, 1.38)
0.94 (0.81, 1.08) 0.96 (0.83, 1.11)
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Results of Model 3 for men and women
MenHR

95% CI

Women
HR

95% CI

Diabetes

With others
Alone

0.87 (0.78, 0.97) 0.73 (0.64, 0.83)
0.81 (0.70, 0.94) 0.85 (0.71, 1.03)

StrokeWith others
Alone0.79 (0.66, 0.94) 0.77 (0.62, 0.95)
0.99 (0.78, 1.25) 0.87 (0.63, 1.19)

Hypertension

With others

0.96 (0.84, 1.04) 0.91 (0.83, 0.99)

Alone

0.93 (0.85, 1.04) 0.94 (0.83, 1.06)

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DISCUSSION and CONCLUSIONSSP prevented some but not all types of NCDs.
 Diabetes and stroke were most effectively prevented in bothgenders.
 SP had a modest preventive effect on hypertension only for
women but no effect on heart disease.
 Cancer was not associated with SP, and HR for hyperlipidemia
was positively associated with SP among women.
16Why diabetes, stroke, and hypertension?
 Preceding studies have found that these types of NCDs haveclose associations with psychological distress (Henderson et al.,2013; Nabi et al., 2011; Pan et al., 2011; Rotella & Mannucci,2013), suggesting that the preventive impact of SP on them may
be mediated by psychological distress.
Why raising the risk of hyperlipidemia?
 ? (dining out)
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Policy implications
 Results imply that policy measures to encourage SP are favorable
for the health of middle-aged adults.
 To enhance the effectiveness of interventions to enhance SP
among adults, we have to encourage personal interactions withother individuals and to avoid social isolation.

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Thank you for your attention!

This presentation is based on Oshio T, Kan M. Preventive impact of social participation on the onset of noncommunicable diseases among middle-aged adults: a 10-wave hazards-model analysis in Japan,” PreventiveMedicine, 2019, 118, 272-278.

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