保健医療科学

2024

Vol.73 No.1 p.55 − 61

Topics: Recent topics in public health in Japan 2024

＜ Review ＞
Epidemiological topics in Japan in the last decade
UEHARA Ritei
Department of Epidemiology and Biostatistics, National Institute of Public Health
Abstract
This paper describes recent trends in the fields of disaster epidemiology, social epidemiology, and birthcohort research. The experience of the Great East Japan Earthquake in 2011 has attracted attention to disaster epidemiology. Social epidemiology aims to identify social environmental exposures associated withvarious physical and mental health outcomes. Birth cohorts are often differentially affected by social events.
Epidemiological research methods are used in a wide range of fields, and can be expected to continue todevelop in the future. In addition, it is expected that the results of various epidemiological studies will be
implemented in society.
keywords: epidemiology, disaster epidemiology, social epidemiology, birth cohort study, Internet of Things(accepted for publication, December 7, 2023)

I. Introduction
Epidemiology is defined as “the study of the occurrence
and distribution of health-related events, states, and processes in specified populations, including the study of thedeterminants influencing such processes, and the appliTable

cation of this knowledge to control relevant health problems.” [1] Based on the 34th Annual Scientific Meeting of
the Japan Epidemiological Association, the presentation
categories are shown in the table, and a wide range of epidemiological fields are classified (Table) [2]. In this paper, I
discuss recent epidemiological topics such as disaster epi-

A list of categories of epidemiology†

Epidemiological methodology
Bioethics
Social epidemiology
Infectious diseases
CancerCardiovascular diseases
Mental health
Nutritional epidemiology
Physical activities
Environmental epidemiology
Occupational healthMaternal and child healthGerontology and Geriatrics
Genetic/Molecular epidemiology
Disaster epidemiology
Non-communicable diseases（obesity, diabetes, metabolic syndrome)
Global health
Oral health
Others†This list was prepared based on the presentation categories of the 34th
Annual Scientific Meeting of the Japan Epidemiological Association.
Corresponding author: UEHARA Ritei
2-3-6 Minami, Wako, Saitama 351-0197, Japan.
Tel: 048-458-6223
E-mail: uehara.r.aa@niph.go.jp

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UEHARA Ritei
demiology, social epidemiology, and birth cohort study, andfinally introduce an epidemiological study using Internet ofThings (IoT).

II. Disaster epidemiology
The experience of the Great East Japan Earthquake in2011 has attracted attention to disaster epidemiology. There
have been more opportunities for epidemiologists to be involved, such as health surveys after the nuclear accident at
the Tokyo Electric Power Company (TEPCO)ʼs Fukushima
Daiichi Nuclear Power Plant. The Fukushima Health Management Survey is an epidemiological survey planned inlight of the health concerns after the accident at TEPCOʼs
Fukushima Daiichi Nuclear Power Plant, and the need tomonitor the health of the people of Fukushima Prefecture
and assess the health effects [3]. The main objective of thestudy is to monitor the long-term health of the populationand to determine if long-term low-dose radiation exposure
affects their health. The study design of the Fukushima
Health Management Survey is a cohort study, which covers all persons living in Fukushima Prefecture after theearthquake, and consists of a basic survey and four detailed
surveys. The basic survey estimated the level of external
exposure of all 2.05 million residents. The internal radiation dose was estimated by Fukushima Prefecture using awhole-body counter. The detailed investigation included
thyroid ultrasound examinations of all children under theage of 18 in Fukushima Prefecture, comprehensive medical
examinations for all residents of the evacuation zone, anevaluation of the mental health and lifestyle habits of allresidents of the evacuation zone, and records of the pregnancies and births of all residents who became pregnant
on March 11. The basic survey had a low response rate(<30%), which was thought to complicate an estimation of
the health effects. The importance of mental health care
was revealed in the mental health and lifestyle survey, as
well as the pregnancy and childbirth survey. Zhang W., et al.
examined the relationship between lifestyle and dietary intake using cohort data from the Fukushima Health Management Survey [4]. Data from 52,314 subjects (23,149 males
and 29,165 females, aged 15 years or older) were analyzed.
The evacuees were classified into three categories: shelters and temporary housing, rental housing and apartments,
relativesʼ homes, and their own homes. Dietary intake wascalculated by segmentation into grains, fruits and vegetables, meat, soy products, dairy products, and fish. Daily consumption of more than the third quartile (Q3) of each foodgroup was defined as “high consumption,” and prevalence
ratios and 95% confidence intervals (CIs) were estimatedusing a modified Poisson regression analysis. Compared56

to respondents living in relativesʼ homes or in their own
homes, people living in rented apartments consumed a significantly lower intake of fruits and vegetables (other thanjuices), meat, soybean products, and dairy products, whilepeople living in shelters or temporary housing consumed
a significantly lower intake of fruits and vegetables (nonjuice), meat, soybean products, and dairy products. The
authors conclude that after the disaster, life outside of personal homes and the homes of relatives is associated withshortages of fruits and vegetables, meat, soy products, anddairy products, and that it is necessary to provide balanced
meals to those who are disadvantaged.
There are affected areas where a cohort of residents was
set up and surveyed before the Great East Japan Earthquake occurred. The post-disaster health effects in this area
are being examined in a manner that fits one of the designsof intervention studies, referred to as natural experiments.
Hikichi H., et al. examined whether pre-disaster community levels of social cohesion were associated with PTSD risk
after the Great East Japan Earthquake and Tsunami [5]. The
population cohort in the target area was established sevenmonths before the earthquake, mainly for seniors aged 65
years and older. A follow-up survey was conducted roughly
two and a half years after the disaster. Of the 3,567 people
analyzed, 11.4% of respondents reported severe PTSD
symptoms. Social cohesion at the individual and community
levels before the disaster was also significantly associatedwith a reduced risk of PTSD, after adjusting for depressive
symptoms at baseline and experiences during the disaster(such as loss of a loved one). The study concluded thatsocial cohesion at the community level will strengthen theresilience of residents after disasters. Another study examined whether group exercise and regular walking participation in disaster areas could reduce the worsening of depressive symptoms in older adults [6]. Changes in depressive
symptoms were assessed using the 15-item Geriatric Depression Scale (GDS). From pre-disaster to post-disaster,
the mean change in GDS score increased by 0.1 percentage
points (95% CI: -0.003 to 0.207). During the same period,
the frequency of group exercise participation and daily walking time also increased by 1.9 days/year and 1.3 minutes/
day, respectively. After adjusting for all covariates, including
personal disaster experiences, increases in the frequency ofgroup exercise participation and daily walking time were associated with lower GDS scores. They concluded that groupexercise participation and regular walking may alleviate
the worsening of depressive symptoms in older adults who
have experienced natural disasters.
In order to grasp the long-term health status of disastervictims aged 18 years and older in four districts in Miyagi Prefecture, I next introduce a study by the Center for

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Epidemiological topics in Japan in the last decade
Community Health at Tohoku University Graduate Schoolof Medicine, which continues to conduct health surveys.
Sekiguchi T., et al. clarified the change in the rate of subjective symptoms of victims of the Great East Japan Earthquake (hereinafter, referred to as the “complainant rate”),
and examined the factors involved in the new occurrenceof subjective symptoms in which the rate of complaints increased [7]. Based on the Comprehensive Survey of Living
Conditions, the rate of cases of subjective symptoms per
1,000 persons was calculated for each subjective symptom
item. Of the 1,239 subjects analyzed (mean age: 62.6 years;
55.6% females), the incidence rate decreased significantly
after four and a half years, compared to six months after theearthquake and tsunami for “irritability” and “dizziness.” On
the other hand, “low back pain” and “urinary incontinence(leakage of urine)” increased significantly. It was foundthat the occurrence of new low back pain was associatedwith drinking habits of more than twice a day and subjective economic situation, and that the new occurrence ofurinary incontinence was significantly related to old age.
In the coastal areas where the damage was severe in the
Great East Japan Earthquake, it is said that many people
moved out of the area after the disaster. Sugawara Y., et al.
examined whether the health status of the victims differeddepending on the extent of their relocation after the disaster [8]. In the seventh year after the earthquake, a self-administered questionnaire was conducted on 3,517 persons,among whom 2,342 (66.6%) were subjected to analysis. Of
the respondents, 51.9% were in the “living in the district”
group, 36.1% were in the “moving within the city” group,and 12.0% were in the “moving out of the city” group. The
odds ratio for sleep disturbances was significantly higher
in the group that moved from the affected area, and therelationship between the extent of the relocation and sleep
disturbances was stronger as the group that moved awayfrom the area where they lived before the disaster. On theother hand, it was reported that there was no relationshipbetween the extent of relocation after the disaster, subjective sense of health, and psychological distress.
As a future issue for disaster epidemiology, Yasumura
S. proposes the following [9]. In the event of a disaster,
epidemiologists in the area should be aware of the possibility of situations in which they may have to engage inthe planning, operation, and evaluation of epidemiologicalinvestigations, regardless of their desires. In particular, wehave learned from the recent nuclear accident that not only
the municipalities where nuclear power plants are located,but also neighboring municipalities are not unrelated. At thevery least, epidemiologists need to be constantly concerned
about the health effects of radiation.

III. Social epidemiology
Social epidemiology is defined as, “A branch or subspecialty of epidemiology that studies the role of social structures, processes, and factors in the production of health anddisease in populations. It uses epidemiological knowledge,
reasoning, and methods to study why and how the distribution of health states is influenced by factors such as ethnicity, socioeconomic status and position, social class, andenvironmental and housing conditions.” [10] Social epidemiology aims to identify social environmental exposures associated with various physical and mental health outcomes[11]. It focuses not on diseases, but on social phenomena
such as social stratification, social networks, discrimination,
workplace organization, and public policy. Socioeconomic
status (SES) is strongly associated with health, and it is
known that lower SES is associated with unhealthy andshorter life expectancy [12]. In social epidemiology, three
types of income, educational history, and occupation areoften measured as SES. Income has a material meaning,such as the amount of economic resources and the ability
to consume, as well as a psychosocial meaning such as status. However, there are many points to be aware of whenmeasuring it, such as various types, such as labor income,assets, and social security. Educational experience is often
measured by the number of years of education or the final
educational attainment. Educational background reflects theability to utilize the resources and knowledge necessary tomaintain and improve health that is acquired through education. Occupations are measured by occupation classification,industry classification, employment status, employee size,
job title, etc.
A meta-analysis of income inequality and health effects
was performed by Kondo N., et al. [13]. When income inequality is measured using the Gini coefficient, it has beenreported that the risk of death increases by roughly 8%
for every 0.05 increase in the Gini coefficient, regardlessof the income level of the individual, and that such a relationship becomes stronger as income inequality increases.
The mechanisms by which income inequality affects healthare considered to be an increase in relative deprivation, adecline in social capital, and inefficiency in activities due tosocial division [14].
The life course approach is one of the methods used insocial epidemiology [10]. Life course epidemiology aims
to investigate the causes of social determinants of healthalong a time axis [15]. According to Kuh D., et al., it is defined as “the study of the long-term effects on later healthor disease risk of physical or social exposures during gestation, childhood, adolescence, young adulthood, and later
adult life.” [16] In life course epidemiology, three main

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UEHARA Ritei
models have been proposed [15]: (1) the theory of the Developmental Origins of Health and Diseases (DOHaD) [17],a critical/sensitive period model which holds that exposurein the fetal and childhood periods has a decisive impact
on future health outcomes; (2) a risk accumulation model
which states that the risk of past and present exposure
has a negative impact on future health outcomes, and (3)a trajectory model/chain of risk model, in which risks at a
certain point in the past give rise to risks that directly affectfuture health. Poverty is taken up as a social environment
in childhood; however, poverty can be grasped as a deprivation, where there is nothing that should be possessed.
In addition, adverse childhood experiences, such as abusehave been reported to affect physical and mental health inadulthood.

IV. Birth cohort study
A birth cohort is defined as “the location of a person inhistorical time, as indexed by his or her year of birth. Birthcohorts are often differentially affected by social events.
Numerous cohort variations in factors that have long-term
effects on health (e.g., childbearing, smoking, and physicalactivity) have been documented.” [18]There are several birth cohorts in Japan. Some of themain birth cohort studies are as follows. First, there is the
TMM Birth and Three-Generation Cohort Study (TMM
BirThree Cohort Study), which was established by the
Tohoku University Tohoku Medical Megabank Organization (ToMMo) and the Iwate Medical University Iwate
Tohoku Medical Megabank Organization (IMM). Once theimportance of intrauterine exposure was recognized, birthcohorts were developed and used to examine the lifetime
effects of intrauterine exposure. Studies that assess apersonʼs lifelong disease risk include the development ofgenomic cohort designs, combined with genomic and omics
information. Birth and three-generation cohort studies are
considered necessary. Study design is difficult, and cohort
studies that involve the actual operation of recruitment andfollow-up of pregnant women, babies, husbands (or partners), and baby grandparents from the early stages of cohort
construction are rare [19]. This birth cohort was planned after the Great East Japan Earthquake, and collected information on important exposure factors and outcomes, including
disaster-related information for newborns and families. The
TMM BirThree Cohort Study includes a plan to utilize thisinformation as well as a wealth of family relationship information.
Another birth cohort study is the Babies and their parentsʼ longitudinal Observation in Suzuki memorial Hospitalon Intrauterine period (BOSHI) study. One of the results of58

this study was a comparison of maternal home blood pressure (HBP) and clinic blood pressure (CBP) measurements
before 20 weeks of gestation, which found an association
with the risk of low-birth-weight in infants [20]. High maternal at-home diastolic blood pressure (DBP) and meanarterial pressure (MAP) before 20 weeks of gestation was
associated with an increased risk of low birth weight, compared to clinic DBP and MAP. Therefore, in addition to CBP,it may be worthwhile to have pregnant women measure
HBP to determine the risk of infant birth weight loss.
The Hokkaido study of Environment and Childrenʼs
Health is a cohort study that has been ongoing since 2002,
and consists of two prospective cohorts: a cohort with one
maternity hospital, and a large cohort with 37 hospitals andclinics in Hokkaido [21]. This study was established to investigate the effects of environmental exposure combinedwith genetic predisposition on prenatal, infancy, and earlychildhood development and health. While several birthcohorts have been established, few reports have been published on the relationship between low levels of environmental exposure and adverse birth outcomes. In addition, in
the field of infant development, the effects of mutations in
the human genome and their modifications on the effects ofharmful environmental exposure (gene-environment interactions) have not been fully investigated. In environmental
epidemiology, it is important to conduct risk assessments
based on accurate exposure measurements, and to apply
scientific results to environmental policy.
The Chiba study of Mother and Childrenʼs Health(C-MACH) is a birth cohort study based on the DOHaD
hypothesis, consisting of three hospital-based cohorts[22]. The aim of this study is to investigate the influenceof genetic and environmental factors, particularly the fetal
environment and life after birth. The primary outcomes areallergies, obesity, endocrine and metabolic disorders, anddevelopmental disorders, and factors related to genomic
levels, metabolome levels, umbilical cord DNA methylation(epigenome), gut microbiota, and environmental chemical
exposure are assessed.
The Hamamatsu Birth Cohort for Mothers and Children (HBC Study) is a birth cohort that aims to clarify the
trajectory of early development of children living in local
communities in Japan [23]. The main objective of the HBC
study is to investigate the trajectory of neurodevelopment,
especially through face-to-face monitoring during the firsttwo years of life. The HBC study also has the secondary
objective of investigating topics such as the long-term effects of household income inequality and low birth weight
infants. This includes long-term personal and social effects
on childrenʼs neurodevelopmental processes.
Since 2011, the Ministry of the Environment Govern-

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Epidemiological topics in Japan in the last decade
ment of Japan has been conducting a large-scale epidemiological survey involving 100,000 pairs of children and theirparents in Japan [24]. This is a birth cohort survey that
regularly checks the health status of children from the fetal
period until the age of 13, in order to clarify how environmental factors affect the growth and development of thechildren. Based on the results of the Japan Environment andChildrenʼs Study (JECS), they aim to clarify the environmental factors that affect the health and growth of children,and to create an environment where children can grow up
to be healthy and raise children with peace of mind. This is
the largest and longest-term survey of childrenʼs health andenvironment that has ever been conducted in Japan, recruiting 100,000 pairs of children and their parents in 15 regions
across the country. Approximately 100,000 pregnant women
registered to participate in the JECS, which began in fiscal
2010, over a three-year period. Biological samples such as
blood, urine, and breast milk were collected from pregnant
women and their children during pregnancy and childbirth.
Afterwards, follow-up is carried out to continue the survey
using questionnaires and other methods until the child is 13
years old.
The main birth cohorts in Japan have been outlined
above. Currently, collaboration between birth cohorts is
progressing, and research is being conducted to develop
meta-analyses of risk factors and prognosis for gestational
hypertension syndrome (HDP) and low birth weight (LBW),
respectively, and for the development of prediction and early detection methods for the disease.

V. An example of epidemiological researchusing the Internet of Things (IoT)
The Masuda study is an ongoing prospective cohort
study of healthy community residents aged 20 to 74 years
in Masuda City, Shimane Prefecture, using Internet ofThings technology to monitor daily trends in blood pressure, diet, nutrition, and physical activity [25]. A total of 242
participants were examined for their daily physical activity,
by wearing an accelerometer on their waist, except whilebathing and sleeping. A study that assessed the number ofsteps taken from the day the World Health Organization(WHO) declared the coronavirus disease 2019 (COVID-19)
pandemic to the day the Japanese government lifted thestate of emergency found that the average number of steps
per day decreased by 9.4% in the first week after the stateof emergency was declared nationwide, but the number ofsteps recovered the following week. Thereafter, no significant decrease in the average number of steps per day wasobserved until the state of emergency was lifted. This study
should consider the possibility of a systematic reporting

bias due to changes in participant behavior when wearing
the device or non-compliance with use of the device, as
well as the impact of activity intensity or non-walking exercise such as cycling. Since objective data can be collected
through use of the IoT, it is expected to be applied to future
epidemiological research.

VI. Conclusion
This paper describes recent trends in the fields of disaster epidemiology, social epidemiology, and birth cohort
research. Epidemiological research methods are used ina wide range of fields, and can be expected to continue todevelop in the future. In addition, it is expected that the results of various epidemiological studies will be implemented in society.

Acknowledgment
I would like to thank Dr. Kawado in the Department of
Epidemiology and Biostatistics, National Institute of Public
Health for her advice on the structure of this paper.
I declare that there are no conflicts of interest.

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Epidemiological topics in Japan in the last decade＜総説＞
日本における最近の疫学のトピックス
上原里程
国立保健医療科学院疫学・統計研究部

抄録
本論文では日本における最近の疫学研究，特に，災害疫学，社会疫学，出生コホート研究のトピッ
クスを記述する．災害疫学は 2011 年の東日本大震災の経験から注目を集めるようになった．社会疫
学は社会環境の曝露と様々な身体的，精神的な健康アウトカムとの関連を明らかにすることを目的としている．出生コホートは社会状況によって様々な影響を受ける．疫学研究は様々な分野で活用され，今後も発展することが期待される．疫学研究による成果が社会実装されることが望まれる．
キーワード：疫学，災害疫学，社会疫学，出生コホート研究，モノのインターネット

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