社会医学研究．第 35 巻 1 号．Bulletin of Social Medicine, Vol.35（1）2018

原著

Loss of access to daily necessities and locomotive syndrome-Nationwide Cross-Sectional Survey on Dietary Environment in Relation
to Difficulty of Shopping for Elderly Living at Home
買物難民とロコモティブシンドローム- 地域在宅高齢者を対象とした買物難民と健康の現状に関する
全国断面調査から Fumie Okada1),2), Satoshi Toyokawa3), Takehiko Kaneko1), Tadashi Furuhata1)
岡田 文江 1）、2）、豊川 智之 3）、金子 健彦 1）、古畑 公 1）
1）Wayo Women's University, Graduate School of Human Ecology, Health and Nutrition Division2）Tokiwa University, Collage of Human Science, Department of Health and Nutrition
3）The University of Tokyo, Graduate School of Medicine, Department of Public Health1）和洋女子大学大学院総合生活研究科
2）常磐大学人間科学部健康栄養学科
3）東京大学大学院医学系研究科公衆衛生学分野
Summary
Background: We examined locomotive syndrome among disadvantaged shoppers to the nearest grocery shop.
Methods: Using the Survey on Difficulty in Shopping and Current Health Conditions in Housebound Elderly
conducted on 15,200 housebound elderly subjects in 46 prefectures, valid responses without missing data wereobtained from 4,969 respondents and used for the analysis (valid response rate: 38.9% ). The survey questionnaire
consisted of 31 questions regarding daily life and health conditions. All analyses were separately conducted using
the independent variable of whether respondents regularly go grocery shopping or not.
Results: For those regularly going to the grocery shop, the distribution of locomotive syndrome was 471(20.3% ) for non-disadvantaged shoppers, 170 (27.2% ) for permanent disadvantaged shoppers, and 108 (27.4% ) for
disadvantaged shoppersdue to shop closure. Multivariate analysis using covariates including public transportation,
revealed that the group of permanent disadvantaged shoppers showed significantly more cases of locomotive
syndrome (OR: 1.28; 95 % CI: 1.02–1.63) than the group of non-disadvantaged shoppers. However, disadvantaged
shoppers due to shop closure showed loss of significant associations (OR: 1.29; 95% CI: 0.98–1.69).
Conclusions: The current study indicated the possibility that more disadvantaged shoppers have locomotive
syndrome than non-disadvantaged shoppers among those regularly going to grocery shops.
抄録
本研究の目的は、買物難民におけるロコモティブシンドロームついて検討することであった。分析データは、買物難民と健康の現状調査で集められた東京都を除く 46 道府県在住の 15,200 人であった。分析項目に欠損の無い 4,969
名を分析対象とした（分析にまで用いられた回答率 38.9％）。調査項目は日常生活と健康状態について尋ねる 31 項目であった。すべての分析は、本人が買物する群としない群に分けて分析した。
自ら買物をしている者では、閉店による買物難民（108 人（27.4％）と以前から買物難民（170 人；27.2％）は、
非買物難民（471 人；20.3％）より多かった。多変量モデルでは、以前から買物難民 (OR: 1.37; 95% CI: 1.10―1.70) と閉店による買物難民（OR: 1.34; 95% CI: 1.04―1.75）は非買物難民に比べてロコモティブシンドロームが多いという有意な関連がみられた。交通機関を共変量に含めた多変量モデルでは、以前から買物難民（OR: 1.28; 95% CI: 1.02-1.63）は有意にロコモティブシンドロームが多く、閉店による買物難民（1.29; 95% CI: 0.98 － 1.69）は有意差がみられなかった。
結果 本研究では、普段買物に行く者において、買物難民にはロコモティブシンドロームが多い可能性が示唆された。
Key words: Food desert, Locomotive syndrome, Local food environment, Disadvantaged shopper, Grocery shop
キーワード : フードデザート、ロコモティブシンドローム、地域の食環境、買物難民、食料店－ 19 －

社会医学研究．第 35 巻 1 号．Bulletin of Social Medicine, Vol.35（1）2018

Ⅰ . Introductionrefers to a condition characterized by a decline inWith the advance of a hyperaging society, thethe functions of the locomotor system, including thenumber of marginal settlements is steadily increasingbones, joints, and muscles 8,9). Although a couple ofin Japan1). Marginal settlements force residents toprevious studies indicated physical inactivities andbecome disadvantaged shoppers, who are kept awayfood consumption might be risk factors of locomotive

from daily necessities by the closure of accessible

syndrome 10-12) , there has been no report on thegrocery shops. The Ministry of Economy, Trade andassociation of disadvantaged shoppers and locomotive

Industry defines disadvantaged shoppers,“kaimono

syndrome. Using the Survey on Difficulty in Shopping

nanmin”(literally, shopping refugees), as elderly

and Current Health Conditions in Houseboundpeople aged 60 and over who have limited access to

Elderly13) conducted on housebound elderly acrossshopping facilities2). The problem of disadvantaged

the country, we examined the association between

shoppers is also referred to as the“food desert”

locomotive syndrome and disadvantaged shoppers.

problem, which was initially defined as places where
people do not have easy access to healthy and

Ⅱ．Methods
1. Subjects and survey procedures

fresh foods, particularly among low socio-economic
residents in inner cities3). Despite a lack of consensus

The sampled subjects were 15,200 houseboundon the definition of food deserts, efforts to identify

elderly people aged 65 and older as of November 1,

areas of concern with respect to limited accessibility

2012, from 46 prefectures, except Tokyo.

to healthy foods are now regarded as critical to a

The study period lasted from November 1 totargeted intervention program for promoting healthy

December 31, 2012. This study was conducted by4)food consumption . The problem addressed in JapanThe Japanese Society for Dietary Health Promotion

was for those in depopulated areas as well as inner(Nihon Shokuseikatsu Kyokai) and by its registeredcities. The main causes of disadvantaged shoppers

170,000 dietary-health-promoting volunteers in 1,411

among the elderly in Japan are not only biologicalmunicipalities in all prefectures except for Tokyo.

aging but also the aging of society, such as the

The ad-hoc survey was implemented by distributing

closing of shops both in depopulated areas and innera questionnaire entitled “Survey on Dietary

cities, and an increase in the number of elderly single

Environment in Relation to Difficulty in Shopping and5)households . The number of small-scale retail stores

Current Health Conditions of Household Elderly”10*13)

is on a downward trend and conventional large-

and by trained dietary-health-promoting volunteers

scale retail stores are opening in the suburbs, which

conducting face-to-face interviews in the subjects’

accelerates the pace of desertification. The number

homes. The volunteers, mostly housewives, areof elderly people who experience inconvenience intrained to acquire the knowledge and skills needed

day-to-day shopping was estimated to be about six

to maintain a healthy diet, under the supervision of

million (16.6% among people aged 65 and over) and ispublic health centers. Volunteers undergo 48 hours of

6)

enrollment training and attend routine seminars four

expected to be on the rise .
Older adults are of particular interest since

to 12 times a year. For the current study, volunteers

their dietary habits may be more strongly influenced

were offered one day of interviewer training in each7)by their neighborhood . Excepting self-sufficientmunicipal unit. Refer to the previous study for details

elderly, disadvantaged shoppers supplemented accessof the survey14). The subjects without data deficiency

to daily necessities by using their own car, publicin the analyzed items were used for statisticaltransportation including bus and taxi, delivered meals,

analysis.

2. Questionnaire items

mobile grocery shops, and neighborhood assistance,
resulting in their inactivity. Their inactivity may

We select 16 items from the questionnaire

cause their health to deteriorate, leading to ailments

consisting of 31 questions regarding daily life andsuch as locomotive syndrome. Locomotive syndrome

health conditions, including grocery shopping and the－ 20 －

社会医学研究．第 35 巻 1 号．Bulletin of Social Medicine, Vol.35（1）2018

use of food delivery services.

into three groups:“single household”, including

On the basis of the answers to the question

deceased or divorced;“married-couple household”;

concerning the use of a mobile grocery shop andand“deceased or divorced and living with children”.

meal delivery, the subjects were classified into two

The subjects who answered“others”, includinggroups:“use”and“no use”. The responses to the“married-couple household with children”, werequestions on the mode of transportation used forincluded in“deceased or divorced and living withshopping, including bicycle, motor bike, car, bus, andchildren”because of the similarity to living withtaxi, were classified into the group of either“yes”

children and the scarcity of samples. Using theor“no”for each transportation mode. On the basis

answers on the use of national nursing care insuranceof the answers to the question regarding access to aservices, the subjects were categorized into“use”,

grocery shop, the subjects were classified into three

and “no use”. Those who answered that theirgroups:“no limitation”,“permanently disadvantaged

pension was their current major source of income

shopper”and“disadvantaged shopper due to shop

were included as“pension”, and those who selected

closure”.

“work (including self-employment)” or “others”

Those who answered“yes”to the question ofwhether they are the person to regularly go shoppingas their source of income were categorized into
“earned”.

to the grocery shop were classified as“regularly

For self-rated health, those who answered

going to grocery shop”and others were grouped into

“good”, or“rather good”on the five-scale responses“not regularly going to grocery shop”. From theto questions about current health conditions wereanswers to the question on the frequency of goingclassified into the high group and those whoout per week, including shopping, the subjects wereanswered“moderate”,“rather poor”, or“poor”

classified into two groups:“three or more”and“lesswere classified into the low group. The statisticalthan three”.

power of the explanation of self-rated health wasThose who answered“yes”to the question of

maximized when the moderate condition waswhether they had diseases of the bones or joints thatcategorized into the low group17). On the basis of thewere being treated were judged to have locomotive

answers to the question regarding the condition of

syndrome. Hypertension, diabetes, and heart diseasevision and hearing, the subjects were classified into

were used as covariates because these diseases

two groups:“poor”and“normal”.

3. Statistical analyses

seemed to be background factors disrupting theirhealth and behavior. Age (65-74, 75-84, ≧ 85), gender,

All analyses were conducted for groups

and body mass index (BMI) [kg/m2; calculated fromaccording to whether or not subjects regularly go toheight and weight: <20, underweight; 20-25, normal;

grocery shops. The percentage of respondents withand25, obese] were also used as covariates. Height

locomotive syndrome was calculated for each item.

and weight were obtained following the protocol

The significance of differences among categories

for unmeasurable cases of the National Health andwas determined in accordance with the odds ratio

15)

Nutrition Survey in Japan . The order of precedence(OR) and its 95

was as follows: 1) those measured at a healthlogistic regression models, setting the presence ofcheck-up that year, 2) those measured using the

locomotive syndrome as the dependent variableinterviewee’s scales, and 3) those in the interviewee’s

and disadvantaged shopper, sex, age, household

memory. The cutoff values for the underweight andcomposition, income resource, certification of needobese groups were the BMI for the elderly defined

for long-term care, hypertension, diabetes, heartin the second term of the National Health Promotion

disease, body mass, vision proficiency, hearing

16)

Movement in the twenty-first century .

% confidence interval (CI) using

proficiency, going out for shopping, use of mobile

On the basis of the answers to the question on

grocery shop, use of delivered meals, and mode ofhousehold composition, the subjects were classified

transportation when grocery shopping, i.e., on foot, by－ 21 －

社会医学研究．第 35 巻 1 号．Bulletin of Social Medicine, Vol.35（1）2018

bicycle, motor bike, car, bus, or taxi, as independent

in relation to the total number of subjects in thevariables. Adjusted OR values were calculated using

analysis). The mean age was 76.1 [standard deviation

multivariate logistic regression models: Model 1(SD), 7.0].

includes sex, age, household composition, source ofTables 1 and 2 show the distribution ofincome, body mass, national nursing care insurance

locomotive syndrome with respect to subjects’services, self-rated health, hypertension, diabetes,characteristics and the results of bivariate analysis

heart disease, vision proficiency, hearing proficiency,

for groups according to whether or not subjects

and frequency of going out; Model 2 is Model 1 withregularly go to grocery shops. Females accounted

the additions of mobile grocery shop and delivered

for approximately ninety percent of those who go tomeals; Model 3 has the further addition of mode

grocery shops regularly, but among those not goingof transportation to the grocery shop. The levels

to grocery shops, males and females were equal inof statistical significance were set at p<0.05. The

number..

Hosmer-Lemeshow test for the goodness of fit wasAmong those going to grocery shops (Table 1),

applied. The statistical tests were conducted using

permanent disadvantaged shoppers numbered 626

18)

Stata 13 .

(18.8% ), and disadvantaged shoppers due to shop closure

4. Ethical considerations

numbered 394 (11.8 % ). The prevalence of locomotive

This survey was carried out in accordance withsyndrome among non-disadvantaged shoppers was 471

the Ethical Guidelines for Epidemiological Research(20.3 % ), that for permanent disadvantaged shoppersof the Ministry of Education, Culture, Sports,

was 170 (27.2 % ), and that for disadvantaged shoppers

Science and Technology, and the Ministry of Health,due to shop closure was 108 (27.4 % ). Those withLabour and Welfare, Japan. Because the subjects

permanent poor access to grocery shops (OR: 1.46,

were asked about their households and personal

95% CI: 1.19-1.79) and poor access due to shop closure

affairs, we took all possible measures to protect and(OR: 1.48, 95 % CI: 1.16-1.89) showed significant risk

manage the subjects’ personal data and to dispel the

associations with locomotive syndrome (Table2).

subjects’ fears regarding protection of privacy. The

Among those not going to grocery shops (Tableinterviewers obtained the subjects’ consent after fully1), permanent disadvantaged shoppers numbered 363

explaining the purpose of the study and the methods(22.2% ), and disadvantaged shoppers due to shop

employed, and that participation in the survey was

closure numbered 224 (13.7 % ). The prevalence

voluntary. The survey and analysis were conductedof locomotive syndrome was 254 (24.3% ) among

with the approval of the Ethics Committee of Tokiwa

non-disadvantaged shoppers, 95 (26.2 % ) among

University (No. 100025). We applied for permission

permanently disadvantaged shoppers, and 73 (32.6% )to use the data of“Survey on Dietary Environment

among disadvantaged shoppers due to shop closure.

in Relation to Difficulty in Shopping and Current

Permanently disadvantaged shoppers (OR: 1.51;

Health Conditions of Household Elderly”, and the

95% CI: 1.10–2.06) showed significant risk associations

application was approved by the chairman of thewith locomotive syndrome (Table3). Disadvantaged

Japanese Society for Dietary Health Promotion.

shoppers due to shop closure (OR: 1.11; 95% CI: 0.84–1.45) showed no significant risk associations.

Ⅲ．Results

Table 2 shows the results of multivariate

Survey responses were obtained from 12,782

analysis of locomotive syndrome compared with

% ). Validthe characteristics of subjects who regularly go

responses without missing data were obtained fromto grocery shops. Permanently disadvantaged

4,969 respondents and used for the analysis (valid

shoppers (Model 3, OR: 1.28, 95 % CI: 1.02–1.63) and

response rate: 38.9% ).

disadvantaged shoppers due to shop closure (Model

respondents (crude response rate: 84.1

The number of females was 3,892 (78.3 % ; the3, OR: 1.29, 95% CI: 0.98–1.69) showed significant risk

percentage indicates the proportion of subjects

associations. Among those not regularly going to－ 22 －

社会医学研究．第 35 巻 1 号．Bulletin of Social Medicine, Vol.35（1）2018

grocery shops (Table 3), permanently disadvantaged

closure (Model 3, OR: 1.28, 95% CI: 0.89–1.85) showed

shoppers due to shop closure (Model 3, OR: 0.90, 95% CI:

no significant associations.

0.65–1.23) and disadvantaged shoppers due to shop
Table1Distributionoflocomotivesyndromewithrespecttosubjects’characteristicsforinhabitantsregularlygoingtogroceryshops
Goingtogroceryshop
Rregularly(N=3,335)
Notregularly(N=1,634)
N%N%
Demographiccharacteristics
Gender
Male
371
11.1%
706
43.2%
Female
2,964
88.9%
928
56.8%
Age
65–74
1,639
49.1%
561
34.3%
75–84
1,403
42.1%
701
42.9%
85andolder
293
8.8%
372
22.8%
Socioeconomicstatus
HouseholdSingle
1,481
44.4%
253
15.5%
Married
1,214
36.4%
642
39.3%
Livingwithchildren
640
19.2%
739
45.2%
Sourceofincome
Earned
250
7.5%
232
14.2%
Pension
3,085
92.5%
1,402
85.8%
Healthcondition
Bodymass
Underweight
594
17.8%
327
20.0%
Average
2,109
63.2%
1,000
61.2%
Obese
632
19.0%
307
18.8%
LongͲtermcare
Yes
3,170
95.1%
1,325
81.1%
No
165
4.9%
309
18.9%
SelfͲratedhealth
Good
1,649
49.4%
970
59.4%
Poor
1,686
50.6%
664
40.6%
Hypertension
No
1,930
57.9%
865
52.9%
Yes
1,405
42.1%
769
47.1%
Diabetes
No
3,068
92.0%
1,431
87.6%
Yes
267
8.0%
203
12.4%
Heartdisease
No
3,083
92.4%
1,416
86.7%
Yes
252
7.6%
218
13.3%
Visionproficiency
No
1936
58.1%
824
50.4%
Yes
1399
41.9%
810
49.6%
Hearingproficiency
No
2421
72.6%
973
59.5%
Yes
914
27.4%
661
40.5%
Shoppingbackground
Goingout3timesormore
2,133
64.0%
731
44.7%
Lessthan3times
1,202
36.0%
903
55.3%
3,143
94.2%
1,560
95.5%
MobilegroceryNotuse
Use
192
5.8%
74
4.5%
Deliveredmeals
Notuse
3,190
95.7%
1,542
94.4%
Use
145
4.3%
92
5.6%
TransportationforshoppingNotonfoot
1,976
59.3%
1,224
74.9%
Onfoot
1359
40.7%
410
25.1%
Notbicycle
2,607
78.2%
1,406
86.0%
Bicycle
728
21.8%
228
14.0%
Notmotorbike
3,199
95.9%
1,595
97.6%
Motorbike
136
4.1%
39
2.4%
Notcar
1,829
54.8%
541
33.1%
Car
1,506
45.2%
1,093
66.9%
Notbus
3,014
90.4%
1,562
95.6%
Bus
321
9.6%
72
4.4%
Nottaxi
3,176
95.2%
1,556
95.2%
Taxi
159
4.8%
78
4.8%
Disadvantagedshoppers
No
2,315
69.4%
1,047
64.1%
Permanently
626
18.8%
363
22.2%
Duetoshopclosure
394
11.8%
224
13.7%






－ 23 －

17

－ 24 －

18



Table3Oddsratiosobtainedusingmultivariatelogisticregressionmodeloflocomotivesyndromeforinhabitantsnotregularlygoingtogroceryshops
CrudeOR
Model1(N=1,634)
Model2(N=1,634)
Model3(N=1,634)
OR 95%CI
OR 95%CI
OR
95%CI
OR 95%CI
Goingout3timesormore
1.76 1.40 ͸ 2.22
͸
1.10 0.84 ͸ 1.43
1.11 0.85 ͸ 1.45
MobilegroceryUse1.40 0.85 ͸ 2.31
͸
1.16 0.67 ͸ 2.01
1.08 0.62 ͸ 1.89
Deliveredmeals
Use
1.58 1.01 ͸ 2.46
͸
0.94 0.56 ͸ 1.56
0.93 0.55 ͸ 1.55
Transportationforshopping Bicycle
0.85 0.61 ͸ 1.18
͸͸
1.12 0.76 ͸ 1.63
Motorbike
0.86 0.40 ͸ 1.82
͸͸
1.18 0.52 ͸ 2.69
Car
0.64 0.51 ͸ 0.80
͸͸
1.13 0.83 ͸ 1.55
Bus
1.89 1.16 ͸ 3.07
͸͸
1.26 0.73 ͸ 2.20
Taxi
2.20 1.38 ͸ 3.50
͸͸
1.44 0.85 ͸ 2.45
Disadvantagedshoppers
No
1.00
1.00
1.00
1.00
Permanently
1.11 0.84 ͸ 1.45
0.85 0.63 ͸ 1.15
0.83 0.61 ͸ 1.13
0.90 0.65 ͸ 1.23
Duetoshopclosure
1.51 1.10 ͸ 2.06
1.23 0.87 ͸ 1.73
1.20 0.84 ͸ 1.70
1.28 0.89 ͸ 1.85
HosmerͲLemeshowtest
P =0.99
P =0.59
P =0.96
Logisticregressionmodel
OR:OddsRatio;CI:ConfidenceInterval
CovariatesofModel1Ͳ3:Gender,Age,Household,Sourceofincome,Bodymass,LongͲtermcare,SelfͲratedhealth,Hypertension,Diabetes,Heartdisease,Visionproficiency,Hearingproficienc

Table2Oddsratiosobtainedusingmultivariatelogisticregressionmodeloflocomotivesyndromeforinhabitantsregularlygoingtogroceryshops
CrudeOR
Model1(N=3,335)
Model2(N=3,335)
Model3(N=3,335)
OR 95%CI
OR 95%CI
OR
95%CI
OR 95%CI
Goingout3timesormore
1.35 1.14 ͸ 1.60
͸
1.00 0.83 ͸ 1.20
0.97 0.81 ͸ 1.17
MobilegroceryUse
1.27 0.91 ͸ 1.76
͸
0.94 0.66 ͸ 1.35
0.93 0.65 ͸ 1.35
Deliveredmeals
Use
1.59 1.11 ͸ 2.28
͸
0.91 0.61 ͸ 1.36
0.90 0.60 ͸ 1.34
Transportationforshopping Bicycle
0.73 0.59 ͸ 0.90
͸͸
0.80 0.63 ͸ 1.02
Motorbike
1.21 0.81 ͸ 1.79
͸͸
1.20 0.77 ͸ 1.85
Car
0.66 0.56 ͸ 0.78
͸͸
0.83 0.65 ͸ 1.05
Bus
1.27 0.98 ͸ 1.66
͸͸
0.79 0.59 ͸ 1.07
Taxi
2.52 1.82 ͸ 3.49
͸͸
1.44 0.99 ͸ 2.08
Disadvantagedshoppers
No
1.00
1.00
1.00
1.00
Permanently
1.46 1.19 ͸ 1.79
1.37 1.10 ͸ 1.70
1.37 1.10 ͸ 1.70
1.28 1.02 ͸ 1.63
Duetoshopclosure
1.48 1.16 ͸ 1.89
1.32 1.02 ͸ 1.70
1.34 1.04 ͸ 1.75
1.29 0.98 ͸ 1.69
HosmerͲLemeshowtest
P =0.92
P =0.82
P =0.88
Logisticregressionmodel
OR:OddsRatio;CI:ConfidenceInterval
CovariatesofModel1Ͳ3:Gender,Age,Household,Sourceofincome,Bodymass,LongͲtermcare,SelfͲratedhealth,Hypertension,Diabetes,Heartdisease,Visionproficiency,Hearingproficienc

社会医学研究．第 35 巻 1 号．Bulletin of Social Medicine, Vol.35（1）2018

社会医学研究．第 35 巻 1 号．Bulletin of Social Medicine, Vol.35（1）2018

Ⅳ．Discussion

Shoppers become disadvantaged as a result of

For those regularly going to grocery shops,

social aging as well as individual aging19). Locomotive

multivariate logistic regression indicated significant

syndrome is associated with of loss of social capital14).

odds ratios of around 1.3 for locomotive syndrome inAccessibility is associated with social exclusion20).

the group of permanently disadvantaged shoppers

With the coming hyperaging society, the number ofand disadvantaged shoppers due to shop closure

disadvantaged shoppers will increase rapidly. Because

compared with the group of non-disadvantaged

food is a basic necessity for maintaining a healthy andshoppers.

dignified life, food-supply stores, in some aspects, may

In the model with adjustment fortransportation (model3), disadvantaged shoppers

be considered public facilities21).

due to shop closure did not indicate significant odds

To prevent locomotive syndrome among

ratio. . Loss of significance of the group of shop

disadvantaged shoppers, the primary possible

closure partly reflects that shop closure might force

measure is to open shops. Previous studies indicatedinhabitants to use transportation and elevate thethat the opening of a new store in a food desert area

prevalence of locomotive syndrome among those

improves access to and the consumption of fruits

regularly going out to buy daily necessities. Amongand vegetables. Neighborhood residents who havethose not regularly going grocery shopping, thebetter access to supermarkets and limited accessassociation of disadvantaged shoppers due to the shop

to convenience stores tend to have healthier diets

closure was too small to enable a comparison withand lower levels of obesity 22). However, opening a

non-disadvantaged shoppers.

new grocery shop is difficult. Alternative measures

The results of the study indicated thatto reduce poor access may be the use of mobile

disadvantaged shoppers suffered the double fettersgrocery shops and delivered meals, although theof poor access to daily necessities and locomotive

current study indicated poor effectiveness against

syndrome. Augmented transportation upon thelocomotive syndrome. Regionally tailored policies,

closure of a shop did not offer any protective effectsuch as enhancing the access to healthy food outlets

against locomotive syndrome. Furthermore, taxi users

or community health centers offering nutrition

showed a risk association with locomotive syndrome.

education and campaigns, could effectively improve

Although there is an explanation of reverse causation

public health outcomes by reducing risk factors andthat those with locomotive syndrome use taxis,

efficiently allocating limited resources 23). Amongtaxi users were subject to the additional burden of

disadvantaged shoppers, users of mobile grocery

expenditure for transportation.

shops and delivered meals were limited to 10.1%

The use of delivered meals and mobile grocery

and 6.8% , respectively, in this study. This shows the

shops had no preventive effect on locomotive

possibility of increasing the number of users of these

syndrome in this study. Perishable foods are heavy

services by providing additional services to promote

to carry for elderly who go shopping by publictheir physical activity and to provide healthy foodtransportation and on foot. Consequently, theymenus for the elderly.

refrain from purchasing perishable foods. As a result,Access to daily necessities can be included underinadequate daily food and nutrient intake is induced.

the umbrella of basic social security. Support provided

The disadvantaged shoppers have no choice but

by local government to communities with regard toto purchase food at the remaining approachable

bus transportation is a current progressive measure2).

shops, where only a limited range of fresh food is

Few local governments have prepared budgets foravailable 1) . Poor access to grocery shops might

opening shops using the facilities of a closed shop or

have multidimensional adverse effects on health.

for establishing mobile grocery shops, citing limited

Disadvantaged shoppers are at the start of acapacity to develop specific plans and limited resources

downward spiral to locomotive syndrome.

as their reasons. In local regions where measures to－ 25 －

社会医学研究．第 35 巻 1 号．Bulletin of Social Medicine, Vol.35（1）2018

aid disadvantaged shoppers are needed, the entry ofevaluated using a self-administered questionnaire.

private services has reached 62 % , including services

Although previous studies focused on area-basedfor delivery and taking orders for purchases, andaggregated-level factors of food deserts19-22), such as

mobile grocery shops. The increase in the number of

the analysis of the relationship between proximity

supplemental services is an opportunity to develop

and density of food suppliers in an area, this study

effective measures not only for disadvantaged

provided an individual-level association between

shoppers but also for the maintenance of healthhealth condition and accessibility of food. Uncertainty

including the prevention of locomotive syndrome.

in the details of the circumstances of disadvantaged

Limitations of this study

shoppers was a significant limitation of the study.

In this cross-sectional study, the causal
correlations remained speculative. The questionnaire

Further study is needed to clarify the association
using a quantitative measurement of accessibility.

items were not reviewed for scale validity. The
external validity of the results was limited because

V. Conclusion

the subjects were not randomly selected from the

The results of this study indicated the possibility

general population. Ad-hoc sampling may induce anthat more disadvantaged shoppers have locomotive

underestimation of disadvantaged shoppers, who

syndrome than non-disadvantaged shoppers amongpresent a possibility of limited sampling. As for thethose regularly going to grocery shops. Daily

household composition of the subjects, the majority

accessing to a grocery shop might have a key role onof males lived in married-couple households, whereas

prevention of locomotive syndrome.

many females lived in single households; these results
seemed to reflect the household composition of theReferences

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