Background: We examined the associations of alcohol consumption and liver holidays with all-cause mortality and with mortality due to cancer, heart disease, cerebrovascular disease, respiratory disease, and injury using a large-scale prospective study in Japan.Methods: We followed 102,849 Japanese who were aged between 40 and 69 years at baseline for 18.2 years on average, during which 15,203 deaths were reported. Associations between alcohol intake and mortality risk were assessed using a Cox proportional hazards model, with analysis by the number of liver holidays (in which a person abstains from drinking for several days a week).Results: A J-shaped association was observed between alcohol intake and total mortality in men (nondrinkers: reference; occasional drinkers: hazard ratio [HR] 0.74; 95% confidence interval [CI], 0.68–0.80; 1–149 g/week: HR 0.76; 95% CI, 0.71–0.81; 150–299 g/week: HR 0.75; 95% CI, 0.70–0.80; 300–449 g/week: HR 0.84; 95% CI, 0.78–0.91; 450–599 g/week: HR 0.92; 95% CI, 0.83–1.01; and ≥600 g/week: HR 1.19; 95% CI, 1.07–1.32) and in women (nondrinkers: reference; occasional: HR 0.75; 95% CI, 0.70–0.82; 1–149 g/week: HR 0.80; 95% CI, 0.73–0.88; 150–299 g/week: HR 0.91; 95% CI, 0.74–1.13; 300–449 g/week: HR 1.04; 95% CI, 0.73–1.48; and ≥450 g/week: HR 1.59; 95% CI, 1.07–2.38). In current drinkers, alcohol consumption was associated with a linear, positive increase in mortality risk from all causes, cancer, and cerebrovascular disease in both men and women, but not heart disease in men. Taking of liver holidays was associated with a lower risk of cancer and cerebrovascular disease mortality in men.Conclusions: Alcohol intake showed J-shaped associations with the risk of total mortality and three leading causes of death. However, heavy drinking increases the risk of mortality, which highlights the necessity of drinking in moderation coupled with liver holidays.

Purpose: The aim of this study was to project new cancer cases/deaths forward to 2054, and decompose changes in cancer cases/deaths to assess the impact of demographic transitions on cancer burden. Methods: We collected data on cancer cases/deaths up to 2019, empirically validated the projection performance of multiple statistical models, and selected optimal models by applying time series cross-validation. Results: We showed an increasing number of new cancer cases but decreasing number of cancer deaths in both genders, with a large burden attributed to population aging. We observed the increasing incidence rates in most cancer sites but reducing rates in some infection-associated cancers, including stomach and liver cancers. Colorectal and lung cancers were projected to remain as leading cancer burdens of both incidence and mortality in Japan over 2020–2054, while prostate and female breast cancers would be the leading incidence burdens among men and women, respectively. Conclusions: Findings from decomposition analysis require more supportive interventions for reducing mortality and improving the quality of life of Japanese elders. We emphasize the important role of governments and policymakers in reforming policies for controlling cancer risk factors, including oncogenic infections. The rapid increase and continued presence of those cancer burdens associated with modifiable risk factors warrant greater efforts in cancer control programs, specifically in enhancing cancer screening and controlling cancer risk factors in Japan.

With an increasing burden of non-communicable disease in Nepal and limited progress towards universal health coverage, country- and disease-specific estimates of financial hardship related to healthcare costs need to be evaluated to protect the population effectively from healthcare-related financial burden. To estimate the cost and economic burden of illness and to assess the inequality in the financial burden due to catastrophic health expenditure from 1995 to 2010 in Nepal. This study used nationally representative Nepal Living Standards Surveys conducted in 1995 and 2010. A Bayesian two-stage hurdle model was used to estimate average cost of illness and Bayesian logistic regression models were used to estimate the disease-specific incidence of catastrophic health payment and impoverishment. The concentration curve and index were estimated by disease category to examine inequality in healthcare-related financial hardship. Inflation-adjusted mean out-of-pocket (OOP) payments for chronic illness and injury increased by 4.6% and 7.3%, respectively, while the cost of recent acute illness declined by 1.5% between 1995 and 2010. Injury showed the highest incidence of catastrophic expenditure (30.7% in 1995 and 22.4% in 2010) followed by chronic illness (12.0% in 1995 and 9.6% in 2010) and recent acute illness (21.1% in 1995 and 7.8% in 2010). Asthma, diabetes, heart conditions, malaria, jaundice and parasitic illnesses showed increased catastrophic health expenditure over time. Impoverishment due to injury declined most (by 12% change in average annual rate) followed by recent acute illness (9.7%) and chronic illness (9.6%) in 15 years. Inequality analysis indicated that poorer populations with recent acute illness suffered more catastrophic health expenditure in both sample years, while wealthier households with injury and chronic illnesses suffered more catastrophic health expenditure in 2010. To minimize the economic burden of illness, several approaches need to be adopted, including social health insurance complemented with an upgraded community-based health insurance system, subsidy program expansion for diseases with high economic burden and third party liability motor insurance to reduce the economic burden of injury.

Background: This study aimed to assess long-term trends in the incidence of prostate cancer by stage at diagnosis before and after the introduction of population-based PSA screening.Methods: We used data from three population-based cancer registries in Japan. A total of 29,458 malignant prostate cancer cases diagnosed between 1993 and 2014 were used for the analysis. Multiple imputation with chained equations was used to impute a specific stage at diagnosis for cases with “unknown” and missing status. We estimated the age-standardized incidence rates by stage at diagnosis from 1993 to 2014, and used joinpoint linear regression models to assess changes in trend.Results: Joinpoint analyses after imputation showed that localized cancer was stable from 1993 to 2000, followed by a pronounced but insignificant increase through 2003 (from 12.1 per 100,000 in 2001 to 34.1 per 100,000 in 2003), and a significant increase thereafter [annual percentage change (APC), 4.1%]. For regional cancer, the imputed data showed that the increasing trend lasted from 1993 to 2006 (APC, 12.5%), then leveled off through 2014. For distant prostate cancer, the imputed data showed the increasing trend continued from 1993 to 2004 (APC, 2.4%), and started to marginally decline thereafter (APC, −2.2%).Conclusions: Our study confirmed a significantly rapid increase in localized prostate cancer after the spread of PSA screening in Japan, with a marginal decrease in distant prostate cancer after 2004.Impact: Evaluation of the effectiveness of PSA screening would require a comprehensive analysis of changes in mortality, survival, and treatment practices over time.

Background: This study was performed to investigate the association between body mass index (BMI) and gastric cancer in East and Southeast Asia where most of gastric cancer is non-cardia gastric cancer. Methods: On the basis of 8,997 gastric cancer cases among the Asia Cohort Consortium participants from China, Japan, Korea, and Singapore (N = 538,835), we assessed gastric cancer risk according to BMI by calculating hazard ratios (HR) and 95% confidence intervals (CI) using the Cox proportional hazard regression model. Results: A U-shaped associations between BMI and gastric cancer risk were observed. Gastric cancer risks in underweight group (<18.5 kg/m2) and in obesity group (≥27.5 kg/m2) were higher than reference BMI group (23–24.9 kg/m2; HR, 1.15; 95% CI, 1.05–1.25 for underweight; HR, 1.12; 95% CI, 1.03–1.22 for obesity, respectively). The associations of underweight and obesity with gastric cancer risk were consistent in the analyses for non-cardia gastric cancer, intestinal-type gastric cancer, and late-onset gastric cancer. No significant association of underweight and obesity with the risk of cardia gastric cancer, diffuse-type gastric cancer, and early-onset gastric cancer was observed. In addition, we found that the U-shaped association between BMI and gastric cancer risk remained in nonsmokers, while only underweight was related to increased gastric cancer risk in smokers. Conclusions: BMI has a U-shaped association with gastric cancer risk in East and Southeast Asian population, especially for the non-cardia gastric cancer, intestinal-type gastric cancer, and late-onset gastric cancer. Impact: Future studies with consideration of anatomic location and histology of gastric cancer are needed to establish the association of underweight as well as obesity with gastric cancer risk.

The association between body mass index (BMI) and oesophageal cancer (OC) has been consistently negative among Asians, whereas different associations based on histological OC subtypes have been observed in Europeans and North Americans. We examined the association between BMI and OC mortality in the Asia Cohort Consortium. We performed a pooled analysis to evaluate the association between BMI and OC mortality among 842 630 Asians from 18 cohort studies. Cox regression models were used to estimate hazard ratios (HRs) and 95% CIs. A wide J-shaped association between BMI and overall OC mortality was observed. The OC mortality risk was increased for underweight (BMI <18.5 kg/m²: HR = 2.20, 95% CI 1.80–2.70) and extreme obesity (BMI ≥35 kg/m²: HR = 4.38, 95% CI 2.25–8.52) relative to the reference BMI (23–25 kg/m²). This association pattern was confirmed by several alternative analyses based on OC incidence and meta-analysis. A similar wide J-shaped association was observed in oesophageal squamous cell carcinoma (OSCC). Smoking and alcohol synergistically increased the OC mortality risk in underweight participants (HR = 6.96, 95% CI 4.54–10.67) relative to that in reference BMI participants not exposed to smoking and alcohol. Extreme obesity and being underweight were associated with an OC mortality risk among Asians. OC mortality and BMI formed a wide J-shaped association mirrored by OSCC mortality. Although the effect of BMI on OSCC and oesophageal adenocarcinoma mortality can be different in Asians, further research based on a large case–control study is recommended.