Evaluation of Blood Pressure Control Medicines Using Health and Medical Checkup Data in Japan: Alternative Methods for Randomized Controlled Trials

Background: Many people take medicines to control high blood pressure (BP), or hypertension. Randomized clinical trials (RCT) are usually used for the evaluation of effects of medicines. However, RCT have some serious problems. Data and Methods: We evaluated the effects of BP medicines in Japan using a dataset containing 113,979 cases. We employed four statistical methods in the analysis. First, we simply compared the systolic blood pressure (SBP) of individuals with and without BP medicines. We then used a regression model with a dummy variable, representing taking medicines or not. We replaced the dummy variable by its expected value, and estimated the regression model again. Finally, we selected individuals who had both taken and not taken medicines at different times. The effect of sample selection was also considered in the estimation. Results: For the simple comparison, SBP with BP medicines was 11 mmHg higher than without medicines. In the next regression analysis, SBP with BP medicines was still 5 mmHg higher. When the dummy variable was replaced by its expected value, SBP with medicines decreased by 7 mmHg. For individuals taking medicines at some times and not at others, SBP decreased by 9 and 8 mmHg in models with and without a sample bias correction, respectively. Conclusion: The methods eliminated some problems of RCT and might be attractive. However, we obtained contradictory conclusions depending on the statistical methods employed, despite using the identical dataset. Statistical methods must be selected carefully to obtain a reliable evaluation. Limitations: The dataset was observatory, and the sample period was only 3 years.

Does High Systolic Blood Pressure Truly Increase Medical Expenditure?—An Empirical Analysis of the New 2017 ACC/AHA Hypertension Guideline

Background: High blood pressure (BP) or hypertension is considered one of the top global disease burden risk factors. In November 2017, the ACC/AHA and other organizations announced a new hypertension guideline of 130/80 mmHg. Data and Methods: We evaluate the effects of BP on increases in medical expenditures using transformation tobit models and a dataset containing 175,123 medical checkups and 6,312,125 receipts from 88,211 individuals in three health insurance societies. The sample period was April 2013 to March 2016. We first created a database of combined checkup results and medical expenditures. The power transformation tobit model was then used to remove the effects of other variables, and we investigated the relation between medical expenditures and BP, especially systolic BP (SBP). Results: We observed negative effects of SBP on medical expenditures. The results raise uncertainty about the reliability of the new guideline, at least for SBP. Although the simple correlation coefficient of medical expenditures and SBP was positive, the sign of the SBP estimate became negative when a variable representing obesity was included. In terms of other medical checkup items, while LDL is considered the “bad” cholesterol, it reduced medical expenditures. Conclusion: Our results did not support the new 2017 ACC/AHA guideline for SBP. A wide and careful range of reviews not only for heart diseases but also for other disease types will be absolutely necessary. New studies to verify the guideline should also be conducted. Limitations: The dataset was observatory, the sample period only 3 years, and we could not complete a time-series analysis of individuals.

Empirical Studies of Effects of High Blood Pressure on Medical Costs and Heart Disease: Is the 2017 ACC/AHA Guideline Supported by Enough Evidence?

Background: The American College of Cardiology (ACC), American Heart Association (AHA) and other organizations announced a new hypertension guideline in November 2017. However, previous studies have pointed out that this new guideline might lack sufficient evidence to justify its use. Data and Methods: The effects of blood pressure (BP) on medical costs and on the probability of having heart disease as anamnesis are analyzed. We used a dataset containing 175,123 medical checkups and 6,312,125 receipts from 88,211 individuals obtained from three health insurance societies from April 2013 to March 2016. The dataset was divided into subgroups based on whether the patients had diabetes and took hypertension medications. The power transformation and probit models were used in the study. Results: We observed negative effects of systolic BP (SBP) on medical costs in most subgroups. We could not find evidence that higher SBP made the medical costs and probability of having heart diseases higher. The results raise uncertainty about the reliability of the new guideline, at least for SBP. Conclusion: The results of this study did not support the new 2017 ACC/AHA guideline, at least for SBP. The new guideline must be more carefully reevaluated by additional studies. Limitations: The dataset was observatory, the sample period was only 3 years, and we could not complete a time-series analysis of individuals.

An Analysis of the Effects of Blood Pressure and Antihypertensive Drugs on Heart Disease

Background: The American College of Cardiology (ACC), American Heart Association (AHA) and other organizations announced a new hypertension guideline (2017 ACA/AHA Guideline) in November 2017. However, other organizations such as the European Society of Cardiology and European Society of Hypertension maintained their diagnostic thresholds. It is necessary to evaluate the effects of blood pressure (BP) and antihypertensive drugs on the probability of having heart disease (HD). Data and Methods: The effects of BP, antihypertensive drugs and other factors on the probability of undergoing HD treatment were analyzed. We used a dataset containing 83,287 medical check-up and treatment records obtained from 35,504 individuals in 5 fiscal years. The probit models were used in the study. Considering the possibility of endogeneity problems, different types of models were used. Results: We could not find evidence that a higher systolic BP increased the probability of undergoing HD treatment. However, diastolic BP increased the probability in most of the models. Taking antihypertensive drugs also increased the probability of undergoing HD treatment. Diabetes was another important risk factor. Conclusion: The results of this study did not support the new 2017 ACC/AHA Guideline. It is necessary to choose proper drugs and methods to reduce the risks of side effects. Limitations: The dataset was observatory, the data were obtained from just one medical society, and sample selection bias might exist.

An Analysis of Blood Pressure Situations in Japan Using the Large-Scale Medical Checkup Dataset

Background: The high blood pressure (BP) or hypertension is a widely prevalent disease and its costs are very high, and many studies about the relationships between BP and health conditions have been done. We need to know the precise distributions of BP and factors affecting BP. Data and Methods: The distributions of BP are analyzed using 12,877,653 observations obtained from the JMDC Claims Database. The factors that may affect the BP are analyzed by the regression models using 4,615,346 observations. Results: The averages of systolic BP (SBP) and diastolic BP (DBP) are 120.4 and 74.2 mmHg with standard deviations of 15.9 and 11.3 mmHg, respectively. Among the nonmodifiable factors, age and gender are important factors. Among the modifiable factors, variables related to obesity are important risk factors. Taking antihypertensive drugs makes SBP and DBP 13.4 mmHg and 7.8 mmHg lower. Conclusion: The criteria of BP should be carefully determined considering age and gender. The effects of age may be a little different for SBP and DBP. It is necessary to use the proper model to evaluate the effect of antihypertensive drugs correctly. Limitations: The dataset is observatory. Although there are various types of treatment methods and antihypertension drugs, their effects are not evaluated.

Estimation of Diabetes Prevalence, and Evaluation of Factors Affecting Blood Glucose Levels and Use of Medications in Japan

Background: Diabetes is a noncommunicable disease caused by high levels of blood glucose, and it is currently one of the most important public health problems in the world. It is important to know the prevalence of diabetes, the factors affecting blood glucose levels, and the percentage of people with diabetes taking medications. Data and Methods Data and Methods: We analyzed the distribution of blood glucose levels and prevalence of diabetes using 10,917,173 observations obtained from the JMDC Claims Database in Japan. The factors that may affect blood glucose levels were analyzed by a regression model using 5,472,205 observations. Treatment with diabetes medications was analyzed with 9,932,854 and 5,466,361 observations using a method to approximate the inverse of probability by a continuous piecewise linear function. Results: The prevalence of diabetes in 2019 was estimated to be 9.63% in males and 5.33% in females ages 20 - 79;10.78% and 7.04% for ages 20 - 89;and 10.93% and 7.65% for ages 20 - 99, respectively. In addition to age and gender, the important variables affecting blood glucose levels were BMI, SBP, Triglyceride, ALT, AST and GGP. The percentage taking medications increased up to a blood glucose level of around 175 mg/dL, but declined over that. Conclusion: The prevalence of diabetes in Japan was estimated using a very large dataset, and considering age, gender, and time trends. Some variables may be effective for controlling blood glucose levels. Nearly half of those at a serious stage of diabetes took no medications. Proper medical care for these individuals is necessary to prevent worsening diabetes and serious complications. Limitations: The dataset was observatory, and did not include those age 80 or over. Revising medical care systems to include those outside of hospitals is necessary;however, practical approaches have not yet been developed.

Measuring the Competitiveness of China＇s Processed Exports

中国在处理贸易的剩余仍然保持大。处理出口是用部分生产的最后的商品，是进口关税的部件释放。因为许多这些出口的增值来自东亚，在整个这个区域的汇率应该影响他们的外国货币价格。这份报纸在他们显著地影响出口的 1993-2013 时期和报告上为处理出口在增值汇率上论述数据。当人民币在 2005 的开始和 2013 的结束之间欣赏了 36% 时，在供应的汇率锁住降低的国家。这在处理出口的价格竞争力上减轻了 RMB 欣赏的效果。

R&D Activities of Manufacturing Multinationals in China:Structure,Motivations and Regional Differences

这份报纸调查在中国操作的各种各样的跨国公司的 R&D 动机，在在科技活动的正式中国统计的大规模、公司级的数据集上绘画。现在的学习显示出在中国的努力那么为外国自己的公司为外国自己、国内的公司，而是更少加强了的那 R&D，也许因为外国自己的公司趋于操作在他们的家国家以内开发的工艺的能力的一个基础。

THE ASYMMETRY OF THE WTO DISPUTE SETTLEMENT MECHANISM AND CHINESE STRATEGY： IN WHAT WAYS DO THE SYSTEM AND RESULTS FAVOR COMPLAINANTS？

By referring to 400 WTO cases, this paper reviews the results of WTO dispute settlement proceedings and the systemic causes in order to find out whether the WTO dispute settlement system ＂s results reflect a clear tendency of favoring complainants, and if so, whether the internal asymmetry of the system leads to such results. Based on these findings, and by considering a number of factors, this paper analyses the influence on national interests brought about by such asymmetry, so as to find whether there is a two-way adjustment effect and relative deprivation effect for developing countries. Then, according to the current economic situations of the WTO＇s Asian countries, this paper suggests that the Asian members should reform their policies to overcome the disadvantages of the WTO asymmetric proceedings. In this part, this paper comprehensively evaluates the measure of actively using the WTO dispute settlement system that favors the complainants, in order to develop overseas markets and realize potential benefits of treaty negotiations.

China＇s Growth Slowdown： Lessons from Japan＇s Experience and the Expected Impact on Japan, the USA and Germany

China is switching from economic growth based on extremely rapid capital accumulation to economic growth based on structural reforms and accelerated total factor productivity growth. Meanwhile, China will also face a serious excess saving problem as capital accumulation slows and, hence, needs to reduce its private saving rate. Based on this analysis, we estimated the economic impact of China＇s growth slowdown and hypothetical economic transformation on Japan, the USA and Germany using the worm input-output database. We compared the following three scenarios for China＇s final demand in 2020 and economic growth from 2015 to 2020： （i） an optimistic scenario （GDP growth rate = 6.2%, investment/GDP = 0.501）; （ii） a slowdown scenario （GDP growth rate = 4%, investment/GDP = 0.501）; and （iii） a structural reform scenario （GDP growth rate = 6.2%, investment/GDP = 0.3）. Our analysis suggests that Japan and Germany would suffer more from structural reforms in China than from a slowdown in growth. Meanwhile, for the USA, the employment decline triggered by structural reforms wouM be much smaller than the employment decline caused by a slowdown in growth.