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...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.展开更多
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...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.展开更多
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 t...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.展开更多
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 organizat...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.展开更多
<strong>Background: </strong>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 condition...<strong>Background: </strong>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. <strong>Data and Methods</strong><strong>:</strong> 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. <strong>Results:</strong> 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. <strong>Conclusion:</strong> 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. <strong>Limitations:</strong> The dataset is observatory. Although there are various types of treatment methods and antihypertension drugs, their effects are not evaluated.展开更多
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 di...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 <em>BMI</em>, <em>SBP</em>, <em>Triglyceride</em>, <em>ALT</em>, <em>AST</em> and <em>GGP</em>. 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.展开更多
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 te...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.展开更多
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 ...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.展开更多
文摘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.
文摘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.
文摘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.
文摘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.
文摘<strong>Background: </strong>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. <strong>Data and Methods</strong><strong>:</strong> 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. <strong>Results:</strong> 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. <strong>Conclusion:</strong> 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. <strong>Limitations:</strong> The dataset is observatory. Although there are various types of treatment methods and antihypertension drugs, their effects are not evaluated.
文摘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 <em>BMI</em>, <em>SBP</em>, <em>Triglyceride</em>, <em>ALT</em>, <em>AST</em> and <em>GGP</em>. 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.
文摘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.
基金We gratefully acknowledge financial support from the Japan Society for the Promotion of Science (Grant No. 16H06322), the Social Science Foundation of China (Grant No. 11AJY006) and the Key Project of Chinese Ministry of Education (Grant No. 12JJD790038).
文摘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.