title: Association between the disability prevention program "Secondary Preventive Services" and disability incidence among the elderly population: A nationwide longitudinal comparison of Japanese municipalities.
abstract: OBJECTIVE
  The aim of the present ecological study was to evaluate the relationship between the rate of participation in Secondary Preventive Services (SPS) and the incidence of disability in Japanese municipalities.
  
  
  METHODS
  We used the national statistics data for Long-term Care Insurance (LTCI), because all Japanese people aged ≥65 years are eligible for LTCI services depending on their functional status assessed by a national uniform standard in all municipalities. The disability incidence rate for the 2-year period in 2009-2010 was compared among five different levels of SPS participation in 2006-2008. The primary outcome was the sum total disability incidence rate in LTCI from 2009 to 2010. The outcome was divided according to disability level into three patterns: "all levels (Support Level 1 - Care Level 5)", "mild disability (Care Level ≤1)" and "moderate to severe disability (Care Level ≥2)".
  
  
  RESULTS
  There was a significant inverse association between the SPS participation rate and disability incidence rate. Among 1541 municipalities, those in the highest SPS participation rate quintile (≥9.79 per 1000 elderly population) had a lower disability incidence rate for all levels than those in the lowest quintile (<1.86 per 1000 elderly population; absolute rate difference 0.6%; age-adjusted incident rate ratio 0.94; 95% CI 0.89-0.99). This inverse association was observed for mild disability and not for moderate to severe disability.
  
  
  CONCLUSIONS
  Municipalities with a higher SPS participation rate have a lower incidence rate of mild disability. SPS could be an effective health policy for containing mild disability incidence among the elderly.
authors.affiliation: Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Yasutake
authors.initials: Y
authors.lastname: Tomata
authors.affiliation: Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.|Department of Rehabilitation, Faculty of Health Science, Tohoku Fukushi University, Sendai, Japan.
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Sone
authors.affiliation: Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Wan-Ting
authors.initials: WT
authors.lastname: Chou
authors.affiliation: Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan.|Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Toru
authors.initials: T
authors.lastname: Tsuboya
authors.affiliation: Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Masako
authors.initials: M
authors.lastname: Kakizaki
authors.affiliation: Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Tsuji
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D015994:Incidence; D007353:Insurance, Long-Term Care; D007564:Japan / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D010342:Patient Acceptance of Health Care; D055502:Secondary Prevention
keywords: Japan; disability; disability prevention program; municipality