Authors examined the impact of sustained and one-time loneliness interventions on memory function among U.S. middle-aged and older adults. Using the nationally representative Health and Retirement Study in 2006–2018, we estimated counterfactual average memory scores over 12 years of follow-up under the following scenarios: (A) a hypothetical intervention eliminating loneliness only at baseline (baseline intervention), (B) a hypothetical intervention eliminating loneliness for 10 years (sustained intervention), and (C) the natural course (no intervention). The analytic sample included 10,136 participants (median baseline age 64 years, representing 50 million community-dwelling adults).

Findings: Over 12 years, estimated mean memory scores declined by 0.58 standardized units under the natural course; the difference in decline (vs natural course) was 0.00 standardized units under the baseline intervention and 0.02 standardized units under the sustained intervention. Compared to the natural course, authors did not find evidence that either the baseline or sustained intervention was associated with better memory function over follow-up.

This article features Yusuke Tsugawa, an affiliate at the UCLA Center for Health Policy Research.

Early detection of atrial fibrillation (AF) is essential for preventing ischemic stroke and other cardiovascular complications. However, the incidence and prognosis of AF in the general middle-aged population remain unclear. In Japan, annual health screenings for employees include mandatory ECGs, offering a unique opportunity to fill this evidence gap. This retrospective cohort study aimed to evaluate the incidence and subsequent cardiovascular outcomes of screening-detected AF in the general working population in Japan, using the Japan Health Insurance Association database, which covers one-quarter of the working-age population of that country. From individuals 35 to 59 years of age who underwent annual health screenings between April 2015 and March 2020, excluding those with a history of cardiovascular disease, those with initial AF detection upon screening ECGs were identified. The primary outcome was hospitalization for ischemic stroke. The secondary outcomes were all-cause death and hospitalization for heart failure. The association between screening-detected AF and outcomes was evaluated using adjusted subdistribution hazard models compared with matched controls.

Findings: Among 9.5 million individuals included in our study, 11,790 initial AF cases  were detected. Individuals with AF were older and more likely to be male compared with non-AF cases (91.6% versus 63.6%, respectively). Among these individuals with screening-detected AF, the 3-year incidences of ischemic stroke, all-cause death, and heart failure were 1.83% , 0.78%, and 3.87%, respectively. Compared with age- and sex-matched controls, individuals with AF had a higher risk of incident ischemic stroke, all-cause death, and heart failure.

These findings highlight the association of screening-detected AF with stroke and heart failure, warranting further study into AF as an early sign of heart failure and optimal cardiovascular risk reduction strategies after AF detection in the general middle-aged population.
 

Authors investigate whether the association between diabetes and suicide risk varies by area-level deprivation. They conducted a matched-pair cohort study using a nationwide health insurance database in Japan. Individuals with diabetes were matched 1:1 with those without diabetes by age, sex, and insurance status (i.e., insured person or their dependents). Area-level deprivation was assessed with a census-based Areal Deprivation Index (ADI). A Cox proportional hazards model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of suicide for individuals with diabetes by area-level deprivation level.

Findings: Among 5,31 million individuals (54.8% men, mean age 52.9 years), we observed 760 suicides. Individuals with diabetes experienced a higher risk of suicide than those without diabetes. The association between diabetes and suicide was stronger in less deprived areas than more deprived areas. Findings suggest greater psychosocial challenges of diabetes diagnosis and management faced by individuals living in less deprived areas, or a possibility that diabetes diagnosis may reduce disparities by improving healthcare access in more deprived areas.

To measure physician-level use of 10 low-value care services that provide no net clinical benefit and to investigate the characteristics of primary care physicians who frequently provide low-value care in Japan. This cross-sectional analysis used a nationwide electronic health record database linked with claims data in Japan to assess visits by adult patients (age ≥18 years) to a solo-practice primary care physician from October 1, 2022, through September 30, 2023. Authors analyzed the rate of low-value care services delivered per 100 patients per year, aggregated across 10 low-value measures, after accounting for case mix and other characteristics.

Findings: Nearly half of these low-value care services were provided by 10% of physicians. After accounting for patient case mix, older physicians (age ≥60 years) delivered 2.1 per 100 patients more low-value care services than those younger than 40 years; not board-certified physicians delivered 0.8 per 100 patients more than general internal medicine board-certified physicians; physicians with higher patient volumes delivered 2.3 per 100 patients more than those with low patient volumes; and physicians practicing in Western Japan delivered 1.0 per 100 patients more than those in Eastern Japan.