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Global Health Econ Sustain Effects of community-based activities on LTC needs

Table 1. Categories of insured persons of LTCI in Japan
Category I Category II
Eligible persons Persons aged 65 or over Persons aged 40–64 who are insured by health-care
insurance
Beneficiaries Persons requiring long-term care (bedridden, dementia), or Those who have become bed-ridden, dementia, and/or frail
persons requiring support (frail) because of specific age-related diseases, such as early-onset
dementia and cerebrovascular diseases
Premiums Collected by LTC insurers (municipalities) Collected with premiums for health care insurance by
health-care insurers and paid in lump sums
Abbreviation: LTCI: Long-term care insurance.

The respondents were randomly identified from the value of 1 for almost daily drinking and 0 otherwise. We
2020 resident registry data of A city. The 4535 identified also created a dichotomous variable of current smoking
respondents accounted for approximately 20% of the almost with a value of 1 for every day to seldom smoking, 0 if never
22,000 residents aged 65 years and older. Almost 30% of the smoked, and a dichotomous variable of a former smoker.
sample was from non-taxed households (N = 1,371; LTC The respondents of the LIFE study assessed their
income categories 1 – 3). We only considered adults living current self-assessed health (SAH) on a 4-point scale
at home and excluded those living in nursing homes from where responses of “very good,” “good,” “fair,” or “poor”
the study. were assigned values of 4, 3, 2, and 1, respectively. We

LIFE study researchers cannot use respondents’ codes created a dichotomous variable of SAPH with a value of 1 if
as they can be matched with their names (Fukuda et al., SAH was fair or poor, and 0 otherwise. Following the same

2023); therefore, we used the delivered respondents’ codes methodology, we created a discrete variable of requiring
when merging datasets of the complete enumeration and care. This variable has a value of 2 if the respondents
sampling survey. The monthly series of insurance premium receive care services, formal LTC services, or informal
categories for primary insured persons were provided. care provided by family caregivers, 1 if not receiving care
Variables regarding social engagement level were collected services despite requiring care, and 0 if not requiring care.
through the sampling survey of LTCI needs, which was Oshio & Kan (2019) examined the respective

conducted in February 2020 in A city. The effective relationships between social participation activities
respondents were 2243 (response rate: 52.2%). Required and three mild lifestyle-related diseases (hypertension,
items of this survey are available on the following site dyslipidemia, and diabetes mellitus). They found that
(https://www.mhlw.go.jp/content/12301000/000560423. women were less likely to be diagnosed with hypertension.
pdf). Our dataset (N = 4,535) was completed by the However, they did not distinguish participation in sports
many-to-many merge method, which creates pairwise activities from other social activities, including “hobbies
combinations of observations that match each ID.
and culture,” “community events,” “support of child-
2.2. Variables related to lifestyle and social raising,” “support for older adults,” and “other social
participation activities participation activities.” As physical exercise is associated
with mild lifestyle-related diseases (Colberg et al., 2016;

The previous studies of the relationship between health Gordon et al., 2014; Hagberg et al., 2000), it is difficult to
behaviors and lifestyle-related diseases have suggested that discriminate between social participation activities and
weight gain is a major risk factor(Brown et al., 2000; Huang physical exercise(Sekizawa et al., 2022). To counteract this

et al., 1998). In addition, increased alcohol consumption difficulty, we created categorical and dichotomous variables
has been found to increase the risk of stroke, whereas it for social participation. The frequency of participation in
decreases the risk of myocardial infarction (Wood et al., hobby group activities took a value of 5 if it occurred more

2018). Furthermore, those who quit smoking are more than 4 times a week, 1 if it occurred a few times a year, and
likely to develop mild lifestyle-related diseases (Sekizawa 0 otherwise. A dichotomous variable took a value of 1 if

et al., 2022). participation occurred at least a few times in a year, and 0
The LIFE study collected data on the frequency otherwise.
of alcohol consumption and on smoking behaviors,
categorizing individuals as those who smoke, those who 2.3. Modeling subjective health and requiring care
quit smoking, and those who have never smoked. We Our empirical strategy was a two-step approach (Figure 1).
created a dichotomous variable of alcohol intake, with a First, we used the instrumental variable method (IV probit)

Volume 1 Issue 1 (2023) 3 https://doi.org/10.36922/ghes.0891