Geographic variation in proportions meeting the waist circumference criterion and having elevated hemoglobin A1c among Specific Health Checkup examinees in Japan: an ecological analysis of the 10th NDB Open Data.

Authors

Hirotaka Nakashima, Takahiro Kamihara, Takuya Omura

Published in

Environmental health and preventive medicine. Volume 31. Pages 54.

Abstract

Publicly available aggregate health data can support regional surveillance of cardiometabolic risk, but analyses must address aggregation, ecological inference, and cell suppression or unavailability. Waist circumference and body mass index (BMI) capture related but distinct aspects of adiposity. We evaluated the usefulness and limitations of selected 10th National Database (NDB) Open Data indicators for prefecture-level cardiometabolic surveillance among Specific Health Checkup examinees in Japan.
We conducted an ecological descriptive analysis of the 10th NDB Open Data. Data were analyzed by prefecture, sex, and 5-year age band among examinees aged 40-74 years. Primary indicators were the percentage meeting the waist circumference criterion (≥85 cm in men, ≥90 cm in women) and the percentage with hemoglobin A1c (HbA1c) ≥6.5%; BMI categories were examined as exploratory indicators. Prefecture-level percentages were internally age-standardized within sex using the age distribution of publicly displayed examinee counts pooled across prefectures for each indicator as the internal standard. Cells displayed as "-" were treated as suppressed/unavailable and not as zero values.
Waist circumference criterion data were complete across prefectures, sexes, and age bands. HbA1c ≥6.5% data were complete among men but included suppressed/unavailable cells among women, and BMI indicators had substantial cell suppression/unavailability. The age-standardized percentage meeting the waist circumference criterion ranged from 45.5% in Niigata to 60.6% in Okinawa among men and from 13.7% in Kyoto to 24.0% in Okinawa among women. HbA1c ≥6.5% ranged from 8.3% in Nagano to 11.3% in Miyagi among men and from 3.9% in Kanagawa to 7.8% in Saga among women. Okinawa had the highest percentage meeting the waist circumference criterion in both sexes. Waist-HbA1c correlations were positive in available-cell analyses, but estimates among women and estimates involving BMI were sensitive to cell availability and the prefectures included in the analysis.
The percentage meeting the waist circumference criterion was the most complete and robust descriptive indicator for prefecture-level cardiometabolic surveillance using the 10th NDB Open Data. HbA1c analyses among women and BMI-based analyses require suppression-aware interpretation. Ecological correlations should be interpreted as descriptive co-patterning of aggregate surveillance indicators, not as individual-level associations or evidence of regional determinants.
Not applicable.

PMID:
42618232
Bibliographic data and abstract were imported from PubMed on 20 Aug 2026.

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