{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T06:55:39Z","timestamp":1790924139834,"version":"4.1.0"},"reference-count":34,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["JGH Open"],"published-print":{"date-parts":[[2026,10]]},"abstract":"ABSTRACT<\/jats:title>\n \n Aims<\/jats:title>\n We investigated the association between prefecture\u2010level colorectal cancer (CRC) mortality and contributing factors, including the regional availability of Board\u2010Certified Fellows of the Japan Gastroenterological Endoscopy Society (BCFJGES), using publicly available data from all 47 Japanese prefectures.<\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n This prefecture\u2010level ecological cross\u2010sectional study used publicly available national data from e\u2010Stat, Cancer Statistics by the Japan National Cancer Center, and JGES records. The dependent variable was the CRC\u2010specific age\u2010standardized mortality rate (AMR) among individuals aged <\u200975\u2009years in 2021. Independent variables (2010\u20132016) included CRC screening and follow\u2010up rates, smoking, alcohol consumption, obesity, physical activity, diabetes prevalence, red meat consumption, mean income, gastroenterologist and BCFJGES density per 10\u2009000 population, CRC stage distribution, and regional classification. Simple linear regression showed that smoking, alcohol consumption, and obesity were significantly associated with higher CRC AMR, whereas physical activity, income, and BCFJGES density were associated with lower AMR. Multiple linear regression confirmed independent associations for smoking (regression coefficient [\n b<\/jats:italic>\n ]\u2009=\u20090.213,\n p<\/jats:italic>\n \u2009=\u20090.011), alcohol consumption (\n b<\/jats:italic>\n \u2009=\u20090.045,\n p<\/jats:italic>\n \u2009=\u20090.003), physical activity (\n b<\/jats:italic>\n \u2009=\u2009\u22120.087,\n p<\/jats:italic>\n \u2009=\u20090.024), and BCFJGES density (\n b<\/jats:italic>\n \u2009=\u2009\u22121.339,\n p<\/jats:italic>\n \u2009<\u20090.001). The Pearson correlation coefficient between AMR and BCFJGES density was \u22120.482 (\n p<\/jats:italic>\n \u2009<\u20090.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Higher prefecture\u2010level smoking and alcohol consumption were associated with higher CRC mortality, while higher physical activity and higher BCFJGES density were associated with lower mortality. Regional disparities in BCFJGES distribution across Japan may contribute to CRC mortality and warrant continued surveillance and policy attention.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/jgh3.70477","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T06:45:36Z","timestamp":1790923536000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Inverse Association Between Regional Availability of Board\u2010Certified Fellows of the Japan Gastroenterological Endoscopy Society and Colorectal Cancer Mortality in Japan: An Ecological Analysis"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2703-9509","authenticated-orcid":false,"given":"Kazuya","family":"Inoki","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine Showa Medical University School of Medicine Tokyo Japan"},{"name":"Graduate School of Public Health, St. Luke's International University Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0053-7791","authenticated-orcid":false,"given":"Mahbubur","family":"Rahman","sequence":"additional","affiliation":[{"name":"Graduate School of Public Health, St. Luke's International University Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sayaka","family":"Mizuno","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine Showa Medical University School of Medicine Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norihiro","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine Showa Medical University School of Medicine Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinya","family":"Nakatani","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine Showa Medical University School of Medicine Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuo","family":"Kikuchi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine Showa Medical University School of Medicine Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5067-5135","authenticated-orcid":false,"given":"Atsushi","family":"Katagiri","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine Showa Medical University School of Medicine Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitoshi","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine Showa Medical University School of Medicine Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi","family":"Kakushima","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine Showa Medical University School of Medicine Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1056\/NEJM199305133281901","article-title":"Reducing Mortality From Colorectal Cancer by Screening for Fecal Occult Blood. 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