{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:38:22Z","timestamp":1787236702847,"version":"build-2736575974"},"reference-count":45,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T00:00:00Z","timestamp":1781395200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":67,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004721","name":"The University of Tokyo","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004721","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Aging Clin Exp Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Long-term population-level evidence on frailty trajectories, particularly among the oldest-old, remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To evaluate 6-year frailty trajectories in community-dwelling adults aged\u2009\u2265\u200950 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cohort study using a regional Japanese administrative claims database from 2012 to 2020. Frailty was measured using the electronic Frailty Index. Inverse probability of censoring weighting accounted for insurance-plan disenrollment, and weighted multinomial logistic regression estimated adjusted 6-year transition probabilities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The cohort included 1,040,663 adults aged\u2009\u2265\u200950 years (mean age, 73.2 years; 58.6% women). Six-year final status worsened with baseline frailty severity: death increased from 12.7% among fit individuals to 23.8%, 34.7%, and 49.1% among those with mild, moderate, and severe frailty. Among those with severe frailty, recovery to fit status occurred in 2.6%, and recovery to fit or mild frailty in 9.0%; 91.0% died or were in moderate-to-severe frailty. Age- and sex-specific patterns differed. Among fit adults aged 65\u201374 years, women had lower mortality than men (4.3% vs. 8.7%) and higher probabilities of being alive with mild or moderate frailty (26.6% vs. 21.8%; 6.1% vs. 4.9%). Among fit adults aged\u2009\u2265\u200985 years, death was the dominant final state, although women had lower mortality (53.9% vs. 59.0%) and higher fit status (21.7% vs. 18.8%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Severe frailty was rarely followed by recovery to fit or mild status. Sex differences in frailty trajectories varied across age groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings highlight severe frailty as a late high-risk state and may inform age- and sex-specific frailty risk stratification and care planning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s40520-026-03434-z","type":"journal-article","created":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T08:46:36Z","timestamp":1781426796000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Trajectory of frailty among the older people in a community setting: A cohort study from the Shizuoka Kokuho Database"],"prefix":"10.1007","volume":"38","author":[{"given":"Shiori","family":"Nishimura","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuki","family":"Morohoshi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryo","family":"Nakamaru","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisateru","family":"Tachimori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Yamamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eiji","family":"Nakatani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masato","family":"Takeuchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiki","family":"Miyachi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shun","family":"Kohsaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroaki","family":"Miyata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiraku","family":"Kumamaru","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,14]]},"reference":[{"key":"3434_CR1","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1016\/S0140-6736(12)62167-9","volume":"381","author":"A Clegg","year":"2013","unstructured":"Clegg A, Young J, Iliffe S et al (2013) Frailty in elderly people. Lancet 381:752\u2013762","journal-title":"Lancet"},{"key":"3434_CR2","doi-asserted-by":"publisher","first-page":"M146","DOI":"10.1093\/gerona\/56.3.M146","volume":"56","author":"LP Fried","year":"2001","unstructured":"Fried LP, Tangen CM, Walston J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol Biol Sci Med Sci 56:M146\u2013M156","journal-title":"J Gerontol Biol Sci Med Sci"},{"key":"3434_CR3","doi-asserted-by":"publisher","first-page":"975","DOI":"10.1111\/j.1532-5415.2006.00738.x","volume":"54","author":"K Rockwood","year":"2006","unstructured":"Rockwood K, Mitnitski A, Song X et al (2006) Long-term risks of death and institutionalization of elderly people in relation to deficit accumulation at age 70. J Am Geriatr Soc 54:975\u2013979","journal-title":"J Am Geriatr Soc"},{"key":"3434_CR4","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1016\/S0140-6736(96)91592-5","volume":"347","author":"K Matsubayashi","year":"1996","unstructured":"Matsubayashi K, Okumiya K, Wada T et al (1996) Secular improvement in self-care independence of old people living in community in Kahoku, Japan. Lancet 347:60","journal-title":"Lancet"},{"key":"3434_CR5","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1016\/S0140-6736(13)60049-5","volume":"381","author":"E Fukutomi","year":"2013","unstructured":"Fukutomi E, Kimura Y, Wada T et al (2013) Long-term care prevention project in Japan. Lancet 381:116","journal-title":"Lancet"},{"key":"3434_CR6","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1100\/tsw.2001.58","volume":"1","author":"AB Mitnitski","year":"2001","unstructured":"Mitnitski AB, Mogilner AJ, Rockwood K (2001) Accumulation of deficits as a proxy measure of aging. ScientificWorldJournal 1:323\u2013336","journal-title":"ScientificWorldJournal"},{"key":"3434_CR7","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/1471-2318-8-24","volume":"8","author":"SD Searle","year":"2008","unstructured":"Searle SD, Mitnitski A, Gahbauer EA et al (2008) A standard procedure for creating a frailty index. BMC Geriatr 8:24","journal-title":"BMC Geriatr"},{"key":"3434_CR8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/ageing\/afac009","volume":"51","author":"S Nishimura","year":"2022","unstructured":"Nishimura S, Kumamaru H, Shoji S et al (2022) Assessment of coding-based frailty algorithms for long-term outcome prediction among older people in community settings: a cohort study from the Shizuoka Kokuho Database. Age Ageing 51:1\u20139","journal-title":"Age Ageing"},{"key":"3434_CR9","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1093\/ageing\/afw039","volume":"45","author":"A Clegg","year":"2016","unstructured":"Clegg A, Bates C, Young J et al (2016) Development and validation of an electronic frailty index using routine primary care electronic health record data. Age Ageing 45:353\u2013360","journal-title":"Age Ageing"},{"key":"3434_CR10","unstructured":"England NHS (2024) accessed October 30,. NHS standard general medical services contract October 2020 n.d. https:\/\/www.england.nhs.uk\/wp-content\/uploads\/2020\/12\/20-21-GMS-Contract-October-2020.pdf"},{"key":"3434_CR11","unstructured":"England NHS (2019) n.d The NHS long term plan. https:\/\/www.england.nhs.uk\/wp-content\/uploads\/2022\/07\/nhs-long-term-plan-version-1.2.pdf (accessed October 30, 2024)"},{"key":"3434_CR12","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1007\/BF02982161","volume":"12","author":"G van Abellan","year":"2008","unstructured":"van Abellan G, Rolland Y, Bergman H et al (2008) The I.A.N.A Task Force on frailty assessment of older people in clinical practice. J Nutr Health Aging 12:29\u201337","journal-title":"J Nutr Health Aging"},{"key":"3434_CR13","doi-asserted-by":"publisher","first-page":"418","DOI":"10.1001\/archinte.166.4.418","volume":"166","author":"TM Gill","year":"2006","unstructured":"Gill TM (2006) Transitions between frailty states among community-living older persons. Arch Intern Med 166:418\u2013423","journal-title":"Arch Intern Med"},{"key":"3434_CR14","doi-asserted-by":"publisher","first-page":"1310","DOI":"10.1093\/gerona\/59.12.1310","volume":"59","author":"K Rockwood","year":"2004","unstructured":"Rockwood K, Howlett SE, MacKnight C et al (2004) Prevalence, attributes, and outcomes of fitness and frailty in community-dwelling older adults: report from the Canadian study of health and aging. J Gerontol Biol Sci Med Sci 59:1310\u20131317","journal-title":"J Gerontol Biol Sci Med Sci"},{"key":"3434_CR15","doi-asserted-by":"publisher","first-page":"e347","DOI":"10.1093\/gerona\/glab196","volume":"76","author":"RE Ward","year":"2021","unstructured":"Ward RE, Orkaby AR, Dumontier C et al (2021) Trajectories of frailty in the 5 years prior to death among U.s. veterans born 1927\u20131934. J Gerontol Biol Sci Med Sci 76:e347\u2013e353","journal-title":"J Gerontol Biol Sci Med Sci"},{"key":"3434_CR16","doi-asserted-by":"publisher","first-page":"63","DOI":"10.12688\/hrbopenres.13286.1","volume":"4","author":"R Romero-Ortuno","year":"2021","unstructured":"Romero-Ortuno R, Hartley P, Knight SP et al (2021) Frailty index transitions over eight years were frequent in The Irish Longitudinal Study on Ageing. HRB Open Res 4:63","journal-title":"HRB Open Res"},{"key":"3434_CR17","unstructured":"Ministry of Internal Affairs and Communications (2026) Population Estimates by Age (Five-Year Groups) and Sex. Population Estimates 2026. https:\/\/www.stat.go.jp\/data\/jinsui\/pdf\/202604.pdf"},{"key":"3434_CR18","doi-asserted-by":"publisher","first-page":"3","DOI":"10.35772\/ghm.2019.01011","volume":"1","author":"H Nakatani","year":"2019","unstructured":"Nakatani H (2019) Population aging in Japan: policy transformation, sustainable development goals, universal health coverage, and social determinates of health. Glob Health Med 1:3\u201310","journal-title":"Glob Health Med"},{"key":"3434_CR19","doi-asserted-by":"publisher","unstructured":"Koutsogeorgopoulou V, Morgavi H (2025) Ageing populations, their fiscal implications and policy responses. https:\/\/doi.org\/10.1787\/6aec03b3-en. Organisation for Economic Co-Operation and Development (OECD)","DOI":"10.1787\/6aec03b3-en"},{"key":"3434_CR20","unstructured":"World Health Organization (2026) Health at a glance | Japan. Health Data Overview for Japan 2024. https:\/\/data.who.int\/countries\/392"},{"key":"3434_CR21","doi-asserted-by":"publisher","first-page":"1106","DOI":"10.1016\/S0140-6736(11)60828-3","volume":"378","author":"N Ikegami","year":"2011","unstructured":"Ikegami N, Yoo B-K, Hashimoto H et al (2011) Japanese universal health coverage: evolution, achievements, and challenges. Lancet 378:1106\u20131115","journal-title":"Lancet"},{"key":"3434_CR22","doi-asserted-by":"publisher","first-page":"391","DOI":"10.2188\/jea.JE20200480","volume":"32","author":"E Nakatani","year":"2022","unstructured":"Nakatani E, Tabara Y, Sato Y et al (2022) Data resource profile of Shizuoka Kokuho Database (SKDB) using integrated health- and care-insurance claims and health checkups: The Shizuoka study. J Epidemiol 32:391\u2013400","journal-title":"J Epidemiol"},{"key":"3434_CR23","doi-asserted-by":"publisher","first-page":"1208","DOI":"10.1093\/ageing\/afaa252","volume":"50","author":"J Hollinghurst","year":"2021","unstructured":"Hollinghurst J, Housley G, Watkins A et al (2021) A comparison of two national frailty scoring systems. Age Ageing 50:1208\u20131214","journal-title":"Age Ageing"},{"key":"3434_CR24","doi-asserted-by":"publisher","first-page":"1771","DOI":"10.1093\/gerona\/glz017","volume":"74","author":"NM Pajewski","year":"2019","unstructured":"Pajewski NM, Lenoir K, Wells BJ et al (2019) Frailty screening using the electronic health record within a Medicare Accountable Care Organization. J Gerontol Biol Sci Med Sci 74:1771\u20131777","journal-title":"J Gerontol Biol Sci Med Sci"},{"key":"3434_CR25","doi-asserted-by":"publisher","first-page":"e035395","DOI":"10.1136\/bmjopen-2019-035395","volume":"10","author":"Y Jauhari","year":"2020","unstructured":"Jauhari Y, Gannon MR, Dodwell D et al (2020) Construction of the secondary care administrative records frailty (SCARF) index and validation on older women with operable invasive breast cancer in England and Wales: a cohort study. BMJ Open 10:e035395","journal-title":"BMJ Open"},{"key":"3434_CR26","doi-asserted-by":"publisher","first-page":"1871","DOI":"10.1007\/s41999-025-01251-7","volume":"16","author":"L Johnson","year":"2025","unstructured":"Johnson L, Guthrie B, Anand A et al (2025) Measuring frailty: a comparison of the cumulative deficit model of frailty in survey and routine data. Eur Geriatr Med 16:1871\u20131880","journal-title":"Eur Geriatr Med"},{"key":"3434_CR27","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1186\/s12877-017-0621-2","volume":"17","author":"N Masnoon","year":"2017","unstructured":"Masnoon N, Shakib S, Kalisch-Ellett L et al (2017) What is polypharmacy? A systematic review of definitions. BMC Geriatr 17:230","journal-title":"BMC Geriatr"},{"key":"3434_CR28","doi-asserted-by":"publisher","unstructured":"Walsh B, Fogg C, Harris S et al (2023) Frailty transitions and prevalence in an ageing population: longitudinal analysis of primary care data from an open cohort of adults aged 50 and over in England, 2006\u20132017. Age Ageing 52. https:\/\/doi.org\/10.1093\/ageing\/afad058","DOI":"10.1093\/ageing\/afad058"},{"key":"3434_CR29","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1186\/s12877-025-06485-5","volume":"25","author":"S-H Lu","year":"2025","unstructured":"Lu S-H, Chan H-J, Lin Y-P et al (2025) Chronic diseases and frailty transitions in community-dwelling older adults: evidence from a national longitudinal cohort study. BMC Geriatr 25:805","journal-title":"BMC Geriatr"},{"key":"3434_CR30","doi-asserted-by":"publisher","first-page":"7341","DOI":"10.1038\/s41598-022-11358-7","volume":"12","author":"N Mielke","year":"2022","unstructured":"Mielke N, Schneider A, Huscher D et al (2022) Gender differences in frailty transition and its prediction in community-dwelling old adults. Sci Rep 12:7341","journal-title":"Sci Rep"},{"key":"3434_CR31","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1016\/j.cger.2021.05.008","volume":"37","author":"C Park","year":"2021","unstructured":"Park C, Ko FC (2021) The science of frailty: Sex differences. Clin Geriatr Med 37:625\u2013638","journal-title":"Clin Geriatr Med"},{"key":"3434_CR32","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1016\/j.exger.2016.12.021","volume":"89","author":"EH Gordon","year":"2017","unstructured":"Gordon EH, Peel NM, Samanta M et al (2017) Sex differences in frailty: A systematic review and meta-analysis. Exp Gerontol 89:30\u201340","journal-title":"Exp Gerontol"},{"key":"3434_CR33","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1016\/j.maturitas.2019.07.025","volume":"128","author":"N Veronese","year":"2019","unstructured":"Veronese N, Siri G, Cella A et al (2019) Older women are frailer, but less often die then men: a prospective study of older hospitalized people. Maturitas 128:81\u201386","journal-title":"Maturitas"},{"key":"3434_CR34","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1093\/eurpub\/cky138","volume":"29","author":"WJ Nusselder","year":"2019","unstructured":"Nusselder WJ, Wapperom D, Looman CWN et al (2019) Contribution of chronic conditions to disability in men and women in France. Eur J Public Health 29:99\u2013104","journal-title":"Eur J Public Health"},{"key":"3434_CR35","doi-asserted-by":"publisher","first-page":"914","DOI":"10.1093\/eurpub\/ckz114","volume":"29","author":"WJ Nusselder","year":"2019","unstructured":"Nusselder WJ, Cambois EM, Wapperom D et al (2019) Women\u2019s excess unhealthy life years: disentangling the unhealthy life years gap. Eur J Public Health 29:914\u2013919","journal-title":"Eur J Public Health"},{"key":"3434_CR36","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1503\/cmaj.050051","volume":"173","author":"K Rockwood","year":"2005","unstructured":"Rockwood K, Song X, MacKnight C et al (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ 173:489\u2013495","journal-title":"CMAJ"},{"key":"3434_CR37","doi-asserted-by":"publisher","first-page":"e2543278","DOI":"10.1001\/jamanetworkopen.2025.43278","volume":"8","author":"S Ji","year":"2025","unstructured":"Ji S, Lim J, An TJ et al (2025) Long-term health and cost outcomes of a 24-week multicomponent frailty intervention in older adults. JAMA Netw Open 8:e2543278","journal-title":"JAMA Netw Open"},{"key":"3434_CR38","doi-asserted-by":"publisher","first-page":"e068788","DOI":"10.1136\/bmj-2021-068788","volume":"377","author":"R Bernabei","year":"2022","unstructured":"Bernabei R, Landi F, Calvani R et al (2022) Multicomponent intervention to prevent mobility disability in frail older adults: randomised controlled trial (SPRINTT project). BMJ 377:e068788","journal-title":"BMJ"},{"key":"3434_CR39","doi-asserted-by":"crossref","unstructured":"Yu R, Tong C, Ho F et al (2020) Effects of a multicomponent frailty prevention program in prefrail community-dwelling older persons: A randomized controlled trial. J Am Med Dir Assoc.;21:294.e1-294.e10","DOI":"10.1016\/j.jamda.2019.08.024"},{"key":"3434_CR40","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1056\/NEJMra2301292","volume":"391","author":"DH Kim","year":"2024","unstructured":"Kim DH, Rockwood K (2024) Frailty in Older Adults. N Engl J Med 391:538\u2013548","journal-title":"N Engl J Med"},{"key":"3434_CR41","doi-asserted-by":"publisher","first-page":"afad012","DOI":"10.1093\/ageing\/afad012","volume":"52","author":"J Travers","year":"2023","unstructured":"Travers J, Romero-Ortuno R, Langan J et al (2023) Building resilience and reversing frailty: a randomised controlled trial of a primary care intervention for older adults. Age Ageing 52:afad012","journal-title":"Age Ageing"},{"key":"3434_CR42","doi-asserted-by":"publisher","first-page":"afac104","DOI":"10.1093\/ageing\/afac104","volume":"51","author":"N Veronese","year":"2022","unstructured":"Veronese N, Custodero C, Demurtas J et al (2022) Comprehensive geriatric assessment in older people: an umbrella review of health outcomes. Age Ageing 51:afac104","journal-title":"Age Ageing"},{"key":"3434_CR43","unstructured":"Ministry of Health, Labour and Welfare (JP) (2026) Community-based Integrated Care System. Ministry of Health, Labour and Welfare (JP). Community-based Integrated Care System n.d. https:\/\/www.mhlw.go.jp\/stf\/seisakunitsuite\/bunya\/hukushi_kaigo\/kaigo_koureisha\/chiiki-houkatsu\/index.html"},{"key":"3434_CR44","doi-asserted-by":"publisher","first-page":"afae010","DOI":"10.1093\/ageing\/afae010","volume":"53","author":"C Fogg","year":"2024","unstructured":"Fogg C, England T, Zhu S et al (2024) Primary and secondary care service use and costs associated with frailty in an ageing population: longitudinal analysis of an English primary care cohort of adults aged 50 and over, 2006\u20132017. Age Ageing 53:afae010","journal-title":"Age Ageing"},{"key":"3434_CR45","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1093\/gerona\/62.7.722","volume":"62","author":"K Rockwood","year":"2007","unstructured":"Rockwood K, Mitnitski A (2007) Frailty in relation to the accumulation of deficits. J Gerontol Biol Sci Med Sci 62:722\u2013727","journal-title":"J Gerontol Biol Sci Med Sci"}],"container-title":["Aging Clinical and Experimental Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s40520-026-03434-z","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40520-026-03434-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40520-026-03434-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:03:46Z","timestamp":1787234626000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s40520-026-03434-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,14]]},"references-count":45,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3434"],"URL":"https:\/\/doi.org\/10.1007\/s40520-026-03434-z","relation":{},"ISSN":["1720-8319"],"issn-type":[{"value":"1720-8319","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,14]]},"assertion":[{"value":"18 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"SN, RN, HY, HM, and HK are affiliated with the Department of Healthcare Quality Assessment at the University of Tokyo. The department is a social collaboration department supported by grants from the National Clinical Database, Intuitive Surgical Sarl, Johnson & Johnson K.K., and Nipro Corporation. SN and HK have received collaborative research funding from Pfizer Japan Inc., which was unrelated to the present study. KM is an employee of Tokio Marine & Nichido Life Insurance Co., Ltd. HT belonged to an endowed course funded by Takeda Pharmaceutical Company Limited and is a member of the board of directors of the Japanese Society of Public Health. HK has received consulting fees from EPS corporation, speakers\u2019 fees from Pfizer Japan Inc. and Novartis K.K., and research funding on an unrelated subject from Amgen Japan and National Clinical Database. EN, YM, SK, and MT have no other relevant financial or non-financial interests to disclose.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Ethics Committee of Shizuoka Graduate University of Public Health (Shizuoka, Japan) [(#SGUPH_2021_001_006].","order":2,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"178"}}