{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T16:41:59Z","timestamp":1792428119971,"version":"4.5.0"},"reference-count":30,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"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":["Diabet Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Regional administrative diabetes indicators are increasingly used for population surveillance and planning, yet they are generated through the healthcare system rather than measuring disease directly. We examined what two complementary indicator families\u2014treatment\u2010side prescription quantities and screening\u2010side HbA1c\u2014measure across 47 Japanese prefectures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Cross\u2010sectional ecological study using the 10th NDB Open Data release. Indicator A was oral antidiabetic agent dispensing volume per population (drug classification 396), related to ageing, income, education and population density by ordinary least squares with VIF assessment and AIC\u2010based comparison. Indicator B comprised the HbA1c high\u2010value rate, mean HbA1c and the D005 laboratory\u2010testing rate, related to three claim\u2010rate outcomes by ordinary least squares with HC3 errors (five sensitivity specifications).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      For Indicator A, ageing was the only significant univariable predictor (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20099961;\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.324); the lowest\u2010AIC model retained ageing and income (\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.394; VIF\u2009=\u20092.18; income\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u200956.6,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.030). For Indicator B, the HbA1c high\u2010value rate was associated with chronic dialysis management (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009195.1\/%pt.,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006,\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.271); mean HbA1c showed a comparable association; the primary association was stable across all five specifications.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Neither indicator family provided a direct estimate of disease burden. Prescription quantities reflected demographic and income structure, whereas HbA1c indicators showed a selective ecological association with downstream service use. Both are better interpreted as ecological surveillance indicators than direct measures of disease burden or prevalence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dme.70501","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T16:06:49Z","timestamp":1792426009000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["What do administrative diabetes indicators measure? Treatment\u2010side and screening\u2010side evidence from nationwide\n                    <scp>NDB<\/scp>\n                    Open Data in Japan"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7890-6068","authenticated-orcid":false,"given":"Haruki","family":"Saito","sequence":"first","affiliation":[{"name":"Department of Epidemiology Fukushima Medical University School of Medicine  Fukushima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4532-7165","authenticated-orcid":false,"given":"Tetsuya","family":"Ohira","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Fukushima Medical University School of Medicine  Fukushima Japan"},{"name":"Radiation Medical Science Center for the Fukushima Health Management Survey Fukushima Medical University  Fukushima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.diabres.2017.03.024","article-title":"IDF diabetes atlas: global estimates for the prevalence of diabetes for 2015 and 2040","volume":"128","author":"Ogurtsova K","year":"2017","journal-title":"Diabetes Res Clin Pract"},{"issue":"3","key":"e_1_2_13_3_1","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s13340-020-00439-5","article-title":"Japanese clinical practice guideline for diabetes 2019","volume":"11","author":"Araki E","year":"2020","journal-title":"Diabetol Int"},{"issue":"3","key":"e_1_2_13_4_1","doi-asserted-by":"crossref","first-page":"380","DOI":"10.2105\/AJPH.93.3.380","article-title":"What is population health?","volume":"93","author":"Kindig D","year":"2003","journal-title":"Am J Public Health"},{"issue":"6","key":"e_1_2_13_5_1","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1111\/1744-9987.12378","article-title":"An overview of regular dialysis treatment in Japan (as of 31 December 2013)","volume":"19","author":"Masakane I","year":"2015","journal-title":"Ther Apher Dial"},{"key":"e_1_2_13_6_1","volume-title":"National Health and Nutrition Survey, 2019","author":"Ministry of Health, Labour and Welfare","year":"2020"},{"key":"e_1_2_13_7_1","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1146\/annurev.publhealth.22.1.213","article-title":"Administrative data for public health surveillance and planning","volume":"22","author":"Virnig BA","year":"2001","journal-title":"Annu Rev Public Health"},{"key":"e_1_2_13_8_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.diabres.2019.05.029","article-title":"Variation in process quality measures of diabetes care by region and institution in Japan during 2015\u20132016: an observational study of nationwide claims data","volume":"155","author":"Sugiyama T","year":"2019","journal-title":"Diabetes Res Clin Pract"},{"issue":"5","key":"e_1_2_13_9_1","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.2337\/dc13-2289","article-title":"Use of antidiabetic drugs in the U.S., 2003\u20132012","volume":"37","author":"Hampp C","year":"2014","journal-title":"Diabetes Care"},{"issue":"2","key":"e_1_2_13_10_1","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph18020836","article-title":"The significant association between health examination results and population health: a cross\u2010sectional ecological study using a nationwide health checkup database in Japan","volume":"18","author":"Nagakura Y","year":"2021","journal-title":"Int J Environ Res Public Health"},{"issue":"4","key":"e_1_2_13_11_1","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.jclinepi.2004.10.012","article-title":"A review of uses of health care utilization databases for epidemiologic research on therapeutics","volume":"58","author":"Schneeweiss S","year":"2005","journal-title":"J Clin Epidemiol"},{"issue":"1","key":"e_1_2_13_12_1","doi-asserted-by":"crossref","first-page":"10","DOI":"10.31662\/jmaj.2023-0078","article-title":"Literature review of studies using the National Database of the health insurance claims of Japan (NDB): limitations and strategies in using the NDB for research","volume":"7","author":"Suto M","year":"2024","journal-title":"JMA J"},{"key":"e_1_2_13_13_1","volume-title":"The 10th NDB Open Data","author":"Ministry of Health, Labour and Welfare","year":"2025"},{"key":"e_1_2_13_14_1","volume-title":"2020 Population Census","author":"Statistics Bureau of Japan","year":"2021"},{"issue":"10","key":"e_1_2_13_15_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001885","article-title":"The REporting of studies conducted using observational routinely\u2010collected health data (RECORD) statement","volume":"12","author":"Benchimol EI","year":"2015","journal-title":"PLoS Med"},{"issue":"9596","key":"e_1_2_13_16_1","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The strengthening the Reporting of observational studies in epidemiology (STROBE) statement","volume":"370","author":"Elm E","year":"2007","journal-title":"Lancet"},{"issue":"1","key":"e_1_2_13_17_1","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1111\/j.1600-0587.2012.07348.x","article-title":"Collinearity: a review of methods to deal with it and a simulation study evaluating their performance","volume":"36","author":"Dormann CF","year":"2013","journal-title":"Ecography"},{"issue":"5","key":"e_1_2_13_18_1","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1007\/s11135-006-9018-6","article-title":"A caution regarding rules of thumb for variance inflation factors","volume":"41","author":"O'Brien RM","year":"2007","journal-title":"Qual Quant"},{"key":"e_1_2_13_19_1","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.puhe.2021.01.022","article-title":"Income\u2010based inequality in nationwide general health checkup participation in Japan","volume":"195","author":"Shimoda A","year":"2021","journal-title":"Public Health"},{"issue":"3","key":"e_1_2_13_20_1","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1093\/ije\/dyr029","article-title":"Type 2 diabetes incidence and socio\u2010economic position: a systematic review and meta\u2010analysis","volume":"40","author":"Agardh E","year":"2011","journal-title":"Int J Epidemiol"},{"issue":"11","key":"e_1_2_13_21_1","doi-asserted-by":"crossref","first-page":"1971","DOI":"10.1007\/s00125-008-1146-1","article-title":"Socioeconomic inequalities in diabetes mellitus across Europe at the beginning of the 21st century","volume":"51","author":"Espelt A","year":"2008","journal-title":"Diabetologia"},{"issue":"1","key":"e_1_2_13_22_1","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1007\/s12020-014-0195-0","article-title":"Impact of social determinants of health on outcomes for type 2 diabetes: a systematic review","volume":"47","author":"Walker RJ","year":"2014","journal-title":"Endocrine"},{"issue":"3","key":"e_1_2_13_23_1","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/j.mayocp.2024.08.016","article-title":"Socioeconomic status and diabetes prevalence in the Japanese: insights from the JPHC\u2010NEXT study","volume":"100","author":"Omura T","year":"2025","journal-title":"Mayo Clin Proc"},{"issue":"10","key":"e_1_2_13_24_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0223431","article-title":"Determination of factors affecting medication adherence in type 2 diabetes mellitus patients using a nationwide claim\u2010based database in Japan","volume":"14","author":"Horii T","year":"2019","journal-title":"PLoS One"},{"issue":"2","key":"e_1_2_13_25_1","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1111\/jdi.13636","article-title":"Retrospective nationwide study on the trends in first\u2010line antidiabetic medication for patients with type 2 diabetes in Japan","volume":"13","author":"Bouchi R","year":"2022","journal-title":"J Diabetes Investig"},{"issue":"1","key":"e_1_2_13_26_1","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1186\/s13104-021-05787-2","article-title":"Analysis of the regional difference in the number of multi\u2010drug prescriptions and its predictors in Japan, 2015\u20132018","volume":"14","author":"Okui T","year":"2021","journal-title":"BMC Res Notes"},{"key":"e_1_2_13_27_1","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.vhri.2015.03.010","article-title":"Supplier\u2010induced demand for chronic disease care in Japan: multilevel analysis of the association between physician density and physician\u2010patient encounter frequency","volume":"6","author":"Sekimoto M","year":"2015","journal-title":"Value Health Reg Issues"},{"issue":"3","key":"e_1_2_13_28_1","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1089\/pop.2019.0141","article-title":"Health inequalities among elderly type 2 diabetes mellitus patients in Japan","volume":"23","author":"Jiang P","year":"2020","journal-title":"Popul Health Manag"},{"issue":"3","key":"e_1_2_13_29_1","doi-asserted-by":"crossref","first-page":"351","DOI":"10.2307\/2087176","article-title":"Ecological correlations and the behavior of individuals","volume":"15","author":"Robinson WS","year":"1950","journal-title":"Am Sociol Rev"},{"key":"e_1_2_13_30_1","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1146\/annurev.pu.16.050195.000425","article-title":"Ecologic studies in epidemiology: concepts, principles, and methods","volume":"16","author":"Morgenstern H","year":"1995","journal-title":"Annu Rev Public Health"},{"issue":"13","key":"e_1_2_13_31_1","first-page":"1","article-title":"Updated guidelines for evaluating public health surveillance systems","volume":"50","author":"German RR","year":"2001","journal-title":"MMWR Recomm Rep"}],"container-title":["Diabetic Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dme.70501","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/dme.70501","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dme.70501","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T16:06:52Z","timestamp":1792426012000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/dme.70501"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,19]]},"references-count":30,"alternative-id":["10.1111\/dme.70501"],"URL":"https:\/\/doi.org\/10.1111\/dme.70501","archive":["Portico"],"relation":{},"ISSN":["0742-3071","1464-5491"],"issn-type":[{"value":"0742-3071","type":"print"},{"value":"1464-5491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,19]]},"assertion":[{"value":"2026-07-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70501"}}