阿江 竜介

<p>目的 地方紙における遺族の自己申告型死亡記事の記載事項を集計し，その地域での死亡やそれに伴う儀式の実態を明らかにするとともに，死亡記事のデータベースとしての利点と問題点を明らかにする。</p><p>方法 栃木の地方紙である下野新聞の自己申告型死亡記事「おくやみ」欄に掲載された2011～2015年の栃木県内の死亡者全員のデータを集計解析し，一部の結果は人口動態統計と比較した。観察項目は掲載年月日，市町村，住所の表示（市町村名のみ，町名・字まで，番地まで含めた詳細な住所），氏名，性別，死亡年月日，死因，死亡時年齢，通夜・告別式などの名称，通夜などの年月日，告別式などの年月日，喪主と喪主の死亡者との続柄の情報である。</p><p>結果 観察期間中の掲載死亡者数は69,793人で，同時期の人口動態統計による死亡者数の67.6%であった。人口動態統計と比較した掲載割合は男女で差がなく，小児期には掲載割合が低く，10歳代で高く，20歳台で低下し，以降は年齢とともに上昇していた。市町別の掲載割合は宇都宮市や小山市など都市化が進んだ地域では低く，県東部や北部で高い市町がみられた。最も掲載割合が高かったのは茂木町（88.0%），低かったのは野木町（38.0%）であった。死亡日から通夜や告別式などの日数から，東京などで起こっている火葬場の供給不足に起因する火葬待ち現象は起こっていないことが判明した。六曜の友引の日の告別式はほとんどなく，今後，高齢者の増加に伴う死者の増加によって火葬場の供給不足が起こった場合には，告別式と火葬を切り離して友引に火葬を行うことも解決策の1つと考えられた。死亡者の子供，死亡者の両親，死亡者の子供の配偶者が喪主の場合には，喪主は男の方が多いことが判明した。老衰，自殺，他殺の解析から，掲載された死因の妥当性は低いことが示された。</p><p>結論 栃木県の地方紙である下野新聞の自己申告型死亡記事「おくやみ」欄の5年分の観察を行い，実態を明らかにした。約3分の2に死亡が掲載されており，データベースとしての使用に一定の価値があると考えられたが，記載された死因の妥当性は低いことが判明した。</p>

Objectives To reveal the features of death and subsequent funeral services, we analyzed self-reported obituaries in The Shimotsuke, a local daily newspaper in Tochigi, Japan. In addition, the usefulness and disadvantages of such a database of deaths based on the obituaries were discussed.Method For a 5-year period, from January 2011 through December 2015, all the obituary columns in The Shimotsuke were computerized as a database and analyzed. Some results were compared with the vital statistics data in the corresponding period of time. Data analyzed were: dead persons' address (municipalities), name, sex, cause of death, age at death, date of death and funeral services, the chief mourner (Moshu), and so on.Results During the observed 5-year period, 69,793 deaths appeared in the columns, which were 67.6% of the all deaths in the vital statistics. No difference was observed in the proportions between the sexes in the published deaths in comparison with the vital statistics. In both sexes, the proportion was low in 0-9 years old, then high among 10-19 years, decreasing in 20s, and after then the proportion increased according to the age. The proportion was low in city areas, such as Utsunomiya and Oyama, and high in some cities and towns in the northern or eastern parts of Tochigi prefecture. The highest was in Motegi Town (88.0%), and the lowest was Nogi Town (38.0%), which is located in the southern-most part of the prefecture and is closest to the Tokyo metropolitan area. Almost all the funeral services were conducted within a week of the death, and no delays were observed to have been caused by the short supply of cremation services, which exists in large cities in Japan. In case where the chief mourner was a child, a parent, or a spouse of a child, the male sex was dominant. Analyses of death from senile decay, suicide, and homicide indicated that the accuracy of the published cause of death was low. The date of the funeral services was strongly influenced by superstitions in this country.Conclusions Observations of the self-reported obituaries in a local daily newspaper over five years revealed the situations of the deaths in the area that could not be observed using vital statistics. Despite limitations, the information was partially useful as a database.

Background: When analyzing regional disparities in healthcare resources, hospital accessibility is given little consideration. We surveyed accessibility from residential districts to medical institutions using GIS (Geographic Information System) and estimated Gini coefficient for each hospital distribution.<br>Methods: The subjects were 2,688 census mesh blocks ( "Cho-cho-aza" ) and 109 hospitals in Tochigi prefecture. The number of hospitals located within the road distances of 5 km, 10 km and 15 km from the geometrical center of each block was calculated using GIS. The Gini coefficient of each hospital per 100 residents was calculated among the regions located within 5 km, 10 km and 15 km from the geometrical center of the census mesh block.<br>Results: The population of each block was 748±1,067 (mean±SD), and the road distance to the nearest hospital from the center of each block was 4.3±4.5 km. The number of census mesh blocks with distances from the center of each block to the nearest hospital within 5 km, 5-10 km, 10-15 km and more than 15 km were 1909 (71.0%), 561 (20.9%), 139 (5.2%) and 79 (2.9%) respectively. The number of hospitals located within 5 km, 10 km and 15 km were 3.3±4.7, 8.3±8.6 and 14.4±11.4. Gini coefficients were 0.65, 0.52 and 0.43.<br>Conclusion: When analyzing regional disparities in healthcare resources, it is necessary to take into account not only the number of physicians and beds, but also accessibility. Gini coefficient is useful to estimate geographical distributions, and can be used as an indicator for improvement projects for hospitals.

Objectives : To determine factors related to peoples' preference for visiting home-doctors when experiencing new health problems.<br>Method : A questionnaire survey was conducted of people receiving annual health checkups in municipalities in the vicinity of Jichi Medical University Hospital. We surveyed personal characteristics, test equipment, having of a home-doctor, and answers to an assumed scenario (asking about willingness to visit a home-doctor in case of getting certain health problems).<br>According to the responses to the scenario, we divided the subjects into two groups (a home-doctor group: visiting a home-doctor; and a specialist group: not visiting a home-doctor) and statistically compared the two groups.<br>Results : In the analytic sample of 1,829, the home-doctor group numbered 1,097 individuals (60%) and the specialist group numbered 732 individuals (40%). The home-doctor group statistically had more home-doctors than the specialist group (adjusted odds ratio, 95% confidence interval: 2.47, 2.00-3.05).<br>More home-doctors in the home-doctor group had test equipment than home-doctors in the specialist group: Gastrointestinal test equipment (gastroscopy, colonoscopy, or ultrasonography) (adjusted odds ratio, 95% confidence interval: 1.39, 1.06-1.83).<br>Conclusion : We revealed two factors relating to the preference for visiting home-doctors: First, those people had home-doctors, and, second, the home-doctors had test equipment.