Behavioral factors associated with SARS-CoV-2 infection in Japan

Takeshi Arashiro; Yuzo Arima; Hirokazu Muraoka; Akihiro Sato; Kunihiro Oba; Yuki Uehara; Hiroko Arioka; Hideki Yanai; Naoki Yanagisawa; Yoshito Nagura; Yasuyuki Kato; Hideaki Kato; Akihiro Ueda; Koji Ishii; Takao Ooki; Hideaki Oka; Yusuke Nishida; Ashley Stucky; Reiko Miyahara; Chris Smith; Martin Hibberd; Koya Ariyoshi; Motoi Suzuki

doi:10.1111/irv.12992

Behavioral factors associated with SARS-CoV-2 infection in Japan

Influenza Other Respir Viruses. 2022 Sep;16(5):952-961. doi: 10.1111/irv.12992. Epub 2022 Apr 26.

Authors

Takeshi Arashiro^{1

2

3

4}, Yuzo Arima¹, Hirokazu Muraoka⁵, Akihiro Sato⁶, Kunihiro Oba⁷, Yuki Uehara⁸, Hiroko Arioka⁹, Hideki Yanai¹⁰, Naoki Yanagisawa¹¹, Yoshito Nagura¹², Yasuyuki Kato¹³, Hideaki Kato¹⁴, Akihiro Ueda¹⁵, Koji Ishii¹⁶, Takao Ooki¹⁶, Hideaki Oka¹⁷, Yusuke Nishida¹⁷, Ashley Stucky¹, Reiko Miyahara¹, Chris Smith^{3

4}, Martin Hibberd³, Koya Ariyoshi⁴, Motoi Suzuki¹

Affiliations

¹ Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan.
² Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan.
³ Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
⁴ School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
⁵ CLINIC FOR Tamachi, Tokyo, Japan.
⁶ KARADA Internal Medicine Clinic, Tokyo, Japan.
⁷ Department of Pediatrics, Showa General Hospital, Tokyo, Japan.
⁸ Department of Clinical Laboratory, St. Luke's International Hospital, Tokyo, Japan.
⁹ Department of General Internal Medicine, St. Luke's International Hospital, Tokyo, Japan.
¹⁰ Department of Clinical Laboratory, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Kiyose, Japan.
¹¹ Yanagisawa Clinic, Tokyo, Japan.
¹² Shinjuku Home Clinic, Tokyo, Japan.
¹³ Department of Infectious Diseases, Graduate School of Medicine, International University of Health and Welfare, Chiba, Japan.
¹⁴ Infection Prevention and Control Department, Yokohama City University Hospital, Yokohama, Japan.
¹⁵ Department of Infectious Diseases, Japanese Red Cross Medical Center, Tokyo, Japan.
¹⁶ Saitama Sekishinkai Hospital, Saitama, Japan.
¹⁷ Department of General Internal Medicine and Infectious Diseases, Saitama Medical Center, Saitama, Japan.

Abstract

Background: The relative burden of COVID-19 has been less severe in Japan. One reason for this may be the uniquely strict restrictions imposed upon bars/restaurants. To assess if this approach was appropriately targeting high-risk individuals, we examined behavioral factors associated with SARS-CoV-2 infection in the community.

Methods: This multicenter case-control study involved individuals receiving SARS-CoV-2 testing in June-August 2021. Behavioral exposures in the past 2 weeks were collected via questionnaire. SARS-CoV-2 PCR-positive individuals were cases, while PCR-negative individuals were controls.

Results: The analysis included 778 individuals (266 [34.2%] positives; median age [interquartile range] 33 [27-43] years). Attending three or more social gatherings was associated with SARS-CoV-2 infection (adjusted odds ratio [aOR] 2.00 [95% CI 1.31-3.05]). Attending gatherings with alcohol (aOR 2.29 [1.53-3.42]), at bars/restaurants (aOR 1.55 [1.04-2.30]), outdoors/at parks (aOR 2.87 [1.01-8.13]), at night (aOR 2.07 [1.40-3.04]), five or more people (aOR 1.81 [1.00-3.30]), 2 hours or longer (aOR 1.76 [1.14-2.71]), not wearing a mask during gatherings (aOR 4.18 [2.29-7.64]), and cloth mask use (aOR 1.77 [1.11-2.83]) were associated with infection. Going to karaoke (aOR 2.53 [1.25-5.09]) and to a gym (aOR 1.87 [1.11-3.16]) were also associated with infection. Factors not associated with infection included visiting a cafe with others, ordering takeout, using food delivery services, eating out by oneself, and work/school/travel-related exposures including teleworking.

Conclusions: We identified multiple behavioral factors associated with SARS-CoV-2 infection, many of which were in line with the policy/risk communication implemented in Japan. Rapid assessment of risk factors can inform decision making.

Keywords: coronavirus disease 2019 (COVID-19); health risk behaviors; public health and social measures; risk factors; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
COVID-19 Testing
COVID-19* / epidemiology
Case-Control Studies
Humans
Japan / epidemiology
SARS-CoV-2
Travel
Travel-Related Illness