Noguchi Shingo, Ishimaru Tomohiro, Yatera Kazuhiro, Fujino Yoshihisa, Zaitsu Masayoshi, Tabuchi Takahiro
Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan.
Department of Respiratory Medicine, Tobata General Hospital.
Environ Health Prev Med. 2025;30:41. doi: 10.1265/ehpm.24-00138.
Although the global COVID-19 mortality rate is decreasing, COVID-19 remains an infectious disease with a high mortality rate, especially in older adults and individuals with comorbidities. In Japan, mask-wearing has been left to individual discretion since March 13, 2023, but remains a key protective measure. This study aimed to identify factors influencing individual mask-wearing behavior in post COVID-19 era, with a focus on risk factors for severe COVID-19.
Data from 33,000 participants, obtained from the Japan COVID-19 and Society Internet Survey 2023, were used, which was conducted from September 25 to November 17, 2023. Participants were randomly selected from approximately 2.2 million panelists from a nationwide Japanese Internet research company, with sampling adjusted by age, sex, and living area to match the population distribution in Japan. The association between wearing a mask and risk factors for severe COVID-19 (age, sex, smoking, COVID-19 vaccination, history of COVID-19, body mass index (BMI), and comorbid conditions) was evaluated using univariate and multivariate analyses.
In total, 28,481 individuals were included, of whom 18,371 (64.5%) answered that they wore masks. After adjusting for confounders, older age (adjusted relative risk [RR], 1.50; 95% confidence interval [CI], 1.45-1.55 for "75-83" years), no history of COVID-19 (adjusted RR, 1.06; 95% CI, 1.04-1.08), low BMI (adjusted RR, 1.04; 95% CI, 1.02-1.07), and increased number of comorbid conditions (adjusted RR, 1.11; 95% CI, 1.05-1.18 for three or more) were significant positive factors for wearing a mask. In contrast, men (adjusted RR, 0.89; 95% CI, 0.87-0.90), no COVID-19 vaccination (adjusted RR, 0.78; 95% CI, 0.76-0.81), and current smoking history (adjusted RR, 0.96; 95% CI, 0.93-0.99) were significant negative factors.
We demonstrated that mask-wearing behavior differed based on individual risk factors for severe COVID-19, with some risk factors negatively influencing mask use in Japan. It may be necessary to recommend mask-wearing for these individuals, especially during situations such as COVID-19 epidemic season or the onset of epidemics, considering individual mask-wearing behavior.
尽管全球新冠病毒疾病（COVID-19）死亡率在下降，但COVID-19仍是一种死亡率较高的传染病，尤其是在老年人和患有合并症的个体中。在日本，自2023年3月13日起，戴口罩一直由个人自行决定，但它仍然是一项关键的防护措施。本研究旨在确定后COVID-19时代影响个人戴口罩行为的因素，重点关注重症COVID-19的风险因素。
使用了从2023年9月25日至11月17日进行的2023年日本COVID-19与社会互联网调查中获得的33000名参与者的数据。参与者是从一家日本全国性互联网研究公司的约220万小组成员中随机抽取的，抽样根据年龄、性别和居住地区进行了调整，以匹配日本的人口分布。使用单因素和多因素分析评估戴口罩与重症COVID-19风险因素（年龄、性别、吸烟、COVID-19疫苗接种、COVID-19病史、体重指数（BMI）和合并症）之间的关联。
总共纳入了28481人，其中18371人（64.5%）回答他们戴口罩。在调整混杂因素后，年龄较大（“75 - 83”岁的调整后相对风险[RR]为1.50；95%置信区间[CI]为1.45 - 1.55）、无COVID-19病史（调整后RR为1.06；95% CI为1.04 - 1.08）、低BMI（调整后RR为1.04；95% CI为1.02 - 1.07）以及合并症数量增加（三种或更多合并症的调整后RR为1.11；95% CI为1.05 - 1.18）是戴口罩的显著正向因素。相比之下，男性（调整后RR为0.89；95% CI为0.87 - 0.90）、未接种COVID-19疫苗（调整后RR为0.78；95% CI为0.76 - 0.81）以及当前吸烟史（调整后RR为0.96；95% CI为0.93 - 0.99）是显著负向因素。
我们证明，戴口罩行为因重症COVID-19的个体风险因素而异，在日本，一些风险因素对口罩使用有负面影响。考虑到个人戴口罩行为，可能有必要向这些个体推荐戴口罩，尤其是在COVID-19流行季节或疫情爆发等情况下。
