Cross-Sectional Investigation of Associated Factors with Electrocardiogram Abnormalities : Tokushima National Health Insurance Database Study

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Electrocardiogram abnormalities (atrial fibrillation and pathological Q waves) (n=54368). Intervention: Class ≥II obesity (BMI ≥30 kg/m2) and cardiometabolic risk factors vs. Normal weight (18.5 ≤ BMI < 23 kg/m2) and absence of risk factors. Primary outcome: Prevalence of atrial fibrillation (AF) on 12-lead electrocardiogram (OR 2.99, 95% CI 2.09-4.28).

Q: What does this research mean for the field?

Class ≥II obesity is strongly associated with increased odds of both atrial fibrillation and pathological Q waves on universal screening electrocardiograms. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Masashi Ishizu; Munehide Matsuhisa

doi:10.2152/jmi.73.390

January 1, 2026The Journal of Medical InvestigationOpen Access

Cross-Sectional Investigation of Associated Factors with Electrocardiogram Abnormalities : Tokushima National Health Insurance Database Study

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Why the study?

The number of patients with CVD in Japan continues to increase with population aging, and following the 2020 implementation of universal 12-lead ECG screening during specific health checkups in Tokushima Prefecture, factors associated with ECG abnormalities needed to be identified.

What clinical and demographic factors are associated with the presence of atrial fibrillation and pathological Q waves in community-dwelling adults undergoing universal 12-lead ECG screening in Japan?

Key Points

To identify clinical characteristics and metabolic risk factors associated with atrial fibrillation and pathological Q waves detected during universal electrocardiogram screening.
Analyzed cross-sectional health checkup data collected between April 1, 2020, and March 31, 2021, from N=54,368 participants aged 40 years and older (median age 71 years; 43.2% men) in the Tokushima National Health Insurance Database.
Assessed standard 12-lead electrocardiograms evaluated by physicians to identify atrial fibrillation (AF) and pathological Q waves (PQW).
Performed multivariable logistic regression analyses adjusting for demographic, anthropometric, laboratory, and medication variables to calculate odds ratios (ORs) with 95% confidence intervals (CIs).
Among 54,368 participants, 538 (1.0%) had AF and 700 (1.3%) had PQW, with only two individuals presenting with both abnormalities.
AF was significantly associated with male sex (OR 3.56, 95% CI 2.90–4.37), age ≥75 years (OR 4.31, 95% CI 2.88–6.44), obesity class ≥II (OR 2.99, 95% CI 2.09–4.28), hypertension (OR 2.05, 95% CI 1.64–2.57), and chronic kidney disease stages G4–5 (OR 4.36, 95% CI 1.83–10.42), while showing inverse associations with hypertriglyceridemia (OR 0.55, 95% CI 0.44–0.70) and hyper-LDL cholesterolemia (OR 0.54, 95% CI 0.42–0.70).
PQW showed positive associations with male sex, older age, hypertension, diabetes mellitus, dyslipidemia medications, underweight, and obesity class ≥II, demonstrating a U-shaped relationship with body mass index.

Study Design

Type

Cross-Sectional (n=54,368)

Multicenter

Yes

Structured PICO

What clinical and demographic factors are associated with the presence of atrial fibrillation and pathological Q waves in community-dwelling adults undergoing universal 12-lead ECG screening in Japan?

P

Population

54,368 community-dwelling adults in Tokushima Prefecture, Japan (median age 71 years; 56.7% female) undergoing universal 12-lead ECG screening during annual specific health checkups between April 2020 and March 2021.

E

Exposure

Universal 12-lead electrocardiography (ECG) screening during specific health checkups and evaluation of clinical risk factors (sex, age, BMI, hypertension, diabetes/prediabetes, dyslipidemia, and CKD stage).

O

Outcome

Presence of atrial fibrillation (AF) and pathological Q waves (PQW) on 12-lead ECG evaluated by physicians at medical institutions during the 2020 specific health checkup.surrogate

Main Result

Odds Ratio: 2.99 (95% CI 2.09–4.28)

Absolute Event Rate: 1.79% vs 0.64%

Limitations

Cross-sectional design precludes causal inference.
Potential selection bias because participants voluntarily underwent health checkups, potentially excluding those already receiving routine medical care.
Single annual ECG recording may miss paroxysmal arrhythmias such as paroxysmal atrial fibrillation.
Medication use was assessed via prescription data only, so actual medication adherence could not be determined.
Cross-sectional design prevents inference of causal relationships from the observed associations.
Potential selection bias because the study population consisted of individuals who voluntarily underwent health checkups, potentially excluding those who routinely receive medical care.
Paroxysmal ECG abnormalities (such as paroxysmal AF) may have been missed because health checkups were conducted only once per year.
Only prescription data were available for medication use, so actual medication adherence could not be determined.

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Answers are grounded in this paper and cite their sources.

Implication

In a large prefecture-wide Japanese health screening cohort, male sex, older age, hypertension, CKD, and class >= II obesity were shared risk factors for both atrial fibrillation and pathological Q waves, while BMI showed a linear association with AF (alongside an inverse lipid paradox) and a U-shaped relationship with pathological Q waves.

Abstract

Background : The number of patients with cardiovascular disease (CVD) in Japan continues to increase with population aging. Since 2020, the Tokushima Prefecture has implemented universal 12-lead electrocardiography (ECG) screening during specific health checkups to facilitate the early detection of CVD. This study aimed to identify factors associated with ECG abnormalities. Methods : Individuals who underwent the 2020 Tokushima Specific Health Checkup were included in this study. Participant characteristics were compared according to the presence of atrial fibrillation (AF) and pathological Q waves (PQW). Logistic regression analyses were conducted to identify associated factors. Results : Among the 54,368 participants (median age, 71 years ; 43.2% men), 538 (1.0%) had AF and 700 (1.3%) had PQW. AF was positively associated with male sex, older age, being overweight and obese, hypertension, prediabetes, and chronic kidney disease (CKD), and negatively associated with hypertriglyceridemia and hyper-low-density lipoprotein cholesterolemia. PQW was positively associated with male sex, older age, being underweight, higher BMI, hypertension, diabetes, dyslipidemia treatment, and CKD, and negatively associated with being overweight. Conclusion : Older age, hypertension, and class ≥ II obesity were positively associated with both AF and PQW. Prediabetes was positively associated with AF, whereas diabetes mellitus was positively associated with PQW. J. Med. Invest. 73 : 390-397, August, 2026

Discussion

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Cite This Study

Ishizu et al. (2026) conducted a cross-sectional in Electrocardiogram abnormalities (atrial fibrillation and pathological Q waves) (n=54,368). Class ≥II obesity (BMI ≥30 kg/m2) and cardiometabolic risk factors vs. Normal weight (18.5 ≤ BMI < 23 kg/m2) and absence of risk factors was evaluated on Prevalence of atrial fibrillation (AF) on 12-lead electrocardiogram (OR 2.99, 95% CI 2.09-4.28).

synapsesocial.com/papers/6af5cd26a40bbe8669e89b93 https://doi.org/10.2152/jmi.73.390

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Cross-Sectional Investigation of Associated Factors with Electrocardiogram Abnormalities : Tokushima National Health Insurance Database Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Cross-Sectional Investigation of Associated Factors with Electrocardiogram Abnormalities : Tokushima National Health Insurance Database Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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