Diverging Trends in Home Respiratory Care in an Aging Society: National Data from Japan

Japan is among the most rapidly aging countries worldwide, and the need for long-term respiratory care continues to grow. Long-term oxygen therapy (LTOT), home positive airway pressure (PAP), and home mechanical ventilation (HMV) are widely used for chronic respiratory diseases; however, nationwide long-term trends in their use remain insufficiently characterized. We aimed to examine recent national patterns in the use of these modalities.

We conducted a descriptive study using National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data from fiscal years (FYs) 2017 to 2023. The annual claim counts for LTOT, PAP, and HMV were extracted. Population-adjusted rates (claims per 100,000 population) were calculated using national demographic data. Subgroup analyses were performed by sex across five age groups (0-24, 25-44, 45-64, 65-74, and ≥75 years), reflecting the clinically meaningful stages of aging in Japan.

The population-adjusted rate of LTOT use increased steadily across all years, age groups, and sexes. PAP use also increased consistently throughout the study period, with larger increases among older adults. In contrast, HMV use demonstrated only small overall changes, with a gradual increase that was most pronounced among adults aged 0-24 years, while a declining trend was observed among those aged ≥75 years. Similar patterns were observed in the age- and sex-stratified analyses.

The nationwide use of LTOT and PAP increased between FY 2017 and FY 2023, whereas HMV use exhibited age-dependent variation. These findings indicate shifting needs in home respiratory support, with growing demand for LTOT and PAP and age-divergent patterns of ventilator use. Continued monitoring is essential to anticipate future service requirements and inform planning for age-appropriate home respiratory care.