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Background  Although the scale of the coronavirus disease (COVID-19) pandemic was relatively small in Japan compared with the rest of the world, the polarisation of areas into high- and low-COVID-19-incidence areas was observed among the 47 prefectures. The aims of this study were not only identifying the factors associated with the polarised COVID-19 pandemic in Japan but also discussing effective preventive measures.    Methods  This was an ecological study using online survey data which was cross-sectionally conducted by the author. A total of 6000 respondents who resided in 10 low- and 10 high-COVID-19 incidence prefectures, with a wide gap in terms of COVID-19 incidence, in Japan were recruited. Data on COVID-19 cases and geodemographic information were obtained from official government sites. Statistical analyses were conducted to compare variables between the two areas and age groups.    Results  This study revealed that that age influenced people’s behaviours and perceptions, except one behaviour of ‘wearing facemasks’. The major factors significantly associated with the cumulative number of COVID-19 cases per 100,000 people were ‘commuting by private automobile’ (adjusted odds ratio [AOR], 0.444; 95% confidence interval [CI], 0.394–0.501), ‘commuting by public transportation’ (AOR, 6.813; 95% CI, 5.567–8.336), ‘washing hands’ (AOR, 1.233; 95% CI, 1.005–1.511), ‘opening windows regularly’ (AOR, 1.248; 95% CI, 1.104–1.412), ‘avoiding crowded places (AOR, 0.757; 95% CI, 0.641–0.893), ‘non-scheduled visits to drinking places’ (AOR, 1.212; 95% CI, 1.054–1.392) and ‘perceived risk of contracting COVID-19’ (AOR, 1.380; 95% CI, 1.180–1.612). These factors were strongly associated with age groups.    Conclusions  Effective preventive measures for COVID-19 transmission can be developed by understanding the characteristics of populated areas, such as public transportation infrastructure and younger people’s movements and behaviours in relation to the population age structure to contain the current epidemic and protect the most vulnerable elderly people.

Polarized nature of the COVID-19 pandemic in Japan: associations with population age structure and behaviours