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. 2012 Jan;9(1):e1001160.
doi: 10.1371/journal.pmed.1001160. Epub 2012 Jan 24.

Adult mortality attributable to preventable risk factors for non-communicable diseases and injuries in Japan: a comparative risk assessment

Nayu Ikeda  1 , Manami Inoue, Hiroyasu Iso, Shunya Ikeda, Toshihiko Satoh, Mitsuhiko Noda, Tetsuya Mizoue, Hironori Imano, Eiko Saito, Kota Katanoda, Tomotaka Sobue, Shoichiro Tsugane, Mohsen Naghavi, Majid Ezzati, Kenji Shibuya
Affiliations

Adult mortality attributable to preventable risk factors for non-communicable diseases and injuries in Japan: a comparative risk assessment

Nayu Ikeda et al. PLoS Med. 2012 Jan.

Abstract

Background: The population of Japan has achieved the longest life expectancy in the world. To further improve population health, consistent and comparative evidence on mortality attributable to preventable risk factors is necessary for setting priorities for health policies and programs. Although several past studies have quantified the impact of individual risk factors in Japan, to our knowledge no study has assessed and compared the effects of multiple modifiable risk factors for non-communicable diseases and injuries using a standard framework. We estimated the effects of 16 risk factors on cause-specific deaths and life expectancy in Japan.

Methods and findings: We obtained data on risk factor exposures from the National Health and Nutrition Survey and epidemiological studies, data on the number of cause-specific deaths from vital records adjusted for ill-defined codes, and data on relative risks from epidemiological studies and meta-analyses. We applied a comparative risk assessment framework to estimate effects of excess risks on deaths and life expectancy at age 40 y. In 2007, tobacco smoking and high blood pressure accounted for 129,000 deaths (95% CI: 115,000-154,000) and 104,000 deaths (95% CI: 86,000-119,000), respectively, followed by physical inactivity (52,000 deaths, 95% CI: 47,000-58,000), high blood glucose (34,000 deaths, 95% CI: 26,000-43,000), high dietary salt intake (34,000 deaths, 95% CI: 27,000-39,000), and alcohol use (31,000 deaths, 95% CI: 28,000-35,000). In recent decades, cancer mortality attributable to tobacco smoking has increased in the elderly, while stroke mortality attributable to high blood pressure has declined. Life expectancy at age 40 y in 2007 would have been extended by 1.4 y for both sexes (men, 95% CI: 1.3-1.6; women, 95% CI: 1.2-1.7) if exposures to multiple cardiovascular risk factors had been reduced to their optimal levels as determined by a theoretical-minimum-risk exposure distribution.

Conclusions: Tobacco smoking and high blood pressure are the two major risk factors for adult mortality from non-communicable diseases and injuries in Japan. There is a large potential population health gain if multiple risk factors are jointly controlled.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Changes in life expectancy at age 40 y and the probability of death under optimal distributions of risk factors in Japan, 2007.
(A) Life expectancy at age 40. (B) Probability of death between 15 and 60 y of age. (C) Probability of death between 60 and 75 y of age. Joint risk is a combination of high blood pressure (directly, or indirectly through high dietary salt intake), high blood glucose, high LDL cholesterol, and high body mass index. BMI, body mass index; CVD, cardiovascular disease; NCD, non-communicable diseases; PUFA, polyunsaturated fatty acids; SFA, saturated fatty acids; TFA, trans fatty acids.
Figure 2
Figure 2. Cancer deaths attributable to tobacco smoking, by age group, 1980–2007.
Data for (A) men and (B) women.
Figure 3
Figure 3. Stroke deaths attributable to high blood pressure, by age group, 1980–2007.
Data for (A) men and (B) women.
See this image and copyright information in PMC

References

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    1. Ministry of Health, Labour and Welfare. Abridged life tables for Japan 2009. Tokyo: Ministry of Health, Labour and Welfare; 2010.
    1. Ikeda N, Saito E, Kondo N, Inoue M, Ikeda S, et al. What has made the population of Japan healthy? Lancet. 2011;378:1094–1105. - PubMed
    1. Ministry of Health, Labour and Welfare. Vital statistics. 2011. Available: http://www.mhlw.go.jp/english/database/db-hw/index.html. Accessed 5 July 2011.

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