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. 2025 Apr;10(4):e321-e332.
doi: 10.1016/S2468-2667(25)00044-1. Epub 2025 Mar 20.

Three decades of population health changes in Japan, 1990-2021: a subnational analysis for the Global Burden of Disease Study 2021

GBD 2021 Japan Collaborators
Collaborators

Three decades of population health changes in Japan, 1990-2021: a subnational analysis for the Global Burden of Disease Study 2021

GBD 2021 Japan Collaborators. Lancet Public Health. 2025 Apr.

Abstract

Background: Given Japan's rapidly ageing demographic structure, comprehensive and long-term evaluations of its national and subnational health progress are important to inform public health policy. This study aims to assess Japan's population health, using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to analyse the country's evolving disease patterns.

Methods: GBD 2021 used Japanese data from 1474 sources, covering 371 diseases, including COVID-19, and 88 risk factors. The analysis included estimates of life expectancy, mortality, and disability-adjusted life-years (DALYs). Estimates were generated using the standardised GBD methodology, which incorporates various data sources through statistical modelling, including the Cause Of Death Ensemble Model for mortality, Bayesian Meta-Regression Disease Model for non-fatal outcomes, and risk factor estimation frameworks to quantify attributable burdens. Life expectancy decomposition by cause of death and annualised rates of change of age-standardised mortality and DALYs were calculated for 1990-2005, 2005-15, and 2015-21.

Findings: Between 1990 and 2021, life expectancy in Japan rose from 79·4 years (95% uncertainty interval 79·3-79·4) to 85·2 years (85·1-85·2), with prefecture-level disparities widening. Gains were primarily driven by reduced mortality from stroke (adding 1·5 years to life expectancy), ischaemic heart disease (1·0 years), and neoplasms, particularly stomach cancer (0·5 years), with variation across prefectures. Leading causes of death in 2021 were Alzheimer's disease and other dementias (135·3 deaths [39·5-312·3] per 100 000 population), stroke (114·9 [89·8-129·3] per 100 000), ischaemic heart disease (96·5 [77·7-106·7] per 100 000), and lung cancer (72·1 [61·8-77·5] per 100 000). Age-standardised mortality for major non-communicable diseases declined, but the pace of this decline has slowed. All-cause annualised rate of change in mortality rate decreased from -1·6% for 2005-15 to -1·1% for 2015-21. Age-standardised COVID-19 mortality rates were 0·8 deaths (0·7-0·9) per 100 000 population (accounting for 0·3% of all deaths) in 2020 and 3·0 (2·5-3·7) per 100 000 population in 2021 (1·0% of deaths). Age-standardised DALY rates for diabetes worsened, with annualised rate of change increasing from 0·1% for 2005-15 to 2·2% for 2015-21. This change parallels worsening trends in major risk factors, particularly high fasting plasma glucose (annualised rate of change of attributable DALYs -0·8% for 2005-15 and 0·8% for 2015-21) and high BMI (0·2% and 1·4%, respectively). Age-standardised DALYs attributable to other major risk factors continued to decrease, albeit slower.

Interpretation: Japan's health gains over the past 30 years are now stalling, with rising regional disparities. The increasing burdens of Alzheimer's disease and other dementias and diabetes, alongside high fasting plasma glucose and high BMI, highlight areas needing focused attention and action.

Funding: Gates Foundation.

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Conflict of interest statement

Declaration of interests S Bhaskar reports grants or contracts from the Japan Society for the Promotion of Science, Japanese Ministry of Education, Culture, Sports, Science and Technology, and from The Australian Academy of Science; leadership or fiduciary roles in board, society, committee, or advocacy groups (paid or unpaid) as the Visiting Director in the Department of Neurology at the National Cerebral and Cardiovascular Center, Suita (Osaka, Japan), as District Chair of diversity, equity and inclusion at the Rotary District 9675, as Chair and Manager of the Global Health and Migration Hub Community (Berlin, Germany), as an editorial member of PLoS One, BMC Neurology, Frontiers in Neurology, Frontiers in Stroke, Frontiers in Aging, Frontiers in Public Health, and BMC Medical Research Methodology, as a member of the College of Reviewers (Canadian Institutes of Health Research, Government of Canada), a member of the Scientific Review Committee at Cardiff University Biobank (UK), an expert advisor and reviewer with the Cariplo Foundation (Milan, Italy), and as Visiting Director at the National Cerebral and Cardiovascular Center, Department of Neurology, Division of Cerebrovascular Medicine and Neurology (Suita, Osaka, Japan); outside the submitted work. N Kawakami reports grants or contracts from Junpukai Foundation and the Department of Digital Mental Health (The University of Tokyo); consulting fees from SB@WORK; leadership or fiduciary role in other board, society, committee, or advocacy group (unpaid) with the Japan Society for Occupational Health; outside the submitted work. T Lallukka reports support for the present manuscript from the Research Council of Finland (330527). M Lee reports support for the present manuscript from the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2023S1A3A2A05095298). S Nomura reports support for the present manuscript from Precursory Research for Embryonic Science and Technology from the Japan Science and Technology Agency (JPMJPR22R8) and the National Cancer Center Research and Development Fund (2024-A-14). B Oancea reports grants or contracts from the MRID, project PNRR-I8 number 842027778, contract number 760096; outside the submitted work. T Tabuchi reports grants or contracts from Daiichi Sankyo Healthcare and consulting fees from Daiichi Sankyo Healthcare, outside the submitted work. Y Yasufuku reports grants or contracts from Shionogi & Co, outside the submitted work.

Figures

Figure 1
Figure 1
Comparison of life expectancy at birth across 47 prefectures in Japan by sex, 1990 and 2021 Error bars are 95% uncertainty intervals. Prefectures are ordered from top to bottom on the y-axis based on their 2021 life expectancy values (from highest to lowest). The values to the right of each 2021 datapoint show the gain in life expectancy (in years) between 1990 and 2021. See appendix (pp 22–25) for detailed life expectancy values and rankings.
Figure 2
Figure 2
Difference between life expectancy and HALE across 47 prefectures in Japan for males and females, 1990 and 2021 Prefectures are numbered from 1 to 47 according to their ISO codes. 1=Hokkaido. 2=Aomori. 3=Iwate. 4=Miyagi. 5=Akita. 6=Yamagata. 7=Fukushima. 8=Ibaraki. 9=Tochigi. 10=Gunma. 11=Saitama. 12=Chiba. 13=Tokyo. 14=Kanagawa. 15=Niigata. 16=Toyama. 17=Ishikawa. 18=Fukui. 19=Yamanashi. 20=Nagano. 21=Gifu. 22=Shizuoka. 23=Aichi. 24=Mie. 25=Shiga. 26=Kyoto. 27=Osaka. 28=Hyogo. 29=Nara. 30=Wakayama. 31=Tottori. 32=Shimane. 33=Okayama. 34=Hiroshima. 35=Yamaguchi. 36=Tokushima. 37=Kagawa. 38=Ehime. 39=Kochi. 40=Fukuoka. 41=Saga. 42=Nagasaki. 43=Kumamoto. 44=Oita. 45=Miyazaki. 46=Kagoshima. 47=Okinawa. HALE=healthy life expectancy.
Figure 3
Figure 3
Decomposition of life expectancy changes in Japan by cause of death and prefecture, showing the number of years gained or lost due to each cause for all sexes combined between 1990 and 2021 Prefectures are ordered based on their total gain in life expectancy (shown in parentheses). NCD=non-communicable disease. CMNNDs=communicable, maternal, neonatal, and nutritional diseases. OPRM=other pandemic-related mortality.
Figure 4
Figure 4
Decomposition of the effect of prevention and treatment of the top 10 cancers on life expectancy in Japan by prefecture for all sexes combined between 1990 and 2021 Prefectures are ordered based on their total gain in life expectancy (shown in parentheses).
Figure 5
Figure 5
GBD Level 3 causes of death in Japan for the years 1990, 2005, 2015, and 2021 for all ages and sexes, with ARCs for age-standardised mortality rates Rankings are based on the number of deaths from each cause. Data on the number of deaths for each cause are available in GBD Compare. ARC=annualised rate of change. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study. ILD=interstitial lung disease.
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