Preventable Risk Factors for NCD

Adult Mortality Attributable to Preventable Risk Factors for Non-Communicable Diseases and Injuries in Japan: A Comparative Risk Assessment

1 Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan, 2 Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan, 3 Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Osaka, Japan, 4 International University of Health and Welfare Graduate School, Tokyo, Japan, 5 Kitasato Clinical Research Center, Kitasato University School of Medicine, Sagamihara, Japan,6 Department of Diabetes and Metabolic Medicine, National Center for Global Health and Medicine, Tokyo, Japan, 7 Department of Epidemiology and International Health, National Center for Global Health and Medicine, Tokyo, Japan, 8 Cancer Information Services and Surveillance Division, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan, 9 Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America, 10 MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United KingdomNayu Ikeda^1*, Manami Inoue², Hiroyasu Iso³, Shunya Ikeda⁴, Toshihiko Satoh⁵, Mitsuhiko Noda⁶, Tetsuya Mizoue⁷, Hironori Imano³, Eiko Saito¹, Kota Katanoda⁸,Tomotaka Sobue⁸, Shoichiro Tsugane², Mohsen Naghavi⁹,Majid Ezzati¹⁰, Kenji Shibuya¹

Abstract Top

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./.../