Major risk factors for adult mortality from NCDs and injuries in Japan

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Institute for Health Metrics and Evaluation - University of Washington

GHME 2013 Conference Session: Risk factor burden Date: June 18 2013 Presenter: Nayu Ikeda Institute: AXA Department of Health and Human Security, University of Tokyo

Health & Medicine News & Politics

Major risk factors for adult
mortality from NCDs and
injuries in Japan
Nayu Ikeda
AXA Department of Health and Human Security
Graduate School of Medicine
The University of Tokyo

Female life expectancy at birth
(Source: Lancet 2011;378:1094-1105)
Australia
UK
West Germany
France
Italy
Sweden
Canada
USA
Japan (1947-2008)
Japan (1900-1936)
Lifeexpectancy(years)
1900 1920 1940 1960 1980 2000
Year

Causes of death in Japan, 2008
(Data source: Vital records, adjusted for ill-defined codes)

CRA data (1/2)
Cause-specific mortality
– Vital records in 2007
– Redistribution of ill-defined codes (GBD 2010)
Selection of 16 risk factors and diseases
– US study (Danaei et al. 2009)
– Infections
Risk exposures
– National Health and Nutrition Survey 2007
– Epidemiological studies

CRA data (2/2)
 Selection of relative risks
1. Literature review of prospective studies in Japan
a. Pooled/individual estimates from large-scale
prospective studies
b. Confirming causalities/associations already
established in past studies
2. Asia-Pacific Cohort Studies Collaboration
3. GBD study
 Theoretical-minimum-risk exposure distribution
– US study

Deaths attributable to risk factors in
Japan, 2007
(Source: PLoS Med 2012;1:e1001160)
129K
104K
Diseases

Dietary risks
High blood pressure
Smoking
Physical inactivity
Ambient PM pollution
High BMI
High plasma glucose
Alcohol use
High total cholesterol
Lead
Occupational risks
Low bone mineral density
Intimate partner violence
Drug use
Ozone
Childhood sexual abuse
Iron deficiency
Radon
Sanitation
Unimproved water
Zinc deficiency
Childhood underweight
Vitamin A deficiency
Household air pollution
Suboptimal BF
0 40k 80k 120k 160k 200k 240k(Source: GBD Compare, IHME)
GBD 2010
Japan, deaths

High sodium
Low fruit
Low nuts & seeds
Low whole grains
Low omega-3
Low fiber
Low vegetables
Low PUFA
Low calcium
High processed meat
Low milk
High sweetened
beverages
High trans fat
High red meat
0 20k 40k 60k 80k 100k(Source: GBD Compare, IHME)
GBD 2010
Japan, deaths

Smoking rate by age and sex
(Data source: National Health and Nutrition Surveys)

Prevalence of high blood pressure
0
10
20
30
40
50
1960
1970
1980
1990
2000
2010
Year
England
Japan
United States
(Source: Ikeda et al. under review)
1970
1980
1990
2000
2010
England
Japan
United States
50
40
30
20
10
0
%ofpopulation
1960 1970 1980 1990 2000 2010
Year

Average dietary salt intake
(Data source: National Health and Nutrition Surveys)

Policy implications
Importance of improving the control of major
risk factors
• Investigate underlying causes for the inadequate
risk factor control at the population level
• Revise and strengthen policies and programs to
appropriately address these issues
Results cited in academic and official materials
for health promotion

Next steps
 Disability-adjusted life years
• Preventing risk factors to decrease the burden of
long-term care for the elderly
 CRA at the subnational level
• Disparity in life expectancy across prefectures

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Major risk factors for adult mortality from NCDs and injuries in Japan

1. Major risk factors for adult mortality from NCDs and injuries in Japan Nayu Ikeda AXA Department of Health and Human Security Graduate School of Medicine The University of Tokyo

2. Female life expectancy at birth (Source: Lancet 2011;378:1094-1105) Australia UK West Germany France Italy Sweden Canada USA Japan (1947-2008) Japan (1900-1936) Lifeexpectancy(years) 1900 1920 1940 1960 1980 2000 Year

3. Causes of death in Japan, 2008 (Data source: Vital records, adjusted for ill-defined codes)

4. CRA data (1/2) Cause-specific mortality – Vital records in 2007 – Redistribution of ill-defined codes (GBD 2010) Selection of 16 risk factors and diseases – US study (Danaei et al. 2009) – Infections Risk exposures – National Health and Nutrition Survey 2007 – Epidemiological studies

5. CRA data (2/2)  Selection of relative risks 1. Literature review of prospective studies in Japan a. Pooled/individual estimates from large-scale prospective studies b. Confirming causalities/associations already established in past studies 2. Asia-Pacific Cohort Studies Collaboration 3. GBD study  Theoretical-minimum-risk exposure distribution – US study

6. Deaths attributable to risk factors in Japan, 2007 (Source: PLoS Med 2012;1:e1001160) 129K 104K Diseases

7. Dietary risks High blood pressure Smoking Physical inactivity Ambient PM pollution High BMI High plasma glucose Alcohol use High total cholesterol Lead Occupational risks Low bone mineral density Intimate partner violence Drug use Ozone Childhood sexual abuse Iron deficiency Radon Sanitation Unimproved water Zinc deficiency Childhood underweight Vitamin A deficiency Household air pollution Suboptimal BF 0 40k 80k 120k 160k 200k 240k(Source: GBD Compare, IHME) GBD 2010 Japan, deaths

8. High sodium Low fruit Low nuts & seeds Low whole grains Low omega-3 Low fiber Low vegetables Low PUFA Low calcium High processed meat Low milk High sweetened beverages High trans fat High red meat 0 20k 40k 60k 80k 100k(Source: GBD Compare, IHME) GBD 2010 Japan, deaths

9. Smoking rate by age and sex (Data source: National Health and Nutrition Surveys)

10. Prevalence of high blood pressure 0 10 20 30 40 50 1960 1970 1980 1990 2000 2010 Year England Japan United States (Source: Ikeda et al. under review) 1970 1980 1990 2000 2010 England Japan United States 50 40 30 20 10 0 %ofpopulation 1960 1970 1980 1990 2000 2010 Year

11. Average dietary salt intake (Data source: National Health and Nutrition Surveys)

12. Policy implications Importance of improving the control of major risk factors • Investigate underlying causes for the inadequate risk factor control at the population level • Revise and strengthen policies and programs to appropriately address these issues Results cited in academic and official materials for health promotion

13. Next steps  Disability-adjusted life years • Preventing risk factors to decrease the burden of long-term care for the elderly  CRA at the subnational level • Disparity in life expectancy across prefectures

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