Adult mortality attributable to preventable risk factors for non-communicable diseases and injuries in Japan: a comparative risk assessment
Open accessAbstract
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.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Similar national comparative risk assessments were done in Australia, Iran, Japan, Mexico, South Africa, Thailand, the USA, and Vietnam.
“National comparative risk assessments (including in Australia, Iran, Japan, Mexico, South Africa, Thailand, USA, and Vietnam) have also been undertaken with similar approaches.11–16”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III)
Grundy, S. M., Becker, D. M., Clark, L. T., Cooper, R., Denke, M. A., Howard, J. L., Hunninghake, D. B., Illingworth, D. R., Luepker, R. V., McBride, P. E., et al. (2002) · Civil War Book Review · Cited by 12,198 · see citing works
Finucane, M. M., Stevens, G. A., Cowan, M. J., Danaei, G., Lin, J. K., Paciorek, C. J., Singh, G. M., Gutierrez, H. R., Lu, Y., Bahalim, A. N., et al. (2011) · The Lancet · doi:10.1016/s0140-6736(10)62037-5 · Cited by 4,050 · see citing works
Self-citationEzzati, M., López, A. D., Rodgers, A., & Murray, C. J. L. (2004) · Cited by 3,319 · see citing works
Self-citationMaking the most of statistical analyses: improving interpretation and presentation
King, G., Tomz, M., & Wittenberg, J. (2000) · American Journal of Political Science · doi:10.2307/2669316 · Cited by 3,232 · see citing works
The global health burden of infection‐associated cancers in the year 2002
Parkin, D. M. (2006) · International Journal of Cancer · doi:10.1002/ijc.21731 · Cited by 2,932 · see citing works
Danaei, G., Ding, E. L., Mozaffarian, D., Taylor, B., Rehm, J., Murray, C. J. L., & Ezzati, M. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000058 · Cited by 2,860 · see citing works
Self-citationTotal energy intake: implications for epidemiologic analyses.
WILLETT, W., & STAMPFER, M. J. (1986) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a114366 · Cited by 2,751 · see citing works
RE: “TOTAL ENERGY INTAKE: IMPLICATIONS FOR EPIDEMIOLOGIC ANALYSES”
Palmgren, J., & Kushi, L. H. (1991) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a115841 · Cited by 2,712 · see citing works
Global Burden of Disease and Risk Factors
López, A. D., Mathers, C. D., Ezzati, M., Jamison, D. T. T., & Murray, C. J. L. (2006) · World Bank, Washington, DC eBooks · doi:10.1596/978-0-8213-6262-4 · Cited by 2,693 · see citing works
Self-citationNoncommunicable diseases country profiles 2011.
Alwan, A., Armstrong, T. P., Cowan, M. J., & Riley, L. M. (2011) · Cited by 1,880 · see citing works
Report of the Committee on the Classification and Diagnostic Criteria of Diabetes Mellitus
Seino, Y., Nanjo, K., Tajima, N., Kadowaki, T., Kashiwagi, A., Araki, E., Ito, C., Inagaki, N., Iwamoto, Y., Kasuga, M., et al. (2010) · Journal of Diabetes Investigation · doi:10.1111/j.2040-1124.2010.00074.x · Cited by 1,780 · see citing works
Mortality from tobacco in developed countries: indirect estimation from national vital statistics.
Peto, R., Boreham, J., Lopez, A. D., Thun, M., & Heath, C. (1992) · The Lancet · doi:10.1016/0140-6736(92)91600-d · Cited by 1,394 · see citing works
The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2009)
Ogihara, T., Kikuchi, K., Matsuoka, H., Fujita, T., Higaki, J., Horiuchi, M., Imai, Y., Imaizumi, T., Ito, S., Iwao, H., et al. (2009) · Hypertension Research · doi:10.1038/hr.2014.68 · Cited by 1,094 · see citing works
Comparative quantification of health risks conceptual framework and methodological issues
Murray, C. J., Ezzati, M., Lopez, A. D., Rodgers, A., & Vander Hoorn, S. (2003) · Population Health Metrics · doi:10.1186/1478-7954-1-1 · Cited by 887 · see citing works
Self-citationWhat has made the population of Japan healthy?
Ikeda, N., Saito, E., Kondo, N., Inoue, M., Ikeda, S., Satoh, T., Wada, K., Stickley, A., Katanoda, K., Mizoue, T., et al. (2011) · The Lancet · doi:10.1016/s0140-6736(11)61055-6 · Cited by 675 · see citing works
Self-citationIn Search of Methuselah: Estimating the Upper Limits to Human Longevity
Olshansky, S. J., Carnes, B. A., & Cassel, C. (1990) · Science · doi:10.1126/science.2237414 · Cited by 645 · see citing works
Seino, Y., Nanjo, K., Tajima, N., Kadowaki, T., Kashiwagi, A., Araki, E., Ito, C., Inagaki, N., Iwamoto, Y., Kasuga, M., et al. (2010) · Diabetology International · doi:10.1007/s13340-010-0006-7 · Cited by 614 · see citing works
Anderson, C. A. M., Appel, L. J., Okuda, N., Brown, I., Chan, Q. M., Zhao, L., Ueshima, H., Kesteloot, H., Miura, K., Curb, J. D., et al. (2010) · Journal of the American Dietetic Association · doi:10.1016/j.jada.2010.02.007 · Cited by 543 · see citing works
Ogihara, T., Kikuchi, K., Matsuoka, H., Fujita, T., Higaki, J., Horiuchi, M., Imai, Y., Imaizumi, T., Ito, S., Iwao, H., et al. (2009) · Hypertension Research · doi:10.1038/hr.2009.34 · Cited by 486 · see citing works
Algorithms for enhancing public health utility of national causes-of-death data
Naghavi, M., Makela, S., Foreman, K., O'Brien, J., Pourmalek, F., & Lozano, R. (2010) · Population Health Metrics · doi:10.1186/1478-7954-8-9 · Cited by 440 · see citing works
Self-citationRole of Smoking in Global and Regional Cardiovascular Mortality
Ezzati, M., Henley, S. J., Thun, M. J., & López, A. D. (2005) · Circulation · doi:10.1161/circulationaha.104.521708 · Cited by 432 · see citing works
Self-citationMaking the Most of Statistical Analyses: Improving Interpretation and Presentation
King, G., Tomz, M. R., & Wittenberg, J. (2002) · ICPSR Data Holdings · doi:10.3886/icpsr01255 · Cited by 414 · see citing works
The Committee of the Japan Diabetes Society on the Diagnostic Criteria of Diabetes Mellitus
Seino, Y. (2010) · Medical Entomology and Zoology · Cited by 322 · see citing works
Teramoto, T., Sasaki, J., Ueshima, H., Egusa, G., Kinoshita, M., Shimamoto, K., Daida, H., Biro, S., Hirobe, K., Funahashi, T., et al. (2007) · Journal of Atherosclerosis and Thrombosis · doi:10.5551/jat.14.45 · Cited by 265 · see citing works
Increase of Maximum Life-Span in Sweden, 1861-1999
Wilmoth, J. R., Deegan, L. J., Lundström, H., & Horiuchi, S. (2000) · Science · doi:10.1126/science.289.5488.2366 · Cited by 265 · see citing works
Stevens, G., Dias, R. H., Thomas, K. J. A., Rivera, J. A., Carvalho, N., Barquera, S., Hill, K., & Ezzati, M. (2008) · PLoS Medicine · doi:10.1371/journal.pmed.0050125 · Cited by 249 · see citing works
Self-citationYoshizawa, H. (2002) · Oncology · doi:10.1159/000048270 · Cited by 229 · see citing works
Ideal body weight estimated from the body mass index with the lowest morbidity.
Tokunaga, K., Matsuzawa, Y., Kotani, K., Keno, Y., Kobatake, T., Fujioka, S., & Tarui, S. (1991) · PubMed · Cited by 225 · see citing works
NIPPON DATA80 Research Group (2006) · Circulation Journal · doi:10.1253/circj.70.1249 · Cited by 218 · see citing works
Cost containment and quality of care in Japan: is there a trade-off?
Hashimoto, H., Ikegami, N., Shibuya, K., et al. (2011) · The Lancet · doi:10.1016/s0140-6736(11)60987-2 · Cited by 202 · see citing works
Self-citationDanaei, G., Rimm, E. B., Oza, S., Kulkarni, S. C., Murray, C. J. L., & Ezzati, M. (2010) · PLoS Medicine · doi:10.1371/journal.pmed.1000248 · Cited by 191 · see citing works
Self-citationKatanoda, K., Marugame, T., Saika, K., Satoh, H., Tajima, K., Suzuki, T., Tamakoshi, A., Tsugane, S., & Sobue, T. (2008) · Journal of Epidemiology · doi:10.2188/jea.je2007429 · Cited by 148 · see citing works
Self-citationHuman papillomavirus in a necessary cause of invasive cervical cancer worldwide
(1999) · Pure Amsterdam UMC · doi:10.1002/(sici)1096-9896(199909)189:1 · Cited by 140 · see citing works
Ohkubo, T., Obara, T., Funahashi, J., Kikuya, M., Asayama, K., Metoki, H., Oikawa, T., TAKAHASHI, H., Hashimoto, J., Totsune, K., et al. (2004) · Hypertension Research · doi:10.1291/hypres.27.755 · Cited by 127 · see citing works
Imano, H., Kitamura, A., Sato, S., Kiyama, M., Ohira, T., Yamagishi, K., Noda, H., Tanigawa, T., Iso, H., & Shimamoto, T. (2009) · Stroke · doi:10.1161/strokeaha.108.538629 · Cited by 116 · see citing works
Self-citationNoncommunicable diseases and post-conflict countries
Roberts, B., Patel, P., & McKee, M. (2011) · Bulletin of the World Health Organization · doi:10.2471/blt.11.098863 · Cited by 114 · see citing works
Correlation among fasting plasma glucose, two-hour plasma glucose levels in OGTT and HbA1c
Ito, C., Maeda, R., Ishida, S., Sasaki, H., & Harada, H. (2000) · Diabetes Research and Clinical Practice · doi:10.1016/s0168-8227(00)00187-x · Cited by 103 · see citing works
Inoue, M., Nagata, C., Tsuji, I., Sugawara, Y., Wakai, K., Tamakoshi, A., Matsuo, K., Mizoue, T., Tanaka, K., Sasazuki, S., et al. (2010) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2010.121830 · Cited by 72 · see citing works
Self-citationIkeda, N. (2008) · Bulletin of the World Health Organization · doi:10.2471/blt.07.050195 · Cited by 67 · see citing works
Self-citationLiver cancer and its prevention.
Tsukuma, H., Tanaka, H., Ajiki, W., et al. (2005) · PubMed · Cited by 65 · see citing works
Alcohol consumption and suicide among middle-aged men in Japan
Akechi, T., Iwasaki, M., Uchitomi, Y., & Tsugane, S. (2006) · The British Journal of Psychiatry · doi:10.1192/bjp.188.3.231 · Cited by 64 · see citing works
Self-citationKato, M., Asaka, M., Shimizu, Y., et al. (2004) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2004.01987.x · Cited by 58 · see citing works
Cardiovascular Disease Epidemiology of Cerebrovascular Disease : Stroke Epidemic in Japan
Shimamoto, T., Iso, H., Iida, M., & Komachi, Y. (1996) · Journal of Epidemiology · doi:10.2188/jea.6.3sup_43 · Cited by 48 · see citing works
Self-citationWakai, K., Marugame, T., Kuriyama, S., Sobue, T., Tamakoshi, A., Satoh, H., Tajima, K., Suzuki, T., & Tsugane, S. (2007) · Cancer Science · doi:10.1111/j.1349-7006.2007.00423.x · Cited by 47 · see citing works
Self-citationTrends in smoking by birth cohorts born between 1900 and 1977 in Japan
Marugame, T., Kamo, K., Sobue, T., et al. (2005) · Preventive Medicine · doi:10.1016/j.ypmed.2005.09.009 · Cited by 45 · see citing works
Self-citationKawabe, H., Saito, I., & Saruta, T. (2005) · Hypertension Research · doi:10.1291/hypres.28.491 · Cited by 43 · see citing works
Murakami, Y., Miura, K., Okamura, T., & Ueshima, H. (2010) · Preventive Medicine · doi:10.1016/j.ypmed.2010.11.009 · Cited by 43 · see citing works
Tanaka, H., Hiyama, T., Tsukuma, H., et al. (1994) · Cancer Causes & Control · doi:10.1007/bf01694754 · Cited by 42 · see citing works
Life Expectancy among Japanese of Different Smoking Status in Japan: NIPPON DATA80
Murakami, Y., Ueshima, H., Okamura, T., Kadowaki, T., Hozawa, A., Kita, Y., Hayakawa, T., & Okayama, A. (2007) · Journal of Epidemiology · doi:10.2188/jea.17.31 · Cited by 40 · see citing works
Hozawa, A., Okamura, T., Murakami, Y., Kadowaki, T., Nakamura, K., Hayakawa, T., Kita, Y., Nakamura, Y., Abbott, R. D., Okayama, A., et al. (2007) · Hypertension Research · doi:10.1291/hypres.30.1169 · Cited by 39 · see citing works
Reduced life expectancy due to smoking in large-scale cohort studies in Japan.
Ozasa, K., Katanoda, K., Tamakoshi, A., Sato, H., Tajima, K., Suzuki, T., Tsugane, S., & Sobue, T. (2008) · Journal of Epidemiology · doi:10.2188/jea.je2007416 · Cited by 36 · see citing works
Self-citationYeh, J. M., Goldie, S. J., Kuntz, K. M., et al. (2009) · Cancer Causes & Control · doi:10.1007/s10552-009-9397-9 · Cited by 35 · see citing works
Attributable Fractions of Risk Factors for Cardiovascular Diseases
Hozawa, A. (2011) · Journal of Epidemiology · doi:10.2188/jea.je20100081 · Cited by 26 · see citing works
Regression analysis of trends in mortality from hepatocellular carcinoma in Japan, 1972–2001
Shibuya, K., & Yano, E. (2004) · International Journal of Epidemiology · doi:10.1093/ije/dyh358 · Cited by 25 · see citing works
Self-citationTakashima, N., Miura, K., Hozawa, A., Kadota, A., Okamura, T., Nakamura, Y., Hayakawa, T., Okuda, N., Fujiyoshi, A., Nagasawa, S., et al. (2010) · BMC Public Health · doi:10.1186/1471-2458-10-306 · Cited by 17 · see citing works
Farzadfar, F., Danaei, G., Namdaritabar, H., Rajaratnam, J. K., Marcus, J. R., Khosravi, A., Alikhani, S., Murray, C. J., & Ezzati, M. (2011) · Population Health Metrics · doi:10.1186/1478-7954-9-55 · Cited by 12 · see citing works
Self-citationFarzadfar, F., Danaei, G., Namdaritabar, H., Rajaratnam, J. K., Marcus, J. R., Khosravi, A., Alikhani, S., Murray, C. J. L., & Ezzati, M. (2011) · The Lancet · doi:10.1016/s0140-6736(13)61301-x · Cited by 12 · see citing works
Self-citationOECD Health Data: Non-medical determinants of health
(2017) · OECD Health Statistics · doi:10.1787/data-00546-en · Cited by 11 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [57]World Health Organization 2010 Global recommendations on physical activity for health Geneva World Health Organization 26180873
Cited by
Sorted by citations
Lim, S. S., Vos, T., Flaxman, A. D., Danaei, G., Shibuya, K., Adair-Rohani, H., AlMazroa, M. A., Amann, M., Anderson, H. R., Andrews, K. G., et al. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61766-8 · Cited by 11,805 · see citing works
Self-citationMasaki, K., Tateno, H., Nomura, A., Muto, T., Suzuki, S., Satake, K., Hida, E., & Fukunaga, K. (2020) · npj Digital Medicine · doi:10.1038/s41746-020-0243-5 · Cited by 102 · see citing works
- Authors
- Ikeda, N., Inoue, M., Iso, H., Ikeda, S., Satoh, T., Noda, M., Mizoue, T., Imano, H., Saito, E., Katanoda, K., Sobue, T., Tsugane, S., Naghavi, M., Ezzati, M., & Shibuya, K.
- Affiliations
- The University of Tokyo (JP)
- National Cancer Centre Japan (JP)
- The University of Osaka (JP)
- International University of Health and Welfare (JP)
- Kitasato University (JP)
- National Center for Global Health and Medicine (JP)
- University of Washington (US)
- Imperial College London (GB)
- Corresponding author
- Ikeda, Nayu
- ORCID
- Venue
- PLoS Medicine
- Publisher
- Public Library of Science (PLoS)
- Published
- 2012-01-24
- Volume
- 9
- Issue
- 1
- Pages
- e1001160
- ISSN
- 1549-1277 (ISSN-L)
- 1549-1676
- PMC
- PMC3265534
- OpenAlex
- W1973443484
- Cited by
- 240
- References
- 59
- Citations by year
- 2026: 9 · 2025: 15 · 2024: 10 · 2023: 23 · 2022: 23 · 2021: 19 · 2020: 32 · 2019: 22 · 2018: 12 · 2017: 18 · 2016: 16 · 2015: 17 · 2014: 11 · 2013: 7 · 2012: 5
- FWCI
- 8.23
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Institutional Repositories DataBase (IRDB) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- Ministry of Health, Labour and Welfare (H22-seisaku-shitei-033)
- Japan Society for the Promotion of Science
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- preventable deaths, non-communicable diseases, injuries, comparative risk assessment, life expectancy, smoking, hypertension, physical inactivity, hyperglycemia, salt intake, alcohol consumption, cardiovascular risk factors, cancer mortality, stroke mortality, Japan, health policy priorities, tobacco control, alcohol control, salt reduction, physical activity promotion, glycemic control, blood pressure control
- MeSH terms
- Adult, Aged, Aged, 80 and over, Female, Health Surveys, Humans, Hypertension, Japan, Life Expectancy, Male, Middle Aged, Risk Factors, Smoking, Risk Assessment
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
