Association between the Standardized Mortality Ratio and Healthy Life Expectancy in Japan

Rikuya Hosokawa; Toshiyuki Ojima; Tomoya Myojin; Jun Aida; Katsunori Kondo; Naoki Kondo

doi:10.31662/jmaj.2022-0140

Association between the Standardized Mortality Ratio and Healthy Life Expectancy in Japan

JMA J. 2023 Jan 16;6(1):27-35. doi: 10.31662/jmaj.2022-0140. Epub 2022 Dec 19.

Authors

Rikuya Hosokawa¹, Toshiyuki Ojima², Tomoya Myojin³, Jun Aida⁴, Katsunori Kondo^{5

6

7}, Naoki Kondo⁸

Affiliations

¹ Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
² Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan.
³ Department of Public Health, Health Management and Policy, Nara Medical University, Nara, Japan.
⁴ Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
⁵ Center for Preventive Medical Sciences, Chiba University, Chiba, Japan.
⁶ Center for Well-being and Society, Nihon Fukushi University, Aichi, Japan.
⁷ Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan.
⁸ School of Public Health and Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Abstract

Introduction: Healthy life expectancy (HLE) remains the principal target of various health plans. We aimed to identify the areas of priority and determinants of mortality to extend HLE across local governments in Japan.

Methods: HLE according to secondary medical areas was calculated using the Sullivan method. People requiring long-term care of level 2 or higher were considered unhealthy. Standardized mortality ratios (SMRs) for major causes of death were calculated using vital statistics data. The association between HLE and SMR was analyzed using simple and multiple regression analyses.

Results: The average (standard deviation) HLE values were 79.24 (0.85) and 83.76 (0.62) years for men and women, respectively. A comparison of HLE revealed regional health gaps of 4.46 (76.90-81.36) and 3.46 (81.99-85.45) years for men and women, respectively. The coefficients of determination for the SMR of malignant neoplasms with HLE were the highest and were 0.402 and 0.219 among men and women, respectively, followed by those of cerebrovascular diseases, suicide, and heart diseases among men and those of heart disease, pneumonia, and liver disease among women. When all major preventable causes of death were analyzed simultaneously in a regression model, the coefficients of determination were 0.738 and 0.425 among men and women, respectively.

Conclusions: Our findings suggest that local governments should prioritize preventing cancer deaths via cancer screening and smoking cessation measures in health plans, with a special focus on men.

Keywords: Japan; healthcare; life expectancy; mortality; standardized mortality ratio.