title: Adult mortality attributable to preventable risk factors for non-communicable diseases and injuries in Japan: a comparative risk assessment.
abstract: 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.
  
  
  RESULTS
  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.
authors.affiliation: Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. ikedan@m.u-tokyo.ac.jp
authors.forename: Nayu
authors.initials: N
authors.lastname: Ikeda
authors.forename: Manami
authors.initials: M
authors.lastname: Inoue
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Iso
authors.forename: Shunya
authors.initials: S
authors.lastname: Ikeda
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Satoh
authors.forename: Mitsuhiko
authors.initials: M
authors.lastname: Noda
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Mizoue
authors.forename: Hironori
authors.initials: H
authors.lastname: Imano
authors.forename: Eiko
authors.initials: E
authors.lastname: Saito
authors.forename: Kota
authors.initials: K
authors.lastname: Katanoda
authors.forename: Tomotaka
authors.initials: T
authors.lastname: Sobue
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Tsugane
authors.forename: Mohsen
authors.initials: M
authors.lastname: Naghavi
authors.forename: Majid
authors.initials: M
authors.lastname: Ezzati
authors.forename: Kenji
authors.initials: K
authors.lastname: Shibuya
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000401:mortality*; D007564:Japan / Q000453:epidemiology; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology / Q000401:mortality*