title: Social cohesion and mortality: a survival analysis of older adults in Japan.
abstract: OBJECTIVE
  We examined the association between social cohesion and mortality in a sample of older adults in Japan.
  
  
  METHODS
  Data were derived from a cohort study of elderly individuals (65-84 years) in Shizuoka Prefecture; 14 001 participants were enrolled at baseline (1999) and followed up in 2002, 2006, and 2009. Among the 11 092 participants for whom we had complete data, 1427 had died during follow-up. We examined the association between social cohesion (assessed at both the community and individual levels) and subsequent mortality after control for baseline and time-varying covariates. We used clustered proportional hazard regression models to estimate hazard ratios (HRs) and confidence intervals (CIs).
  
  
  RESULTS
  After control for individual characteristics, individual perceptions of community cohesion were associated with a reduced risk of all-cause mortality (HR = 0.78; 95% CI = 0.73, 0.84) as well as mortality from cardiovascular disease (HR = 0.75; 95% CI = 0.67, 0.84), pulmonary disease (HR = 0.66; 95% CI = 0.58, 0.75), and all other causes (HR = 0.76; 95% CI = 0.66, 0.89). However, no statistically significant relationship was found between community cohesion and mortality risk.
  
  
  CONCLUSIONS
  Among the elderly in Japan, more positive individual perceptions of community cohesion are associated with reduced risks of all-cause and cause-specific mortality.
authors.affiliation: Sachiko Inoue, Soshi Takao, and Hiroyuki Doi are with the Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan. Sachiko Inoue is also with and Ichiro Kawachi is with the Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA. Takashi Yorifuji is with the Department of Human Ecology, Okayama University Graduate School of Environmental and Life Science, Okayama, Japan.
authors.forename: Sachiko
authors.initials: S
authors.lastname: Inoue
authors.forename: Takashi
authors.initials: T
authors.lastname: Yorifuji
authors.forename: Soshi
authors.initials: S
authors.lastname: Takao
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Doi
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death / Q000639:trends; D016001:Confidence Intervals; D005260:Female; D033062:Friends; D006304:Health Status; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D009026:Mortality / Q000639:trends*; D016016:Proportional Hazards Models; D012931:Social Environment; D016019:Survival Analysis