title: Associations of all-cause mortality with census-based neighbourhood deprivation and population density in Japan: a multilevel survival analysis.
abstract: BACKGROUND
  Despite evidence that neighbourhood conditions affect residents' health, no prospective studies of the association between neighbourhood socio-demographic factors and all-cause mortality have been conducted in non-Western societies. Thus, we examined the effects of areal deprivation and population density on all-cause mortality in Japan.
  
  
  METHODS
  We employed census and survival data from the Japan Public Health Center-based Prospective Study, Cohort I (n = 37,455), consisting of middle-aged residents (40 to 59 years at the baseline in 1990) living in four public health centre districts. Data spanned between 1990 and 2010. A multilevel parametric proportional-hazard regression model was applied to estimate the hazard ratios (HRs) of all-cause mortality by two census-based areal variables--areal deprivation index and population density--as well as individualistic variables such as socioeconomic status and various risk factors.
  
  
  RESULTS
  We found that areal deprivation and population density had moderate associations with all-cause mortality at the neighbourhood level based on the survival data with 21 years of follow-ups. Even when controlling for individualistic socio-economic status and behavioural factors, the HRs of the two areal factors (using quartile categorical variables) significantly predicted mortality. Further, this analysis indicated an interaction effect of the two factors: areal deprivation prominently affects the health of residents in neighbourhoods with high population density.
  
  
  CONCLUSIONS
  We confirmed that neighbourhood socio-demographic factors are significant predictors of all-cause death in Japanese non-metropolitan settings. Although further study is needed to clarify the cause-effect relationship of this association, the present findings suggest that health promotion policies should consider health disparities between neighbourhoods and possibly direct interventions towards reducing mortality in densely populated and highly deprived neighbourhoods.
authors.affiliation: Department of Geography and Institute of Disaster Mitigation for Urban Cultural Heritage, Ritsumeikan University, Kita-ku, Kyoto, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Nakaya
authors.affiliation: Global Collaboration Center, Osaka University, Suita, Osaka, Japan.
authors.forename: Kaori
authors.initials: K
authors.lastname: Honjo
authors.affiliation: School of International Liberal Studies, Chukyo University, Toyota, Aichi, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Hanibuchi
authors.affiliation: Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Chuo-ku, Tokyo, Japan.
authors.forename: Ai
authors.initials: A
authors.lastname: Ikeda
authors.affiliation: Public Health, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Iso
authors.affiliation: Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Chuo-ku, Tokyo, Japan; Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Manami
authors.initials: M
authors.lastname: Inoue
authors.affiliation: Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Chuo-ku, Tokyo, Japan.
authors.forename: Norie
authors.initials: N
authors.lastname: Sawada
authors.affiliation: Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Chuo-ku, Tokyo, Japan.
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Tsugane
mesh_terms: D000328:Adult; D019352:Censuses; D005260:Female; D006304:Health Status; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011156:Population Density; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors