GHME 2013 Conference Session: Risk factor burden Date: June 18 2013 Presenter: Nayu Ikeda Institute: AXA Department of Health and Human Security, University of Tokyo

1. Major risk factors for adult
mortality from NCDs and
injuries in Japan
Nayu Ikeda
AXA Department of Health and Human Security
Graduate School of Medicine
The University of Tokyo

2. Female life expectancy at birth
(Source: Lancet 2011;378:1094-1105)
Australia
UK
West Germany
France
Italy
Sweden
Canada
USA
Japan (1947-2008)
Japan (1900-1936)
Lifeexpectancy(years)
1900 1920 1940 1960 1980 2000
Year

3. Causes of death in Japan, 2008
(Data source: Vital records, adjusted for ill-defined codes)

4. CRA data (1/2)
Cause-specific mortality
– Vital records in 2007
– Redistribution of ill-defined codes (GBD 2010)
Selection of 16 risk factors and diseases
– US study (Danaei et al. 2009)
– Infections
Risk exposures
– National Health and Nutrition Survey 2007
– Epidemiological studies

5. CRA data (2/2)
 Selection of relative risks
1. Literature review of prospective studies in Japan
a. Pooled/individual estimates from large-scale
prospective studies
b. Confirming causalities/associations already
established in past studies
2. Asia-Pacific Cohort Studies Collaboration
3. GBD study
 Theoretical-minimum-risk exposure distribution
– US study

6. Deaths attributable to risk factors in
Japan, 2007
(Source: PLoS Med 2012;1:e1001160)
129K
104K
Diseases

7. Dietary risks
High blood pressure
Smoking
Physical inactivity
Ambient PM pollution
High BMI
High plasma glucose
Alcohol use
High total cholesterol
Lead
Occupational risks
Low bone mineral density
Intimate partner violence
Drug use
Ozone
Childhood sexual abuse
Iron deficiency
Radon
Sanitation
Unimproved water
Zinc deficiency
Childhood underweight
Vitamin A deficiency
Household air pollution
Suboptimal BF
0 40k 80k 120k 160k 200k 240k(Source: GBD Compare, IHME)
GBD 2010
Japan, deaths

8. High sodium
Low fruit
Low nuts & seeds
Low whole grains
Low omega-3
Low fiber
Low vegetables
Low PUFA
Low calcium
High processed meat
Low milk
High sweetened
beverages
High trans fat
High red meat
0 20k 40k 60k 80k 100k(Source: GBD Compare, IHME)
GBD 2010
Japan, deaths

9. Smoking rate by age and sex
(Data source: National Health and Nutrition Surveys)

10. Prevalence of high blood pressure
0
10
20
30
40
50
1960
1970
1980
1990
2000
2010
Year
England
Japan
United States
(Source: Ikeda et al. under review)
1970
1980
1990
2000
2010
England
Japan
United States
50
40
30
20
10
0
%ofpopulation
1960 1970 1980 1990 2000 2010
Year

11. Average dietary salt intake
(Data source: National Health and Nutrition Surveys)

12. Policy implications
Importance of improving the control of major
risk factors
• Investigate underlying causes for the inadequate
risk factor control at the population level
• Revise and strengthen policies and programs to
appropriately address these issues
Results cited in academic and official materials
for health promotion

13. Next steps
 Disability-adjusted life years
• Preventing risk factors to decrease the burden of
long-term care for the elderly
 CRA at the subnational level
• Disparity in life expectancy across prefectures