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Population health and regional variations of disease burden in Japan, 1990–2015: a systematic subnational analysis for the Global Burden of Disease Study 2015

BACKGROUND: Japan has entered the era of super-ageing and advanced health transition, which is increasingly putting pressure on the sustainability of its health system. The level and pace of this health transition might vary across regions within Japan and concern is growing about increasing regiona...

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Autores principales: Nomura, Shuhei, Sakamoto, Haruka, Glenn, Scott, Tsugawa, Yusuke, Abe, Sarah K, Rahman, Md M, Brown, Jonathan C, Ezoe, Satoshi, Fitzmaurice, Christina, Inokuchi, Tsuyoshi, Kassebaum, Nicholas J, Kawakami, Norito, Kita, Yosuke, Kondo, Naoki, Lim, Stephen S, Maruyama, Satoshi, Miyata, Hiroaki, Mooney, Meghan D, Naghavi, Mohsen, Onoda, Tomoko, Ota, Erika, Otake, Yuji, Roth, Gregory A, Saito, Eiko, Tabuchi, Takahiro, Takasaki, Yohsuke, Tanimura, Tadayuki, Uechi, Manami, Vos, Theo, Wang, Haidong, Inoue, Manami, Murray, Christopher J L, Shibuya, Kenji
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5613077/
https://www.ncbi.nlm.nih.gov/pubmed/28734670
http://dx.doi.org/10.1016/S0140-6736(17)31544-1
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author Nomura, Shuhei
Sakamoto, Haruka
Glenn, Scott
Tsugawa, Yusuke
Abe, Sarah K
Rahman, Md M
Brown, Jonathan C
Ezoe, Satoshi
Fitzmaurice, Christina
Inokuchi, Tsuyoshi
Kassebaum, Nicholas J
Kawakami, Norito
Kita, Yosuke
Kondo, Naoki
Lim, Stephen S
Maruyama, Satoshi
Miyata, Hiroaki
Mooney, Meghan D
Naghavi, Mohsen
Onoda, Tomoko
Ota, Erika
Otake, Yuji
Roth, Gregory A
Saito, Eiko
Tabuchi, Takahiro
Takasaki, Yohsuke
Tanimura, Tadayuki
Uechi, Manami
Vos, Theo
Wang, Haidong
Inoue, Manami
Murray, Christopher J L
Shibuya, Kenji
author_facet Nomura, Shuhei
Sakamoto, Haruka
Glenn, Scott
Tsugawa, Yusuke
Abe, Sarah K
Rahman, Md M
Brown, Jonathan C
Ezoe, Satoshi
Fitzmaurice, Christina
Inokuchi, Tsuyoshi
Kassebaum, Nicholas J
Kawakami, Norito
Kita, Yosuke
Kondo, Naoki
Lim, Stephen S
Maruyama, Satoshi
Miyata, Hiroaki
Mooney, Meghan D
Naghavi, Mohsen
Onoda, Tomoko
Ota, Erika
Otake, Yuji
Roth, Gregory A
Saito, Eiko
Tabuchi, Takahiro
Takasaki, Yohsuke
Tanimura, Tadayuki
Uechi, Manami
Vos, Theo
Wang, Haidong
Inoue, Manami
Murray, Christopher J L
Shibuya, Kenji
author_sort Nomura, Shuhei
collection PubMed
description BACKGROUND: Japan has entered the era of super-ageing and advanced health transition, which is increasingly putting pressure on the sustainability of its health system. The level and pace of this health transition might vary across regions within Japan and concern is growing about increasing regional variations in disease burden. The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) provides a comprehensive, comparable framework. We used data from GBD 2015 with the aim to quantify the burden of disease and injuries, and to attribute risk factors in Japan at a subnational, prefecture-level. METHODS: We used data from GBD 2015 for 315 causes and 79 risk factors of death, disease, and injury incidence and prevalence to measure the burden of diseases and injuries in Japan and in the 47 Japanese prefectures from 1990 to 2015. We extracted data from GBD 2015 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), life expectancy, and healthy life expectancy (HALE) in Japan and its 47 prefectures. We split extracted data by prefecture and applied GBD methods to generate estimates of burden, and attributable burden due to known risk factors. We examined the prefecture-level relationships of common health system inputs (eg, health expenditure and workforces) to the GBD outputs in 2015 to address underlying determinants of regional health variations. FINDINGS: Life expectancy at birth in Japan increased by 4·2 years from 79·0 years (95% uncertainty interval [UI] 79·0 to 79·0) to 83·2 years (83·1 to 83·2) between 1990 and 2015. However, the gaps between prefectures with the lowest and highest life expectancies and HALE have widened, from 2·5 to 3·1 years and from 2·3 to 2·7 years, respectively, from 1990 to 2015. Although overall age-standardised death rates decreased by 29·0% (28·7 to 29·3) from 1990 to 2015, the rates of mortality decline in this period substantially varied across the prefectures, ranging from −32·4% (−34·8 to −30·0) to −22·0% (−20·4 to −20·1). During the same time period, the rate of age-standardised DALYs was reduced overall by 19·8% (17·9 to 22·0). The reduction in rates of age-standardised YLDs was very small by 3·5% (2·6 to 4·3). The pace of reduction in mortality and DALYs in many leading causes has largely levelled off since 2005. Known risk factors accounted for 34·5% (32·4 to 36·9) of DALYs; the two leading behavioural risk factors were unhealthy diets and tobacco smoking in 2015. The common health system inputs were not associated with age-standardised death and DALY rates in 2015. INTERPRETATION: Japan has been successful overall in reducing mortality and disability from most major diseases. However, progress has slowed down and health variations between prefectures is growing. In view of the limited association between the prefecture-level health system inputs and health outcomes, the potential sources of regional variations, including subnational health system performance, urgently need assessment. FUNDING: Bill & Melinda Gates Foundation, Japan Ministry of Education, Science, Sports and Culture, Japan Ministry of Health, Labour and Welfare, AXA CR Fixed Income Fund and AXA Research Fund.
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spelling pubmed-56130772017-09-29 Population health and regional variations of disease burden in Japan, 1990–2015: a systematic subnational analysis for the Global Burden of Disease Study 2015 Nomura, Shuhei Sakamoto, Haruka Glenn, Scott Tsugawa, Yusuke Abe, Sarah K Rahman, Md M Brown, Jonathan C Ezoe, Satoshi Fitzmaurice, Christina Inokuchi, Tsuyoshi Kassebaum, Nicholas J Kawakami, Norito Kita, Yosuke Kondo, Naoki Lim, Stephen S Maruyama, Satoshi Miyata, Hiroaki Mooney, Meghan D Naghavi, Mohsen Onoda, Tomoko Ota, Erika Otake, Yuji Roth, Gregory A Saito, Eiko Tabuchi, Takahiro Takasaki, Yohsuke Tanimura, Tadayuki Uechi, Manami Vos, Theo Wang, Haidong Inoue, Manami Murray, Christopher J L Shibuya, Kenji Lancet Articles BACKGROUND: Japan has entered the era of super-ageing and advanced health transition, which is increasingly putting pressure on the sustainability of its health system. The level and pace of this health transition might vary across regions within Japan and concern is growing about increasing regional variations in disease burden. The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) provides a comprehensive, comparable framework. We used data from GBD 2015 with the aim to quantify the burden of disease and injuries, and to attribute risk factors in Japan at a subnational, prefecture-level. METHODS: We used data from GBD 2015 for 315 causes and 79 risk factors of death, disease, and injury incidence and prevalence to measure the burden of diseases and injuries in Japan and in the 47 Japanese prefectures from 1990 to 2015. We extracted data from GBD 2015 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), life expectancy, and healthy life expectancy (HALE) in Japan and its 47 prefectures. We split extracted data by prefecture and applied GBD methods to generate estimates of burden, and attributable burden due to known risk factors. We examined the prefecture-level relationships of common health system inputs (eg, health expenditure and workforces) to the GBD outputs in 2015 to address underlying determinants of regional health variations. FINDINGS: Life expectancy at birth in Japan increased by 4·2 years from 79·0 years (95% uncertainty interval [UI] 79·0 to 79·0) to 83·2 years (83·1 to 83·2) between 1990 and 2015. However, the gaps between prefectures with the lowest and highest life expectancies and HALE have widened, from 2·5 to 3·1 years and from 2·3 to 2·7 years, respectively, from 1990 to 2015. Although overall age-standardised death rates decreased by 29·0% (28·7 to 29·3) from 1990 to 2015, the rates of mortality decline in this period substantially varied across the prefectures, ranging from −32·4% (−34·8 to −30·0) to −22·0% (−20·4 to −20·1). During the same time period, the rate of age-standardised DALYs was reduced overall by 19·8% (17·9 to 22·0). The reduction in rates of age-standardised YLDs was very small by 3·5% (2·6 to 4·3). The pace of reduction in mortality and DALYs in many leading causes has largely levelled off since 2005. Known risk factors accounted for 34·5% (32·4 to 36·9) of DALYs; the two leading behavioural risk factors were unhealthy diets and tobacco smoking in 2015. The common health system inputs were not associated with age-standardised death and DALY rates in 2015. INTERPRETATION: Japan has been successful overall in reducing mortality and disability from most major diseases. However, progress has slowed down and health variations between prefectures is growing. In view of the limited association between the prefecture-level health system inputs and health outcomes, the potential sources of regional variations, including subnational health system performance, urgently need assessment. FUNDING: Bill & Melinda Gates Foundation, Japan Ministry of Education, Science, Sports and Culture, Japan Ministry of Health, Labour and Welfare, AXA CR Fixed Income Fund and AXA Research Fund. Elsevier 2017-09-23 /pmc/articles/PMC5613077/ /pubmed/28734670 http://dx.doi.org/10.1016/S0140-6736(17)31544-1 Text en © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Articles
Nomura, Shuhei
Sakamoto, Haruka
Glenn, Scott
Tsugawa, Yusuke
Abe, Sarah K
Rahman, Md M
Brown, Jonathan C
Ezoe, Satoshi
Fitzmaurice, Christina
Inokuchi, Tsuyoshi
Kassebaum, Nicholas J
Kawakami, Norito
Kita, Yosuke
Kondo, Naoki
Lim, Stephen S
Maruyama, Satoshi
Miyata, Hiroaki
Mooney, Meghan D
Naghavi, Mohsen
Onoda, Tomoko
Ota, Erika
Otake, Yuji
Roth, Gregory A
Saito, Eiko
Tabuchi, Takahiro
Takasaki, Yohsuke
Tanimura, Tadayuki
Uechi, Manami
Vos, Theo
Wang, Haidong
Inoue, Manami
Murray, Christopher J L
Shibuya, Kenji
Population health and regional variations of disease burden in Japan, 1990–2015: a systematic subnational analysis for the Global Burden of Disease Study 2015
title Population health and regional variations of disease burden in Japan, 1990–2015: a systematic subnational analysis for the Global Burden of Disease Study 2015
title_full Population health and regional variations of disease burden in Japan, 1990–2015: a systematic subnational analysis for the Global Burden of Disease Study 2015
title_fullStr Population health and regional variations of disease burden in Japan, 1990–2015: a systematic subnational analysis for the Global Burden of Disease Study 2015
title_full_unstemmed Population health and regional variations of disease burden in Japan, 1990–2015: a systematic subnational analysis for the Global Burden of Disease Study 2015
title_short Population health and regional variations of disease burden in Japan, 1990–2015: a systematic subnational analysis for the Global Burden of Disease Study 2015
title_sort population health and regional variations of disease burden in japan, 1990–2015: a systematic subnational analysis for the global burden of disease study 2015
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5613077/
https://www.ncbi.nlm.nih.gov/pubmed/28734670
http://dx.doi.org/10.1016/S0140-6736(17)31544-1
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