Why are the Japanese living longer?

Ischemic stroke and the gene for angiotensin-converting enzyme in Japanese hypertensives

BACKGROUND

The ACE insertion/deletion (I/D) polymorphism is reported to be associated with myocardial infarction in both whites and Japanese. However, there have been no reports on the association of this polymorphism with stroke in each race. Furthermore, there are some racial differences in the demographics of cardiovascular disease. In Japanese, stroke (especially that which occurs in preexisting hypertension) is more common and coronary artery disease much less common than in whites. We propose that the ACE I/D polymorphism might be associated with hypertensive cerebrovascular disease in Japanese.

METHODS AND RESULTS

To study the association between the ACE I/D polymorphism and hypertensive cerebrovascular disease, we identified the ACE I/D genotype in 228 hypertensive and 104 normotensive Japanese subjects. Compared with its frequency (0.31) in the 90 hypertensives without lacunae detected by magnetic resonance imaging, the ACE*D allele frequency was significantly higher (0.47; P<.001) in the 138 hypertensives with silent or clinically overt ischemic stroke, whereas there was no significant difference between its frequency in hypertensives without lacunae and in 104 normotensive control subjects (0.34). The positive association between the ACE I/D genotype and ischemic stroke in hypertensive patients was independent of other risk factors.

CONCLUSIONS

We found a positive association between the ACE*D allele and ischemic stroke in Japanese hypertensives in our study. The ACE*D allele may be an independent risk factor for the development of cerebrovascular disease in hypertensive patients.

Senile dementia in Japan: prevalence and response

Early studies of the prevalence of dementia in Japan indicated low rates, but more recently rates have been rising to the levels shown in other countries. Extended family care of the elderly has been typical, but recent developments suggest that this is declining. The implications of recent social changes for the care of the demented elderly are discussed.

Different trends in serum cholesterol levels among rural and urban populations aged 40-59 in Japan from 1960 to 1990

In Japan, coronary heart disease mortality is low and has been declining since 1970, despite recent increases in serum cholesterol levels which have been reported in nationwide surveys. Longitudinal and cross-sectional surveys of serum cholesterol levels in rural and urban populations from 1960 to 1990 were reviewed. In the surveys in the 1960s, serum cholesterol levels in urban populations were higher than those in rural populations. An increase in serum cholesterol levels for men and women was observed in all longitudinal studies among rural populations; mean increases in serum cholesterol levels per year were 0.034 mmol/l (p < 0.001) and 0.033 mmol/l (p < 0.001), respectively. These trends were still observed after combining the data from the longitudinal and cross-sectional studies in both men and women (0.027 and 0.028 mmol/l per year, respectively), while there was no significant increase among urban populations. The results of National Nutrition Surveys are consistent with these findings and show that meat consumption per day per capita increased from 23.9 to 66.2 g in rural populations and 51.2 to 77.6 g in urban populations in the 1966 and 1990 surveys. It is suggested that different trends in coronary heart disease mortality should also be apparent in rural and urban populations over this period.

Factors affecting the incidence of death at home of residents of Hida district, Japan

This study compared the percentage of residents who died from disease at home in Hida district, Japan, between the years 1979-1981 and 1989-1991, and found it decreased from 46.9% during the earlier period to 32.6% during the latter. It differed significantly by age and underlying cause of death. Residents aged 85 and over were almost twice as likely to die at home as were all other subjects. Patients who died of malignant neoplasms showed the lowest proportion of death at home. A greater percentage of residents who lived far from hospitals or those who had the causal disease for a prolonged time died at home. The proportion for 1989-1991 was lower than that for 1979-1981 after adjustment for age, gender, cause of death, period of illness, and availability of hospital. It was speculated that the increase of hospital beds affected the proportion of death at home.

Nutrition and the global risk for chronic diseases: the INTERHEALTH nutrition initiative. The INTERHEALTH Steering Committee

As chronic, noncommunicable diseases (NCDs) have emerged as leading causes of morbidity and mortality worldwide, the World Health Organization's INTERHEALTH Programme, an international collaboration currently involving 15 countries, has focused its attention on population-based NCD prevention. Participating nations include Australia, Chile, China, Cuba, Cyprus, Finland, Japan, Lithuania, Malta, Mauritius, Russia, Sri Lanka, Tanzania, Thailand, and the United States. This paper will review and assess global trends in food and nutrient intake among INTERHEALTH countries between 1954 and 1986.

Social deprivation indices of patients on renal replacement therapy (RRT) in Grampian

The social deprivation scores of 169 patients who resided in Grampian region and commenced renal replacement therapy (RRT) in Aberdeen during the period 1 January 1985-30 June 1991 were measured when their serum creatinine concentrations were first > = 300 mumol/l, using the Jarman Underprivileged Area (UPA) and Carstairs indices. The numbers in the population of Grampian for each score were obtained from the Information Services team of Grampian Health Board based on the 1981 census. Comparison of the numbers of patients in each category of both Jarman and Carstairs indices showed no differences between the observed numbers of patients and the numbers in the general population. Thus in this study social deprivation occurred no more frequently in those commencing RRT than in the general population.

Low risk to certain diseases in aging: role of the autonomic nervous system and calcium metabolism

The low risk of aging Africans, as opposed to high risk of Caucasians, to certain major disorders, including Parkinson's disease, myocardial infarction, osteoporosis and fractures, some rheumatic diseases, and an overall reduced incidence of cancer, has not been explained. In this study it is proposed, firstly, that relative risk is determined by a common physiological mechanism in which ANS status and calcium metabolism play a central role; secondly, that distinctive features of this mechanism in Africans may be subtly increased vagal tone, relatively enhanced dopaminergic versus noradrenergic activity, and an efficient dopamine/vitamin D-parathormone, anabolic hormone regulation of bone metabolism, and cell calcium homeostasis; and thirdly, that the neuroendocrine-metabolic context determines the response to specific stimuli; consequently, 'risk' factors, as defined for particular disorders, are not universally applicable. Maintained dopaminergic activity, as proposed for Africans, coupled with low risk to certain disorders, confirms the experimentally demonstrated paramount importance of this neurotransmitter in retarding aging processes in animals. The neuroendocrine profile as defined for Africans is consistent with a potentially extended period of physical and mental competence and a conceivable shorter duration of involutionary decline.

Survival analysis of dialysis patients in Okinawa, Japan (1971-1990)

We analyzed longitudinal data obtained from the initiation of chronic dialysis in Okinawa, Japan. A total of 1,982 patients (824 females and 1,158 males) were registered in the Okinawa Dialysis Study (OKIDS) up to the end of 1990. The number of patients dying, undergoing renal transplantation, or being transferred was 605 (30.5%), 75 (3.8%), and 23 (1.2%), respectively. The mean acceptance rate per million population increased from 19.7 in 1971 to 1975 to 157.4 in 1986 to 1990. The percentage of diabetic patients and the annual gross mortality rate were, respectively 0% and 0.52 (1971 to 1975), 7.3% and 0.12 (1976 to 1980), 14.4% and 0.06 (1981 to 1985), and 24.6% and 0.07 (1986 to 1990). Cox proportional hazard analysis was used to determine the relative risk (RR) for sex, primary renal disease, age at entry, and the year of starting dialysis. The RR for males was 1.09 (1.00 for females) and the 95% confidence interval (CI) was 0.93 to 1.28. The RR for diabetics was 1.88 (95% CI; 1.55 to 2.28) when that for nondiabetics was set at 1.00. The RR (95% CI) for starting dialysis in 1976 to 1980, 1981 to 1985, and 1986 to 1990 was 0.65 (0.59 to 0.72), 0.43 (0.35 to 0.52), and 0.28 (0.20 to 0.38), respectively, when the RR in 1971 to 1975 was taken as 1.00. During the last two decades, the survival of chronic dialysis patients in Okinawa has continued to improve despite the large increase in acceptance rate, the older age of the new patients, and the increase in diabetic patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Geographical patterns of proportionate mortality for the most common causes of death in Brazil

Mortality due to chronic diseases has been increasing in all regions of Brazil with corresponding decreases in mortality from infectious diseases. The geographical variation in proportionate mortality for chronic diseases for 17 Brazilian state capitals for the year 1985 and their association with socio-economic variables and infectious disease was studied. Calculations were made of correlation coefficients of proportionate mortality for adults of 30 years or above due to ischaemic heart disease, stroke and cancer of the lung, the breast and stomach with 3 socio-economic variables, race, and mortality due to infectious disease. Linear regression analysis included as independent variables the % of illiteracy, % of whites, % of houses with piped water, mean income, age group, sex, and % of deaths caused by infectious disease. The dependent variables were the % of deaths due to each one of the chronic diseases studied by age-sex group. Chronic diseases were an important cause of death in all regions of Brazil. Ischaemic heart diseases, stroke and malignant neoplasms accounted for more than 34% of the mortality in each of the 17 capitals studied. Proportionate cause-specific mortality varied markedly among state capitals. Ranges were 6.3-19.5% for ischaemic heart diseases, 8.3-25.4% for stroke, 2.3-10.4% for infections and 12.2-21.5% for malignant neoplasm. Infectious disease mortality had the highest (p < 0.001) correlation with all the four socio-economic variables studied and ischaemic heart disease showed the second highest correlation (p < 0.05). Higher socio-economic level was related to a lower % of infectious diseases and a higher % of ischaemic heart diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

The economics of health care in Japan

Japan's health care system balances universal coverage at reasonable cost. The government has taken on the responsibility of acting as insurer and subsidizing health care spending for the employees of small enterprises and the self-employed. Despite the fee-for-service form of payment, costs have been contained by the use of a nationally uniform fee schedule that is mandatory for all providers. However, the increasingly affluent and aging population is making new demands on the system that can only be met by a major restructuring.

Healthy lifestyles are associated with higher natural killer cell activity

BACKGROUND

To investigate the association of individual lifestyle with immune response against tumors, we assayed peripheral blood lymphocytes of 62 healthy males ranging in age from 30 to 60 years for natural killer (NK) cell activity, which is the first line of defense against tumors, and for frequencies of NK cell subsets.

METHODS

The NK cell activity was determined by 51Cr release assay, and NK cell subsets were counted using surface antigens (CD16, CD57) which recognize NK cell subgroups with different cytolytic potentials. Subjects were classified into groups reporting good, moderate, and poor lifestyles according to their responses on a questionnaire regarding eight health practices (tobacco smoking, alcohol consumption, hours of sleep, physical exercise, eating breakfast, balanced nutrition, hours of work habits, and mental stress).

RESULTS

Individuals reporting good lifestyle habits were found to have the highest NK cell activity and it was significantly higher than the NK cell activity in those reporting poor lifestyle habits. Those reporting good health practices regarding smoking and physical exercise showed significantly higher NK cell activity at an effector-to-target-cell ratio of 40:1.

CONCLUSIONS

The higher NK cell activity among individuals reporting good lifestyle practices may reflect an increase in the cytolytic potential of NK cell activity within the CD16+, CD57- subset.

Health status and lifestyle in elderly Hawaii Japanese and Australian men. Exploring known differences in longevity

OBJECTIVE

To contrast health status and lifestyle in two elderly populations with differing longevity.

DESIGN

Comparison of two cross-sectional data sets.

SETTING

Non-institutionalised subjects.

SUBJECTS

Men aged 60-81 years resident in Dubbo, New South Wales (n = 1183, 1988-1989) and Japanese men of the same ages resident in Hawaii (n = 1376, 1980-1982).

MAIN OUTCOME MEASURES

Cardiovascular and non-cardiovascular disease prevalence, risk factors, social and health status.

RESULTS

A history of heart attack, angina and stroke was twice as prevalent in Dubbo men as in Hawaii Japanese. Other diseases were many times more prevalent in Dubbo--liver disease sixfold, prostate and renal disease twofold, and arthritis 1.5-fold. Hypercholesterolaemia and untreated hypertension were more prevalent in Dubbo (threefold and 1.5-fold respectively). Current smoking was similar in both groups, while diabetes was twice as prevalent in the Hawaii Japanese. More Dubbo men were widowed or lived alone, and fewer remained in paid employment. Dubbo men had more limited physical mobility.

CONCLUSIONS

Elderly Dubbo men have an excess of cardiovascular disease and associated risk factors, as well as an excess of non-cardiovascular disease, compared with Hawaii Japanese. This may account, in part, for a higher total mortality rate in elderly Australians compared with Japanese. Some of this disease burden may be amenable to risk factor intervention.

National mortality rates: the impact of inequality?

Although health is closely associated with income differences within each country there is, at best, only a weak link between national mortality rates and average income among the developed countries. On the other hand, there is evidence of a strong relationship between national mortality rates and the scale of income differences within each society. These three elements are coherent if health is affected less by changes in absolute material standards across affluent populations than it is by relative income or the scale of income differences and the resulting sense of disadvantage within each society. Rather than socioeconomic mortality differentials representing a distribution around given national average mortality rates, it is likely that the degree of income inequality indicates the burden of relative deprivation on national mortality rates.

Social inequalities in health

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The macrophage theory of depression

Excessive secretion of macrophage monokines is proposed as the cause of depression. Monokines when given to volunteers can produce the symptoms necessary for the Diagnostic and Statistical Manual of Mental Disorders, Third Edition Revised (DSM-III-R) diagnosis of major depressive episode. Interleukin-1 (IL-1) can provoke the hormone abnormalities linked with depression. This theory provides an explanation for the significant association of depression with coronary heart disease, rheumatoid arthritis, stroke and other diseases where macrophage activation occurs. The 3:1 female/male incidence of depression ratio is accounted for by estrogen's ability to activate macrophages. The extraordinary low rate of depression in Japan is consistent with the suppressive effect of eicosapentanoic acid on macrophages. Fish oil is proposed as a prophylaxis against depression and omega-6 fat as a promoter. Infection, tissue damage, respiratory allergies and antigens found in food are some of the possible causes of macrophage activation triggering depression.

Relation between use of health check ups starting in middle age and demand for inpatient care by elderly people in Japan

OBJECTIVE

To find out whether there is any correlation between the use of general health check ups (provided for by the Health Services for the Elderly Act 1982) by insured Japanese residents aged 40 or older and demand by the elderly for inpatient care.

DESIGN

A questionnaire was posted in 1988 to municipal offices of Japanese cities. All questionnaires were returned with data for 1983 and 1986.

SETTING

All 509 Japanese cities with a population of 30,000-199,999.

SUBJECTS

All people aged 40 or older who hold a resident card and are not offered health examinations at work are eligible for general health check ups. The questionnaire also inquired about use of inpatient care by elderly residents (aged 70 or older) who were covered by national health insurance.

MAIN OUTCOME MEASURES

Correlation coefficients between the rates of use of general health check ups and mean annual bed days for the elderly. Comparison of relative changes by analysis of correlation between improvement indices in mean bed days and mean inpatient fee.

RESULTS

In cities with relatively high rates of use of health check ups both the mean annual bed days and the mean inpatient fee for the elderly tended to be low. Correlation coefficients between the logarithmic rates of use of check ups and mean bed days by sizes of cities and number of beds were all negative values. There tended to be more correlation between improvement indices for rate of use of check ups and both mean bed days and mean inpatient fee with higher rates of use in 1983, and the correlation was significant for rates of 60% or more.

CONCLUSIONS

Strong health service programmes that start in middle age decrease the demand for inpatient care of the elderly. It was estimated that in a single year from 1985 to 1986, when there was an increase in the rate of use of check ups from 25.5% to 27.6%, the reduction in the number of bed days for the total of 8.5 million elderly insured people was 2.21 million bed days.

Psychosocial and biobehavioral characteristics of hypertensive men with elevated atherogenic lipids

Epidemiologic studies demonstrated an excess risk of ischemic heart disease (IHD) among individuals who simultaneously exhibit hypertension and elevated atherogenic lipids (coronary high risk (CHR)-status). Yet, relatively little is known about factors which contribute to the development of CHR-status during early and middle adulthood. The present study explores the role of selected biobehavioral and psychosocial factors in explaining CHR-status using data from a prospective 6.5 years investigation of a cohort of 416 middle-aged (40.8 +/- 9.6 years) male blue-collar workers. Multivariate logistic regression analysis shows that overweight (odds ratio (o.r.) 4.14), smoking (o.r. 2.19), low promotion prospects at work (o.r. 2.71), competitiveness at work (o.r. 2.79) and feelings of sustained anger (o.r. 5.41) independently contribute to the explanation of CHR-status. Furthermore, the operational definition of CHR-status is validated by estimating its power in predicting IHD incidence in the study cohort. In conclusion, co-manifestation of hypertension and elevated lipids is more likely to exist among those blue-collar men who exhibit distinct work-related characteristics in addition to established biobehavioral risks such as overweight and smoking. In view of the high prevalence of CHR-status and of IHD among men in the lower socio-economic strata this finding is also of interest for health policy.