The State of Health in Older Adults in Japan: Trends in Disability, Chronic Medical Conditions and Mortality

Validating the short-version European Health Literacy Survey Questionnaire for community-dwelling older adults in Japan

The European Health Literacy Survey Questionnaire (HLS-EU-Q47) is available in multiple languages, and shortened versions have also been developed. This study aimed to examine the reliability and validity of the short version of the questionnaire (HLS-Q12) developed for community-dwelling older adults in Japan. The HLS-Q12 was developed using 12 of the 47 items of the Japanese version of the HLS-EU-Q47. In this study, the survey was conducted by distributing self-administered questionnaires to community-dwelling individuals aged 65 years and older who consented to participate; their responses were collected by mail. The correlation between the HLS-Q12 and the HLS-EU-Q47 was tested to assess criterion validity. To test construct validity, nine novel hypotheses were proposed. We also conducted a confirmatory factor analysis of the HLS-Q12. Based on a resurvey after 5-7 days, test-retest reliability was examined using interclass correlation coefficients (ICCs) and Bland-Altman analysis. In total, 118 individuals provided valid responses to the questionnaire. The Spearman rank correlation coefficient between the HLS-Q12 and the HLS-EU-Q47 was r = 0.98 (p < 0.001), and eight of the nine hypotheses were supported. The ICC was 0.96 (p < 0.001), and the 95% limit of agreement was -0.26 ± 5.9, suggesting no systematic error. Thus, the Japanese version of the HLS-Q12 was found to be reliable with high criterion validity and reproducibility. Hence, the HLS-Q12 is a useful scale for measuring health literacy among older adults in Japan.

Age-wise examination of the association of obesity based on body mass index and waist circumference with metabolic diseases in comprehensive health checkup participants

Aim

Body mass index and waist circumference are used for obesity diagnosis and screening of visceral fat; however, their evidence in older adults is insufficient. This study investigated the age-specific association of body mass index and waist circumference with metabolic diseases, assessing their applicability as diagnostic criteria for individuals aged ≥65 years.

Methods

Analysis included 46,324 individuals aged ≥18 years, categorized into five age groups: 18-44, 45-54, 55-64, 65-74, and ≥75 years. Logistic regression analyses identified associations between obesity and metabolic diseases, stratified by age and sex.

Results

Men with obesity based on body mass index had a significantly high risk of hypertension, diabetes mellitus, and dyslipidemia across all age groups (all, p < 0.05). Obesity based on waist circumference was significantly positively associated with all metabolic diseases (all, p < 0.05). Women with obesity based on body mass index and waist circumference had a significantly high risk of all metabolic diseases across all age groups (all, p < 0.05), except for diabetes mellitus in individuals aged ≥75 years.

Conclusions

Participants with obesity based on body mass index and waist circumference exhibited a high risk of hypertension, diabetes mellitus, and dyslipidemia among those aged 18-74 years and men aged ≥75 years. This study contributes to the early prevention and control of metabolic diseases.

Temporal, seasonal, and spatial patterns in fall-related mortality in Japan: Analysis of national vital statistics from 1975 to 2019

BACKGROUND

Falls are a significant public health issue in aging societies. This study aimed to examine the temporal, seasonal, and spatial patterns in fall-related mortality in Japan, and to investigate the potential factors associated with fall-related mortality.

METHODS

The number of unintentional fall-related deaths from 1979 to 2019 were obtained from Japanese vital statistics and crude and direct age-standardized mortality rates (DSR) were calculated. We also calculated the standardized mortality ratio (SMR) to determine seasonal and prefectural differences. In addition, spatial regression was conducted to examine the potential factors associated with fall-related mortality.

RESULTS

The DSR among those over 65 years old showed a decreasing trend from 1979, but remained unchanged from 1990 to 2019. Based on the spatial regression model, the factors significantly associated with SMRs were the proportion of the aged population (Coefficient: 0.049), the number of hospitals (0.118), the number of clinics (1.169), the number of hospital beds (-0.060), and the number of physiotherapists (-0.069) for men; and the proportion of aged single households (-0.060), the number of hospitals (0.132), the number of clinics (1.498), the number of hospital beds (-0.051), and the number of physicians (-0.308) for women.

CONCLUSIONS

Fall-related mortality among Japanese elderly people has remained unchanged in recent years. In addition, seasonal and spatial patterns were also observed, and it was found that demographic data and healthcare resources in the prefectures affected fall-related mortality rates. Appropriate prevention measures of fall-related deaths should be considered according to the region-specific characteristics and issues.

Positive psychological factors and the risk of pneumonia-associated mortality: Japan Collaborative Cohort Study

OBJECTIVE

To examine the association between positive psychological factors and the risk of pneumonia-associated mortality in a large prospective Japanese cohort.

METHODS

The Japan Collaborative Cohort Study assessed 64,231 participants (26,293 men and 37,938 women), aged 40-79 years, without a history of stroke, myocardial infarction, cancer or tubercules at baseline (1988-1990). We used self-administered questionnaires about lifestyle, medical history, and mental states, including three positive psychological factors, and followed-up for mortality outcomes until the end of 2009. The Cox proportional hazard model was used to calculate the multivariable hazard ratios (HRs) with 95% confidence intervals (CIs) of pneumonia-associated mortality after adjustment for potential confounding factors, mutually positive psychological factors, and consideration for the competing risk.

RESULTS

Having Ikigai (in Japanese) was inversely associated with the risk of pneumonia-associated mortality in both men and women; the multivariable HRs (95% CIs) for high versus low levels were 0.68 (0.48-0.97), P trend =0.090 and 0.66 (0.43-1.00), P trend =0.146, respectively. Such inverse associations were more pronounced in working men and non-working women; the multivariable HRs (95% CIs) for high versus low levels were 0.52 (0.32-0.85), P trend =0.010 and 0.59 (0.37-0.94), P trend =0.079, respectively. Being relied upon by others and Enjoyment of life was not associated with the risk in both genders.

CONCLUSION

Having Ikigai was associated with a lower risk of pneumonia-associated mortality in both genders, especially in working men and non-working women.

Can mild cognitive impairment with depression be improved merely by exercises of recall memories accompanying everyday conversation? A longitudinal study 2016-2019

Purpose

The purpose of this study is to find out a simple cognitive intervention method to use MCI and suffering people with depression. As the elderly society increases around the world, the number of elderly people with diseases and dementia is increasing rapidly. Mild cognitive impairment (MCI), a pre-stage to dementia, is a critical treatment time to slow disease progression. However, there is currently no appropriate medication. Furthermore, MCI patients with depression are more difficult to treat.

Design/methodology/approach

To overcome these problems, the authors confirmed improvements and delayed effects in MCI patients in this study for three years through cognitive intervention, demonstrating its effectiveness. Cognitive interventions were conducted for memory retrieval and steadily stimulated the brain by performing tasks to solve problems during daily conversations.

Findings

As a result, the intervention group retained mini-mental state examination and Montreal cognitive assessment scores on the domains of cognitive function and also instrumental activities of daily living in the domain of motion compared to the non-intervention group. Moreover, significant improvements in geriatric depression scales-15 and quality-of-life scales enabled the patients to maintain stable living compared to before the intervention. In addition, the intervention group showed a change in patterns that allowed them to voluntarily devote time to going out at the end of the study.

Research limitations/implications

This study was originally planned to compare the rates of transmission from MCI to dementia by tracking over five years (2016–2021). However, due to the impact of COVID-19, which began to spread around the world in 2020, further face-to-face visits and cognitive intervention became impossible. Thus, only half of the data in the existing plans were collected. Although it is difficult to present accurate results for the rate of transmission from MCI to dementia, the tendency was confirmed, indicating sufficient implications as an intervention.

Originality/value

This study was originally planned to compare the rates of transmission from MCI to dementia by tracking three years (2016–2019). The authors had studied for long-term effect.

Temporal trends in 6-minute walking distance for older Japanese adults between 1998 and 2017

BACKGROUND

The 6-minute walking distance (6MWD) is an excellent measure of both functional endurance and health. The primary aim of this study was to estimate temporal trends in 6MWD for older Japanese adults between 1998 and 2017; the secondary aim was to estimate concurrent trends in body size (i.e., height and mass) and self-reported participation in exercise/sport.

METHODS

Adults aged 65-79 years were included. Annual nationally representative 6MWD data (n = 103,505) for the entire period were obtained from the Japanese Ministry of Education, Culture, Sports, Science and Technology. Temporal trends in means (and relative frequencies) were estimated at the gender-age level by best-fitting sample-weighted linear/polynomial regression models, with national trends estimated by a post-stratified population-weighting procedure. Temporal trends in distributional variability were estimated as the ratio of coefficients of variation.

RESULTS

Between 1998 and 2017 there was a steady, moderate improvement in mean 6MWD (absolute = 45 m (95% confidence interval (95%CI): 43-47); percent = 8.0% (95%CI: 7.6%-8.4%); effect size = 0.51 (95%CI: 0.48-0.54)). Gender- and age-related temporal differences in means were negligible. Variability in 6MWD declined substantially (ratio of coefficients of variation = 0.89, 95%CI: 0.87-0.92), with declines larger for women compared to men, and for 75-79-year-olds compared to 65-74-year-olds. Correspondingly, there were moderate and negligible increases in mean height and mass, respectively, and negligible increases in the percentage who participated in exercise/sport at least 3 days per week and at least 30 min per session.

CONCLUSION

There has been a steady, moderate improvement in mean 6MWD for older Japanese adults since 1998, which is suggestive of corresponding improvements in both functional endurance and health. The substantial decline in variability indicates that the temporal improvement in mean 6MWD was not uniform across the distribution. Trends in 6MWD are probably influenced by corresponding trends in body size and/or participation in exercise/sport.

Walking speed and balance both improved in older Japanese adults between 1998 and 2018

Background/objective

Physical function, the ability of an individual to carry out physical tasks, is meaningfully related to health among older adults. Few studies have analyzed temporal trends in objective performance measures of physical function for older adults. The aim of this study was to estimate temporal trends in balance and walking speed for older Japanese adults (aged 65–79 years) between 1998 and 2018.

Methods

Annual, cross-sectional, national fitness surveillance data for balance (n = 114,785) and walking speed (n = 112,289) were reported descriptively by the Japanese Ministry of Education, Culture, Sports, Science and Technology across the 1998–2018 period. Trends in means were estimated by sample-weighted regression, with trends in variability estimated as the ratio of coefficients of variation.

Results

There was a moderate improvement in both mean balance (standardized effect size (ES) change (95% confidence interval (CI)): 0.50 (0.48–0.52)) and mean walking speed (ES change (95%CI): 0.53 (0.51–0.55)). Improvements were seen in all gender and age groups, with small gender-related and negligible age-related temporal differences. Variability declined substantially for both balance (ratio of CVs (95%CI): 0.77 (0.75–0.79)) and walking speed (ratio of CVs (95%CI): 0.87 (0.85–0.89)).

Conclusion

Improved physical performance is suggestive of a corresponding improvement in health. Declines in variability indicate that temporal improvements were not uniform across the distribution.

Temporal trends in handgrip strength for older Japanese adults between 1998 and 2017

OBJECTIVE

to estimate temporal trends in handgrip strength (HGS) for older Japanese adults between 1998 and 2017.

DESIGN AND METHODS

adults aged 60-79 years were included. Annual nationally representative HGS data (n = 176,449) for the 19-year study period were obtained from the Japanese Ministry of Education, Culture, Sports, Science and Technology. Temporal trends in mean HGS were estimated by sample-weighted regression models relating the year of testing to mean HGS. National trends in absolute, percent and standardised HGS were estimated by a post-stratified population-weighting procedure. Temporal trends in variability were estimated as the ratio of coefficients of variation (CVs).

RESULTS

collectively, there was a small improvement in mean HGS of 1.4 kg (95% confidence interval [CI]: 1.3-1.5), 4.5% (95%CI: 4.3-4.7) or 0.27 standard deviations (95%CI: 0.26-0.28) between 1998 and 2017. The rate of improvement progressively increased over time, with more recent values (post-2008) 1.5-fold larger than earlier values. Gender- and age-related temporal differences were negligible. Variability in HGS declined substantially over time (ratio of CVs [95%CI]: 0.88 [0.86-0.90]), with declines 1.9-fold larger in women compared to men and 1.7-fold larger in 70- to 79-year-olds compared to 60- to 69-year-olds.

CONCLUSIONS

there has been a small, progressive improvement in mean HGS for older Japanese adults since 1998, which is suggestive of a corresponding improvement in strength capacity. The substantial decline in variability indicates that the improvement in mean HGS was not uniform across the population.

Living Longer, With or Without Disability? A Global and Longitudinal Perspective

BACKGROUND

Significant gains in life expectancy have been achieved, but living longer does not necessarily mean the years gained are productive and healthy. Different theories predict different patterns of time trends in old-age disability prevalence.

METHODS

Using the Gateway to Global Aging Data, which provides internationally harmonized longitudinal data from the Health and Retirement Study and its sister surveys, we compare time trends (from 2004 to 2014) in disability prevalence across countries.

RESULTS

Disability prevalence varies greatly across countries, and divergent time trends are observed across countries. For countries such as Belgium, Czechia, and Mexico, we observe an increase of disability prevalence, whereas in countries such as Denmark, England, Greece, Korea, Poland, and Sweden, we observe a substantial decrease in disability prevalence. Looking further into the severity of disability, we often observe differential trends in prevalence, but there is no evidence supporting the dynamic equilibrium hypothesis that predicts increased prevalence of modest disability but a decrease in severe disability prevalence.

CONCLUSIONS

Significant gains in life expectancy have translated into different gains in healthy years of life across different countries. Diverse time trends in disability prevalence across countries reaffirm that the expansion of late-life disability is not inevitable.

Tendência temporal da mortalidade em idosos em municípios no estado do Acre

Resumo Objetivo Analisar a tendência temporal da mortalidade na população de idosos em municípios selecionados das cinco regionais de desenvolvimento no estado do Acre, Brasil. Método Estudo descritivo, ecológico de séries temporais, que utilizou dados do Sistema de Informações sobre Mortalidade (SIM), no qual foi selecionado o universo de óbitos ocorridos em idosos, registrados nos municípios acreanos de 1996 a 2015. Foram calculadas as taxas de mortalidade brutas e ajustadas por idade, utilizando o método direto e a população mundial como referência. Para a análise das tendências, foi realizada a estimativa da variação percentual anual da mortalidade com nível de confiança de 95% pelo software Joinpoint Regression Program. Resultados A tendência da mortalidade geral apresentou-se decrescente em Rio Branco e com oscilações nos demais municípios investigados. As principais causas de óbito foram as doenças do aparelho circulatório, respiratório e neoplasias. Em Rio Branco, as taxas de mortalidade padronizadas por idade nas doenças do aparelho circulatório reduziram 2,26% (p<0,001) ao ano e as neoplasias apresentaram tendência crescente e constante com uma variação anual de 1,02% (p=0,010). Conclusão O estudo mostrou evidências de polarização epidemiológica, geográfica e social no comportamento das tendências da mortalidade. Rio Branco, a capital do estado, apresentou padrões semelhantes aos das regiões desenvolvidas brasileiras. Por outro lado, os demais municípios apresentaram consideráveis oscilações nas tendências que podem estar relacionadas à elevada proporção de causas mal definidas. Esses achados podem auxiliar no planejamento de ações estratégicas e sugestões de hipóteses para novos estudos.

Comorbidity status in hospitalized elderly in Japan: Analysis from National Database of Health Insurance Claims and Specific Health Checkups

The detailed comorbidity status of hospitalized elderly patients throughout Japan has remained largely unknown; therefore, our goal was to rigorously explore this situation and its implications as of the 2015 fiscal year (from April 2015 to March 2016). This study was based on a health insurance claims database, covering all insured policy holders in Japan aged ≥60 years (male: n = 2,135,049, female: 1,969,019) as of the 2015 fiscal year. Comorbidity status was identified by applying principal factor analysis to the database. The factors identified in male patients were [1] myocardial infarction, hypertension, dyslipidemia, and diabetes mellitus; [2] congestive heart failure (CHF), cardiac arrhythmia, and renal failure; [3] Parkinson's disease, dementia, cerebrovascular disease, and pneumonia; [4] cancer and digestive disorders; and [5] rheumatoid arthritis and hip fracture. However, in female patients, the results obtained for the quaternary and quinary factors were the opposite of those obtained in male patients. In superelderly patients, dementia, cerebrovascular disease, and pneumonia appeared as the tertiary factor, and hip fracture and osteoporosis appeared as the quaternary factor. The comorbidities in the elderly patients suggest the importance of coronary heart disease and its related metabolic disorders; in superelderly patients, fracture and osteoporosis appeared as factors, in addition to dementia and pneumonia.

Living well in older age: what can we learn from the Japanese experience?

Japan has the most aged population in the world. Not only do people live longer in Japan, they also age better. While the ageing population reflects a success story driven by lifestyle factors and health promotion initiatives, it also results in challenges for policymakers, families and older people. Other countries with ageing population profiles, such as the UK, can learn from the Japanese experience. In this article, the authors focus on the potential of health promotion strategies, social connections and technology to enhance well-being in older age.

Combined effects of body mass index and unhealthy behaviors on disability in older Japanese adults: the Okayama study

Background

Body mass index (BMI) is a significant predictor of functional disability in older adults. However, when evaluated, the association between BMI and incident functional disability, considering behaviors only as covariates or not, may not be appropriate. The primary purpose of the study was to investigate the combined effects of BMI and unhealthy behaviors on the risk of incident functional disability.

Methods

This was a retrospective cohort study that took place in Okayama City, Japan. Data on BMI and unhealthy behaviors were obtained using the health check-up questionnaire. The certification of Long-Term Care Insurance was used to measure functional disability. Cox proportional hazard models were used; adjusted hazard ratios (HRs) with 95% confidence interval (CI) were calculated for incidence of functional disability across categories of BMI and number of unhealthy behaviors.

Results

The relationship between BMI and incident functional disability was U-shaped (HR = 1.18, 95% CI [1.11–1.25], among the underweight range; and 1.26 [1.19–1.34] among the obesity range), and its risk was significantly higher within the normal-to-overweight range of BMI values with co-occurring unhealthy behaviors (with normal weight range and one, 1.17 [1.01–1.21]; two, 1.29 [1.18–1.41]; and three or four unhealthy behaviors 1.38 [1.24–1.54]; as well as among overweight range and one, 1.16 [1.05–1.27]; two, 1.26 [1.15–1.38]; and three or four unhealthy behaviors, 1.47 [1.31–1.64]). In each BMI category, the risk of incident functional disability increased with increasing number of unhealthy behaviors (p < 0.05 for linear tread), with the highest risk (1.87 [1.58–2.20]) occurring in combination with at least three unhealthy behaviors with BMI ≥ 27.5, for both sexes (2.20 [1.64–2.92] in men and 1.66 [1.35–2.04] in women).

Conclusion

It is necessary to consider the combined effects of BMI and behaviors on incident functional disability. Furthermore, interventions targeting multiple behaviors should be considered as such interventions may offer greater benefits than simple interventions.

Moral hazard under zero price policy: evidence from Japanese long-term care claims data

We evaluate the presence and magnitude of moral hazard in Japan's public long-term care insurance (LTCI) market. Using monthly LTCI claim records from January 2006 to December 2015 linked to concurrent death records, we construct a sample by propensity score matching insured individuals who co-pay 10% of their fees to those with no required copayments, and we implement fixed-effect estimations. We find that a ten-percentage-point reduction in the copayment rate increases monthly costs by 10.2 thousand yen, corresponding to a price elasticity of about - 0.1. Insured individuals with no copayments tend to use more services and have more utilization days than those with copayments do. Furthermore, we find that insured individuals who die from cerebral (myocardial) infarction increase their service use more in response to a reduction in the copayment rate than those who die from senility do, indicating a positive association between ex-ante health risks and ex-post service use. We verify that a cost-sharing adjustment is a valid solution for soaring LTCI expenditures. These findings could provide broad implications for the rapidly aging world.

Links between organizational preparedness and employee action to seek support among a Japanese working population with chronic diseases

Objectives

This study examined the association between workplace rules and training programs regarding combining employees’ work and treatment for chronic diseases, and actions actually taken by employees to manage this issue. These workplace measures (rules and training programs) are consistent with the Japanese Guideline for Workplace Patient Coordination and Disease Treatment.

Methods

In February 2018, we conducted an online, cross‐sectional survey of 1134 employed individuals with chronic diseases who needed workplace support to combine work and disease treatment. All participants were aged 18‐65 years and lived in Japan. We investigated associations between workplace rules and training programs (two items) and employee actions (eight items), using a questionnaire based on the guideline and logistic regression analysis.

Results

In total, 76.5% of the participants said they had reported their chronic disease to their employer (manager, personnel department, or occupational physician). However, less than half (47.5%) had submitted a written report about their job to their doctor. Employees were more likely to take action in workplaces that had rules or training programs than in workplaces without such measures. More actions were taken among employees in workplaces with both rules and training programs than in those with either measure alone.

Conclusion

It is important to establish rules to support employees with chronic diseases and provide training to improve awareness of these rules to encourage employees with chronic diseases to take action to access the support they need.

Association between environmental noise and subjective symptoms related to cardiovascular diseases among elderly individuals in Japan

Noise in housing environments may increase the risk of cardiovascular diseases (CVDs); however, the most significant sources of noise among elderly individuals remain poorly understood. A nationwide cross-sectional study comprised of 6,181 elderly people (age ≥ 65 years) was conducted using a web-based self-reported questionnaire in 2014. Questions pertaining to CVD-related subjective symptoms within the past year addressed symptoms of chest pain, disturbances in pulse, acute impaired tongue movement, limb paralysis, and foot pain or numbness during walking. Questions concerning noise included awakening during the night due to noise, automobile, neighborhood, construction, railway, and aircraft noise. The multivariable analyses revealed that all symptoms were significantly associated with awakening during the night due to noise. Automobile, construction, railway, and aircraft noise were significantly associated with more CVD-related symptoms at nighttime than at daytime. Our results suggest that noise at nighttime is an important risk factor for CVDs. Although several different sources of environmental noise, including automobile, neighborhood, construction, railway, and aircraft noise were found to be significantly associated with CVD-related symptoms, the strongest association was observed for construction noise, followed by neighborhood and automobile noise. The adjusted odds ratios (95% confidence intervals) for construction noise at nighttime were 1.12 (1.06–1.19) with disturbances in pulse, 1.21 (1.08–1.35) in acute impaired tongue movement, 1.25 (1.15–1.36) in limb paralysis, and 1.19 (1.12–1.28) in foot pain or numbness during walking. The associations with railway and aircraft noise were found to be weaker than those with automobile, neighborhood, and construction noise. Our study suggests that CVD-related symptoms may exhibit a greater association with construction, neighborhood, and automobile noise than with railway and aircraft noise.

Disability, poverty, and role of the basic livelihood security system on health services utilization among the elderly in South Korea

With rapid aging, many of the elderly suffer from poverty and high healthcare needs. In Korea, there is a means-tested and non-contributory public assistance, the National Basic Livelihood Security System (NBLSS). The purpose of this study is to show older population's condition of disability and poverty, to evaluate the impact of NBLSS on health services utilization, and to examine the differential effect of the NBLSS by disability status among the elderly. This study used the Korea Welfare Panel Study data 2005-2014 with the final sample of 40,365, who were 65 years and older. The participants were divided into people with mild disability, severe disability, and without disability according to the Korean disability registration system. The income-level was defined to the low-income with NBLSS, the low-income without NBLSS, and the middle and high income, using the relative poverty line as a proxy of the low-income. The dependent variables were the number of outpatient visits and inpatient days, experience of home care services, total healthcare expenditure, and financial burden of healthcare expenditure. We performed Generalized Estimating Equations population-averaged model using the ten years of panel data. The result showed that within the same disability status, the low-income without NBLSS group used the least amount of inpatient care, but their financial burden of health expenditure was the highest among the three income groups. The regression model showed that if the elderly with severe disability were in the low-income without NBLSS, they reduced the outpatient and inpatient days; but their financial burden of healthcare became intensified. This study shows that the low-income elderly with disability but without adequate social protection are the most disadvantaged group. Policy is called for to mitigate the difficulties of this vulnerable population.

Secondary Data Analysis of National Surveys in Japan Toward Improving Population Health

Secondary data analysis of national health surveys of the general population is a standard methodology for health metrics and evaluation; it is used to monitor trends in population health over time and benchmark the performance of health systems. In Japan, the government has established electronic databases of individual records from national surveys of the population’s health. However, the number of publications based on these datasets is small considering the scale and coverage of the surveys. There appear to be two major obstacles to the secondary use of Japanese national health survey data: strict data access control under the Statistics Act and an inadequate interdisciplinary research environment for resolving methodological difficulties encountered when dealing with secondary data. The usefulness of secondary analysis of survey data is evident with examples from the author’s previous studies based on vital records and the National Health and Nutrition Surveys, which showed that (i) tobacco smoking and high blood pressure are the major risk factors for adult mortality from non-communicable diseases in Japan; (ii) the decrease in mean blood pressure in Japan from the late 1980s to the early 2000s was partly attributable to the increased use of antihypertensive medication and reduced dietary salt intake; and (iii) progress in treatment coverage and control of high blood pressure is slower in Japan than in the United States and Britain. National health surveys in Japan are an invaluable asset, and findings from secondary analyses of these surveys would provide important suggestions for improving health in people around the world.