, but also in their Japanese counterparts [4][5][6][7] . Psychological distress is considered to be a risk factor for MetS. A cross-sectional study of 87 monozygotic and 86 dizygotic male twin pairs in the US showed that depressive symptoms were associated with metabolic risk factors such as body mass index, waistto-hip ratio, mean arterial pressure, triglycerides and glucose 8) . A 7-year prospective study of 425 middleaged women in the US showed that depressive symptoms were predictive of a risk of MetS 9). A 14-year large-scale prospective study of 10,308 middle-aged men and women in England showed that chronic work stress was associated with a risk of MetS 10) . Finally, a recent 15-year prospective study of 523 middle-aged pre-menopausal women in the US also indi-
To examine the factors associated with cause-specific mortality, a cohort of 1,405 randomly selected elderly people aged 65 years and over living in Settsu, Osaka Prefecture, was followed up for 54 months. Multivariate analysis using Cox proportional hazards model identified male sex, age, disability, medical treatment, and no participation in social activities as independent factors for overall mortality. Use of health checks and daily health enhancing practices showed an independent negative association with overall mortality. As for cause-specific mortality, male sex was a constant factor for the three major causes of death: cancer, heart disease and stroke. Advanced age and no participation in social activities showed a close association with heart disease mortality, while disability and medical treatment were independent factors for death caused by stroke and cancer, respectively. Use of health checks and daily health enhancing practices exhibited a strong negative association with all three major causes of death. The same tendencies were seen after those who reported undergoing medical treatment for the index diseases of heart disease and stroke at entry were excluded. These results suggest that predictive factors for mortality vary for specific causes of death, but that health promoting measures contribute to a reduction in mortality related to three major causes of death, thus resulting in a decrease in overall mortality among the elderly.
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