Inter‐prefecture disparity in under‐5 mortality: 115 year trend in Japan

Nagata, Chie; Moriichi, Akinori; Morisaki, Naho; Gai-Tobe, Ruoyan; Ishiguro, Akira; Mori, Rintaro

doi:10.1111/ped.13304

Cited by 6 publications

(6 citation statements)

References 12 publications

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“…Previous studies have shown that natural disasters can cause a temporary increase in mortality, especially among the most vulnerable 35 . While we could not detect such a spike in deaths in our study, we cannot rule out the possibility that such an influence was not evident because of the small sample size.…”

Section: Discussioncontrasting

confidence: 82%

Secular trends in longevity among people with Down syndrome in Japan, 1995–2016

Motegi

Morisaki

Suto

et al. 2021

Pediatrics International

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Background Life expectancy in Japan has increased dramatically and is one of the longest in the world. However, the changes in lifespan in Japanese individuals with congenital diseases remain unknown. We investigated secular changes in the lifespan of people with Down syndrome over the last 20 years. Methods We observed secular trends in the number of stillbirths, deaths and the mortality rates at ages 20, 40, and 60 among all deaths registered with Down syndrome as the cause of death (ICD10 code: Q90) in the Japan national death registry database between 1995 and 2016. Changes in the median age at death between 1995–2005 and 2006–2016 were investigated based on sex and history of surgery. Results We identified 240 stillbirths and 1,099 deaths in this period. The annual number of stillbirths and deaths above the age of 1 year increased, whereas the number of deaths below 1 year did not change. The proportional mortality indicator at ages 20, 40, and 60 increased from 21.7%, 11.7%, and 1.7% in 1995 to 69.9%, 66.7%, and 36.6% in 2016, respectively. The median age at death was higher in females, individuals without a surgical history, and deaths occurring in 2006–2016. The median age at death increased over the period in those without a surgical history. Conclusions The age at death among people with Down syndrome has increased over the last 20 years, with currently 1 in 3 persons living over 60 years, necessitating adequate social welfare services in this aging population.

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Section: Discussioncontrasting

confidence: 82%

Secular trends in longevity among people with Down syndrome in Japan, 1995–2016

Motegi

Morisaki

Suto

et al. 2021

Pediatrics International

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“…4 However, these risks are not necessarily homogeneous across the regions of Japan. For example, Nagata et al (2017) recently reported that inter-prefecture inequality in child mortality had increased since the 2000s. 5 This increase in inequality in regional child mortality may be linked to changes in some of the social determinants of child mortality observed across highincome countries that include relative poverty, income inequality and social policies, such as workplace maternal leave policies.…”

Section: Introductionmentioning

confidence: 99%

“…For example, Nagata et al (2017) recently reported that inter-prefecture inequality in child mortality had increased since the 2000s. 5 This increase in inequality in regional child mortality may be linked to changes in some of the social determinants of child mortality observed across highincome countries that include relative poverty, income inequality and social policies, such as workplace maternal leave policies. [6][7][8] As the relative poverty rate for children in Japan increased by 1.5 times from 1985 to 2012, it is possible that an expansion in social and economic differences might also be affecting the IMR and increasing regional inequalities.…”

Section: Introductionmentioning

confidence: 99%

Infant Mortality Rates for Farming and Unemployed Households in the Japanese Prefectures: An Ecological Time Trend Analysis, 1999–2017

Kanamori¹,

Kondo²,

Nakamura

2021

Journal of Epidemiology

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Background: Recent research suggests that Japanese inter-prefecture inequality in the risk of death before reaching 5 years old has increased since the 2000s. Despite this, there have been no studies examining recent trends in inequality in the infant mortality rate (IMR) with associated socioeconomic characteristics. This study specifically focused on household occupation, environment, and support systems for perinatal parents. Methods: Using national vital statistics by household occupation aggregated in 47 prefectures from 1999 through 2017, we conducted multilevel negative binomial regression analysis to evaluate occupation=IMR associations and joinpoint analysis to observe temporal trends. We also created thematic maps to depict the geographical distribution of the IMR. Results: Compared to the most privileged occupations (ie, type II regular workers; including employees in companies with over 100 employees), IMR ratios were 1.26 for type I regular workers (including employees in companies with less than 100 employees), 1.41 for the self-employed, 1.96 for those engaged in farming, and 6.48 for unemployed workers. The IMR ratio among farming households was 1.75 in the prefectures with the highest population density (vs the lowest) and 1.41 in prefectures with the highest number of farming households per 100 households (vs the lowest). Joinpoint regression showed a yearly monotonic increase in the differences and ratios of IMRs among farming households compared to type II regular worker households. For unemployed workers, differences in IMRs increased sharply from 2009 while ratios increased from 2012. Conclusions: Inter-occupational IMR inequality increased from 1999 through 2017 in Japan. Further studies using individuallevel data are warranted to better understand the mechanisms that contributed to this increase.

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“…Disparities are known to exist in the rates of both infant and adult mortality among prefectures in Japan [49,50], and understanding and correcting the differences in perinatal outcomes among regions might contribute to improving these disparities in the future. There are some limitations in this study.…”

Section: Discussionmentioning

confidence: 99%

Differences in Rates of Low Birth Weight among Prefectures in Japan: An Ecological Study Using Government Statistics Data

Okui

Nakashima

2022

Children

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The differences in the rates and trends of the overall low birth weight and term low birth weight in recent years are unknown for the Japanese prefectures. In this ecological study, we revealed the rates for each prefecture and investigated the factors affecting the regional differences in these outcomes. Aggregated vital statistics data from 2007 to 2019 were obtained from the Ministry of Health, Labour, and Welfare in Japan. The association between the outcomes and the variables, including the infants’ birth characteristics, medical characteristics, and socioeconomic characteristics of the prefectures, were analyzed. An analysis of repeated-measures data was conducted using the data from 2013 and 2018 for each prefecture. The trend for the rates of overall low birth weight and term low birth weight over the years differed among the prefectures. Moreover, the proportions of multiple births and lean (body mass index <18.5 kg/m2) and obese (body mass index ≥25.0 kg/m2) women had a statistically significant positive association with both the overall low birth weight rate and the term low birth weight rate among the prefectures. It was suggested that to resolve the difference in these outcomes among the prefectures, being obese or underweight needs to be addressed in mothers.

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Inter‐prefecture disparity in under‐5 mortality: 115 year trend in Japan

Abstract: The disparities in child health appear to be widening, and may serve as a warning to today's society that increasing socioeconomic gradients may lead to rising health inequity among children. Further investigations into the causes, mechanisms, and possible interventions are needed.

Cited by 6 publications

References 12 publications

Secular trends in longevity among people with Down syndrome in Japan, 1995–2016

Secular trends in longevity among people with Down syndrome in Japan, 1995–2016

Infant Mortality Rates for Farming and Unemployed Households in the Japanese Prefectures: An Ecological Time Trend Analysis, 1999–2017

Differences in Rates of Low Birth Weight among Prefectures in Japan: An Ecological Study Using Government Statistics Data

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