Associations of All-Cause Mortality with Census-Based Neighbourhood Deprivation and Population Density in Japan: A Multilevel Survival Analysis

Abstract

BackgroundDespite evidence that neighbourhood conditions affect residents' health, no prospective studies of the association between neighbourhood socio-demographic factors and all-cause mortality have been conducted in non-Western societies. Thus, we examined the effects of areal deprivation and population density on all-cause mortality in Japan.MethodsWe employed census and survival data from the Japan Public Health Center-based Prospective Study, Cohort I (n = 37,455), consisting of middle-aged residents (40 to 59 years at the baseline in 1990) living in four public health centre districts. Data spanned between 1990 and 2010. A multilevel parametric proportional-hazard regression model was applied to estimate the hazard ratios (HRs) of all-cause mortality by two census-based areal variables —areal deprivation index and population density—as well as individualistic variables such as socioeconomic status and various risk factors.ResultsWe found that areal deprivation and population density had moderate associations with all-cause mortality at the neighbourhood level based on the survival data with 21 years of follow-ups. Even when controlling for individualistic socio-economic status and behavioural factors, the HRs of the two areal factors (using quartile categorical variables) significantly predicted mortality. Further, this analysis indicated an interaction effect of the two factors: areal deprivation prominently affects the health of residents in neighbourhoods with high population density.ConclusionsWe confirmed that neighbourhood socio-demographic factors are significant predictors of all-cause death in Japanese non-metropolitan settings. Although further study is needed to clarify the cause-effect relationship of this association, the present findings suggest that health promotion policies should consider health disparities between neighbourhoods and possibly direct interventions towards reducing mortality in densely populated and highly deprived neighbourhoods.

Neighbourhood socio-economic status and all-cause mortality in adults with atrial fibrillation: A cohort study of patients treated in primary care in Sweden

“…Low neighbourhood SES is shown to predict all-cause mortality [16, 17, 24], mortality after myocardial infarction [25], and the risk of mortality among adults with cancers [26]. The results of our study extend the above-mentioned findings by reporting the effects of neighbourhood deprivation on all-cause mortality among patients with atrial fibrillation.…”

“…For example, neighbourhood SES has been found to be associated with overall health [13], cardiovascular health [14, 15], and all-cause mortality [16, 17]. A previous study found an association between neighbourhood SES and hospitalization of atrial fibrillation patients in women that no longer remained significant after adjustment for individual factors [18].…”

Neighborhood contextual factors for smoking among middle-aged Japanese: A multilevel analysis

“…For deprivation, we used the Kyuson-level deprivation index, devised by Nakaya (2011), which is a composite indicator consisting of weighted sums of several poverty-related census-based variables, such as proportion of old couple households, proportion of old single households, proportion of single-mother households, proportion of rented houses, proportion of sales and service workers, proportion of agricultural workers, proportion of blue collar workers, and the unemployment rate, from the 1995 population census. Details of the deprivation index are described elsewhere (Nakaya, 2011;Nakaya et al, 2014). Residential instability in each neighborhood was defined as the proportion of individuals who had lived in the same municipality for five years or less.…”

How does area-level deprivation depress an individual’s self-rated health and life satisfaction? Evidence from a nationwide population-based survey in Japan

“…It is well known that area-level socioeconomic conditions have a contextual association with an individual's health outcomes [1][2][3]. Many studies have indicated that area-level deprivation, which re ects various aspects of an area's socioeconomic positions, can affect the health outcomes of its residents, including mortality [4][5][6][7], morbidity [8][9][10][11], mental health [12,13], poor birth outcomes [14][15][16], and health risk behavior [17,18]. The impact of area-level deprivation on health matters for not only public health policies but also macroeconomic and social policies, which are committed to income redistribution, labor market regulations, and other issues related to social welfare.…”