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.
Highlights
In the field of study on social disparities in health, interest is growing in the relationships between neighbourhood conditions and health [1,2], likely owing to initial findings of associations between mortality and various census-based deprivation indices that reflect the socio-economically disadvantaged conditions of small areas [3,4]
The JPHC Study began in January 1990 with a baseline survey that was distributed to registered subjects aged 40 to 59 years who lived in one of four public health centre (PHC) districts: Ninohe PHC in Iwate prefecture, Yokote PHC in Akita prefecture, Saku PHC in Nagano prefecture, and Ishikawa PHC in Okinawa prefecture
Based on Model 3, we performed the following two analyses: (1) We examined whether alcohol drinking, smoking, and sports activity mediate the association between areal factors and mortality by adding these behavioural variables as covariates (Model 4); (2) we investigated the interactions of the two areal factors by using the interaction term of every quartile category for areal DI (ADI) and population density (Model 5)
Summary
In the field of study on social disparities in health, interest is growing in the relationships between neighbourhood conditions and health [1,2], likely owing to initial findings of associations between mortality and various census-based deprivation indices that reflect the socio-economically disadvantaged conditions of small areas [3,4]. Variations in health as a function of areal deprivation and socio-economic status have been widely reported in both cross-sectional and prospective studies conducted in many Western societies [5,6,7]. Meijer et al [10] conducted a meta-analysis using 18 multilevel studies to examine the areal contextual effects on mortality. They identified that such areal effects are generally salient for smaller units, those with less than 5,000 residents per neighbourhood area in high-income Western societies. Despite 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 nonWestern societies. We examined the effects of areal deprivation and population density on all-cause mortality in Japan
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