NATIONAL CENTER Series 3 

For HEALTH STATISTICS INumber 10 

VITAL and HEALTH STATISTICS 

ANALWICAL STUDIES PROPERTY OFI’HE -

PUBLICATIONS BRANCH 

EDITORIAL LIBRARY 

RecentRetardation 

of MortalityTrends 

in Japan 

A study of recent trends in 

ing to sex, age, and cause 

a survey of mortality trends 

countries. 

Washington, D. C. 

U.S. DEPARTMENT OF 

HEALTH, EDUCATION, AND WELFARE 

Wilbur J. Cohen 

Secrets ry 

the death rates of Japan accordof death, undertaken as part of 

in the United States and other 

June 1968 

Public Health Service 

William H. Stewart 

Surgeon General 
,., 

Fublic Health Service Publication No. 1000-Series 3-No. 10 

For sale by the Superintendent of Documents, U.S. Government Printing Olllce 

Washington, D. C., 20402- Price 35 cents 
NATIONAL CENTER FOR HEALTH STATISTICS 

THEODORE D.WOOLSEY, DiTeCtOT 

PHILIP S. LAWRENCE, SC.D., Associate Director 

OSWALD K. SAGEN, PH.D.,, Assistant Director for Health Statistics Development ,. 

‘ ,, WALT R. SIMMONS, M.A.,Assistant Director for Research and Scientific Development ,, 

&ICE M. WATERHOUSE, M. D., Medical Consultant 

JAMES E. KELLY, D. D. S., Dental Advisor 

LOUIS R. STOLCIS, M. A., Executive O//icer 

MARGERY R. CUNNINGHAM, Information O//icer 

OFFICE OF HEALTH STATISTICS ANALYSIS 

IWAO M. MORIYAMA, Ph.D.,Director 

DEAN E. KRUEGER, Deputy Director 

Public Health Service Publication No. 1000. Series 3-No. 10 

Libra~ of Congress Catalog Card Number 67-61850 
FOREWORD


This is the fourth in a series of reports on studies undertaken to 

suggest possible reasons for changes in mortality trends observedin 

the United States in recent years. 

In Japan as in anumber of countries, the rapid decline immortality which occurred earlierin this century has ceased. Mortality trends 

have leveled off, andin some cases thecrude death rate has increased. 

Since the phenomenon has been observed in countries with different 

levels of mortality and varied social and cultural conditions, analyses 

of data from these nations may identify common factors associated with 

its occurrence. The results should provide a broader base of knowledge 

for interpreting changing trends in the United States. 

The Office of Health Statistics Analysis has arranged for investigators in the countries concerned to undertake these studies and report 

their results. Three previous reports bearing on this problem have 

appeared in Series 3 of vital and Health Statistics: 

the 

Number 1, “The Change in Mortality Trend in the United States”


Number 2, “Recent Mortality Trends in Chile”


Number 3, “Changes in Mortality Trends in England and Wales”


The methodology, findings, and conclusions presented are those of


investigators.


Iwao M. Moriyama, Ph.D.


Director


Office of Health Statistics Analysis


... Ill 
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SYMBOLS 

Data not available 

Category not applicable . . . 

Quantity zero -

Quantity more thanO but less than O.05---- 0.0 

Figure doesnot meet standards of 

* reliabilityor precision 

iv 
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CONTENTS 

Foreword --_---

Introduction


Retardation of Mortality Decline


Meaning of the Retardation


Method of Analysis


Identification From Graphs


Retardation hdexand Its Changes


Determination of Trend Lines and Degreeof Retardation


Problems Concerning Classificationof Causes of Death -----------------


Retardation by Age Group ----------------------------------------------

Retardation by Causes of Death -----------------------------------------

Broad Categories of Causes of Death --------------------------------


Retardation by B-List Categories and Age or Locality


Retardationby Detailed Classification of Causes of Death


Retardationby Detailed Classification and Age-------------------------


Factors Influencing the Retardation Phenomenon


Summary----------------=-------------------------------------------­

l{eferences


Detailed Tables


Page 

... 111 

1 

1 

2 

2 

2 

3 

3 

4 

4 

5 

5 

8 

12 

15 

17 

18 

19 

20 
ThIS REPORT continues a series of analytical studies designed to ascertain causes underlying the change in mortality trend o bsevved in the 

United States and in a number of othev countvies in recent years. 

In this report retardation of mortality decline is defined as an abrupt 

and discontinuous change in vate of decrease of a declining mortality 

tvend. Two measu~es of this phenomenon-the retardation index and the 

retardation ratio—are presented and used in the analysis of ~ecent 

movtality trends in Japan. 

Retardation of mortality decline occuvred around 1955 in Japan. The 

phenomenon was obse?wed in all prefectures and was especially noticeable among males in the middle-aged groups. Chunges in the trend of 

movtality from infectious diseases weve primarily responsible fov the 

retardation. Further anulysis of these changes by age and detailed cause 

of death revealed significant retardation, of trends for b~onchitis and 

pneumonia and for entevitis andrelated causes. FOV these cause WOUPS 

retardation was noticeable in the age groups of 15-44 and 45-64 years 

fo~ each sex. 

Information on occurrence of influenza, use of antibiotics, and infection 

by vesistant strains during the same peviod was analyzed. No defiiiite 

velation between these factors and the retardation of mortality decline 

was found. Some retardation of a declining trend in the incidence of 

bactevial and vival infections, howevev, is suspected to be a facto~ in 

the vetavdation of mortality decline, 

vi 
RECENT RETARDATION OF MORTALITY TRENDS


IN JAPAN


~dkemune Soda,a Masabumi 

Reisaku Tsunoda$ Tatsuji 

INTRODUCTION 

Retardation of Mortality Deciine 

After World War II, mortality of Europe and 

the American countries had been steadily improving. However, around 1950, retardation of 

mortality decline started to show up, and, in 

Norway and other countries, a slight increase in 

the crude death rate was observed. 

Moriyama observed a similar retardation of 

mortality decline for infants and most other age 

groups, for most States, and for both white and 

nonwhite persons in the United States, and investigated the various possible sources of this 

retardation phenomenon.1~2 It is suspected that 

a specific underlying cause may exist to make 

a retardation of mortality decline. 

In Chile, a similar analysis was undertaken.3 

According to this report, a significant retardation 

of mortality decline in the middle-aged groups of 

men was attributed to infectious diseases; the 

authors point out that the main reason for this 

retardation was insufficient public health activity. 

“M.D., Dr. bled. Sci., M.P.H., F..A.P.H.A.; Director, Institute 

hh, ~ci ‘ Senior Researcher, Department of Public Health Demography, 

Kimura,b Takeshi Hirayama,c 

Suganuma,e and Kozo Uedaf 

In England and Wales, improvement in mortality of all age groups dampened between 1955 

and 1961.4 The main cause of this dampening was 

reported to be an imbalance between increase 

for coronary artery disease and diminishing 

improvements in infectious and respiratory diseases. Although a mathematical analysis of this 

trend indicates the dampening mortality, it was 

reported that a complete alteration of trend was 

not observed in those years. 

In order to examine whether a similar retardation phenomenon exists in Japan, the yearly 

changes in selected diseases between 1900 and 

1963 have been investigated. 

The results show that the retardation of 

mortality decline, that is, the leveling off of 

the trend, was observed for deaths from pneumonia and bronchitis (figs. 1 and 2). 

The retardation or the leveling off of these 

mortalities did not seem to take place at a gradual 

pace but suddenly happened at a certain year or 

around that year, changing the inclination of the 

trend observed up to that tirrie. 

of Fublic Hdalth (IPH), Tokyo. 

., IPH. 

chl.D,, Dr. bled. Sci., M.P. H.; Chief, Department of I?pidemiology, National Cancer Center Research Institute, Tokyo; (formerly) 

S(,nior Rost~nrchor, Department of Epidemiology, IPH. 

d t7hiof Stiltisticinn, Di\ision of Health and \Velfare Statistics (DHWS), hlinistry of Health and Welfare, Japan. 

l’hl,D,, Dr. hlod. Sci,, D, P, H.; hledical Statistician, Section of Health Statistics, DHWS. 

‘Stntisticiun, EC.AFE, Bangkok; (formerly) Statistician, Section of Vital Statistics, DHWS. 
,o~ 1903 Iflln 1920 1930 Iwo 1950 1%0

Fijure 1. Deattl rates per IvG,L!.L population [Ur 

,.neuinonia, by sex: Japan, 1900-1943 and 1947-

63. 

Meaning of the Retardation 

Broadly speaking, the retardation phenomenon means that the improvement in mortality 

during aspecific time interval under observation 

is gradually curtailed with time. Here, however, 

the retardation phenomenons limited tothespecific meaning that the improvement in mortality, 

which has been following a certain regular trend, 

changes discontinuously its trend in a certain year 

and shifts to a new and slower course of improvement. In this case, the mortality curve of trend 

is observed to have a breaking point and to be 

composed of two trend lines for the respective 

periods before and after this point of time. 

Mortality from some diseases, especially 

the infectious diseases, might be reduced to no 

cases in the future. On the other hand, mortality due to the diseases of old age cannot be reduced to the zero level, as it can be suppressed 

only to a certain limit above zero. When mortality is lowered and approaches this limit, the 

proportion of decrease becomes smaller. Even 

in this case, so far as each of the component 

death rates changes following a certain regular 

trend, the rate of decrease in the total mortality may be said to diminish with a certain regularity. Accordingly, this case may be considered 

as a retardation in a broad sense, but it is not 

called as such according to the stated definition. 

Lotka proved that the retardation of decrease 

and even the increase of crude death rates are 

observable in a logistically growing population.5 

This retardation can also be estimated accordin < 

to a mathematical rule and the change of mortality is not the retardation phenomenon to bs 

discussed here. Therefore, it was sought to avoid 

~~arious complicated problems involved in the 

crude death rate by studying mortality rates 

specific for sex and age as far as possible. 

The curve of retardation may be the result 

of the addition of two or more different trend:;, 

some increasing and others decreasing. The 

type of retardation of the aggregate mortalir y 

will depend on the mixing proportion of deatks 

in each category. If a new category of disease 

is considered to show up from a certain yea]”. 

this would be one of the main causes for retar ­

dation defined here. 

METHOD OF ANALYSIS 

Identification From Graphs 

Annual changes in mortality during the period 

1947-63 are drawn in the figures according to 

various combinations of such variables as age, 

sex, region, and cause of death. Six experts in 

vital statistics were divided into three teams of 

two persons each. The teams were asked to examine such figures and determine on each graph 

where the retardation occurred. The graphs we-e 

M 

B 32 Br.mhut,, 

1( ---% 

] %“1“ 5 

1 1 I I I I I 

lWI 1910 192(I 1931 1!71(1 I!1’-,11 I!MI 

Figure 2. Death rates per 100,000 population for 

bronchitis, by sex: Japan, 1900 -19W3 and 19L7-

fjj, 
also classified according to whether the retardat ion phenomenon was clearly identifiable, identifiable, or unidentifiable. The three teams of 

experts designated the time of the breaking point 

when ~he retardation phenomenon was observed 

to occur. If the year of the breaking point was 

difficult to determine, selection of two points was 

permitted. This method was used mainly for the 

analysis of data on cause of death according to 

broad categories and according to the detailed 

classification of the International Classification 

of Diseases. 

Retardation Index and Its Changes 

Case I. —If mortality, qt, were reduced by 

a constant proportion each year during a certain 

period, that is, the amount of annual decrease 

approaches zero in a geometric series, the 

following equation for the curve can be considered: 

‘4+a q~ —= —=k.

qt qt–i! 

Here, k is a constant, and 

—/qt+a — 

qt =R.Z. =1. 

C/t qt_a 

This index is designated as the retardation 

index (R.1.). If the trend of death rate changed near 

year t, the value of k at this breaking point 

naturally changes and the R.I. is either greater 

or smaller than 1. When a retardation in trend 

is observed, it is obvious that the R.I. should be 

greater than 1, and when the decline in mortality 

continues at a new and constant rate again, the 

R.1. would return to 1 again. 

The R.I. can be calculated continuously using 

1-year intervals t -1, t,t+1, or using 5-year 

intervals, t- 5, t, t + 5. Here, the R.I. has been 

calculated for each year using 5-year intervals. 

If the breaking point exists at year t,,the break 

in trend can be detected by the changing R.I. as 

t moves along the time axis near tr.The R.I. 

increases as t approaches tr,and it reaches 

the highest value at t~ . After t, is passed, 

the 1{.1, returns to its previous level. 

Case II. —If mortality, qt, has a lower limit, 

77, and qt – @ diminishes exponentially as t 

proceeds, 

qt–zi 

C4–=-G . k’ 

where k‘ is a constant. Then the retardation 

index is 

R. I.=~/+ >1. 

Thus, the R.I. is always greater than 1 in 

this case. Generally, a lower limit exists for 

most causes of death, with some exceptions such 

as some of the infectious diseases. Mortality 

for each age group also has a lower limiting 

value. Thus, within the range of observable mortality, the R.1. is always expected to be greater 

than 1, and in most cases the calculated values 

are actually greater than 1. Even when the mor ­

tality has a lower limit, if the abrupt change in 

decreasing trend is observed at t,,the R.I. 

makes a peak point at t,, as in Case I. TIN-IS, the 

year of a significant change in mortality trend 

also can be easily detected by observing an exceptional fluctuation in the R.1. over time, though 

the index always remains above 1. 

Determination of Trend Lines and 

Degree of Retardation 

By taking into account expert judgments of 

retardation based on the examination of a graph 

of mortality trend, and change of the retardation 

index, the time of the breaking point can be 

determined from the data. A trend with a breaking point at t~ is represented by two equations, 

fitted by the method of least squares, 

Yl=e –%+%x), X<tr. 

and 

y2=e —(a2+b2yJ, X>tr.


3 
------------------------------------

------------------------------------

------------------------------------

------------------------------------

The ratio of the difference between slopes detailed list were also analyzed, using five broad 

before and after the breaking point, to the orig- age groups—under 1, 1-14, 1.5-44, “45-64, and 

inal slope, is designated as the retardation ratio 65 and over—and the annual change in each cause 

(R.R.). expressed as a percent. was examined. 

RETARDATION BY AGE GROUP R. R.(%)=~ x 100=100- + x 100. 

1 1 

Figures 3 and 4 show death rates by sex for 

each age group. Corresponding changes in the 

If slopes bl and bz are equal, R.R. is z-. If retardation index, as described in the discussion 

b2 approaches zero, R.R. approaches 100 per- of methodology, are shown in figure 5. 

cent. In other words, if the trend line becomes The R.I. based on the interval 1947/52/57 is 

horizontal after t,, R.R. approaches 100 per- very high and greater than at any other time. This


cent. proves a significant retardation of mortality de-


cline after 1952, compared with the trend between


Problems Concerning 1947 and 1952. This phenomenon occurred more


Classification of Causes of Death or less regularly in each of the age groups. This 

may be considered as a change reflecting transiThere are several tabulation lists presented tion, or the recovery process from unusual to 

in the WHO Manual of the International Statistical more usual living conditions following World 

Classification of Diseases, Injuvies and Causes War H. 

of Death.6 In Japan, mortality analysis, crossed The R. I. based on 1950/55/60 is also higher 

with sex, age, locality, and other variables, is than those based on earlier and later intervals 

generally based on List B. In this research, be- for all age groups (the peak occurs 1 year earlier 

sides this B List, another classification by broader for infant mortality), and this proves a possible 

categories, adopted by the Health and Welfare break in trend abut 1955. 

Statistics Division, Ministry of Health and Welfare Similar analyses by age group have also been 

of Japan, such as A, B, C, D, and E grows, was attempted for representative prefectures in Japan 

also employed. These groups contain categories i.e., Hokkaido, Tokyo, Shizuoka, Kyoto, Okayama 

of deaths classified as infectious diseases (Group and Kagoshima. 

A), adult diseases (Group B), diseases of preg- Differences between urban and rural prefecnancy and infancy (Group C), external causes of tures were very small and the retardation indexe~ 

death (Group D), and causes not elsewhere classi- for the crude death rates in these prefecture 

fied (Group E). Specific B-List categories in- were within the range between 1.3 and 1.5. Tht! 

cluded in each group are shown below. 

Group A:	 B1-B17, B23, B30, B31, B32, B36, 

B43a,g B43bg ‘fid. nor,e: IrI JqJmrese vital statistics reports, suhcwt,,. 

Group B: B18, B19, B22, B25, B27, B28, B29, gories of certain B-List causes are shown separately. Thwe 

subcategories are designated by a lower case letter following

B45ag the B- List number. The subcategories listed in the text corrr,. 

Group C: B40, B41, B42, B43c~ B44 spend to three-digit International Lists numbers as follows: 

Group D: BE47-BE50 

Group E: All B-List classifications other 

than A, B, C, and D groups 

B-List 

subcategory 

Detailed list 

numbers 

B43a 763 

A table containing the detailed list of causes B43b 764 

of death by age groups can be found in the annual B43c 765.768 

statistical reports on causes of death in Japan.7 B45a 7’94 

However, the analysis of causes of death is usually For a listing of all such subcategories, see Vital Statistics 

carried out using B-List categories and 5-year 1964, Japan, Vol. 2, Health and \Yelfare Statistics nivisi{,n, 

age groups. In this study, categories from the Ministry of Health and \\’elfare, ,Japan, pp. 3!)-43 ] 

4 
change of index for each age group in these prefectures was similar, with a few exceptions, to the 

national averages 

RETARDATION 

BY CAUSES OF DEATH 

Broad Categories of Causes of Death 

Figure 6 shows the changes of the crude death 

rate from 1947 through 1963 for causes of death 

classified in each of the broad groups A through 

E. 

1111111 1111111111 1


20000-

80+ 

10000– 

Sooo– 

6000– 

4000- 70-74 

2000


60-64


1000


ml 

WI 50-54


0-4


400


1


40-44


200–


30-34


100- 20-24


80-


WI–


40–


10-14


In order to detect the occurrence of retardation, the retardation index was calculated, using 

5-year intervals, for each of the years of 1952-58. 

The change of R.I. is shown in figure 7. 

Group A shows peculiar change, with a high 

R.I. for both 1952 and 1955, i.e., 1.7 and 1.9. 

Almost similar trends are observed for Groups 

B and E. Group E shows a high R.L for the years


1952, 1955, and 1958. Group B has R.I.’s ranging


between 0.8 and 1.2, and the trend is considered


to fluctuate around 1.0. It should be noted, however,


that these Groups B and E have a pattern similar


to that of Group A. Group C has a mortality rate


11111111111 II ITIT I


– 20000


– 10000


75-79 – 8000


- 6000 

– 4000


– 2000


65-69


- 1000


55-59
 - 800


- 600


45-49 - 400


35-39 – 200


25-29


- 100


– 80


15-19 – 60


5-9


– 40


2(1 I 1 I I I 1 I 1 I I 1 I I 1 r 1 1 I I ( I I I ! I I I 1 I 1 I 120
 1950 1960 1950 1960


Figure 3. Death rates per 100,000 population among males for al 1 causes of death, by age groups: 

Japan, 1947-63. 
---

---

,,, I ‘ ‘ ‘ ‘ 1’ “ ‘ I ‘ ‘ ‘ 1 [ I

I I I ,

I I 1 I , 

20000– – 201JIIC 80+ 

10000 – 75-79 - 10000 

8000– – 8000 

6000– 70-74 – 6001)


4000– 65-69 – 4001)


60-64


2000– – 2000


55-59


1000– 50-54 – luau 

800– – 800 

600– 0-4 45-49 – 600 

400– 40-44 – 40(J 

‘,, 

‘, 35-39 ~.. -

-... 

200– 30-34 – ml
 25-2:)
 20-24


100– .%-- 15-19 – 10IJ . . . . 

80– ~.g – N I 

60– – 6(J 

10-14 

40– – 40


701.- I I 1 I I 1 1 1 I I I I I I I I 1 1 I 1 I r 1 1 I I 1 r 1 I 1 , I I — 20 -. 1950 1960 1950 1960


Figure 4. Death rates per 100,000 population among females for all causes of death, by age grou~s: 

Japan, 19W7-63. 

which tends to decrease, and its R.I.’s for 1957 

and 1958 areO.8. GroupD has the highest R.I.. 

1.3 for 1952, and shows changes different from 

the other groups. The R.I. decreases almost 

linearly. The trend of mortality rates (fig. 6) 

shows that Group D mortality decreased until 

1952 and turned to increase at 1953, where the 

trend stayed at asteady rate until quite recently 

when actual mortality declineagainwasobserved. 

As canbe seen in figures6and7, retardation 

of mortality decline for Group A (infectious 

diseases) seems to occur around 1955. GroupE 

(other diseases) shows retardation in the same 

year, and the presence of another breaking pcint 

is also estimated around 1958. Mortality trends 

for Group A, Group E, and also Group B(acult 

diseases), all showing a similar change ofR.I., 

overlap to produce a general mortality trend for 

all causes, with abreaking point of trendat 1955. 

While theR.I,was examinedtodetect breaking 

points, judgments ofexpertsofthe breakingpoints 

as observed on charts of the trends were also 

obtained. The breaking points thus obtained w~re 

observed in 1955 for Group A, 1955 for Grou~ C, 

and 1953 and1957 for GroupE.Nodefinite bretking point at any given year was observed for 

6

----

Groups B and D. Table 1 shows 

sents slopes for the trend lines 

the breaking point, as obtained 

least squares. The calculations 

each sex separately. The value 

the R.R. andpreon either side of 

by the method of 

were done for 

of the slope before 

the breaking point is highest for Group A, with 

bl = 0.07. Next come Groups C and E with 0.04. 

Slope bz, after the breaking point, is largest for 

Group C with a value of 0.03-0.04 for each sex, 

followed by Group A with a value of about 0.025 

and Group E, about 0.015. 

Group A had the largest R.R. of about 65 

percent with a breaking point at 1955 and Group E 

Iln I , 1 I 1 , ( , 

Figure 5. Change in retardation index, by se1ected age groups: Japan, 1947/52/57-1953/ 

58/63. 

(NOTE: For al 1 ages, R.1. is 1,53, 1.1[, 1.28,


21II III -

IIllnl
 –


w ­


(Ill}
 –


400”
–

21)(1
 –


1[)1)
 –


H(1–


(ill
 —


ill
–

Figure


1,36, 1,1!, 0,97, 1.14, respectively)


, I , , I 1 ! 1 I 1 I 1 I 

1

2000


1000 

800 All causes 600 

B group 400 b 

s,, 

.,... 

..- -.. -........ I200 

........... . 

-. ....... ... .... 

. E group 100 

A group 80 

/ 

D group 60 $?40

:m.w 

i

i 

120 

1.8 -

1.7 -

1.6 -

1.5 -

1.4 -

1.3 -

1.2 -

1.1-

1.0 -

0.9 -

0.8 - ;

‘,-----

0.7 I I I I I I I 

D 

c. 

Figure 7. Change in retardation index, by major


groups of causes of death: Japan, 1947/52/57-


1953/58/63.


6. Death rates per 100,OGO population for,


nla]or groups of causes of death: Japan, 1947- (NOTE: For all causes of death, R.1. is 1.53,


63. 1,11, 1.28, 1.36, 1.l!, 0.97,1. IW, respectively)


7


I 
-----. ------------

--.----------. ----- ------

...

had R.R. of 60-63 percent (1953 )or51-54percent Retardation by B-List Categories 

(1957). For Group C, the R.R. abut the 1955 and Age or Locality 

breaking point was 20-30 percent and theretardation was not so significant. There seems to be In figure 8 the trends of mortality by age for 

no relation between the R. R. and the levels of bl selected categories of the B List are shown. 

and b2. No difference between the sexes was Calculated values of the retardation inde K ~ 

observed in the R.R.’s of Groups A and E. based on 1950/55/60 for three selected cause,~ 

9 

I I I I I I 1 1 I I I I I I I I I I I I I I I i I I I I [ 8 1 I I I 1 I 

B 18 Malignant neoplasms B1, 2 Tuberculosis, alt forms - 4000 

4000– 

- 2000


200.
 0-


- 10QO


1000- 70-74


80-1- : 8W


800-


-600 

600- # 60-64 

#---- -400 .. 

4“- \ ,,,” 

,/’ 

~ 50-54 200 -\,-_....-” . ..--.. 1 .. . . . ‘“”.. 70-74 ,,.. ~., ~ ,. .’n”~80+ 100

100 .,..”;’ ,//.~..---\ [ 

‘. 

801...- ./ -H “ 60-64 ~ 40-44 1 w 

- 60 

,,
 50-54 - 40
 i’
‘“\. 40 [ \ 40-44 

30-34 -.-=”i 

30-34 -20 

20


I\\+ / -lo


0-4 -8


-6 

\\\..”] 10-14 ZU-L* 

-4 

4 ‘1 o-4 

2 

1 ‘u –2 

, 1– I I I I I I I I I I I I , ,~1 10-14 I I I I I I I I I 1 I I I I I I -p 

1950 1960 1950 1960 

Figure 8. Death rates per 100,000 populat i m for selected causes of death, ky selected aqe Qt_OU)]S: 

Japan, 19!7-63. 

8 
.

are shown in figures 9-11. Values for the causes


presented—tuberculosis, pneumonia and bron­


chitis, and gastrointestinal diseases—are higher


than those for other causes of death. Forpneu­


monia and bronchitis, a retardation index greater


than 2.5 occurs in three age groups—20-24, 40-44,


and 45-49 years— when data for both sexes are


I I I I I I I I I I 1 i I I I I I I


B22 Vascular lesions affecting


central nervous system


4000-


t ~’o+


2000€

~ 70-74


t 

1000


800


600 ~ 60-64


400


1


200 ~,”.,4 1


100


80


60I


401~40.44 

,~ 1950 1960


combined. For males alone such high values occur


in each 5-year agegroupof 30-34, 35-39, 40-44,


45-49, 50-54, and 55-59. Values are especially


high between ages 30and 50. Theindexfor tuber­


culosis is higher for persons around 20 and40


years, and that for the gastrointestinal diseases


is higher for persons in their twenties. A trend


[ I I I I I I I I I I I I I I I 1 I I 1


B 25, 26, 27’ Major heart diseases


4


- 4000


80+ – 2000


- 1000 

- 800 

70-74 – 600


- 100 .. ~,o-,, – 80


- 60


– 40


40-44


– 20


30-34


- 10 ... 20-24 - 8 

.. . . . .... – 6 

0-4 

‘. – 4 . 

— J I I I I I ! I I I I I I I I I I I +
 1950 1960


Figure8, Death rates per 100,000 population for selected causes of death, by selected a9e9rouPs: 

Japan, 1947-63-Con. 

9€
..-... -/......

B 31, 32, 43a Pneumonia and Bronchitis B 36, 43b Gastritis, duodenitis, enteritis and colitis I 

80+ 

‘i 

‘! 

‘, 

‘), ,,., 

!., . . 

. . 

. . .

b

i.%-
 ---­


..,. 70-74

0-4 

!000 

!000 

.00b 

100 

;00 

m 

!00 

100 

30 

60-64 

50-54 

40-44 

30-34 

20-24 

‘ 10-14 

~ 

50 

40 J’(w’””

20 

10 

8 

6 

4 

2 

I I I I I I I I i I I I 1 

1950 1960 

Figure 8. Death rates per 100,000 population for selected causes of death, by selected age groups:


Japan, 19Y7-63—Con.


10 
10000 

won 

limo


ill(l) 

‘?(N)[) 

ltloo 

m) 

(;00 

400 

2[10 

1(11) 

N1 

(i(I 

10 

2() 

10 

s 

G 

4 

,2 

B 38 Nephritis and nephrosis 

80+ 

70-74 

60-64 

50-54 

40-44 

30-34 

20-24 

10-14 

B 45a Senility 

IOU 

DO


00 

L \ 80+ 

30 

\ 70-74 

I_ ~ 

Figure 8, Death tYtiX!S per 100,000 population for selected causes of death, by se]e~ted ~~e groups: 

Japan, 19!7-63—Con. 

11

---

Bl, 2 Tuberculosis, all forms 

1 [ 

R.I. 

both sexes 

I male I 

1--4 

female I I€

I J 

I I r I , I 1 I 1 I I I 1 I 

o 10 20 30 40 50 60 70 80 Age 

Figure 9. Retardation index for tuberculosis, all 

forms, by sex and age: Japan, 1950/55/60. 

similar to that of tuberculosis is observed for 

nephritis andnephrosis. 

The retardation phenomenon for bronchitis 

is observedinall prefecturesaround 1955(fig.12). 

Thus, the phenomenon is certainly not related to 

the geographical differences. 

Retardation by Detailed Classification 

of Causes of Death 

Ascanb$ seen from the analysis usingbroad 

categories and the B-List classifications, the 

retardation phenomenon is significant for infectious diseases, particularly the respiratory 

infectious diseases. However, some categoriesin 

the B List are subdivided into more detaikl 

classifications, which differ more or less n 

nature, clinical appearance, complication, cm 

origin of the disease. And the use of some detaikd 

list categories is inevitably necessary for a further, more accurate analysis of the retardaticm 

phenomenon of mortality. 

On the other hand, when the detailed class if ,.-

cation is used, the number of deaths in each di:: -

ease category becomes smaller and the fluctu: - I 

tion with time is greater; sometimes it is difficult ~ 

to analyze and detect changes in trend effective~~. 

Therefore, causes with the following charat:­

teristics were selected from the detailed classif -

cation: (a) number of deaths sufficiently large 10 

B 31, 32, 43a Pneumonia and Bronchitk 

R.I. 

both sexes 

3!.0-

20 

1.0 

4.0 t male -1 

I I I I 1 I 1 I I I , I ! I 

O 10 20 30 40 50 60 70 80 A~e 

Figure 10, Retardation index for pneumonia arid 

bronchitis, by sex and age: Japan, 1950/55/60, 

12 
B 36, 43b Gastritis, duodenitis, enteritis and colitis	 categories and their category numbers for which 

retardation was significant are acute bronchitis 

(500), bronchitis, unqualified (501), other bacterial 

R.1. / 

both sexes	 diseases (050-064), acute upper respiratory infections (470-475), bronchopneumonia (491), pneumonia, other and unspecified (493), gastroenteritis 

‘“t , L– /	 and colitis, except ulcerative (57 1), and lobar 

pneumonia (490), as shown in table 4. 

The results of the judgments of the experts 

for these detailed causes of death agree with 

those based on the retardation index. When the 

male by experts, and the degree of retardation is remarkable, the index for the cause is high. On the 

2,0 - other hand, when the retardation for the category 

in the detailed classification is not detected at 

1.0 w all, the index is low. Thus, such a cause of death 

is assumed to follow the same unbroken declining 

trend or a more remarkably diminishing trend. 

B 32 Bronchitis 

female 

retardation phenomenon is detected on the graph 

2.0 - MIE !!$& 

L SHIGA 1.0 v EOKKAIDO ~ KYOTO 

+$MO;I OSAKA


s.Ymf.YAo


MIYAGI


& JVAKAYAMA


I I I I I I I I I I I I I I I AXITA TOTTORI 

o	 10 20 30 40 50 60 70 80 Age 

YAMAGATA 

Figure 11, Retardation index for gastritis, duo.- ++ FUKUSHIMA ‘w sHIafANE denitis, enteritis, and colitis, by sex and age: IBARAKI 

Japan, 1950/55/60, TOCHIGI OKAYGUNM& Q hlROSHIMA 

$33;WA ++ $AMAGUCH 

TOKUSKIMf & TOKYO 

be divided into certain age groups; (b) deaths not XANAGAV?A EHIME 

concentrated near extreme ages (causes specific NIIGATA 

TOYAMA KOCEU 

to infants are included); (c) causes related to in- FuxuoKi 

fectious diseases, There were 33 causes of death 

or groups of causes selected. Their changes in L 

ISEIKAWA 

FUKUI 

YAMANASHI & SAGA 

NAGASAKI 

mortality trend are shown in tables 2 and 3; d NAGANO KIJJAMOT( 

changes for some of these causes are also shown 

in figures 13 and 14. && GIFU 

SHIZUOKA 

KAGOSSIMi 

MIYAZAK When the retardation index is calculated for AICHI 47% 

both of the periods, 1950/55/60 and 1952/57/62, I I J I , , , I 

1951 1960 1951 1960 

the value is higher for 1950/55/60 and the breaking point is estimated at 1955 or before. After 

Figure 12. Death rates per 100,000 population

1955 the trend becomes more horizontal. Disease for bronchitis, by prefecture: Japan, 1951-60. 

13

..

I I I I I I I I I I I I I I I I I I I I I I I I 1 I I I 

400–


763


200–


100–


80–


60–


40–


002


20 “’’.>- 4,()


&’.......:’’’*L:


10 \


8 , ‘,


‘,.



6 L--.,.
.


‘.,


4 ..-,
 ..\\
 ...\


x ,080-096
 \
 572


21


,Lb_kL_—
 1950 1960


– 40C 

t \ -1 

– 20 

– 10


– 8


– 6


– 4


– 2


~, 1950 1960


Figure 13. Death rates per 100,000 population among males for selected causes of death: Japan, 1950-62.


(Rates for 763 and 764 are


However, as can be seen from table 4,the 

retardation for some causes of death cannot 

always be detected on the graph in spite of the 

high index(e.g., 470-475,690-698,640 atal.), and 

sometimes on the contrary, the retardation for 

a cause of death can be fairly observed on the 

graph in spite of a low index (e.g., 591, 593). 

The reason for these paradoxical results is that 

large fluctuation of the death rates existed and 

the choice of 1950/55/60 for use inthecalculations happened to produce a high index for the 

former cases. In the case of the nephritis group 

(591, 593) the breaking point was a few years 

based on 100,000 live births)


before 1955and the peak ofthe index hadalreacly 

passed in the year 1955. 

Next, for each cause in the detailed classific:Ltionwhichhad a clear breaking point, trend lint:s 

before and after the breaking point were fitte~, 

and the R.R. was calculated, first for both sexe;, 

and then for males and females separately 

(table 5). For both sexes the bronchitis group500, 501, and 502—has the highest R. R.’s, each 

exceeding 90 percent, and they are followed ]Jy 

causes of the pneumonia group—490, 491, ard 

493—with values of 77-93 percent. The pattern 

is about the same for males and females consi[l14

.

.

..

..

----

I I I I I I I I I I I I I I I

I 

763


002


490


57i


491


592


..

..,\ 

080-096


-4”0 

‘, 

‘, 

‘} 

‘ii 

‘. 241 

‘,, 

‘.
 1..
,
 k‘....

‘,, 

-

....

..\ 

500 

.
.
.


..\\


050-064


~, 1950 1960


– 200 

– 100


– 80


– 60


– 40


– 20


— 10


– 8


– 6


– 4


– 2


Figure 14. Death rates per lCII?,t.rC population among females for selecie-1 causes of +ewth: J~pan, 

1950-62. 

( Rates for 763 and 76! are 

ered separately, but the brea!<ing point for chronic 

bronchitis (502) was not clear for each sex. Retardation for gastritis and duodenitis (543) was 

clearly observed for males and females separately, and R.R.’s were 61-84 percent. 

Retardation by Detailed Classification 

and Age 

For detailed categories with ahigh retardation index a further analysis of the retardation 

phenomenon by age was conducted, using visual 

inspection of ~raphs, The following 11 causes of 

based on IOO,GOO live births) 

death were examined (some are shown in figure 

15): pulmonary tuberculosis (002), pleural tuberculosis (003), lobar pneumonia (490), bronchopneumonia (491), pneumonia, other andunspecified (493), acute bronchitis (500), bronchitis, 

unqualified (501), chronic bronchitis (502), gastritis and duodenitis (543), gastroenteritis and 

colitis, except ulcerative (571), chronic enteritis 

and ulcerative colitis (572). 

The diseasesabove areallincludedin GroupA 

(infectious diseases) of the broad categories. As 

stated before, for Group A the breaking point 

stands out clearly and seems to be around 1952 

15 
Sci3- 490 Lobar pneumonia 

600– 

4(M – Under 1 year 

~... 200 – 65+ male 

100– —.4.’A,>,, ;“’’.........”’’’””’ 

w . female ‘“-----: 

m – 

40 -

2 -N&CL ... ,,.., . ..< ..... ,.-~- ,,.’...... ...’ ‘., 

‘ “..;:i:l’l “/ 

8 ..,. 

6 .. \: ‘- --...,, ; 

‘,...- .,..,. 15-44 

4 %....” .--.. --.., 

..... ‘0 %k .. -

2-

1-

0.8– 

0.6– 

0.4– 

0.2 

0.1 

L 

1950 Iwl 

Figure 15. Death rates per 100,000 population for selected


1950-62.


Ooo 493 Pneumonia, other 

&lo and unspecified 

400 

2oil 

1; :’$fSzL=.: 

A. /) ‘“’.,. ..”../..’” 

....... ..? ‘,./-- ,.../”’ 

20 

10 -

8 -

6 -

4 

2 – 

1 -

0.s -

1-

Vv 

0.2 

0.1 11 causes of death, by sex and age: Japm,


or 1955. Trend lines and the retardation index 

for the detailed causes indicate a breaking point 

in 1955 for the majority, and a breaking point 

at 1953 for a very few. Here, however, a slight 

difference according to age group in detailed 

classification exists. For acute bronchitis (500), 

bronchitis, unqualified (501), gastritis and duodenitis (543), and gastroenteritis and colitis, 

except ulcerative (571), almost the same retardation phenomenon appears for each age group 

and the trend is similar for males and females, 

with the breaking point at 1955. For lobar pneumonia (490) and bronchopneumonia (491), the 

retardation phenomenon varies by age and the 

time of the breaking points varies between 1953 

and 1955. For pulmonary tuberculosis (O02)tl]e 

breaking point is barely observable in age groups 

between 30 and 60 for males and females. The 

breaking point is around 1953 but is not cle:r. 

For chronic bronchitis (502) and chronic enteritis 

and ulcerative colitis (572), the retardation phenomenon is not significant in each age group hut 

can be observed for all ages combined, 

-1 
.

....... .......

.

..... . ......

.. .

... ...

......

...

...... ... ~.,

----

....

..

.

..

...

..

.

..

..... ..

.....

...... . ----.

.....

....

...

...

......

m) – 500 Acute broncbftis 80Q —543Gastritis andduodenitis – 

Mill– 600 – 

4(KI– 400— 

y,1,I— ., Unclur 1 year 200 200– 

,., 

llnl – 65+ Under 1 year ““”. 100– ‘..,, 100 ..%% 

Ml – ..

~., + .,,. . ,. 80 - ‘“.~,, till – ‘.,, [\ 60 – .... .,/ ~, male k.,:~ ........ .,, ..,. A ,)’ .. ,,,’‘!,... 41 .... . ../ ... 40 - “ !., 65+ : :V:: male ‘,‘., 

803 -571 Gastroenteritis andcolitis­

.... 600 ... 

..,, 

400 ..... Underl year 

.%. ,..,, 

‘-..... 

...... 200:\: 

100


~ :=S 

60 – ‘“% ... 

... 

40 .
.


.,1-14
 .


20 - . “-....
 . ..$
 ,. $...
 . . .


10 %.,.
 ..45-64 “


8	 . .
 .
 6 ~‘\ ‘.,. . 

.
 \
 4– ‘..%


~..
.


.
.


2 . E-44


.
.


=..
...
 1 ‘....
 _


0.8 ..,.


i L
 0.6


0.4I


0.2


0.1


~ h: female ..... 

... 

21I 20 

1(1– 10 w 8 

& 6 ,.,, 

!4– ‘..,, 4 .-.,,‘..,. 

$,, ,., ~..““i 45-64 

o~ \

i, 2 ,,?...,+-~.e-.., ! ,’ ,$, ,, .,..+:... \ .“.. 

1 

i..
 ‘-;:.!.,.
 . ~.,~.~ ,
 .
 ,,.
...,,’


\,. 20–
 ‘.....,


i...
 ,
;\: .


10:


~.::,.8–


r J


6– ““....


4	 .
 ,,


. 

$..,. 45-64


‘t,:\ 

:..-... 

45-64 2 – “’... Under 1 ye~’.. ..,$

..”,., ~, ,-... ‘! ,:~ :

,!,, ..”/ 

\ .,‘,, L i . ,,,.., 1 

‘\:., 

,$. ,.,, s.
 J . .. 1,,.,- \ 11.s “ 0,8 .$,...../. 0.8 –... “ ,,,,..1 ... ~! It.ti 1: \ ‘ ““- “::4 !, : k; ...

.._ -... 

... 0,6 \, --..,1-14 0.6 – “=--,, :

i

I ,,

/’ .,,,

., \
 ;\;
 [1..i 15-44 0.4 i,,. ..”.!, . .....

\ ‘~..,~


,,.” i 

11.2— h: \ ...!.’ ~, 0.2 .

\ 

,:

\

\ 

(1.1- 0.1 L 

I I I I I 1!):4 IWa 

0.4
-k, ‘“ “ “..
 ..,,
 ,,,.. 15-44
 . . . ,,-
 *, ., 15-44 

0.2 ?(+/ \, . . – J’ ~,;,;, \	 \ j: ~_14
 \/\1
 \, i? . 0.1 – 

Figu,re IS, Eeath rates per 13C,C,00 population for selected causes of death, by sex and age: Japan,


1950-62–Con,


The retardation phenomenon is generally


clearer for the acute diseases than for the


chronic and for the middle-aged groups than for


other age groups.


FACTORS INFLUENCING THE 

RETARDATION PHENOMENON 

(1) Operative hypotheses can reformulated


considering any of the following as factors in­


fluencing the retardation phenomenon described


above: virus mutation, radiation,cigarettesmok­


ing, antibioticsand other drugs, changes in diet,


air pollution,urbanization, and public health and


social security activities.


The retardation phenomenon canalsobeex­


plained apart from these factors. Since strong


persons survive and weak persons die during and


immediately after a war, mortality declines sig­


nificantly a few years after the war. But after


several more years, the rate of mortality decline


slows down as the after-war effectdiminishes. On


the other hand, weak persons may also have sur­


vived because of some new method of treatment


17


-1 
which introduces the possibility of reducing total 

mortality or the mortality resulting from some 

specific causes. After some years, such weak 

survivors might have begun to die dampening the 

decrease of death rates. It is doubtful, however, 

whether such changes occur suddenly or discontinuously. 

(2) Morbidity data would need to be analyzed 

in the same manner to support the findings of 

mortality analysis. 

When the incidence of disease is examined 

using household survey data observed by annual 

surveys using consistent methodology, it shows 

a steadier level since 1953. Respiratory diseases 

constitute a greater proportion of total diseases 

and the “common cold” is the most frequent of 

these. Next, the diseases of the digestive system, 

such as diarrhea and enteritis and duodenitis, are 

very frequent. The data in table 6 suggest an 

increasing trend of each disease incidence rather 

than a decreasing trend. But the tabulated data 

were not sufficient for further analysis. 

(3) The supply of antibiotics in the country, 

when estimated in monetary value, was 12.6 

million yen in 1952 and was stable until 1956. 

Since 1957 it has gradually increased and reached 

37.8 million yen in 1963. From these results, the 

use of antibiotics from 1950 to 1956 can be considered stable. 

A standard was established for use of antibiotics in medical insurance schemes in 1953, 

but penicillin and its derivatives had been used 

by medical insurance schemes since 1948. Penicillin was probably widely used before 1953. 

When the frequency of appearance of resistant 

strains against antibiotics in tuberculosis and 

dysentery patients was analyzed, the proportion 

of tuberculosis patients with resistant bacterial 

infection at the time of hospital admission was 

found to be over 10 percent in 1955 and near 20 

percent recently. Increase of occurrence of resistant bacteria in patients with dysentery is 

more remarkable than among patients with tuberculosis, increasing from 1 percent in 1955 to 10 

percent in 1958 and, more recently, exceeding 20 

percent (fig. 16). 

The increase in resistant strains along with 

the use of antibiotics had already begun before 

1955, but it seems to have increased more rapidly 

since then. 

, , , I , , 

$)4 

30 

20 

10


5 

Q kenteq strain examination 

1 I I I I I I I I I I I I I I I I 

]48 50 52 54 5(3 58 GO 62 

Figure 16, Percent of hospitalized t.uberculosi; 

patients with strains resistant against anti ­


biotics, and percent of dysentery strains re.


sistant against antibiotics,


(4) It is difficult to isolate sufficiently tk e 

role of influenza in the retardation, but it is irr ­

portant to analyze its influence, considering tt e 

parallel upheaval of pneumonia and bronchics 

or the increase of mortality due to heart disease 

during the influenza epidemic period. Especial” y 

if the retardation phenomenon is to be studied cm 

a worldwide scale, influenza with a rapid speed 

of infection should be considered as an importalt 

disturbing factor in the ever-improving mortali:y 

trend. 

SUMMARY 

In a broad sense, the retardation phenomenon 

means that decline in mortality over certain tinle 

intervals diminishes. Here, use of the ‘‘retardation phenomenon” is restricted to the meanir g 

that a regular rate of mortality decline changes 

abruptly and discontinuously after a specific year, 

and the rate of decline is significantly reduced. 

When such data are observed, suspicion arisl?s 

that some specific circumstance brought about 

18

such a change in trend at that particular year. 

Thus, detecting that circumstance, it maybe possible to find a way of recovering the earlier, 

rapidly lowering trend of mortality. 

This retardation, in a restricted sense, of 

the declining mortality is especially significant 

near the year 1955 in the middle-aged group of 

males throughout the country, and the phenomenon 

is mainly due to infectious diseases. In Chile, a 

similar trend was seen and in England and Wales 

;I dampening of mortality decline was observed. 

For broad cause-of-death categories, the 

retardation phenomenon is significant for Group A 

(infectious diseases) in 1955. Breaking points 

are also observed for Group E (all other diseases) 

in 1953 and 1957 by visual observation. 

For pneumonia, bronchitis, enteritis, and 

nephritis of the B List, the R.I. for males of the 

middle-aged group is noticeably high. 

In the detailed categories of the International 

Classification of Diseases, retardation is noticeable for the bronchitis and pneumonia group, and 

the R. R. trend line is over 80 percent. The R.R. 

for the enteritis group is over 60 percent. 

When this retardation phenomenon is analyzed 

for detailed categories by age group, retardation 

is noticeable in age groups 15-44 and 45-64 for 

Imth males and females in the above-mentioned 

C:luses. 

In order to investigate factors underlying 

the retardation phenomenon, information was 

gathered concerning influenza epidemics, utilization of antibiotics, and the frequency of occurrence of infection by resistant strains. These 

data are not supposed to have definite relation to 

—000 

the results of the mortality analysis described 

above. However, a generally decreasing trend of 

bacterial and viral infections showed a breaking 

point about 1953-55, and it cannot be denied that 

these influential factors are suspected to be 

essential for the sudden retardation of mortality 

in those years. 

The recent change of morbidity, especially 

in respiratory and intestinal diseases, and its 

causes should be investigated further. 

REFERENCES 

lMoriyama, I. M.: Recent changes in infant mortality trend. 

Pub. Health Rep. 75(5):319-405, May 1960. 

2Moriyama, I. M.: Preliminary observations on recent mortality trend. Pub. Health Rep. 76(12):1056-1058, Dec. 1961. 

3National Center for Health Statistics: Recent mortditY 

trends in Chile. Vital and Health Statistics. PHS Pub. No. 

1000-Series 3-No. 9. Public Health Service. Washington. U.S. 

Government Printing Office, Apr. 1964. 

4National Center for Health Statistics: Changes in mortality 

trends in England and Wales, 1931-1961. Vital and Health Statistics. PHS Pub. No. 10()()-Series 3-No. 3. Public Health Serv­

~ashington. U.S. Government Printing Office, Nov. 1965. 

5Lotka, A. J.: The structure of a growing population.	 Hu­

.— man Biol. 3(4):459-493, Dec. 1931. 

6World Health organization: Manual of the International 

Statistical Classification of Diseases, Injuries and Causes of 

Death. Geneva. \Vorld Health Organization, 1957. 

7Health and \Velfare Statistics Di}tision: Vital Statistics, 

Japan, published annually. Ministry of Health and \Yelfare. “ —. 

Japan. 

‘%da, T., and others: Retardation of mortality decrease 

in Japan, KOSEI.N().SHIHYO (\Velfare Index) Special Issue for 

Scientific Papers-1963. 1963. (in Japanese) . 

19 
------------------------------------------------------------------------

--------------------------------------------------------------

DETAILED TABLES 

Page


Table 1.	 Identification of breaking points, inclination of trend lines before and after


the breaking points, and retardation ratio (R.R.%), by sex and broad classifica­


tion of causes of death--------------------------------------------------------- 21


2. Death rates for males, by selected causes of death: Japan, 1950-62-------------- 22


3. Death rates for females, by selected causes of death: Japan, 1950-62------------ 24


4.	 Retardation index,1950/55/60, compared with retardation judgments of three teams


of experts for selected causes of death----------------------------------------- 26


5.	 Identification of breaking points, inclination of trend lines before and after


the breaking points, and retardation ratio (R.R.%), by sex and selected cauaea
 of death 27


6.	 Incidence ratea for all diseases and for major groups of diseaaes: Japan, 1953-


62---------------- 28


20 
--------------------------------

--------------------------------

Table 1. Identificationof breaking points,inclination of trend lines before and after


the breaking points, and retardation ratio (R.R.%),1 by sex and broad classification


of causes of death


Inclination Retardation Sex and broad cause group2 Breaking 

point ratio

bl X 10– b2x 10–5 (R.R.%)1 

Male


All causes 1955 1,665 490 70.6


Group A-------B1-B17,B23,B30-B32,B36,
B43a3,B43b3 1955 7,162 2,576 64.0 

Group B------------B18-B19,B22,B25,B27-B29, 

Group C------------------------B4O-B42,B43C~,B44 1955 4,582 3,074 32.9 

Group D--------------------------------BE47-BEso 

Group E‘--------------------------------Residual 

� .. 1953 ... 4,462 

.0. 

1,784 � ** 

60.0 

1957 3,052 1,490 51.2 

B45a3 .*. ... ... � .0 

Female


All causes 1955 1,636 767 53.1


Group A-------B1-B17,B23,B30-B32,B36, 

Group B------------B18-B19,B22,B25,B27-B29,B45as ... 

Group C------------------------B4O-B42,B43C3,B44 1955 � .. 4,406 ... 3,552 � *O 

19.4 

Group D-------------------------------.BE47-BE5o ..* ... .0. � .. Group E‘--------------------------------Residual 1953 4,214 1,558 63.0 

1957 3,648 1,674 54.1 

IThe retardation ratio (R.R.%)“isdefined as: R.R.(Oh)=!?&!ZX 100. 

B43a~,B43b8 1955 6,842 2,332 65.9


‘Cause groups are composed of the designated categories of the B List, Seventh Revision of the International Lists, 1955. 

:Isee editorts note, P. 4. 

21

---------------- --------------

------------------------------------------------------------

----------------------------

------------------------------------------------ ------------------------------------------

-------------------------------------------------------------

Table 2. Death rates for males, by selected causes of death: Japan, 1950-62


Cause of death 1962 1961
 (Seventh Revision-International Lists, 1955)


Pulmonary tuberculosis--------------------------------------------OO2 34.2 33.8


Pleural tuberculosis----------------------------------------------OO3


Tuberculosis of meninges and central nervous system---------------OlO M M


General paralysis of insane---------------------------------------O25 1.3


Other bacterial diseases -------. 050-064 ;:;


Septicemia and pyemia-------------------------------------------053 ;:; 0.9


Tetanus---------------------------------------------------------O6l 0.7 0.9


Diseases attributable to viruses------------------------------O8O-O96 3.1


Acute infectious encephalitis-----------------------------------O82 ::;


Asthma 241 14.9 1:::


Inflammatory diseases of central nervous system---------------34O-345


Acute upper respiratory infections 470-475 ::: :::


Lobar pnewonia---------------------------------------------------49O 19.3 17.6


Bronchopneuonia--------------------------------------------------49l 11.2


Pneumonia, other and unspecified----------------------------------493 4.8 ::?


Acute bronchitis --500 3.8 3.7


Bronchitis, unqualified -501 2.1 2.1


Chronic bronchitis------------------------------------------------5O2 2.4


Abscess of lung---------------------------------------------------52l :::


Bronchiectasis----------------------------------------------------526 1.2 :::


Gastritis and duodenitis------------------------------------------543 2.8 2.8


Gastroenteritis and colitis, except ulcerative, age 4 weeks and
 over 571 10.2 11.1


Chronic enteritis and ulcerative colitis--------------------------572 2.7 2.9


Peritonitis-------------------------------------------------------576


Acute nephritis---------------------------------------------------59O ;:2 M


Nephritis with edema, including nephrosis-------------------------59l 2.0


Chronic nephritis-------------------------------------------------592 8.6 ::! 

Nephritis, not specified as acute or chronic----------------------593 2.5 

Infections of kidney----------------------------------------------6OO ;:? 

Infections of skin and subcutaneous tissue--------------------69O-698 0.6 M 

Pneumonia of newborn----------------------------------------------763 230.8 275.1


Diarrhea of newborn-----------------------------------------------764 23.2 29.2.


22

� 

Table 2. Death rates for males, by selected causes of death: Japan, 1950-62—Con.


,r1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950


Rate per 100,000 males 

38.5 38.7 42.4 49.0 49.7 51.5 60.5 61.0 7;.; 98.9 130.8 

1.3 1.4 1.7 1.7 2.2 3.1 4.1 ::; 1.2 1.4 1.6 1.9 H 3.3 ::; 5:1 6.6 

2.0 2.8 ;.; u ;:: u ::: ‘R 4.4 ::: ::2 6.6 1::: 16.4 

0.8 0.9 0.9 1.0 1.0 1.1 1.3 1.5 1:4 1.6 1.7 

0.9 0.9 1.3 1.7 2.1 2.4 

3.7 4.2 ::: ::; ::: :.; ::2 9.7 13.6 n 1.9 M 

1::: 1;:: 13.5 1::: 1::!/ 15:4 1::: 2::! 18.3 2::: 2;:; 

2.7 3.9 4.1 4.4 5.3 6.4 10.7 

::; R 3.8 6.8 ::: ::; 7.8 

21.8 1%; 19.2 2;:: 19.0 1::: 2::: 25.6 25.1 28.5 29.3 

12.2 11.2 12.3 16.4 12.4 12.0 13.8 19.0 16.6 22.1 24.9 

4.1 6.3 4.8 6.1 5.3 6.7 

N ;.; ::; 5.1 ::; ::: 5.2 7.3 9.5 J:: 

2.6 � 2.3 3.0 2.6 3.2 ;:; 5.0 7.0 8.8 

2.9 3.5 3.7 ::; 4.5 5.9 8.8 

::: ::: H M 

;.: 0.7 ;:2 M ::: 0:5 ::; 0.4 ::: M . 3.0 3.0 3.1 3.3 3.2 3.4 4.2 4.2 u 5.4 

12.4 14.0 14.7 15.3 18.6 20.0 25.2 30.2 35.8 49.1 60.9 

3.3 3.5 :.: 4.3 4.9 5.1 6.2 6.9 9.3 11.6 

1.2 1.7 2.3 ;:; 4.3 

2.8 ::: 4:0 47, i:: H 4.4 ::: 5.1 %: 6.4 

$:: 9:5 ;:: 1::? 1::; d:: 1;:; l::! 1;:: 1;:: 1::: 

4.1 4.2 4.2 4.5 6.0 6.9 

::; ;:; N ::: 0.6 0.6 0.7 0.7 ;:: 1.0 

1.1 1.1 1.1 1.0 1.0 1.2 1.1 1.1 1.2 1.6 M 

Rate per 100,000 male live births


289.3 317.8 308.1 300.3 302.8 2:;.; 288.8 284.1 275.8 272.3 246.1 

32,7 42.7 42.8 51.5 59.6 . 79.2 92.0 97.6 106.1 122.9 

I I 1 I 

23

-------------------------------------------- ----------------------------------------------

-------------------------------------- -------------------------------------- ----------------------------------- ------------------------------------------------- ----------------------------- ----------------------------------- ----------------------------

---------------------------- -------------------------------------------------- -------------------------------------------------- --------------------------------- -------------------------------------------------- ------------------------------------------- ---------------- ------------------------

------------------------

---------------------------------------------------

---------

-------------------

-------------------------------------- ---------------------------------------

----------------------------------

Table 3. Death rates for females,by selected causes of death: Japan, 1950-62


Cause of death


(Seventh Revision— InternationalLists, 1955)


Pulmonary tuberculosis 002 17.9


Pleural tuberculosis 003 0.7


Tuberculosis of meninges and central nervous system---------------OlO 0.6


General paralysis of insane 025 0.4


Other bacterial diseases 050-064 1.7


Septicemia and pyemia-------- 053 0.8


Tetanus-------- 061 0.4


Diseases attributable to viruses 080-096 2.5


Acute infectious encephalitis 082


Asthma-----------------------­
-.------y 241 $;


Inflammatory diseases of central nervous system---------------340-345 1.9


Acute upper respiratory infections 470-475


Lobar pneumonia 490 12:; 

Bronchopneumonia 491 

Pneumonia, other and unspecified 493 ::; 

Acute bronchitis 500 4.2 

Bronchitis, unqualified 

Chronic bronchitis ---.----l 

501 

502 

2.1 

2.1 

Abscess of lung......--------------------- 521 0.4 

Bronchietasis----.---.-----------------------------.--------------526 0.6


Gastritis and duodenitis------------------------------------------543 3.9


Gastroenteritis and colitis, except ulcerative, age 4 weeks and
 over-------------------------------------------------------------
 571 12.1


Chronic enteritis and ulcerative colitis..................--------572


Peritonitis-------------------------------------------------------576 ?:;


Acute nephritis 590 2.2


Nephritis with edema, including nephrosis-------------------------591 1.4


Chronic nephritis................------------------------ 592 8.1


Nephritis, not specified as acute or chronic----------------------593 2.3


Infections of kidney--------------------------- 600 1.2


Infections of skin and subcutaneous tissue--------------------69O-698 0.5


Pneumonia of newborn-------- 763 200.6


Diarrhea of newborn-------- 764 20.1


Sepsis of pregnancy,childbirth,and puerperium, including abortion


with sepsis 640,641,651,681,682,684 3.9


18.L 

O.a .

;:f! 

1.[1 

g.:i 

.~ 

2.?


l.:!


8.;!


2.()


&;


8,7


3.(;


3.!)


::+


()-i+


().6


3.8


13.~t


4.1)


~o~


2.7


1.5


8.5


2.5


l.i


0.7


2;;.;
 .


4.9


1


24

Table 3. Death rates for females,by selected causes of death: Japan, 1950-62-Con.


1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950


21.7 2;.: 2S.7 

1.0 

M! 1:1 1.3 

0.4 0.5 

2.6 ::: 

M 0.9 

0.4 ::; 0.4 

3.3 3.7 

H 

;:: k: 8.7 

::; M ::: 

17.6 16.2 16.1 

10.8 9.8 11.0 

4.0 

4.6 ::: R 

2.4 2.2 

R 2.3 

;:: 0.4 0.4 

0.5 

3.8 R N 

14.7 1:.; 17.6 

4.3 5.3 

1.3 1:4 

$; 

?:: ?:: 

9.2 10:3 

2.7 ::: 3.1 

;.: 0.9 

. 0.9 M 

245.5 260.8 272.4


33.3 33.7 I 42.0


Rate per 100,000 females


31.1 32.1 35.1 41-.5 44.9 54.8 76.3 102.4 

1.1 1.3 1.2 1.5 1.7 2.4 3.4 

1.5 1.8 3.1 3.9 ::; 6.3 

0.6 0.6 M 1.1 1.1 H 

3.6 3.7 M ::: 9.8 16.8 

::: 1.0 1.1 1.2 1.5 H 1.4 1.7 

1.0 1.1 1.3 

::! H %; %; 9.4 1;:; 9.0 

N 

1!:: Iii: lkf. ::; 1::; 11.7 1::; 1::: 

3.1 5.3 9.0 

M 2:: ::: U !:; 

2::? 16.3 16.7 18.3 2;:2 21.6 24.4 2::: 

13.9 10.7 10.6 12.2 16.9 15.0 19.5 22.5 

5,4 4.3 5.5 4.5 5.8 

5.2 ::: ::: 4.8 9.1 1!:: 

3.1 2.4 2.5 3.1 ::! ::: 8.3 

3.1 4.4 4.5 ;:: 6.6 

;:; ;:: ::: 0.6 0.7 

0.2 ::: ::: 0.l ::; 

::2 H 3.9 4.5 5.2 R 5.9 6.6 

17.4 20.8 22.5 27.9 33.1 38.5 50.1 60.7 

5.5 6.3 ;.; 10.0 11.2 13.5 

N ;:: 4.0 5.1 

N 4.6 R 4.8 4:8 ::; 7.1 7.0 

1.6 

1;:; 1::; 1::! 11.7 1;:; 1::: 1::; 1+:; 

4.4 4.5 4.9 8.7 

0.9 1:0 1.0 1.1 ?:: H ::; 

0.8 0.9 1.0 1.0 1.0 1.0 1.2 ::; 

Rate per 100,000 female live births


2:;.; 258.2 252.8 2;;.; I 255.7 235.7 243.5 229.2 . 52.6 57.9 . 75.9 81.3 94.0 102.8 

Rate per 100,000 total births


6.0 ] 5.4 I 6.2 I 5.6 I 6.7 I 7.4 I 8.6 ] 806 I 10.1 I 12.51 13.7


25


I 

I 
------------------

-------- -------- -------- ---

Table 4. Retardation index, 1950/55/60, compared with retardation judgments of three


teams of experts for selected causes of death


Retardation observed 

by teams of experts 

Cause of death ~etardation 

(Seventh Revision-International Lists, 1955) index 

Acute bronchitis-------------------------------500


Bronchitis, unqualified------------------------5Ol


Other bacterial diseases-------------------O5O-O64


Acute upper respiratory infections---------47O-475


Bronchopneumonia -------------------------------491 

Infections of kidney---------------------------6OO


Pulmonary tuberculosis-------------------------OO2


pneumonia, other and unspecified---------------493


Gastroenteritis and colitis, except ulcerative,


age 4 weeks and over--------------------------57l


Lobar pneumonia--------------------------------4gO


Pleural tuberculosis---------------------------OO3


Infections of skin and subcutaneous tissue-690-698


Gastritis and duodenitis-----------------------543


peritonitis------------:---:----------------:--576


SeDsis of Premancv, chlldblrth, and PUerPerUQ~


i~cluding- ab~rtiofi‘with


sepsis --640,641,651,681,682,684


Abs&ess of Iung-------------------------------;szl


Chronic bronchitis-----------------------------5O2


Asthma -----------------------------------------241


Inflammatory diseases of central nervous


system------------------------------------34O-345


Chronic enteritis and ulcerative colitis-------572


Tuberculosis of meninges and central nervous


system----------------------------------------OlO


Chronic nephritis------------------------------592


Tetanus----------------------------------------O6l


General paralysis of insane--------------------O25


Bronchiectasis---------------------------------526


Septicemia and pyemia--------------------------O53


Nephritis not specified as acute or chronic----593


Nephritis with edema, including nephrosis------59l


Diseases attributable to viruses-----------O8O-O96


Diarrhea of newborn----------------------------764


Acute nephritis--------------------------------59O


Pneumonia of newborn 763


Number of )egree of


teamsl sssurance:


3.37 3 1, 1, 1 

3.37 3 1, 1, 1 

2.40 2 2, 2 

2.12 . . . 

2.12 2 1, 2 

1.93 3 1, 1, 1 

1.87 3 1, 2, 2 

1.87 3 1, 1, 2 

1.82 2 

1.71 3 

1.58 3 

1.56 . . . 

1.55 3 1, 2, 2 

1.51 3 1, 2, 2 

1.50 

1.47 ; 1, 2;”:! 

1.46 3 1, 1, 2 

1.46 3 1, 2, 2 

1.46 2 1, L 

1.45 1 2 

1.24 2 2, 2 

1.24 2 2, 2 

1.24 ..0 

1.23 i 2, 2 

1,18 . . . 

1.17 

;.:; i 2, ; 

. 1 2 

1.07 .,. 1.01 . . . 0.98 .,. 

0.91 . ..” 

lNumber of teams reporting occurrence of retardation among the three teams of e>.­
 perts who examined the graphs.


2Deg-feeof assurance reported by each team that detected occurrence of retardatiorl.


Assurance reports are coded as 1, clearly identifiable; or 2, identifiable.


26

--------------

Table 5. Identification of breaking pointa,inclination of trend linea before and after the break­


ing points, and retardation ratio (R.R.%),1 by sex and selected causes of death


Inclination Retar-


Sex and cause of death Breaking dation


(Seventh Revision— International Liats, 1955) point ratio


10-! 

Both sexes


Pulmonary tuberculosis---------------------.--------.---OO2


Pleural tuberculosis--.---------------------------------OO3


Other bacterial diseases--------------------------.-O5O-O64


Inflammatory diseases of central nervous system-----345-345


Lobar pneumonia-----------------------------------------490


Bronchopneumonia----------------------------------------4gl


Pneumonia, other and unspecified------------------------493


bl X10– b2x (R.R.%)1 

1955 9,364 3,500 62.6 

1955 7,287 3,982 45.4 

1955 10,914 5,088 53.4 ... ... ... ... 1955 3,428 398 88.4 

1955 5,868 1,374 76.6 

1955 4,285 314 92.7 

Acute bronchitis----------------------------------------500 1955 8,360 460 94.5


Bronchitis, unqualified---------------------------------5Ol


Chronic bronchitis--------------------------------------5O2


Abscess of lung-----------------------------------------52l


Gastritis and duodenitis--------------------------------543


Gaatroenteritia and colitis, except ulcerative, age 4


weeks and over----------------------.------------------5~~


Chronic enteritis and ulcerative colitis----------------572


Peritonitis‘--------------------------------------------576


Acute nephritis----------------------------------------_5gO


Male


Pulmonary tuberculoais----------------------------------OO2


Pleural tuberculosis------------------------------------OO3


Other bacterial diseases‘---------------------------050-064


Inflammatory diseases of central nervous sYstem-----345-345


Lobar pneumonia-----------------------------------------4gO


Bronchopneumonia----------------------------------------491


Pneumonia, other and unspecified------------------------493


Acute bronchitis----------------------------------------5OO


Bronchitis, unqualified---------------------------------5Ol


Chronic bronchitis--------------------------------------5O2


Abscess of lmg-----------------------------------------52l


Gaatritis and duodenitis--------------------------------543


Gastroenteritis and colitis, except ulcerative, age 4


weeks and over-----------------------------------------57~


Chronic enteritis and ulcerative co~itis-.---572----_---572


peritOnitiS---------------------------------_-----------576 

Acute nephritia-----------------------------------------5gO


Female


Pulmonary tuberculosis----------------------------------OO2


Pleural tuberculosis------------------------------------OO3


Other bacterial diseases----------------------------O5O-O64


Inflammatory diseases of central nervous system-----345-345


Lobar pneumonia-----------------------------------------4gO


Bronchopneumonia----------------------------------------491


Pneumonia, other and unspecified------------------------493


Acute bronchitis----------------------------------------5OO


Bronchitis, unqualified =------------------501


Chronic bronchitis------.------------..------------------5O2


Abscess of lung-----------------------.-----------------52l


Gastritis and duodenitis---------------.----------------543


Gastroenteritis and colitis , exce~t ulcerative, age 4


weeks and over---------.--------~----------------------57~


Chronic enteritis and ulcerative colitis----------------572


Peritonitis‘--------------------------------------------576


Acute nephritis--------------------------------..-------5gO


1955 19,007 1,452 92.4 

1959 5,713 -692 112.1 ... ... ... ... ... ... ... ... 

1957 8,300 3,506 57.8 

1955 6,097 3,772 38.1 

1955 7,419 3,528 52.4 ... ... ... ... 

1953 12,579 3,056 75.7 ... ... ... ... 1955 9,861 5,014 49.2 

1955 6,508 2,055 68.4 

1955 3,440 260 ;3.: 

1955 5,783 1,440 

1955 4,200 234 94:4 

1955 8,424 708 91.6 

1955 10,275 1,496 85.4 ... ... ... ... 1955 5,646 1,934 65.7 

1955 4,611 1,786 61.3 

1955 9,775 4,122 57.8 

1955 6,686 4,128 38.3 

1955 6,879 3,206 53.4 ... ... ... ... 

1953 13,921 4,630 66.7 

1955 8,581 3,984 53.6 

1955 11,976 5,226 56.4 

... ... ... ... ... ... ... ... ... ... ... ... 1955 4,386 402 90.8 

1955 8,295 318 96.2 

1955 9,737 1,346 86.2 ... ... ... ... ... ... � .. ... 1955 3,869 616 84.1 

1957 7,966 3,396 57.4 

1955 5,745 3,488 39.3 

1955 7,972 3,820 52.1 

1953 4,478 3,966 11.4 

lThe retardation ratio (R.R.%) is defined as: R.R.(Oh)=— bl–b2 x 100 

bl 

27 
I

Table 6. Incidence rates for all diseases and for major groups of diseases: Japan,


1953-62
 I 

I Major groups of diseases


.
 All


Nervous


and


Year diseases	 Infectious Respiratory Digestive system and Circulator>’


parasitic System system sense organs


Rate per 1,000 persons 

1962-------- 2,053 51 919 359 122 31. 

1961-------- 2,109 55 830 397 127 4:! 

1960-------- 2,099 52 847 370 132 3(; 

1959-------- 2,134 48 849 371 132 36 

1958-------- 2,041 59 831 331 111 2‘7 

1957-------- 2,150 59 1,024 273 111 23 

1956-------- 2,000 64 799 322 121 2~+ 

1955-------- 1,783 62 728 276 102 21. 

1954-------- 1,911 67 724 314 111 23 

1953-------- 2,053 86 851 316 106 20 

SOURCE: Health and Welfare Statistics Division, Ministry of Health and Welfare,


Japan, National Health Survey, Report, published annually, 1953-62.


28

Public Health Service Publication No.1OOO 

Serzes 1. PvogYams andcollection pvocedures.— Reports which describe the general programs of the National 

SeVies 2. 

Sevies 3. 

Series 4. 

SeVies 10. 

SeVies 11. 

I Series 12. 

SeYies 13. 

Series 20. 

Sevies 21. 

SeVies 22. 

Center for Health Statistics and its offices and divisions, data collection methods used, definitions, 

and other material necessary for understanding the data. 

Data evaluation and methods ?-esearch. —Studies of new statistical methodology including: experimental tests of new survey methods, studies of vital statistics collection methods, new analytical 

techniques, objective evaluations of reliability of collected data, contributions to statistical theory. 

Analytical studies. —Reports presenting analytical or interpretive studies based on vital and health 

statistics, carrying the analysis further than the expository types of reports in the other series. 

Documents and committee reports. —Final reports of major committees concerned with vital and 

health statistics, and documents such as recommended model vital registration laws and revised birth 

and death certificates. 

Data from the Health Interview Survey. —Statistics on illness, accidental injuries, disability, use of 

hospital, medical, dental, and other services, and other health-related topics, based on data collected 

in a continuing national household interview survey. 

Data from the Health Examination Survey. — Data from direct examination, testing, and measurement of national samples of the population provide the basis for two types of reports: (1) estimates 

of the medically defined prevalence of specific diseases in the United States and the distributions of 

the population with respect to physical, physiological, and psychological characteristics; and (2) 

analysis of relationships afnong the various measurements without reference to an explicit finite 

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Data fyom the Institutional Population Sutweys. —Statistics relating to the health characteristics of 

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samples of establishments providing these services and samples of the residents or patients. 

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Data on mortality. -Various statistics on mortality other than as included in annual or monthly 

reports— special analyses by cause of death, age, and other demographic variables, also geographic 

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Data on nata~ity, mavviage, and divorce. —Various statistics on natality, marriage, and divorce other 

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Data from the National Nata.!ity ad Moytality .SUvveys. —statistics on characteristics of births and 

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including such topics as mortality by socioeconomic class, medical experience in the last year of 

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For a list of titles of reports published in these series, write to: Office of Information 

National Center for Health Statistics 

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