BMC Public Health Research article Municipal health expectancy in Japan: decreased healthy longevity of older people in socioeconomically disadvantaged areas Yoshiharu Fukuda*, Keiko Nakamura and Takehito Takano BioMed Central Open Access Address: Health Promotion/International Health, Division of Public Health, Graduate School of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan Email: Yoshiharu Fukuda* - fukuda.hlth@tmd.ac.jp; Keiko Nakamura - nakamura.ith@tmd.ac.jp; Takehito Takano - secretary1.hlth@tmd.ac.jp * Corresponding author Published: 14 June 2005 BMC Public Health 2005, 5:65 doi:10.1186/1471-2458-5-65 This article is available from: http://www.biomedcentral.com/1471-2458/5/65 Received: 07 September 2004 Accepted: 14 June 2005 © 2005 Fukuda et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: Little is known about small-area variation in healthy longevity of older people and its socioeconomic correlates. This study aimed to estimate health expectancy at 65 years (HE65) at the municipal level in Japan, and to examine its relation to area socio-demographic conditions. Methods: HE65 of municipalities (N = 3361) across Japan was estimated by a linear regression formula with life expectancy at 65 years and the prevalence of those certificated as needing nursing care. The relation between HE65 and area socio-demographic indicators was examined using correlation coefficients. Results: The estimated HE65 (years) ranged from 13.13 to 17.39 for men and from 14.84 to 20.53 for women. HE65 was significantly positively correlated with the proportion of elderly and per capita income, and negatively correlated with the percentage of households of a single elderly person, divorce rate, and unemployment rate. These relations were stronger in large municipalities (with a population of more than 100,000) than in small and medium-size municipalities. Conclusion: A decrease in healthy longevity of older people was associated with a higher percentage of households of a single elderly person and divorce rate, and lower socioeconomic conditions. This study suggests that older people in urban areas are susceptible to socio- demographic factors, and a social support network for older people living in socioeconomically disadvantaged conditions should be encouraged. Background The ageing of the population has been progressing throughout the world, and Japan is the leading country with population ageing: the proportion of elderly (aged 65 years or over) was 17.4% in 2000 and is estimated to be over 35% in 2050 [1]. The quality of the years lived and well-being in an ageing society with declining mortality and increased life expectancy (LE) have been addressed [2]. To measure health levels including the aspects of quality of life and well-being, several comprehensive health indi- cators have been developed, and among them health expectancy (HE) has been commonly used [2-5]. HE is calculated by application of prevalence of morbidity data such as disability prevalence on age-specific person years in a life table [2,6]. The national health plan in Japan, "Health Japan 21", accompanied by local action plans, aims to prolong HE at the national and local levels Page 1 of 9 (page number not for citation purposes)