Three decades of population health changes in Japan, 1990–2021: a subnational analysis for the Global Burden of Disease Study 2021
Authors: Shuhei Nomura, Michio Murakami, Santosh Kumar Rauniyar, Naoki Kondo, Takahiro Tabuchi, Haruka Sakamoto, Yasuharu Tokuda, Nishali Patel, Jose Navarro de Pablo, Joseph L Dieleman, Angela Y Chang, Vegard Skirbekk, Sarah K Abe, Norito Kawakami, Erika Ota, Scott D Glenn, Chimedsuren Ochir, Hiroaki Miyata, Manami Inoue, Kenji Shibuya, Isaac Yeboah Addo, Mohammed Ahmed Akkaif, Syed Mahfuz Al Hasan, Waad Ali, Mohammad Al-Wardat, Hany Aly, Anayochukwu Edward Anyasodor, Jalal Arabloo, Ahmed Y. Azzam, Kavita Batra, Sonu Bhaskar, Samuel Adolf Bosoka, Ester Cerin, Vijay Kumar Chattu, Dong-Woo Choi, Bryan Chong, Samuel Demissie Darcho, Nicole Davis Weaver, Kuldeep Dhama, Robert Kokou Dowou, Temitope Cyrus Ekundayo, Ibrahim Farahat El Bayoumy, Pietro Ferrara, Nuno Ferreira, Takeshi Fukumoto, Xiang Gao, Samer Hamidi, Simon I Hay, Yuta Hiraike, Mehdi Hosseinzadeh, Nayu Ikeda, Arit Inok, Md. Rabiul Islam, Masao Iwagami, Ammar Abdulrahman Jairoun, Mihajlo Jakovljevic, Inn Kynn Khaing, Mohammad Jobair Khan, Atulya Aman Khosla, Tea Lallukka, Thao Thi Thu Le, Munjae Lee, Seung Won Lee, Wei-Chen Lee, Raimundas Lunevicius, Medha Mathur, Hadush Negash Meles, Mohammadreza Mobayen, Jama Mohamed, Abdollah Mohammadian-Hafshejani, Yanjinlkham Munkhsaikhan, Christopher J L Murray, Ganesh R Naik, Samidi Nirasha Kumari Navaratna, Phuong The Nguyen, Dieta Nurrika, Bogdan Oancea, Michael Safo Oduro, Takayoshi Ohkubo, Osaretin Christabel Okonji, Sok King Ong, Mahesh Padukudru P A, Jagadish Rao Padubidri, Romil R Parikh, Sungchul Park, Mahmoud Mohammed Ramadan, Shakthi Kumaran Ramasamy, Sheena Ramazanu, Elrashdy M. Moustafa Mohamed Redwan, Taeho Gregory Rhee, Cameron John Sabet, Vijaya Paul Samuel, Jennifer Saulam, Mohammad Ali Shamshirgaran, Premalatha K Shetty, Mika Shigematsu, Aminu Shittu, Emmanuel Edwar Siddig, Zhong Sun, Chandan Kumar Swain, Ruri Syailendrawati, Sree Sudha T Y, Jabeen Taiba, Masayuki Teramoto, Ngoc Ha Tran, Nguyen Tran Minh Duc, Dominique Vervoort, Muhammad Waqas, Kazumasa Yamagishi, Yuichiro Yano, Yuichi Yasufuku, Dong Keon Yon, Naohiro Yonemoto, Iman Zare, Zhiqiang Zhang, Hanqing Zhao, Claire Chenwen Zhong, Mohsen Naghavi
Journal: The Lancet Public Health (2025)

Given Japan's rapidly ageing demographic structure, comprehensive and long-term evaluations of its national and subnational health progress are important to inform public health policy. This study aims to assess Japan's population health, using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to analyse the country's evolving disease patterns. GBD 2021 used Japanese data from 1474 sources, covering 371 diseases, including COVID-19, and 88 risk factors. The analysis included estimates of life expectancy, mortality, and disability-adjusted life-years (DALYs). Estimates were generated using the standardised GBD methodology, which incorporates various data sources through statistical modelling, including the Cause Of Death Ensemble Model for mortality, Bayesian Meta-Regression Disease Model for non-fatal outcomes, and risk factor estimation frameworks to quantify attributable burdens. Life expectancy decomposition by cause of death and annualised rates of change of age-standardised mortality and DALYs were calculated for 1990-2005, 2005-15, and 2015-21. Between 1990 and 2021, life expectancy in Japan rose from 79·4 years (95% uncertainty interval 79·3-79·4) to 85·2 years (85·1-85·2), with prefecture-level disparities widening. Gains were primarily driven by reduced mortality from stroke (adding 1·5 years to life expectancy), ischaemic heart disease (1·0 years), and neoplasms, particularly stomach cancer (0·5 years), with variation across prefectures. Leading causes of death in 2021 were Alzheimer's disease and other dementias (135·3 deaths [39·5-312·3] per 100 000 population), stroke (114·9 [89·8-129·3] per 100 000), ischaemic heart disease (96·5 [77·7-106·7] per 100 000), and lung cancer (72·1 [61·8-77·5] per 100 000). Age-standardised mortality for major non-communicable diseases declined, but the pace of this decline has slowed. All-cause annualised rate of change in mortality rate decreased from -1·6% for 2005-15 to -1·1% for 2015-21. Age-standardised COVID-19 mortality rates were 0·8 deaths (0·7-0·9) per 100 000 population (accounting for 0·3% of all deaths) in 2020 and 3·0 (2·5-3·7) per 100 000 population in 2021 (1·0% of deaths). Age-standardised DALY rates for diabetes worsened, with annualised rate of change increasing from 0·1% for 2005-15 to 2·2% for 2015-21. This change parallels worsening trends in major risk factors, particularly high fasting plasma glucose (annualised rate of change of attributable DALYs -0·8% for 2005-15 and 0·8% for 2015-21) and high BMI (0·2% and 1·4%, respectively). Age-standardised DALYs attributable to other major risk factors continued to decrease, albeit slower. Japan's health gains over the past 30 years are now stalling, with rising regional disparities. The increasing burdens of Alzheimer's disease and other dementias and diabetes, alongside high fasting plasma glucose and high BMI, highlight areas needing focused attention and action. Gates Foundation.