Associations of all-cause mortality with census-based neighbourhood deprivation and population density in Japan: a multilevel survival analysis

PLoS One. 2014 Jun 6;9(6):e97802. doi: 10.1371/journal.pone.0097802. eCollection 2014.


Background: 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 non-Western societies. Thus, we examined the effects of areal deprivation and population density on all-cause mortality in Japan.

Methods: We 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.

Results: We 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.

Conclusions: We 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Censuses
  • Female
  • Health Status
  • Humans
  • Japan
  • Male
  • Middle Aged
  • Mortality*
  • Population Density*
  • Residence Characteristics / statistics & numerical data*
  • Socioeconomic Factors

Grants and funding

This work was supported by grants-in-aid for National Cancer Center Research and Development Fund (23-A-31[toku] and 26-A-2) (since 2011) and a Grant-in-Aid for Cancer Research from the Ministry of Health, Labour and Welfare of Japan (from 1989 to 2010), the Special Coordination Funds for Promoting Science and Technology from the Ministry of Education, Culture, Sports, Science and Technology for the Osaka University Program for the Support of Networking among Present and Future Women Researchers. This work was also supported by JSPS KAKENHI Grant (Number 24300323 and 20590793). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.