Health  Vol.5 No.8 , August 2013
Causal relationships between survival rates, dietary and lifestyle habits, socioeconomic status and physical, mental and social health in elderly urban dwellers in Japan: A chronological study
Abstract: Life expectancy was well known to associate with life habits, socioeconomic condition, and three health-related dimensions (physical, mental and social health status). However, the causal effect relationship among these variables remains unclear. The purpose of this study was to determine the causal relationships among health and life conditions, socioeconomic status, dietary and life habits and three health-related dimensions in elderly urban dwellers in Tokyo, Japan. Of 16,462 eligible elderly individuals aged 65 years and older, 13,195 participants responded to the questionnaire survey conducted in September 2001 (a response rate of 80.2%). A follow-up survey was conducted in September 2004 and a total of 8162 survivors were followed until the end of August 2007 through the municipal resident's registry. Exploratory factor analysis defined five latent variables based on the 13 observed variables. From a cross-lagged effects variation model using structural equation modeling, causal relationships were analyzed using longitudinal data obtained at the 2001 and 2004 survey and the number of survival days between 2004 and 2007. After estimating a best-fit model, we discovered that health and life conditions were not determined by current dietary and life habits, which many studies showed. However, the conditions were more directly affected by three health-related dimensions three years earlier, and indirectly affected by educational attainment and previous annual income as well. The current model suggests that it might be of great importance for elderly individuals to emphasize the maintenance of psychological well being, physical activity, social communication and participation, as well as income, rather than focusing on improvements in diet and health-related life s per se.
Cite this paper: Hoshi, T. , Yuasa, M. , Yang, S. , Kurimori, S. , Sakurai, N. and Fujiwara, Y. (2013) Causal relationships between survival rates, dietary and lifestyle habits, socioeconomic status and physical, mental and social health in elderly urban dwellers in Japan: A chronological study. Health, 5, 1303-1312. doi: 10.4236/health.2013.58177.

[1]   [1] Mathers, C.D., Murray, C.J., Salomon, J.A., Sadana, R., Tandon, A., Lopez, A.D., Ustun, B. and Chatterji, S. (2003) Healthy life expectancy: Comparison of OECD countries in 2001. Australian and New Zealand Journal of Public Health, 27, 5-11. doi:10.1111/j.1467-842X.2003.tb00372.x

[2]   Marmot, M.G. and Smith, G.D. (1989) Why are the Japanese living longer? British Medical Journal, 299, 1547-1551. doi:10.1136/bmj.299.6715.1547

[3]   Yoshinaga, K. and Une, H. (2005) Contributions of mortality changes by age group and selected causes of death to the increase in Japanese life expectancy at birth from 1950 to 2000. European Journal of Epidemiology, 20, 49-57. doi:10.1007/s10654-004-9557-x

[4]   Asiskovitch, S. (2010) Gender and health outcomes: The impact of healthcare systems and their financing on life expectancies of women and men. Social Science & Medicine, 70, 886-895. doi:10.1016/j.socscimed.2009.11.018

[5]   Kondo, N., Mizutani, T., Minai, J., Kazama, M., Imai, H., Takeda, Y. and Yamagata, Z. (2005) Factors explaining disability-free life expectancy in Japan: The proportion of older workers, self-reported health status, and the number of public health nurses. Journal of Epidemiology, 15, 219-227. doi:10.2188/jea.15.219

[6]   A new perspective on the health of Canadians. A Working Document.

[7]   Healthy People, The surgeon general’s report on health promotion and disease prevention.

[8]   Bronnum-Hansen, H., Juel, K., Davidsen, M. and Sorensen, J. (2007) Impact of selected risk factors on quality-adjusted life expectancy in Denmark. Scandinavian Journal of Public Health, 35, 510-515. doi:10.1080/14034940701271908

[9]   Willcox, B.J., He, Q., Chen, R., Yano, K., Masaki, K.H., Grove, J.S., Donlon, T.A., Willcox, D.C. and Curb, J.D. (2006) Midlife risk factors and healthy survival in men. JAMA, 296, 2343-2350. doi:10.1001/jama.296.19.2343

[10]   Enstrom, J.E. and Breslow, L. (2008) Lifestyle and reduced mortality among active California Mormons, 1980-2004. Preventive Medicine, 46, 133-136. doi:10.1016/j.ypmed.2007.07.030

[11]   Nothlings, U., Ford, E.S., Kroger, J. and Boeing, H. (2010) Lifestyle factors and mortality among adults with diabetes: Findings from the European prospective investigation into cancer and nutrition-potsdam study. Journal of Diabetes, 2, 112-117. doi:10.1111/j.1753-0407.2010.00069.x

[12]   Tamakoshi, A., Kawado, M., Ozasa, K., Tamakoshi, K., Lin, Y., Yagyu, K., Kikuchi, S. and Hashimoto, S. (2010) Impact of smoking and other lifestyle factors on life expectancy among Japanese: Findings from the Japan collaborative cohort (JACC) study. Journal of Epidemiology, 20, 370-376. doi:10.2188/jea.JE20100017

[13]   Hoi, le V., Phuc, H.D., Dung, T.V., Chuc, N.T. and Lindholm, L. (2009) Remaining life expectancy among older people in a rural area of Vietnam: Trends and socioeconomic inequalities during a period of multiple transitions. BMC Public Health, 9, 471. doi:10.1186/1471-2458-9-471

[14]   Matthews, R.J., Jagger, C. and Hancock, R.M. (2006) Does socio-economic advantage lead to a longer, healthier old age? Social Science & Medicine, 62, 2489-2499. doi:10.1016/j.socscimed.2005.11.019

[15]   Jagger, C., Gillies, C., Moscone, F., Cambois, E., Van Oyen, H., Nusselder, W. and Robine, J.M. (2008) Inequalities in healthy life years in the 25 countries of the European Union in 2005: A cross-national meta-regression analysis. Lancet, 372, 2124-2131. doi:10.1016/S0140-6736(08)61594-9

[16]   Sugiura, Y., Ju Y.S., Yasuoka, J. and Jimba, M. (2010) Rapid increase in Japanese life expectancy after World War II. BioScience Trends, 4, 9-16.

[17]   Kagamimori, S., Gaina, A. and Nasermoaddeli, A. (2009) Socioeconomic status and health in the Japanese population. Social Science & Medicine, 68, 2152-2160. doi:10.1016/j.socscimed.2009.03.030

[18]   (1946) The constitution of the World Health Organization. International Health Conference, New York.

[19]   Byberg, L., Melhus, H., Gedeborg, R., Sundstrom, J., Ahlbom, A., Zethelius, B., Berglund, L.G., Wolk, A. and Michaelsson, K. (2009) Total mortality after changes in leisure time physical activity in 50 year old men: 35 year follow-up of population based cohort. British Journal of Sports Medicine, 43, 482.

[20]   Donaldson, L.J. and Jagger, C. (1983) Survival and functional capacity: Three year follow up of an elderly population in hospitals and homes. Journal of Epidemiology & Community Health, 37, 176-179. doi:10.1136/jech.37.3.176

[21]   Eplov, L.F., Jorgensen, T., Birket-Smith, M., Segel, S., Johansen, C. and Mortensen, E.L. (2005) Mental vulnerability as a predictor of early mortality. Epidemiology, 16, 226-232. doi:10.1097/01.ede.0000152904.95284.0f

[22]   Kaplan, G.A., Goldberg, D.E., Everson, S.A., Cohen, R.D., Salonen, R., Tuomilehto, J. and Salonen, J. (1996) Perceived health status and morbidity and mortality: Evidence from the Kuopio ischaemic heart disease risk factor study. International Journal of Epidemiology, 25, 259-265. doi:10.1093/ije/25.2.259

[23]   Berkman, L.F. and Syme, S.L. (1979) Social networks, host resistance, and mortality: A nine-year follow-up study of Alameda County residents. American Journal of Epidemiology, 109, 186-204.

[24]   Seeman, T.E., Kaplan, G.A., Knudsen, L., Cohen, R. and Guralnik, J. (1987) Social network ties and mortality among the elderly in the Alameda County Study. American Journal of Epidemiology, 126, 714-723.

[25]   Khaw, K.T., Wareham, N., Bingham, S., Welch, A., Luben, R. and Day, N. (2008) Combined impact of health behaviours and mortality in men and women: The EPICNorfolk prospective population study. PLoS Medicine, 5, e12. doi:10.1371/journal.pmed.0050012

[26]   Branch, L.G., Katz, S., Kniepmann, K. and Papsidero, J.A. (1984) A prospective study of functional status among community elders. American Journal of Public Health, 74, 266-268. doi:10.2105/AJPH.74.3.266

[27]   Koyano, W., Shibata, H., Nakazato, K., Haga, H. and Suyama, Y. (1991) Measurement of competence: Reliability and validity of the TMIG Index of Competence. Archives of Gerontology and Geriatrics, 13, 103-116. doi:10.1016/0167-4943(91)90053-S

[28]   Blazer, D.G. and Houpt, J.L. (1979) Perception of poor health in the healthy older adult. Journal of the American Geriatrics Society, 27, 330-334.

[29]   Perruccio, A.V., Badley, E.M., Hogg-Johnson, S. and Davis, A.M. (2010) Characterizing self-rated health during a period of changing health status. Social Science & Medicine, 71, 1636-1643. doi:10.1016/j.socscimed.2010.07.042

[30]   Berkman, L.F. and Breslow, L. (1983) Health and ways on living; The Alameda county study. Oxford University Press, New York.

[31]   Ford, E.S., Zhao, G., Tsai, J. and Li, C. (2011) Low-risk lifestyle behaviors and all-cause mortality: Findings from the National Health and Nutrition Examination Survey III Mortality Study. American Journal of Public Health, 101, 1922-1929. doi:10.2105/AJPH.2011.300167

[32]   Millen, B.E., Quatromoni, P.A., Pencina, M., Kimokoti, R., Nam, B.H., Cobain, S., Kozak, W., Appugliese, D.P., Ordovas, J. and D’Agostino, R.B. (2005) Unique dietary patterns and chronic disease risk profiles of adult men: The Framingham nutrition studies. Journal of the American Dietetic Association, 105, 1723-1734. doi:10.1016/j.jada.2005.08.007

[33]   van Dam, R.M., Li, T., Spiegelman, D., Franco, O.H. and Hu, F.B. (2008) Combined impact of lifestyle factors on mortality: Prospective cohort study in US women. British Medical Journal, 337, a1440. doi:10.1136/bmj.a1440

[34]   Diehr, P., O’Meara, E.S., Fitzpatrick, A., Newman, A.B., Kuller, L. and Burke, G. (2008) Weight, mortality, years of healthy life, and active life expectancy in older adults. Journal of the American Geriatrics Society, 56, 76-83. doi:10.1111/j.1532-5415.2007.01500.x

[35]   Iestra, J., Knoops, K., Kromhout, D., de Groot, L., Grobbee, D. and van Staveren, W. (2006) Lifestyle, mediterranean diet and survival in European post-myocardial infarction patients. European Journal of Cardiovascular Prevention & Rehabilitation, 13, 894-900. doi:10.1097/

[36]   Knoops, K.T., de Groot, L.C., Kromhout, D., Perrin, A.E., Moreiras-Varela, O., Menotti, A. and van Staveren, W.A. (2004) Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: The HALE project. The Journal of the American Medical Association, 292, 1433-1439. doi:10.1001/jama.292.12.1433

[37]   Tucker, K.L., Hallfrisch, J., Qiao, N., Muller, D., Andres, R. and Fleg, J.L. (2005) The combination of high fruit and vegetable and low saturated fat intakes is more protective against mortality in aging men than is either alone: The Baltimore longitudinal study of aging. Journal of Nutrition, 135, 556-561.

[38]   Spiers, N., Jagger, C., Clarke, M. and Arthur, A. (2003) Are gender differences in the relationship between selfrated health and mortality enduring? Results from three birth cohorts in Melton Mowbray, United Kingdom. Gerontologist, 43, 406-411. doi:10.1093/geront/43.3.406

[39]   Hoshi, T., Ryu, S. and Fujiwara, Y. (2007) Urban health and determinant factors for longer life for the elderly urban dwellers in Tokyo. Proceedings of the International Symposium on Sustainable Urban Environment, 61-66.

[40]   Hoshi, T., Takagi, C., Bosako, Y., Nakayama, N., Yan, S., Kurimori, S., Hasegawa, T., Inoue, N., Yamamoto, C., Takahashi, T., et al. (2011) Chronological evaluation of physical, psychological and social health of urban elderly dwellers over 6 years and assesment of cuasal interrelationships. Nihon Koshu Eisei Zasshi, 58, 491-500.

[41]   Leinsalu, M., Vagero, D., Kunst, A.E. (2003) Estonia 1989-2000: Enormous increase in mortality differences by education. International Journal of Epidemiology, 32, 1081-1087. doi:10.1093/ije/dyg192

[42]   Singh-Manoux, A., Clarke, P. and Marmot, M. (2002) Multiple measures of socio-economic position and psychosocial health: Proximal and distal measures. International Journal of Epidemiology, 31, 1192-1199. doi:10.1093/ije/31.6.1192

[43]   Wardle, J. and Steptoe, A. (2003) Socioeconomic differrences in attitudes and beliefs about healthy lifestyles. Journal of Epidemiology & Community Health, 57, 440-443. doi:10.1136/jech.57.6.440