Stroke trends in Japan
1Department of Clinical Studies, Radiation Effects Research Foundation, Hiroshima, Japan.
Insights
Stroke incidence and mortality have decreased in Japan, with improved survival rates. Lifestyle changes and better blood pressure management are key factors, though cerebral infarction remains a concern in older adults.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- Stroke is a leading cause of death in Japan, historically ranking first.
- While overall stroke mortality has declined, cerebral infarction incidence remains high in older populations, posing a significant disability challenge.
- Nationwide data on stroke incidence and survival rates are limited.
Purpose of the Study:
- To analyze trends in stroke mortality, incidence, and survival rates in Japan.
- To identify factors contributing to observed changes in stroke epidemiology.
- To highlight persistent challenges in stroke care, particularly for cerebral infarction.
Main Methods:
- Analysis of mortality data from national statistics.
- Review of regional stroke incidence studies (e.g., Akita/Osaka, Nagano, Hiroshima/Nagasaki, Hisayama).
- Examination of survival rate data from cohort studies (e.g., Hiroshima/Nagasaki).
Main Results:
- Stroke mortality peaked around 1970 and has since decreased, with heart disease now being the leading cause of death.
- Studies indicate significant decreases in both cerebral infarction and cerebral hemorrhage incidence across various regions.
- Survival rates for stroke, including cerebral hemorrhage and infarction, have improved over time.
- The reduction in cerebral infarction incidence is less pronounced, especially in the elderly, where disability rates remain high.
Conclusions:
- Declining stroke incidence and mortality, alongside improved survival, suggest less severe strokes and enhanced medical care.
- Adoption of healthier lifestyles and effective blood pressure management are considered the most significant contributors to these positive trends.
- Cerebral infarction in advanced age continues to be a critical public health issue requiring further attention.
Abstract:
In Japan, stroke now ranks third among all causes of death following cancer and heart disease. Stroke was the leading cause of death for 3 decades after 1951. Stroke mortality tended to increase until about 1970, but it decreased and yielded first place to cancer in 1981. Heart disease deaths outnumbered stroke deaths beginning in 1985. There have not been any nationwide studies of stroke incidence in Japan, but results of studies in model areas such as Akita/Osaka, Nagano, Hiroshima/Nagasaki, and Hisayama show remarkable decreases in the incidence of cerebral infarction and cerebral hemorrhage. However, the decrease in cerebral infarction is less, especially at advanced ages where the frequency of disability is still high, and a major problem. There have not been any nationwide studies of survival rates after stroke either. In the Hiroshima/Nagasaki Study, the cumulative survival rates of cerebral hemorrhage and cerebral infarction improved from 1958 to 1969 to the period from 1970 to 1984. The decreasing incidence and mortality rates of stroke and the improving survival rate may be explained by the trends toward less severe strokes and improved medical service; however, the most influential factors are considered to be adoption of a less traditional life-style and improved blood pressure management throughout Japan.
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