ArticleBMJ open2026
Association between rurality and mortality from major diseases in Japan: an ecological study.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Psychiatric standardized claim ratios by rurality and deprivation in Japan: A nationwide ecological study with contextual suicide mortality.PCN reports : psychiatry and clinical neurosciences · 2026Article
- Testing and evaluating updated variants of the rurality index for Japan: a nationwide methodological study.BMJ open · 2026Article
- Association of municipal rurality and area deprivation with cause-specific mortality in Japan: a nationwide ecological study.BMJ public health · 2026Article
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2 authors.
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Abstract
objectivesThis study aimed to examine rural-urban disparities in healthcare outcomes in Japan using the Rurality Index for Japan (RIJ). It evaluated the association between rurality and mortality from five major diseases prioritised by the Japanese government, accounting for socioeconomic and demographic factors.
designAn ecological study using publicly available data at municipal and administrative district levels.
settingAll municipalities and administrative districts within government-designated cities in Japan.
participantsA total of 1897 municipalities and administrative districts were analysed, excluding areas with zero population. The total number of the population was approximately 126 million. EXPOSURE: Rurality was measured using RIJ. PRIMARY OUTCOME MEASURES: Standardised mortality ratios (SMRs) were used for acute myocardial infarction (AMI), cerebrovascular diseases (stroke and haemorrhage), cancer and suicide. The standardised claim ratio (SCR) for diabetes outpatient care served as a proxy measure due to the unavailability of mortality data.
resultsGreater rurality, as quantified by RIJ, was associated with higher SMRs for cerebrovascular diseases and male suicide. A dose-response relationship was observed among SMRs for cerebrovascular disease and male suicide, whereas AMI mortality was higher in rural areas but lacked a strict dose-dependent trend. No significant association was found between rurality and cancer mortality or diabetes in outpatient SCR. Additionally, RIJ was positively correlated with the proportion of older adults (Spearman's ρ=0.67) and the Arial Deprivation Index (ρ=0.55).
conclusionThese findings highlight the need for targeted rural health policies that improve access to emergency care and mental health services.
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