ArticleJMA journal2026
Disparities in Coronavirus Disease 2019 Mortality among Japanese and Non-Japanese Residents: A Natural Experimental Study.
Article in JMA journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Universal health coverage has been cited as a critical factor in Japan's success in limiting mortality due to coronavirus disease 2019 (COVID-19). It is unclear if this success extended to non-Japanese residents, especially prior to roll out of COVID vaccines. Non-Japanese residents represent a growing minority of Japan's population, so this study aimed to assess any disparities in COVID-19 mortality between Japanese nationals and non-Japanese residents. Methods: In this natural experiment, mortality due to COVID-19 was derived from death certificate data (2020-2021) registered by the Ministry of Health, Labour and Welfare (MHLW). Mortality rates were compared between Japanese nationals and non-Japanese residents, and then mortality was further explored by nationality. (South) Korean residents were identified as a subgroup of interest due to their status as the most populous non-Japanese nationality historically and their disproportionately high mortality rates. Age-standardized mortality rates and years of potential life lost (YPLL) were computed using vital statistics and life expectancy data from MHLW. Results: Of the 20,775 COVID-19 deaths in 2020/21, 98.3% were Japanese nationals, while non-Japanese residents accounted for the remaining 358 deaths. The nationwide age-standardized mortality rate was 16.5 per 100,000 individuals, with 14.9 for non-Japanese residents. Among older adults (≥65 years), the mortality rate for non-Japanese residents was 152.3 per 100,000, compared to 52.5 for the general population. Koreans accounted for 193 (53.9%) of non-Japanese deaths. Crude mortality rate was 51.5 per 100,000 for this group, sharply increasing among older adults (162.1). Total YPLL due to COVID-19 in 2020/21 was 76,544.1 years, with YPLL rates of 59.5 years per 100,000 among Japanese nationals, 178.4 for non-Japanese residents, and 268.2 for Koreans. Conclusions: Notable disparities in COVID-19 mortality were uncovered, particularly among older non-Japanese and Korean residents. With growing diversity domestically, these findings suggest a need for institutional monitoring of health outcomes by nationality to better inform equitable public health in Japan.
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