Background Due to the lack of a national mortality inequality monitoring framework, the overall picture in Japan remains unclear. Here, we investigated educational inequalities in mortality and their cause-specific contribution in Japan. Method Data were obtained by linking the 2010 Japanese population census and death records between 1 October 2010 and 30 September 2015. We included 7 984 451 Japanese people aged 30–79 years who had a unique ‘matching key’ generated by sex, birth year/month, address (municipality), marital status and age of spouse (9.9% of the total census population). We computed population-weighted all-cause and cause-specific age-standardized mortality rates (ASMRs) by education level. In addition, we calculated the slope index of inequality (SII), relative index inequality (RII) by education level, and population attributable fraction (PAF) referenced with the highest education (e.g. university graduation). Results Individuals with less education had higher all-cause and cause-specific ASMRs than highly educated individuals. All-cause SII (per 100 000 person-years) values were 433 (95% CI: 410–457) for men and 235 (95% CI: 217–252) for women. RII values were 1.48 (95% CI: 1.45–1.51) for men and 1.47 (95% CI: 1.43–1.51) for women. Estimated PAFs, excess premature deaths caused by educational inequalities, were 11.6% for men and 16.3% for women, respectively. Cerebrovascular diseases, ischaemic heart diseases and lung cancer were the major contributors to mortality inequalities for both sexes. Conclusions This first census-based comprehensive report on cause-specific educational mortality inequalities suggested that differences in unfavourable health risk factors by educational background might be associated with these inequalities in Japan.

中文翻译：

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日本全因和特定原因死亡率的教育不平等：2010-15 年全国人口普查相关死亡率数据

背景 由于缺乏全国死亡率不平等监测框架，日本的整体情况仍不清楚。在这里，我们调查了日本教育不平等及其具体原因的影响。方法 数据是通过将 2010 年日本人口普查和 2010 年 10 月 1 日至 2015 年 9 月 30 日之间的死亡记录联系起来而获得的。我们纳入了 7 984 451 名 30-79 岁的日本人，他们拥有根据性别、出生年份/生成的独特“匹配密钥”。月份、地址（市）、婚姻状况和配偶年龄（占人口普查总人口的 9.9%）。我们按教育水平计算了人口加权全因和特定原因年龄标准化死亡率（ASMR）。此外，我们还计算了不平等斜率指数（SII）、按教育程度划分的相对不平等指数（RII）以及以最高教育程度（例如大学毕业）为参考的人口归因分数（PAF）。结果受教育程度较低的个体比受过高等教育的个体具有更高的全因和特定原因 ASMR。男性全因 SII（每 10 万人年）值为 433（95% CI：410-457），女性为 235（95% CI：217-252）。男性 RII 值为 1.48（95% CI：1.45–1.51），女性为 1.47（95% CI：1.43–1.51）。据估计，男性 PAF（即教育不平等导致的过多过早死亡）分别为 11.6% 和 16.3%。脑血管疾病、缺血性心脏病和肺癌是造成​​男女死亡率不平等的主要原因。结论 第一份基于人口普查的关于特定原因教育死亡率不平等的综合报告表明，不同教育背景的不利健康风险因素的差异可能与日本的这些不平等有关。