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Trends in cause specific mortality across occupations in Japanese men of working age during period of economic stagnation, 1980-2005: retrospective cohort study

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e1191 (Published 06 March 2012) Cite this as: BMJ 2012;344:e1191

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Re: Trends in cause specific mortality across occupations in Japanese men of working age during period of economic stagnation, 1980-2005: retrospective cohort study

Although not mentioned by the authors, smoking appears to be the most important heath-related behavior that explain the dramatic rise in the mortality in the particular period among the professional/management class workers by the following reasons.

First, there is no doubt that smoking is the leading cause of mortality due to cancers and cardiovascular diseases 1, and its connection with increased suicide is also reported 2.

Second, a higher job demand and strains, imposed on the working classes probably through socioeconomical changes as the authors speculated, is known to be positively associated with increased smoking and smoking intensity 3 4.

Third, changes in smoking behavior appear to explain the relatively steep increase in the mortality in the particular period in the study better than those in other health-related behaviors such as diet and exercise, as was suggested by the relatively short period, a few years as minimum, by which smoking cessation reduces cardiovascular disease mortality 5. Explorations into to the underlying mechanisms are required to mount efficient strategies to mitigate the negative health impact of socioeconomical fluctuations currently occurring worldwide.

1. Ikeda N, Inoue M, Iso H, Ikeda S, Satoh T, Noda M, et al. Adult mortality attributable to preventable risk factors for non-communicable diseases and injuries in Japan: a comparative risk assessment. PLoS medicine 2012;9(1):e1001160.
2. Scherrer JF, Grant JD, Agrawal A, Madden PA, Fu Q, Jacob T, et al. Suicidal Behavior, Smoking, and Familial Vulnerability. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco 2011.
3. Hellerstedt WL, Jeffery RW. The association of job strain and health behaviours in men and women. International journal of epidemiology 1997;26(3):575-83.
4. Radi S, Ostry A, Lamontagne AD. Job stress and other working conditions: Relationships with smoking behaviors in a representative sample of working Australians. American journal of industrial medicine 2007;50(8):584-96.
5. Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA : the journal of the American Medical Association 2003;290(1):86-97.

Competing interests: No competing interests

17 March 2012
Takeharu Koga
Internist
Asakura Medical Association Hospital
Riaharu 422-1, Asakura 838-0069, Japan