『保健医療科学』 2022 第71巻 第2号 p.175-183（2022年5月）
特集：最近の薬事行政の話題と改正GMP省令について ＜原著＞
都道府県別喫煙率の経年変化と死因別死亡率の経年変化との関係
逸見治，石川みどり，横山徹爾
国立保健医療科学院生涯健康研究部
The associations between secular changes in smoking rate and those in cause-specific death rates among prefectures in Japan
HEMMI Osamu, ISHIKAWA Midori, YOKOYAMA Tetsuji
Department of Health Promotion, National Institute of Public Health
抄録
目的：公開されている公的データを活用し，全国と都道府県別の喫煙率の経年変化を確認したうえで，都道府県別の喫煙率の経年変化が主要な死因（悪性新生物等）による死亡率の経年変化とどのような関連があるかを明らかにすることを目的とした．
方法：国民生活基礎調査で調査が開始された2001年から2019年までの全国と都道府県の喫煙のデータをe-Statより収集し，喫煙率を算出した．死因別死亡は，同期間の人口動態調査の死因（死因簡単分類）と人口推計等をそれぞれ同様に収集し，死因別死亡率を算出した．その後，全国と都道府県別に年齢調整喫煙率と死因別の年齢調整死亡率（いずれも「基準人口の改訂に向けた検討会による平成27年（2015年）平滑化人口」を基準人口とした直接法）をそれぞれ算出した．同期間の年齢調整喫煙率の平均年変化率を確認したうえで，年齢調整喫煙率の平均年変化率と年齢調整死亡率の平均年変化率との相関関係を，死因別に，都道府県を単位とした生態学的研究により確認した．
結果：全国の年齢調整喫煙率の経年変化は，平均年変化率（相対変化，％ /年）が，男性:-2.8％（95％信頼区間:-2.9, -2.6），女性:-2.3％（-2.7, -1.9）と男女とも有意に低下していた．都道府県別では，男性は全ての都道府県で有意な低下が確認され，女性では，青森県，鳥取県，佐賀県，鹿児島県を除く都道府県で有意な低下が確認された．男性に比べ女性では低下率が小さいことが多かった．喫煙の変化と死因別死亡の変化との関連は，死因と性別によって変化量が異なるが，年齢調整喫煙率の平均年低下率が相対的に大きい県では，男女とも全死亡，悪性新生物，脳血管疾患において年齢調整死亡率の平均年低下率が相対的に大きい，有意な正の相関関係（全死亡（Pearsonの相関係数; 男性0.456，女性0.439），悪性新生物（男性0.359，女性0.431），脳血管疾患（男性0.460，女性0.331））が確認された．
結論：都道府県別の喫煙と死因別死亡との関係は，年齢調整喫煙率の平均年低下率が相対的に大きい都道府県では，男女ともに全死亡，悪性新生物，脳血管疾患の年齢調整死亡率の平均年低下率が相対的に大きい，有意な正の相関関係が確認された．本解析方法は地域における要因の変化と結果の変化との関連を検討する方法のひとつとして提案できる．
キーワード: 都道府県，年齢調整喫煙率，死因別年齢調整死亡率，経年変化
Abstract
Objectives: The purpose of this study is to confirm the secular changes in smoking rate in each prefecture and in the whole country of Japan, and to ecologically examine the associations between secular changes in smoking rate and those in death rates from selected major causes among prefectures in Japan.
Methods: Smoking rate (SR) was calculated from Comprehensive Survey of Living Conditions (the large-scale survey conducted every three years). Smoking data in 2001, 2004, 2007, 2010, 2013, 2016, and 2019 were collected from e-Stat, which is portal site of official statistics of Japan. Cause-specific death rate (CSDR) was calculated from data of Vital Statistics and Population Estimates, etc. from 2001 to 2019, which were collected from e-Stat. The age-standardized SR and CSDR (standardized to the 2015 model population of Japan by the investigation committee for revision) were calculated between 2001-2019. We investigated the average annual percent change (AAPC) of age-standardized SR and CSDR in each prefecture and in the whole country of Japan from 2001 to 2019. Then, the associations between AAPC of the age-standardized SR and the AAPCs of age-standardized CSDR from selected major causes, were examined as an ecological study with all prefectures.
Results: Age-standardized SR in the whole country significantly decreased after 2001 in both genders, with AAPC of -2.8% (95% confidence interval: -2.9, -2.6) in men and -2.3% (-2.7, -1.9) in women. Age-standardized SR significantly decreased after 2001 in all prefectures in men, however in women it significantly decreased in prefectures excluding Aomori, Tottori, Saga and Kagoshima prefectures. The associations of age-standardized SR and CSDR among the prefectures were different according to the causes of death and genders. We confirmed that the correlations between AAPC of age-standardized SR and the AAPCs of age-standardized CSDR from all-cause (Pearsonʼs correlation coefficient: men 0.456, women 0.439), malignant neoplasms (men 0.359, women 0.431), and cerebrovascular diseases (men 0.460, women 0.331) were statistically significant in both genders. These correlations mean that the larger the average annual decreasing rates of age-standardized SR, the larger the average annual decreasing rates of age-standardized death rates from all-cause, malignant neoplasms, and cerebrovascular diseases in both genders.
Conclusion: The AAPC of age-standardized SR and AAPCs of the age-standardized death rates from all-cause, malignant neoplasms, and cerebrovascular diseases were significantly positively correlated among prefectures in both genders. Our analysis method would be one of the methods to confirm the association between secular changes in cause and result.
keywords: prefectures, age-standardized smoking rate, age-standardized cause-specific death rate, secular changes
