• Tim Adair, Rebecca Kippen, Mohsen Naghavi, and Alan D Lopez.
• Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia.
• Plos One. 2019 Jan 1; 14 (3): e0214578.

IntroductionAdult male and female mortality declines in Japan have been slower than in most high-income countries since the early 1990s. This study compares Japan's recent life expectancy trends with the more favourable trends in Australia, measures the contribution of age groups and causes of death to differences in these trends, and places the findings in the context of the countries' risk factor transitions.MethodsThe study utilises data on deaths by age, sex and cause in Australia and Japan from 1950-2016 from the Global Burden of Disease Study. A decomposition method measures the contributions of various ages and causes to the male and female life expectancy gap and changes over four distinct phases during this period. Mortality differences by cohort are also assessed.FindingsJapan's two-year male life expectancy advantage over Australia in the 1980s closed in the following 20 years. The trend was driven by ages 45-64 and then 65-79 years, and the cohort born in the late 1940s. Over half of Australia's gains were from declines in ischaemic heart disease (IHD) mortality, with lung cancer, chronic respiratory disease and self-harm also contributing substantially. Since 2011 the trend has reversed again, and in 2016 Japan had a slightly higher male life expectancy. The advantage in Japanese female life expectancy widened over the period to 2.3 years in 2016. The 2016 gap was mostly from differential mortality at ages 65 years and over from IHD, chronic respiratory disease and cancers.ConclusionsThe considerable gains in Australian male life expectancy from declining non-communicable disease mortality are attributable to a range of risk factors, including declining smoking prevalence due to strong public health interventions. A recent reversal in life expectancy trends could continue because Japan has greater scope for further falls in smoking and far lower levels of obesity. Japan's substantial female life expectancy advantage however could diminish in future because it is primarily due to lower mortality at old ages.

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