• Michel Poulain and Anne Herm.
• Université Catholique de Louvain (UCLouvain), Louvain-la-Neuve, Belgium.
• J. Intern. Med. 2024 Apr 1; 295 (4): 387399387-399.

AbstractDemographers have studied the Japanese mortality pattern since Japan became the most longevous population worldwide, half a century ago. Nutrition and lifestyle were considered by epidemiologists, gerontologists and other scientists as the most important reasons explaining the Japanese superiority. In Okinawa, the mortality pattern is even more exceptional, but few demographers have pointed out this exception. Other scientists proposed different explanations - for example some genetic characteristics, less salt and more animal protein in the food, a mild climate, a higher level of activity, a better consideration of the oldest in the population and, globally speaking, a more traditional lifestyle. At the end of the 1980s, lower improvements of mortality among young adults were identified in Okinawa. In 2002, Okinawa fell from the 4th to the 26th place in the ranking of the 47 Japanese prefectures by male life expectancy. This has been considered by the population of Okinawa as a 'shock'. Our in-depth analysis of available life tables and associated mortality rates proves that the population of Okinawa is divided into two groups of generations: those born before World War II and those born after. The older generations clearly experience a highly favourable mortality pattern, whereas the younger generations show mortality levels that are definitively higher compared to mainland Japan. This contribution considers which factors may explain such a situation, including the plausible invalidation of the age of some oldest in the population. We plea for in-depth demographic age validation that will enhance all scientific findings so far and boost the exceptional longevity in Okinawa.© 2023 The Association for the Publication of the Journal of Internal Medicine.

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