The Structural Determinants of Mortality in Japanese Prefectures

This cross-sectional multivariate analysis of age- and sex-standardized mortality for the 47 Japanese prefectures explores and tests the hypotheses that structural pluralism and differentiation, interpreted as dimensions of social problem solving capacity, determine lower mortality rates, controlling on the availability of medical facilities. The postulated explanatory principle is that participation in community problem-solving optimizes the biological functioning of the residents, which fosters better health. A factor analysis generated two factors (plus a third index of medical facilities) that measure the structural dimensions. Regression analysis showed that pluralism predicted lower mortality for both males and females, but differentiation gave contradictory results. Surprisingly, medical facilities predicted higher male mortality. A control on the more recently industrialized and the hyper-urbanized prefectures refined the analysis so that the differentiation factor predicted consistently and the spurious correlation between medical facilities and male mortality dissolved.