Prevalence of cerebral hemorrhage and thrombosis in Japan: Study of the major causes of death

Abstract The view has long been held that cerebrovascular disease and especially cerebral hemorrhage is the major killer in Japan, causing about 25% of all deaths, and that these diseases are more frequent in the North. This impression is based on information from death certificates. Data are presented to show a large diagnostic error in certification of cerebrovascular diseases, and especially of cerebral hemorrhage. Comparison of these data with those from autopsies done throughout Japan reveal major discrepancies: malignant neoplasms are the major killer, vascular lesions of the CNS constitute 4.5% of deaths, cerebral thrombosis exceeds cerebral hemorrhage, and predilection for the North is not found. These necropsy data, however, have many deficits, notably factors of selection, age and sex distribution, quality of reports, and small number in relation to total deaths. Autopsies performed by the Atomic Bomb Casualty Commission have greater validity. They are free from biases of selection for hospitalization and clinical interest. The group studied has age and sex characteristics of the mortality group in Japan. The quality of data is relatively high, and material is available for review. The ABCC findings also reveal that malignant neoplasms are the major cause of death, being 30.4%. Vascular lesions of the CNS were the fifth most frequent cause of death, and may be lower. Cerebral thrombosis slightly exceeded hemorrhage in the ABCC series. Clinical data further substantiate the concept that the rate of fatal cerebrovascular disease in Japan is similar to that in the United States. It is suggested that the high rate of cerebrovascular disease, and especially of cerebral hemorrhage, in Japan is an artefact of diagnosis and method of recording.