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Compared to the large volume of research focused on mortality differentials within Japan, relatively little is known about regional variations in health expectancy, particularly among older people. This article has two interrelated objectives. The first objective is to estimate prefecture-specific disability-free life expectancy (DFLE) at 65 years of age in 2010. DFLE at 65 by gender and prefecture was computed using the Sullivan method, which was applied to prefecture-specific life tables and prevalence of disability from Kokumin Seikatsu Kiso Chosa (Comprehensive Survey of Living Conditions) of 2010. The second objective is to investigate macro-level factors associated with DFLE at 65 across 47 Japanese prefectures. Our results indicate regional disparities in DFLE at older ages. Importantly, we note close relationships between a prefecture's wealth, labor, and welfare characteristics and DFLE at 65. Income per capita, the proportion of workers older than 65, and welfare expenditures are positively related to DFLE, whereas unemployment and long-term care insurance expenditures per-capita are inversely associated with DFLE for both genders. The proportion of older adults relying on public assistance is negatively related only to women's DFLE. These results suggest that narrowing socioeconomic disparities may contribute to the health of Japanese elders. Reducing regional health disparities therefore requires policy makers to take into account the broader socioeconomic conditions of each prefecture.

An analysis of factors related to disability-free life expectancy at 65 years of age across Japanese prefectures in 2010