Although people in Japan are known for their longevity, longer life does not automatically equate to better health compared with other populations. New research from Karolinska Institutet and collaborators suggests that older adults in Japan and Sweden experience a similar number of healthy years—if “healthy” is defined as living independently at home without formal elder care. At the same time, mortality rates among those receiving elder care are lower in Japan than in Sweden.
“Japan’s high life expectancy may not simply reflect a healthier population,” explains Karin Modig, senior lecturer and associate professor at the Institute of Environmental Medicine. “Our findings point to a more nuanced reality, where the key differences appear among individuals who require care.”
The study, led by Modig, examined remaining life expectancy at age 75 for both women and men in Sweden and Japan, drawing on large-scale registry data. It included over 850,000 individuals in Sweden and more than 330,000 individuals across nine municipalities in Japan. Participants were grouped based on whether they received home care, lived in residential care, or did not use formal elder care services.
Published in BMC Medicine, the findings show that while older Japanese adults generally have lower mortality rates than their Swedish counterparts, this advantage is largely concentrated among those receiving some form of care. For example, a 75-year-old woman in Japan could expect an average of 10.4 years living independently without formal care and an additional 5.1 years receiving care. In Sweden, the comparable figures were 9.9 years without care and 3.8 years with care.
“These results suggest that Japanese women spend more years in care, but the underlying reasons are not yet clear,” says Shunsuke Murata. “Understanding which aspects of elder care contribute to longer survival is essential, especially as more people reach very advanced ages.”
Among men, the differences were minimal. Japanese men at age 75 could expect 9.8 years of independent living compared with 9.6 years in Sweden, alongside 2.2 years with care in Japan versus 2.1 years in Sweden.
The researchers suggest several possible factors behind the observed differences in mortality among care recipients. These include variations in eligibility and timing of care, structural differences in care systems, more intensive medical treatment at the end of life in Japan, and a stronger role for family-based care at home. As Modig notes, this study represents an early step in a broader collaboration exploring ageing in the two countries, with further research already underway to examine health outcomes across different stages of care.
More information: Shunsuke Murata et al, Understanding Japan’s mortality advantage: a comparison of mortality in independent and dependent older adults in Japan and Sweden, BMC Medicine. DOI: 10.1186/s12916-026-04786-z
Journal information: BMC Medicine Provided by Karolinska Institutet
