Introduction. Hypertension and cigarette smoking are dominant risk factors for cardiovascular disease in Japan while in westernized countries, broader effects encompass obesity, diabetes, and hypercholesterolemia. This paper examines whether different associations also appear important in the manifestation of activities of daily living (ADL) in older Japanese men in Hawaii and Japan. Methods. Measures of ADL (feeding, toileting, dressing, bathing, and walking around the house) were assessed from 1995 to 1999 in 1,893 men in Hawaii and 543 men in Japan. Concomitant risk factors were measured from 1990 to 1993. Results. In Hawaii, diabetes increased the odds of ≥1 ADL impairment nearly 1.5-fold ( ). A similar association was absent in Japan. In contrast, the odds of an ADL impairment in Japan was increased more than 5-fold in the presence of stroke ( ). The association in Hawaii was significantly weaker ( ). In both cohorts, past alcohol use was associated with a greater likelihood of ADL impairment. Conclusion. In this comparison of genetically similar samples, findings suggest that different strengths in risk factor associations with cardiovascular disease in Japan and westernized countries may also include different strengths in associations with impaired ADL. 1. Introduction Hypertension and cigarette smoking are often considered the most important risk factors for total mortality and morbidity from cardiovascular disease in Japan while in more westernized countries, broader effects encompass obesity, diabetes, and hypercholesterolemia [1]. Although in need of further study, differences in these risk factor associations could also have similar affects on declines in late-life physical function and activities of daily living (ADL), including difficulties in feeding, toileting, dressing, bathing, and walking around the house. A demonstration that this is the case would suggest that ADL is not an inevitable consequence of aging but is culturally or environmentally determined, and prevention or delays in onset are possible. It might further imply that the most effective countermeasures or campaigns to prevent declines in ADL should include a greater emphasis on culturally dominant risk factors (e.g., hypertension and smoking in Japan versus obesity and diet in more westernized countries). Implications are important since chronic disability and impairments in ADL will have an increasingly high impact on long-term care and public health resources as populations rapidly age [2, 3]. Social and economic support will need to be broad and comprehensive as they
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