Covariates

The covariates at the individual level included age at the time of death, sex, presence of spouse (ie, present, unmarried, widowed, or divorced), designated level of care need under LTC insurance, and the most common underlying causes of death in Japanese population over 65 years old (ie, cancer [ICD-10 code C00–C97], cerebrovascular diseases [I60–I69], cardiovascular diseases [I01, I020, I05–I09, I20–I25, I27, and I30–I52], senility [R54], and pneumonia [J12–J18]).¹⁶ At the municipal level, we controlled for population size, age over 65 years, sex, households with older persons living alone, households with older married couples, the crude death rate among people aged over 65 years, population density, annual income per capita, the number of hospital beds per older population, the number of clinics per 1000 older population, the number of home care support clinics per 1000 older population, the number of home care support hospitals per 1000 older population, the number of beds in LTC welfare facilities per older population, and dummy variables for 47 prefectures.