Long-Term Associations Between Disaster Experiences and Cardiometabolic Risk: A Natural Experiment From the 2011 Great East Japan Earthquake and Tsunami

Association of disaster-related damage with inflammatory diet among older survivors of the Great East Japan Earthquake and Tsunami

Traumatic experiences from disasters have enduring effects on health, both directly and indirectly by influencing health behaviours. Among potential pathways, the impact of disaster-related trauma on dietary patterns has been understudied. This study investigated the relationship between disaster-related trauma and dietary inflammatory index (DII®), and how these relationships differed by gender and whether they prepare meal by themselves or not among older survivors of the 2011 Great East Japan Earthquake and Tsunami (n 1375). Dietary data were collected in 2020 using a brief-type self-administered diet history questionnaire, from which we derived a dietary inflammatory index (DII®) based on twenty-six food/nutrient items, where higher scores indicate pro-inflammatory (i.e. unhealthy) diet. We found that the experience of housing damage due to the earthquake and tsunami was associated with slightly higher DII scores (coef. = 0·38, 95 % CI -0·05, 0·81). Specifically, women who cooked by themselves tended to have higher DII when they experienced housing damage (coef. = 1·33, 95 %CI -0·63, 3·28). On the other hand, loss of friends was associated with a lower DII score (coef. = -0·28, 95 % CI -0·54, -0·01). These findings highlight the importance of providing support to groups who are at increased risk of deterioration in dietary quality in the aftermath of disasters.

Association between electrocardiographic abnormalities and flood exposure among middle-aged and elderly people: A national longitudinal study in China

BACKGROUND

Flooding has become more frequent and intensive due to climate change, particularly in Asian countries. However, evidence on the long-term health effects of floods from large-scale studies on the vulnerable aged population in China is insufficient. This study analyzed the long-term effects of exposure to flood on electrocardiographic (ECG) abnormalities, a commonly used indicator of cardiovascular disease (CVD) screening, in middle-aged and elderly people.

METHOD

We evaluated the Chinese National Stroke Screening Survey data of 80,711 follow-up records from 38,375 participants aged > 40 years with two or more visits between 2013 and 2018 in this longitudinal study. Flood exposure was assessed as the presence of a satellite-detected flooded area within 500 m of the residence within 5 years before the survey date. The association between ECG abnormalities and flood exposure was analyzed using a random effects model with multiple adjustments. As age is an important CVD risk factor, a varying-coefficient function was derived to estimate the nonlinear modifying effect of age on the association between ECG abnormalities and flood exposure. The strata-specific associations between ECG abnormalities and flood exposure were applied to characterize vulnerability to flood.

RESULTS

The fully adjusted model suggested that flood exposure was associated with an increased risk for ECG abnormalities among the middle-aged and elderly population (odds ratio [OR] 1.74, 95 % confidence interval [CI] 1.49, 2.03). The ORs of flood exposure for ECG suggesting atrial fibrillation, ST depression, and left ventricular hypertrophy were 1.85 (95 % CI 1.16, 2.94), 6.92 (95 % CI 5.23, 9.16), and 1.55 (95 % CI 0.66, 3.65), respectively. These associations were generally robust in various subpopulations, while a sublinear curve for the negative modifying effect of age was observed on the population vulnerability to flood.

CONCLUSION

Flood exposure was associated with an increased long-term risk for an ECG abnormality. The need for effective measures to mitigate vulnerability to flood is not negligible in China.

Association of parity with the prevalence of hypertension in Japan: The Tohoku Medical Megabank Community-based cohort study

This study investigated the association of parity with hypertension prevalence in Japanese women while considering a clinical history of hypertensive disorders of pregnancy (HDP) and menopausal status. This cross-sectional study included 30,530 Japanese women (6700 premenopausal; 23 830 postmenopausal). The association between parity and the prevalence of hypertension was evaluated using a multiple logistic regression model with possible confounders. In premenopausal women, no statistically significant association between parity and hypertension prevalence was found. When not adjusted for current body mass index (BMI), a linear graded association was observed between parity and the prevalence of hypertension in postmenopausal women. However, the association between parity and hypertension prevalence in postmenopausal women was attenuated after adjustment for current BMI. Both current BMI and a clinical history of HDP were significantly associated with a high risk of hypertension in both premenopausal and postmenopausal women. Our results also suggest that continuous surveillance and preventive measures for hypertension should be provided for women with HDP and high parity.

Association between dietary pattern and insomnia symptoms among independent older adults: A cross-sectional study based on JAGES

BACKGROUND

Poor diet can cause sleep disorders; however, this association has not been established in older populations. This study investigated the association between dietary patterns and insomnia symptoms in independent older adults.

METHODS

This cross-sectional study targeted independent older Japanese adults aged ≥74 years. We used insomnia symptoms classified into three domains: difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and insomnia. These symptoms were assessed as dependent variables by a self-reported questionnaire. Dietary patterns (DP), identified by principal component analysis of a self-administered diet history questionnaire, were used as independent variables. Poisson regression analysis was used to estimate the prevalence ratios and 95% confidence intervals with adjustment for potential confounders.

RESULTS

Among 1,311 participants (mean age = 80.1; women, 48.5%), we identified three dietary patterns: DP1 was characterized by a high intake of vegetables, soy products, and fruits and a low intake of rice; DP2 was characterized by a high intake of fish, chicken, processed meat, and noodles and a low intake of soy products; and DP3 was characterized by a lower intake of fruits and confectionaries. Higher DP1 scores were significantly associated with a lower prevalence of DIS (p-for-trend = 0.012). A higher DP2 score was significantly associated with a higher prevalence of insomnia (p-for-trend = 0.032). There was no significant association between DP3 and insomnia symptoms (p-for-trend >0.05).

CONCLUSION

Our results highlighted that a dietary pattern with a high intake of vegetables, soy products, and fruits may contribute to reducing insomnia symptoms among independent older adults.

Change in Geographic Accessibility to Dental Clinics Affects Access to Care

Access to dental clinics is a feature of the neighborhood service environment that may influence oral health care utilization. However, residential selection poses a challenge to causal inference. By studying the involuntary relocation of survivors of the 2011 Great East Japan Earthquake and Tsunami (GEJE), we examined the association between changes in geographic distance to dental clinics and dental visits. Longitudinal data from a cohort of older residents in Iwanuma City directly impacted by the GEJE were analyzed in this study. The baseline survey was conducted in 2010, 7 mo before the occurrence of GEJE, and a follow-up was conducted in 2016. Using Poisson regression models, we estimated the incidence rate ratios (IRR) and 95% confidence intervals (CIs) for the uptake of denture use (as a proxy for dental visits) according to changes in distance from the nearest dental clinic to their house. Age at baseline, housing damage by the disaster, deteriorating economic conditions, and worsened physical activity were used as confounders. Among the 1,098 participants who had not worn dentures before the GEJE, 495 were men (45.1%), with a mean ± SD age at baseline of 74.0 ± 6.9 y. During the 6-year follow-up, 372 (33.9%) participants initiated denture use. Compared to those who experienced a large increase in distance to dental clinics (>370.0-6,299.1 m), a large decrease in distance to dental clinics (>429.0-5,382.6 m) was associated with a marginally significantly higher initiation of denture use among disaster survivors (IRR = 1.28; 95% CI, 0.99-1.66). The experience of major housing damage was independently associated with higher initiation of denture use (IRR = 1.77; 95% CI, 1.47-2.14). Improved geographic access to dental clinics may increase dental visits of disaster survivors. Further studies in non-disaster-affected areas are needed to generalize these findings.

Longitudinal Associations Between Disaster Damage and Falls/Fear of Falling in Older Adults: 9-Year Follow-Up of Survivors of the 2011 Great East Japan Earthquake and Tsunami

Background and Objectives

Fear of falling and falls are common in older adults. However, their associations with natural disaster exposures remain poorly understood. This study aims to examine longitudinal associations between disaster damage with fear of falling/falls among older disaster survivors.

Research Design and Methods

In this natural experiment study, the baseline survey (4,957 valid responses) took place 7 months before the 2011 Great East Japan Earthquake and Tsunami, and 3 follow-ups were conducted in 2013, 2016, and 2020. Exposures were different types of disaster damage and community social capital. Outcomes were fear of falling and falls (including incident and recurrent falls). We used lagged outcomes in logistic models adjusting for covariates and further examined instrumental activities of daily living (IADLs) as a mediator.

Results

The baseline sample had a mean (standard deviation) age of 74.8 (7.1) years; 56.4% were female. Financial hardship was associated with fear of falling (odds ratio (OR), 1.75; 95% confidence interval (CI) [1.33, 2.28]) and falls (OR, 1.29; 95% CI [1.05, 1.58]), especially recurrent falls (OR, 3.53; 95% CI [1.90, 6.57]). Relocation was inversely linked with fear of falling (OR, 0.57; 95% CI [0.34, 0.94]). Social cohesion was protectively associated with fear of falling (OR, 0.82; 95% CI [0.71, 0.95]) and falls (OR, 0.88; 95% CI [0.78, 0.98]) whereas social participation increased the risk of these issues. IADL partially mediated observed associations between disaster damage and fear of falling/falls.

Discussion and Implications

Experiences of material damage rather than psychological trauma were associated with falls and fear of falling, and the increased risk of recurrent falls revealed a process of cumulative disadvantage. Findings could inform targeted strategies for protecting older disaster survivors.

Uncovering Heterogeneous Associations Between Disaster-Related Trauma and Subsequent Functional Limitations: A Machine-Learning Approach

This study examined heterogeneity in the association between disaster-related home loss and functional limitations of older adults, and identified characteristics of vulnerable subpopulations. Data were from a prospective cohort study of Japanese older survivors of the 2011 Japan Earthquake. Complete home loss was objectively assessed. Outcomes in 2013 (n = 3,350) and 2016 (n = 2,664) included certified physical disability levels, self-reported activities of daily living, and instrumental activities of daily living. We estimated population average associations between home loss and functional limitations via targeted maximum likelihood estimation with SuperLearning and its heterogeneity via the generalized random forest algorithm. We adjusted for 55 characteristics of survivors from the baseline survey conducted 7 months before the disaster. While home loss was consistently associated with increased functional limitations on average, there was evidence of effect heterogeneity for all outcomes. Comparing the most and least vulnerable groups, the most vulnerable group tended to be older, not married, living alone, and not working, with preexisting health problems before the disaster. Individuals who were less educated but had higher income also appeared vulnerable for some outcomes. Our inductive approach for effect heterogeneity using machine learning algorithm uncovered large and complex heterogeneity in postdisaster functional limitations among Japanese older survivors.

Post-Disaster Mental Health and Dietary Patterns among Older Survivors of an Earthquake and Tsunami

OBJECTIVES

Research suggests that cardiometabolic disease risks are elevated among survivors of natural disasters, possibly mediated by changes in diet. Using the Brief Dietary History Questionnaire, we examined (1) dietary patterns among older survivors of the 2011 Great East Japan Earthquake and Tsunami, and (2) the contribution of posttraumatic stress symptoms (PTSS)/depressive symptoms, as well as relocation to temporary housing on dietary patterns and (3) gender differences in the associations.

DESIGN, SETTING AND PARTICIPANTS

Data came from a prospective cohort study of 1,375 survivors aged 65-89 years (44.6% male).

MEASUREMENTS

PTSS/depression onset was evaluated in 2013, 2.5 years after the disaster. Dietary data was collected with a self-administered brief-type diet history questionnaire in 2020. A principal component analysis identified three posterior dietary patterns.

RESULTS

Diet 1 consisted of high intake of vegetables, soy products, and fruits; Diet 2 consisted of carbohydrate-rich foods and snacks/sweets; Diet 3 consisted of high intake of alcoholic beverages, meat, and seafood. Least-squares linear regression revealed that individuals with PTSS/depression were less likely to exhibit Diet 1, while individuals with PTSS were more likely to exhibit Diet 2 and 3. Especially, males who had depression showed an unhealthy dietary pattern. Those who have lived in a trailer-style temporary housing reported less consumption of Diet 3.

CONCLUSION

Survivors of disaster with symptoms of mental illness tended to exhibit less healthy dietary patterns after 9 years. Diet varied by type of post-disaster mental illness, gender, and current social circumstances. We lacked pre-disaster BDHQ data, which is a limitation.

Telemedicine Familiarity and Post-Disaster Utilization of Emergency and Hospital Services for Ambulatory Care Sensitive Conditions

INTRODUCTION

In this study, we examined the association between telemedicine use before a disaster and utilization of emergency or hospital services for ambulatory care sensitive conditions post-disaster.

METHODS

Difference-in-differences analyses were conducted in 2020‒2021 to assess pre- to post-fire changes in emergency or hospital utilization for 5 ambulatory care sensitive conditions: asthma, diabetes, hypertension, coronary artery disease, and heart failure across all Kaiser Permanente Santa Rosa patients (N=108,113) based on telemedicine utilization before the 2017 Tubbs wildfire. Inverse probability of treatment weighting was employed for cohort balancing across telemedicine familiar status.

RESULTS

Utilization for any ambulatory care sensitive condition increased from 9.03% pre-fire to 9.45% post-fire across the full cohort. Telemedicine familiarity (ref: not familiar) was associated with decreased absolute risk in pre- to post-fire inpatient and emergency department utilization for 4 conditions: asthma (absolute risk= -1.59%, 95% CI= -2.02%, -1.16%), diabetes (absolute risk= -0.68%, 95% CI= -0.89%, -0.47%), hypertension (absolute risk= -2.07%, 95% CI= -2.44%, -1.71%), and coronary artery disease (absolute risk= -0.43%, 95% CI= -0.61%, -0.24%). Telemedicine familiarity was associated with decreased relative change in pre- to post-fire utilization for 5 conditions: asthma (RRR=0.70, 95% CI=0.64, 0.75), diabetes (RRR=0.54, 95% CI=0.47, 0.63), hypertension (RRR=0.57, 95% CI=0.52, 0.62), heart failure (RRR=0.64, 95% CI=0.50, 0.82), and coronary artery disease (RRR=0.56, 95% CI=0.47, 0.67). Similar results were seen among patients residing in evacuation zones.

CONCLUSIONS

Telemedicine familiarity pre-fire was associated with decreased inpatient and emergency department utilization for certain ambulatory care sensitive conditions for 1-year post-fire. These results suggest a role for telemedicine in preventing unnecessary emergency and hospital utilization following disasters.

Long-Term Associations between Disaster-Related Home Loss and Health and Well-Being of Older Survivors: Nine Years after the 2011 Great East Japan Earthquake and Tsunami

BACKGROUND

Little research has examined associations between disaster-related home loss and multiple domains of health and well-being, with extended long-term follow-up and comprehensive adjustment for pre-disaster characteristics of survivors.

OBJECTIVES

We examined the longitudinal associations between disaster-induced home loss and 34 indicators of health and well-being, assessed ∼9y post-disaster.

METHODS

We used data from a preexisting cohort study of Japanese older adults in an area directly impacted by the 2011 Japan Earthquake (n=3,350 and n=2,028, depending on the outcomes). The study was initiated in 2010, and disaster-related home loss status was measured in 2013 retrospectively. The 34 outcomes were assessed in 2020 and covered dimensions of physical health, mental health, health behaviors/sleep, social well-being, cognitive social capital, subjective well-being, and prosocial/altruistic behaviors. We estimated the associations between disaster-related home loss and the outcomes, using targeted maximum likelihood estimation and SuperLearner. We adjusted for pre-disaster characteristics from the wave conducted 7 months before the disaster (i.e., 2010), including prior outcome values that were available.

RESULTS

After Bonferroni correction for multiple testing, we found that home loss (vs. no home loss) was associated with increased posttraumatic stress symptoms (standardized difference=0.50; 95% CI: 0.35, 0.65), increased daily sleepiness (0.38; 95% CI: 0.21, 0.54), lower trust in the community (-0.36; 95% CI: -0.53, -0.18), lower community attachment (-0.60; 95% CI: -0.75, -0.45), and lower prosociality (-0.39; 95% CI: -0.55, -0.24). We found modest evidence for the associations with increased depressive symptoms, increased hopelessness, more chronic conditions, higher body mass index, lower perceived mutual help in the community, and decreased happiness. There was little evidence for associations with the remaining 23 outcomes.

DISCUSSION

Home loss due to a disaster may have long-lasting adverse impacts on the cognitive social capital, mental health, and prosociality of older adult survivors. https://doi.org/10.1289/EHP10903.

Effects of Housing Aid on Psychosocial Health after a Disaster

Little is known about whether the provision of aid in the aftermath of a large-scale natural disaster affects psychological well-being. We investigate the effects of housing assistance, a key element of the reconstruction program implemented after the 2004 Indian Ocean tsunami. Population-representative individual-level longitudinal data collected in Aceh, Indonesia, during the decade after the tsunami as part of the Study of the Tsunami Aftermath and Recovery (STAR) are used. Housing aid was targeted to people whose homes were destroyed and, to a lesser extent, damaged by the tsunami and to those who lived, at the time of the tsunami, in communities that sustained the greatest damage. The effects of receipt of aid on post-traumatic stress reactivity (PTSR) are examined using panel data models that take into account observed and unobserved individual-specific fixed characteristics that affect both PTSR and aid receipt, drawing comparisons in each survey wave between individuals who had been living in the same kecamatan when the tsunami hit. Those who received aid have better psychological health; the effects increase with time since aid receipt and are the greatest at two years or longer after the receipt. The effects are concentrated among those whose homes were destroyed in the tsunami.

Community intervention programs prolong the onset of functional disability among older Japanese

Aim

This study examined the effects of a “community‐based center” intervention to prevent the onset of functional disability among residents in disaster‐affected areas.

Methods

We used data from a prospective cohort study conducted from 2010 to 2016 in Iwanuma City, Japan. Participants were community‐dwelling independent adults aged ≥65 years. The exposure variable was the experience of using a community‐based center. The outcome variable was functional disability onset. The average treatment effect on the treated (ATET) was estimated by adjusting for possible confounders. Additional analysis stratified by sex was conducted considering the sex differences in social participation rates.

Results

Among 3794 participants (mean ± SD age = 72.9 ±5.3 years, 46.0% men), 196 (5.2%) used the community‐based center, and 849 (22.4%) exhibited disability onset. Of those with functional disabilities, 40 (20.4%) used the community‐based center, while 809 (22.5%) did not. The ATET for functional disability onset with community‐based center activities across all participants were not significant (ATET: 0.51 years [95% confidence interval [CI] = −0.23; 1.27]). However, the direction of the effect of community‐based center activities differed by sex (ATET: −0.14, 95% CI = −2.59; 2.31 for men [n = 18], and 0.66, 95% CI = 0.18; 1.16 for women [n = 178]). Women exhibited a 15.63% (95% CI = 3.58; 27.68) increase in the time until functional disability onset.

Conclusions

The use of community‐based centers was associated with a longer period without functional disability in women. Geriatr Gerontol Int 2022; 22: 465–470.

The Associations between Evacuation Status and Lifestyle-Related Diseases in Fukushima after the Great East Japan Earthquake: The Fukushima Health Management Survey

Background: This study aimed to investigate the association between evacuation status and lifestyle-related disease risks among Fukushima residents following the Great East Japan earthquake. Methods: Fukushima health management survey respondents were classified into non-evacuees, returnees, evacuees in lifted areas, and evacuees in banned areas. During a seven-year follow-up, 22,234 men and 31,158 women were included. Those with a history of diabetes, hypertension, or dyslipidemia at baseline were excluded. The odds ratios of risk factors (ORs) and 95% confidence intervals (CIs) for diabetes, hypertension, and dyslipidemia were calculated using a logistic regression model. Spatial autocorrelation of the prevalence of these diseases in the Fukushima area in 2017, was calculated to detect the disease prevalence status. Results: The risks of diabetes, hypertension, and dyslipidemia were higher in evacuees in banned areas than in non-evacuees; the multivariable ORs were 1.32 (95% CI: 1.19–1.46), 1.15 (1.06–1.25), and 1.20 (1.11–1.30) for diabetes, hypertension, and dyslipidemia, respectively. Returnees and evacuees in lifted areas had no increased risk of diseases. The area analyzed had a non-uniform spatial distribution of diabetes, hypertension, and hyperlipidemia, with clusters around Fukushima and Koriyama. Conclusion: Our findings imply the need for continuous support for evacuees in banned areas.

Trajectory and course of problematic alcohol use after the Great East Japan Earthquake: Eight-year follow-up of the Higashi-Matsushima cohort study

BACKGROUND

Problematic alcohol use (PAU) after natural disasters is an unignorable public health issue. However, the long-term trajectory and course of PAU after an earthquake disaster remain unknown.

METHODS

The Higashi-Matsushima cohort study was conducted between 2012 (time 1) and 2019 (time 8) in areas affected by the Great East Japan Earthquake in 2011. In the annual health checks, participants responded to self-report questionnaires on PAU, traumatic experiences (e.g., house damage), resources (e.g., social support), and other covariates (e.g., gender, psychological distress). The trajectory and course of PAU were estimated by latent growth model and latent class analyses. Risk factors for the long-term course of PAU were calculated by multinomial logistic regression analysis with multiple imputation. The analytical sample comprised 8929 residents who participated in at least one survey across the eight time points.

RESULTS

The trajectory of PAU showed a sustained trend (slope <0.001). Three potential courses of PAU (No PAU course: 84.3%, Subthreshold PAU course: 12.4%, and Persistent PAU course: 3.4%) were estimated. The long-term course of PAU, especially the persistent PAU course, was predicted by house damage (OR = 1.43, 95% CI 1.06 to 1.92), less social support (OR = 0.71, 95% CI 0.53 to 0.96), gender (male) (OR = 16.86, 95% CI 9.42 to 30.20), and psychological distress (OR = 1.15, 95% CI 1.09 to 1.20).

CONCLUSIONS

Long-term support is needed after an earthquake disaster, especially for residents who in early phases of the disaster suffer from PAU, males, and those in vulnerable situations resulting from conditions such as severe house damage, low social support, or high psychological distress.

Uncovering heterogeneous associations of disaster-related traumatic experiences with subsequent mental health problems: A machine learning approach

AIM

Understanding the differential mental health effects of traumatic experiences is important to identify particularly vulnerable subpopulations. We examined the heterogeneous associations between disaster-related traumatic experiences and postdisaster mental health, using a novel machine learning-based causal inference approach.

METHODS

Data were from a prospective cohort study of Japanese older adults in an area severely affected by the 2011 Great East Japan Earthquake. The baseline survey was conducted 7 months before the disaster and the 2 follow-up surveys were conducted 2.5 and 5.5 years after (n = 1150 to n = 1644 depending on the exposure-outcome combinations). As disaster-related traumatic experiences, we assessed complete home loss and loss of loved ones. Using the generalized random forest algorithm, we estimated conditional average treatment effects (CATEs) of the disaster damages on postdisaster mental health outcomes to examine the heterogeneous associations by 51 predisaster characteristics of the individuals.

RESULTS

We found that, even when there was no population average association between disaster-related trauma and subsequent mental health outcomes, some subgroups experienced severe impacts. We also identified and compared characteristics of the most and least vulnerable groups (ie, top versus bottom deciles of the estimated CATEs). While there were some unique patterns specific to each exposure-outcome combination, the most vulnerable group tended to be from lower socioeconomic backgrounds with preexisting depressive symptoms for many exposure-outcome combinations.

CONCLUSIONS

We found considerable heterogeneity in the association between disaster-related traumatic experiences and subsequent mental health problems.

Heterogeneity in cognitive disability after a major disaster: A natural experiment study

Cognitive disability following traumatic experiences of disaster has been documented; however, little is known about heterogeneity in the association across individuals. In this natural experiment study of approximately 3000 Japanese older adults in an area directly affected by the 2011 Great East Japan Earthquake, the baseline survey was established 7 months before the 2011 earthquake. To inductively identify heterogeneity in postdisaster cognitive disability by predisaster characteristics, we applied a machine learning–based causal inference approach—generalized random forest. We identified strong evidence for heterogeneity in the association between home loss and cognitive disability objectively assessed 2.5 and 5.5 years after the 2011 earthquake. The subgroups with the strongest disaster-dementia associations tended to be from low socioeconomic backgrounds and have predisaster health problems. The study demonstrated that some subpopulations are particularly prone to experience cognitive disability after disasters, which could be overlooked in studies assessing population average associations only.

Causal Inference in Studying the Long-Term Health Effects of Disasters: Challenges and Potential Solutions

Two frequently encountered but underrecognized challenges for causal inference in studying the long-term health effects of disasters among survivors include 1) time-varying effects of disasters on a time-to-event outcome and 2) selection bias due to selective attrition. In this paper, we review approaches for overcoming these challenges and demonstrate application of the approaches to a real-world longitudinal data set of older adults who were directly affected by the 2011 Great East Japan Earthquake and Tsunami (n = 4,857). To illustrate the problem of time-varying effects of disasters, we examined the association between degree of damage due to the tsunami and all-cause mortality. We compared results from Cox regression analysis assuming proportional hazards with those derived using adjusted parametric survival curves allowing for time-varying hazard ratios. To illustrate the problem of selection bias, we examined the association between proximity to the coast (a proxy for housing damage from the tsunami) and depressive symptoms. We corrected for selection bias due to attrition in the 2 postdisaster follow-up surveys (conducted in 2013 and 2016) using multivariable adjustment, inverse probability of censoring weighting, and survivor average causal effect estimation. Our results demonstrate that analytical approaches which ignore time-varying effects on mortality and selection bias due to selective attrition may underestimate the long-term health effects of disasters.

A systematic review of the burden of hypertension, access to services and patient views of hypertension in humanitarian crisis settings

INTRODUCTION

Globally, a record number of people are affected by humanitarian crises caused by conflict and natural disasters. Many such populations live in settings where epidemiological transition is underway. Following the United Nations high level meeting on non-communicable diseases, the global commitment to Universal Health Coverage and needs expressed by humanitarian agencies, there is increasing effort to develop guidelines for the management of hypertension in humanitarian settings. The objective was to investigate the prevalence and incidence of hypertension in populations directly affected by humanitarian crises; the cascade of care in these populations and patient knowledge of and attitude to hypertension.

METHODS

A literature search was carried out in five databases. Grey literature was searched. The population of interest was adult, non-pregnant, civilians living in any country who were directly exposed to a crisis since 1999. Eligibility assessment, data extraction and quality appraisal were carried out in duplicate.

RESULTS

Sixty-one studies were included in the narrative synthesis. They reported on a range of crises including the wars in Syria and Iraq, the Great East Japan Earthquake, Hurricane Katrina and Palestinian refugees. There were few studies from Africa or Asia (excluding Japan). The studies predominantly assessed prevalence of hypertension. This varied with geography and age of the population. Access to care, patient understanding and patient views on hypertension were poorly examined. Most of the studies had a high risk of bias due to methods used in the diagnosis of hypertension and in the selection of study populations.

CONCLUSION

Hypertension is seen in a range of humanitarian settings and the burden can be considerable. Further studies are needed to accurately estimate prevalence of hypertension in crisis-affected populations throughout the world. An appreciation of patient knowledge and understanding of hypertension as well as the cascade of care would be invaluable in informing service provision.

Six-year follow-up study of residential displacement and health outcomes following the 2011 Japan Earthquake and Tsunami

Studies examining the long-term health consequences of residential displacement following large-scale disasters remain sparse. Following the 2011 Japan Earthquake and Tsunami, victims who lost their homes were resettled by two primary means: 1) group relocation to public housing or 2) individual relocation, in which victims moved into public housing by lottery or arranged for their own accommodation. Little is known about how the specific method of residential relocation affects survivors' health. We examined the association between residential relocation and long-term changes in mental and physical well-being. Our baseline assessment predated the disaster by 7 mo. Two follow-up surveys were conducted ∼2.5 y and 5.5 y after the disaster to ascertain the long-term association between housing arrangement and health status. Group relocation was associated with increased body mass index and depressive symptoms at 2.5-y follow-up but was no longer significantly associated with these outcomes at 5.5-y follow-up. Individual relocation at each follow-up survey was associated with lower instrumental activities of daily living as well as higher risk of cognitive impairment. Our findings underscore the potential complexity of long-term outcomes associated with residential displacement, indicating both positive and negative impacts on mental versus physical dimensions of health.

Long-term effects of housing damage on survivors' health in rural China: Evidence from a survey 10 Years after the 2008 Wenchuan earthquake

BACKGROUND

Disaster experiences have long-term health effects. However, less is known about the pathways of the association between disaster experiences and people's long-term health. We aimed to examine the long-term (10-year) effect of housing damage in the 2008 Wenchuan earthquake on survivors' health and to explore the pathways of the long-term effect.

METHODS

We used data from a survey conducted in 2018 in rural areas affected by the 2008 Wenchuan earthquake. The survey collected information on housing damage caused by the earthquake from survivors aged 18 years old or above. Our primary outcome was dichotomous self-rated health in 2018. We considered decreased living standards and debt burden as mediators. To examine the long-term effect of housing damage on health, we performed multivariable binary logistic regression models. We also performed mediation analyses using the "KHB-method".

RESULTS

Compared with no/slight damage, serious damage (odds ratio (OR): 1.50, 95% confidence interval (CI): 1.11,2.04) and collapse (OR: 1.57, 95% CI: 1.13,2.18) were associated with a higher risk of poor health. Decreased living standards and debt burden mediated 8.49% and 4.79%, respectively, of the association between serious damage and poor health and 10.64% and 6.10%, respectively, of the association between collapse and poor health.

CONCLUSION

Housing damage in a natural disaster is a long-term risk for survivors' health. Long-term policies and interventions are necessary to protect and promote the health of survivors who experience housing damage. In addition to house reconstruction assistance, policies and interventions can be designed to promote living standards and financial situations to protect survivors' health.

Increase in Body Weight Following Residential Displacement: 5-year Follow-up After the 2011 Great East Japan Earthquake and Tsunami

BACKGROUND

Previous studies have linked residential displacement as a result of the 2011 East Japan Earthquake to increases in body weight. However, no study has examined longer-term trajectories of body weight among displaced survivors. We compared body weight change between survivors relocated to temporary housing (TH) group versus other types of accommodation for up to 5 years after the Great East Japan Earthquake.

METHODS

Longitudinal follow-up was conducted from 2011 to 2015 in a cohort of 9,909 residents of 42,831. We compared trends in body weight in the TH group (n = 3,169) and the non-TH group (n = 6,740) using a mixed linear regression model stratified by sex (mean age, 61.0 years old; male, 38.9%).

RESULTS

In age-adjusted analysis, the body weight in the 2011 survey was not significantly different between two groups for either sex. In men, the TH group significantly increased body weight compared to the non-TH group since 2012. In women, body weight sharply increased in the TH group while body weight did not change in the non-TH group during survey time points. The interaction of living conditions and survey years was statistically significant in both sexes (men; F-value, 6.958; P < 0.001: women; F-value, 19.127; P < 0.001).

CONCLUSION

Survivors relocated to temporary housing had an increased risk of weight gain. The weight gain in this group is a potential risk factor for metabolic syndrome in the post-disaster period.

Occurrence of Cerebrovascular Diseases Decreased after the Great East Japan Earthquake and Tsunami of 2011

Background

A temporary increase in the occurrence of cerebrovascular diseases (CVDs) after the Great East Japan Earthquake and Tsunami of 2011 was reported; however, no studies have been conducted to investigate long-term effects. We assessed the long-term impact of the disaster on the incidence of CVDs.

Methods

Incidence data for CVDs from 2008 to 2017 were acquired from the population-based Stroke Registry with an inventory survey of Iwate Prefecture, Japan. Part of the coastal area in Iwate Prefecture was mildly flooded and the other part was severely flooded. Age-adjusted incidence rates of CVDs (according to the Japanese standard population) were calculated for each area. The relative risk (RR) of incidence based on the years before the disaster (2008–2010), adjusted by stratified age groups, was calculated for the year of the disaster (2011), and the years after the disaster (2012–2017) in each area.

Results

The age-adjusted incidence rates gradually decreased in all areas, with the exception of a temporary increase among men who lived on the coast the year the disaster occurred. The adjusted RR in the disaster year were not significant in any area and those of the postdisaster years were 0.91 (95% CI 0.87–0.96) for all inland men, 0.93 (0.89–0.97) for all inland women, 0.85 (0.78–0.93) for all coastal men, 0.87 (0.81–0.94) for all coastal women, 0.88 (0.80–0.98) for men at mildly flooded coast, 0.82 (0.75–0.89) for women at mildly flooded coast, 0.79 (0.68–0.91) for men at severely flooded coast, and 0.98 (0.86–1.11) for women at severely flooded coast.

Conclusions

The occurrence of CVDs in the flooded coastal areas did not increase in the year of the Great East Japan Earthquake and Tsunami; furthermore, it decreased for men according to the severity of flood damage in the subsequent years; this can be attributed to supportive activities for the tsunami victims and the migration of the population.

Mediation of the relationship between home loss and worsened cardiometabolic profiles of older disaster survivors by post-disaster relocation: A natural experiment from the Great East Japan earthquake and tsunami

The underlying mechanism for deterioration in cardiometabolic health after major natural disasters is unknown. We leveraged natural experiment data stemming from the 2011 Great East Japan Earthquake and Tsunami (n = 1165) to examine whether specific types of post-disaster accommodations explain the association between disaster-related property damage and objectively measured cardiometabolic profiles of older disaster survivors. Causal mediation analysis showed that relocation to trailer-style temporary shelters largely mediated the associations between home loss and unhealthy changes in anthropometric measures (72.6% of 0.65 kg/m² for body mass index and 62.3% of 3.89 cm for waist circumference), but it did not mediate the associations with serum lipid measures. This study demonstrates that there are outcome-specific pathways linking disaster damage and health of survivors.

Causal effect of deteriorating socioeconomic circumstances on new-onset arthritis and the moderating role of access to medical care: A natural experiment from the 2011 great east Japan earthquake and tsunami

Socioeconomic disadvantage is a risk factor for arthritis, but its causal relationship remains unclear. This study examined the causal relationship between socioeconomic circumstances and new-onset arthritis by taking advantage of the "natural experiment" that resulted from the Great East Japan Earthquake and Tsunami. The baseline survey was conducted in August 2010, 7 months before the disaster. Self-reported questionnaires were mailed to all eligible residents of Iwanuma City in Miyagi Prefecture. The earthquake and tsunami occurred on March 11, 2011. The follow-up survey was conducted in October 2013, as well as the gathering of information about disaster damage (housing damage and subjective deterioration of economic circumstances) and health-related information. We used a two-stage least squares instrumental variable model to analyze 2360 survivors who did not have arthrosis at baseline, of whom 95 (4.0%) developed arthritis over the 2.5-year follow-up period. We used the linear probability model for the estimations. Our results revealed that both the subjective deterioration of economic circumstances and housing damage were associated with the development of arthritis (95% confidence interval [CI], 0.08 [0.03-0.12] and 0.02 [0.01-0.04], respectively). In addition, we also found that the disruption of access to orthopedics was associated with the development of arthritis. Our findings added robust evidence of the causal relationship between worsening economic circumstances and the development of arthritis. Our study emphasized the importance of recovery as well as the establishment of the post-disaster orthopedic medical system in the aftermath of a disaster.

Increased incidence of metabolic syndrome among older survivors relocated to temporary housing after the 2011 Great East Japan earthquake & tsunami

Background

Beyond the immediate toll of injuries and deaths, major disasters are often associated with long-term increased risks of chronic disease. We sought to investigate the incidence of metabolic syndrome (MetS) among survivors of the 2011 Great East Japan Earthquake and tsunami.

Methods

Subjects aged ≥18 years from the tsunami-stricken area participated in a prospective cohort study of disaster survivors (the RIAS Study) from 2011 to 2015. After excluding subjects who were previously diagnosed with MetS, we observed the cumulative incidence of MetS across four annual examinations among 7318 subjects (mean age, 59.8 years; 43.5% men). We defined MetS using the International Diabetes Foundation criteria.

Results

The 4-year cumulative incidence of MetS was 18.0% in the overall sample. The incidence was significantly higher among older women survivors relocated to prefabricated temporary housing (40.9%, 95% confidence interval, 36.4-44.6), and other types of housing (36.2%, 95% CI: 32.3-40.6) compared to those who were not relocated (34.1%, 95% CI: 30.9-37.4). An increase in incidence of MetS was not observed for older men, or younger survivors aged ≤64 years.

Conclusion

Relocation to prefabricated temporary housing was a risk factor for increased incidence of MetS in older women.

Chronic stress and age-related pattern of blood pressure: A cross-sectional study in rural China

OBJECTIVE

Chronic stress is a risk factor for hypertension in adults. However, there is conflicting evidence for older adults. We hypothesized that age-related arterial stiffening, which leads to a lower blood pressure (especially diastolic blood pressure [DBP]), is more pronounced among older adults with high vs low stress. The objectives of this study were (a) to investigate age-related trends in systolic and DBPs among adults in rural Fujian, China, and (b) to examine differences in age-related blood pressure trends according to levels of stress by using Epstein-Barr virus (EBV) antibody titer as a marker of chronic stress status.

METHODS

We collected cross-sectional data from 764 rural community-dwelling adults in rural Fujian, China (mean age = 59.4). Participants were categorized into high and low stress groups by median split of EBV antibody titer. A least-squares regression analysis was used to investigate the association between age and blood pressures.

RESULTS

We observed an inverted U-shaped association between age and DBP, while there was a linear association between age and systolic blood pressure in the overall sample. When stratified by stress, the inverted U-shaped associations with age (both systolic and DBPs) were seen only among those with high stress; DBP peaked at the age of ~68 years, and the declining trend later in life was more clearly observed among those with high chronic stress.

DISCUSSION

Decrease of DBP was more pronounced among older adults with high vs low chronic stress in rural China.

Impact of heavy rains of 2018 in western Japan: disaster-induced health outcomes among the population of Innoshima Island

Southwestern Japan suffered its worst rains in 2018 causing floods and mudslides, claiming 225 lives and forcing millions for evacuations. Referred as "Heisei san-jū-nenshichi-gatsugōu", the disaster was the result of incessant precipitation caused by the interaction of typhoon "Prapiroon" with the seasonal rain front "Baiu". The present epidemiological study aims to investigate disaster-induced health issues in 728 residents of Innoshima island in the Hiroshima Prefecture by comparing their clinical data in pre-disaster (2017) and disaster-hit (2018) years which was obtained from annual health screening. Comparison of data showed a significant increase in the urine protein concentration in victims following the disaster. Probing further into the household conditions, showed that a total of 59,844 households were affected with water outage during the heavy rains, which was accompanied by severe damage of sewerage pipelines with complete recovery process taking two weeks. This two weeks of the crisis forced victims to refrain from using restrooms which in turn led to infrequent urination, thereby explaining the increased urine protein concentration in victims following the disaster. The present study addresses the acute health implications caused by the water crisis and serves as a precautionary measure for disaster management council to provide enhanced aftercare services in victims in further events of natural disasters.