Assessment of medium-term cardiovascular disease risk after Japan's 2011 Fukushima Daiichi nuclear accident: a retrospective analysis

Was there an improvement in the years of life lost (YLLs) for non-communicable diseases in the Soma and Minamisoma cities of Fukushima after the 2011 disaster? A longitudinal study

OBJECTIVES

This study aimed to determine cause-specific years of life lost (YLL) changes between predisaster and postdisaster in disaster-affected municipalities, compared with the national average. We estimated the YLL in Soma and Minamisoma cities (the subject area) in Fukushima, Japan, where the tsunami and the nuclear accident hit in 2011.

PARTICIPANTS

We used vital registration records from a national survey conducted between January 2006 and December 2015. We analysed 6369 death data in the predisaster period (2006-2010) and 6258 death data in the postdisaster period (2011-2015).

METHODS

We incorporated vital statistics data as follows: age-based, sex-based and International Classification of Diseases, 10th Revision-based cause-specific deaths and calculated YLLs by ages 0, 40, 65 and 75 and sex for attributable causes of death for heart diseases, cerebrovascular diseases, pneumonia, all cancers and specific cancers; breast cancer, colorectal cancer, leukaemia, lung cancer, stomach cancer and uterine cancer for predisaster and postdisaster in the subject area.

RESULTS

YLL attributed to heart diseases for males showed no decrease and YLL postdisaster was 0.37 years larger than that of the national average at age 0. The difference was -0.17 (95% uncertainty interval: -0.40 to 0.05) years at age 65. It decreased for females; the difference was 0.37 (0.18-0.57) years after the disaster. YLL decrease (that is, difference) in cerebrovascular diseases at age 0 was 0.27 (0.09-0.44) years and 0.18 (0.04-0.32) years; however, the YLLs postdisaster were still 0.24 and 0.25 years larger than those for the national average for males and females, respectively. YLL attributed to cancer did not increase even after the nuclear disaster.

CONCLUSIONS

We specified the causes of death to be reduced in disaster-affected areas in the future. This study emphasised the importance of understanding how the health situation changed for the whole society of the area from a comprehensive perspective, rather than focusing only on small mortality increases.

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.

Comparative risk assessment of non-communicable diseases by evacuation scenario- a retrospective study in the 7 years following the Fukushima Daiichi nuclear power plant accident

Background: As a result of the Fukushima Daiichi nuclear power plant accident, many residents evacuated and were exposed to changes in their living environment and socioeconomic status, and to persistent stressors. Past studies have suggested the potential for these circumstances to contribute to long-term changes to population health.Objective: The objective of this study was to gain a better understanding of long-term health effects of evacuation, by evaluating the risk of non-communicable diseases among evacuees from Minamisoma City (one of the closest municipalities to the power plant) until 2017.Methods: The study evaluated data from annual health check-ups for residents aged 40-74 years covered by National Health Insurance (who are largely self-employed) from 2010 to 2017 administered by Minamisoma City. Diabetes, hyperlipidemia, and hypertension were defined from the results of blood sampling. Annual changes in age-adjusted prevalence were estimated by evacuation scenario. We also performed an inverse-probability weighting (IPW) analysis to adjust for baseline covariates in 2010 and estimated the differences in the risk of diabetes, hyperlipidemia, and hypertension by evacuation scenario as of the 2017 health check-up in reference to the no-evacuation group.Results: A total of 1,837 individuals were considered in this study. Regardless of evacuation scenario, there was statistical evidence suggesting an upward and a downward trend in diabetes and hypertension from 2010 to 2017, respectively, while hyperlipidemia showed no remarkable change. IPW analyses demonstrated that disease risks in 2017 did not differ significantly among people with different evacuation scenarios.Conclusions: Region-specific factors played an important role in the health effects of the evacuation. Our findings have important implications for the need of an assessment of the health effects of evacuations in more localized manner. Further research in this area will strengthen the communities' preparedness for future disasters that require mass evacuation.

Associated factors related to participation in general health checkup and survey of the effect of low-dose radiation exposure on health of residents of Fukushima Prefecture after the Fukushima Daiichi nuclear power plant accident

The Fukushima Daiichi nuclear power plant accident caused radioactive contamination of the surrounding area. In addition to annual health checkups, a survey of the effects of low-dose radiation exposure on health among Fukushima Prefecture residents after the accident has been conducted. Despite health literacy (HL) being recognized as essential to health, its association with participation in these checkups and the survey remains unknown. We aimed to describe the HL status of the Fukushima Prefecture residents and to verify the hypothesis that HL is associated with participation in both checkup and survey. In a cross-sectional study, a questionnaire was sent to 2000 randomly sampled Fukushima Prefecture residents; data from 770 individuals were analyzed. Communicative and critical HL were measured using a 5-point scale. Factors associated with participation were examined using logistic regression. The survey's valid response rate was 38.5%. The average HL score was 3.11 ± 0.81. HL was not associated with checkup or survey participation. Checkup participation was negatively associated with radiation anxiety (odds ratio 0.93, 95% confidence interval 0.86-0.99, p = 0.03). The HL of Fukushima Prefecture residents after the accident was relatively lower than that of the Japanese general population, which may be attributed to difference in educational background. The complexities involved in understanding the effects of radiation on the health of residents could explain why no association between HL and participation in a health checkup and survey was observed. Future studies with a longitudinal design should clarify causality between anxiety and checkup participation.

Multiple Organ Lesions in a Case of Contamination With Multiple Radionuclides After 38 Years

The patient was contaminated with multiple radionuclides 38 years ago due to an accident. To investigate the effects of radionuclide contamination on humans, he has been followed up by examinations for many years. Long-term effects gradually emerge in these years. Lung cancer was diagnosed by medical examinations. Besides, chronic gastritis with intestinal metaplasia was indicated by gastroscopic biopsies, while colorectal polyps found by colonoscopy. All 13 colorectal polyps were removed, and radical surgery for lung cancer was performed. Fortunately, pathological examinations indicated that it was early lung cancer. The ground glass nodule (GGN) in left lung identified during the follow-up will be resected when needed. It is speculated that multiple manifestations of the patient may be related to radiation, and different lesions in the organs may be related to systemic adaptive response. However, longer follow-up is needed due to a lack of effective and direct evidence. This work is expected to provide experiences for similar patients' treatment and follow-up.