Evacuation after the Fukushima Daiichi Nuclear Power Plant Accident Is a Cause of Diabetes: Results from the Fukushima Health Management Survey

Resilient design in nuclear energy: Critical lessons from a cross-disciplinary analysis of the Fukushima Dai-ichi nuclear accident

This paper presents a multidisciplinary analysis of the Fukushima Dai-ichi Nuclear Power Plant accident. Along with the latest observations and simulation studies, we synthesize the time-series and event progressions during the accident across multiple disciplines, including in-plant physics and engineering systems, operators' actions, emergency responses, meteorology, radionuclide release and transport, land contamination, and health impacts. We identify three key factors that exacerbated the consequences of the accident: (1) the failure of Unit 2 containment venting, (2) the insufficient integration of radiation measurements and meteorology data in the evacuation strategy, and (3) the limited risk assessment and emergency preparedness. We conclude with new research and development directions to improve the resilience of nuclear energy systems and communities, including (1) meteorology-informed proactive venting, (2) machine learning-enabled adaptive evacuation zones, and (3) comprehensive risk-informed emergency planning while leveraging the experience from responses to other disasters.

Factors affecting the changes in body mass index among emergency workers at the Fukushima Daiichi Nuclear Power Plant

Understanding the effects of lifestyle and radiation on health is important for the health management of disaster recovery workers. International research has demonstrated the relationship between natural disasters and diseases. The lifestyle and working conditions following the Great East Japan Earthquake potentially increased the incidence of cardiovascular disease and obesity among affected individuals. The aim of this study was to analyze the body mass index (BMI) of 1,341 emergency workers who responded to the accident at the Fukushima Daiichi Nuclear Power Plant. The BMI of each emergency worker was measured immediately after the accident and compared with that measured at the initial survey conducted 5 yr later to determine the effect of lifestyle habits on BMI. Awareness of the frequency of eating out and caloric intake helped maintain their BMI, while evacuation contributed to the increase in BMI. Prevention of obesity, which can trigger or exacerbate certain health conditions, such as heat exhaustion, infection, and cerebro-cardiovascular disease, requires diet counseling, with a focus on maintaining adequate caloric intake; moreover, special consideration should be provided to evacuated workers.

Association Between Changes in Alcohol Consumption Before and After the Great East Japan Earthquake and Risk of Hypertension: A Study Using the Ministry of Health, Labour and Welfare National Database

BACKGROUND

The 2011 Great East Japan Earthquake has resulted in a nuclear accident, forcing residents of the surrounding areas to evacuate. To determine any association between excessive drinking and hypertension in the setting of disaster, we assessed whether the proportion of excessive drinkers increased and if post-disaster excessive drinking was a risk factor for hypertension.

METHODS

This retrospective study assessed data from the Japanese National Database. Cumulative population data for Fukushima Prefecture (3,497,576 people) were analyzed by categorizing residents into four areas-evacuation, coastal, central, and mountainous-to calculate the proportion of excessive, heavy (equivalent to binge drinking), and at-risk drinkers for 2008-2017. The hazard ratios (HRs) for the incidence of hypertension for 2012-2017 were examined in association with changes in drinking status pre- and post-disaster, which included 136,404 people who received specific health checkups pre-disaster (2008-2010) and post-disaster (2011-2012).

RESULTS

The proportion of excessive drinkers among women increased after the disaster in all areas examined. The association between excessive drinking and the incidence of hypertension was determined among men and women in all areas; it was stronger among women in the evacuation areas, with the sex- and age-adjusted HRs for the incidence of hypertension of 1.41 for pre-disaster excessive drinking, 2.34 for post-disaster excessive drinking, and 3.98 for pre- and post-disaster excessive drinking, compared with not excessive drinking pre- and post-disaster.

CONCLUSION

Excessive drinking post-disaster may be associated with an increased risk of hypertension among men and women, especially among women in the evacuation areas.

Trends and Regional Differences in the Prevalence of Dyslipidemia before and after the Great East Japan Earthquake: A Population-Based 10-Year Study Using the National Database in Japan

Since the Great East Japan Earthquake in March 2011, an increase in lifestyle-related diseases due to changes in living environment following the nuclear power plant accident has been reported in Fukushima Prefecture, especially among evacuees. However, no long-term studies covering the entire Fukushima Prefecture have been conducted. The study aim was to investigate the effects of post-disaster evacuation life on the prevalence of dyslipidemia in Fukushima Prefecture using a national database. The data from 3,866,674 people who underwent specific health checkups between fiscal year (FY) 2008 and FY2017 were analyzed. Fukushima Prefecture was divided into four areas, and the prevalence of dyslipidemia and related parameters were compared. The prevalence of dyslipidemia increased overall, with a particularly sharp increase after FY2011 in the evacuation area. The sex- and age-adjusted odds ratio (95% confidence intervals) of having dyslipidemia in the evacuation area compared with that in the control area was 0.951 (0.929-0.973) in FY2008-2010, which increased to 1.130 (1.105-1.155) in FY2012-2014 and 1.117 (1.092-1.143) in FY2015-2017. Since the prevalence of dyslipidemia has increased and remained high after the earthquake in Fukushima Prefecture, especially in the evacuation area, continued measures to prevent cardiovascular diseases among the residents are needed.

Trends in Lifestyle-related Diseases and Their Risk Factors After the Fukushima Daiichi Nuclear Power Plant Accident: Results of the Comprehensive Health Check in the Fukushima Health Management Survey

Residents were forced to evacuate owing to the radiation released after the Fukushima Nuclear Power Plant (NPP) accident following the Great East Japan Earthquake on 11/03/2021; thus, their lifestyles drastically changed. The Comprehensive Health Check (CHC) of the Fukushima Health Management Survey (FHMS) was performed to evaluate health statuses and prevent lifestyle-related diseases in evacuation area residents. The first part of the CHC survey is a retrospective analysis of pre- and post-disaster data on health check-ups of evacuation area residents. The second part is a cross-sectional, prospective analysis of post-disaster (fiscal year (FY) 2011-2017) data on health check-ups. Subjects were men and women living in 13 municipalities in areas surrounding the NPP in Fukushima Prefecture. Post-disaster (FY 2011-2012) overweight, hypertension, dyslipidemia, diabetes mellitus, metabolic syndrome, liver dysfunction, hyperuricemia, polycythemia and atrial fibrillation cases increased from the pre-disaster (FY 2008-2010) levels. This tendency was strongest among residents who were forced to evacuate. Proportion of overweight people remained unchanged, the prevalence of liver dysfunction decreased and the proportion of people with treated hypertension and dyslipidemia increased during FY 2011-2017. Meanwhile, the prevalence of diabetes mellitus and mean levels of HbA1c increased. Furthermore, Evacuees showed higher risks of diabetes mellitus, dyslipidemia, chronic kidney diseases and liver dysfunction than non-evacuees. Therefore, residents in the evacuation area, especially evacuees, are at high risk of developing lifestyle-related diseases, especially cardiovascular diseases; therefore, it is necessary to observe health statuses and implement measures to prevent lifestyle-related diseases.

Effects of External Radiation Exposure Resulting From the Fukushima Daiichi Nuclear Power Plant Accident on the Health of Residents in the Evacuation Zones: the Fukushima Health Management Survey

BACKGROUND

Associations have been reported between lifestyle-related diseases and evacuation after the Great East Japan Earthquake (GEJE). However, the relationship between lifestyle-related diseases and the effective radiation dose due to external exposure (EDEE) after the GEJE remains unclear.

METHODS

From among 72,869 residents of Fukushima Prefecture (31,982 men; 40,887 women) who underwent a comprehensive health check in fiscal year (FY) 2011, the data of 54,087 residents (22,599 men; 31,488 women) aged 16 to 84 years were analyzed. The EDEE data of 25,685 residents with incomplete results from the basic survey, performed to estimate the external radiation exposure dose, were supplemented using multiple imputation. The data were classified into three groups based on EDEE (0 to <1, 1 to <2, and ≥2 mSv groups and associations between the incidence of diseases and EDEE from FY2011 to FY2017 were examined using a Cox proportional hazards model, with FY2011 as the baseline.

RESULTS

A higher EDEE was associated with a greater incidence of hypertension, diabetes mellitus, dyslipidemia, hyperuricemia, liver dysfunction, and polycythemia from FY2011 to FY2017 in the age- and sex-adjusted model. However, after further adjustment for evacuation status and lifestyle-related factors, the significant associations disappeared. No association was found between EDEE and other lifestyle-related diseases.

CONCLUSION

EDEE was not directly associated with the incidence of lifestyle-related diseases after the GEJE. However, residents with higher external radiation doses in Fukushima Prefecture might suffer from lifestyle-related diseases related to evacuation and the resultant lifestyle changes.

Loss of participation among evacuees aged 20-37 years in the disaster cohort study after the Great East Japan Earthquake

The present study aimed to clarify the characteristics of young evacuees who had missed the Comprehensive Health Check of the Fukushima Health Management Survey (FHMS) after the Great East Japan Earthquake in 2011. The FHMS has been conducted as a prospective cohort study to evaluate the health status of evacuees annually after the great earthquake in 2011. This study focused on the annual participation rate in the Comprehensive Health Check of evacuees aged between 20 and 37 years in 2011 who evacuated due to the Fukushima Daiichi Nuclear Power Plant accident. The characteristics of subjects who did not participate after the second survey year were identified with a multivariate logistic regression model. The participation rate was estimated at 26.6% (9720 among 36,502 residents) and 15.6% (5691 residents) in 2011 and 2012, respectively. The logistic regression model revealed the following characteristics at baseline as independent predictors of non-participation after the second year of the survey: age ≤ 24 years (adjusted odds ratio 2.11, 95% CI 1.84-2.42), 25-29 years of age (1.28, 1.13-1.45), men (1.52, 1.38-1.69), evacuation outside the municipality but within Fukushima prefecture (1.54, 1.40-1.70), evacuation outside the Fukushima prefecture (1.40, 1.21-1.63), anemia (1.23, 1.06-1.43), smoking habit (1.34, 1.21-1.48), and drinking habit (1.20, 1.09-1.32). A medical history of heart disease showed opposite odds ratios, which indicate the association with continuous participation (0.43, 0.26-0.72, respectively). We observed deteriorated participation in the prospective study of the Comprehensive Health Check of the FHMS among evacuees of a younger age group, men, those evacuated outside their municipalities, and those with history of anemia, smoking and drinking habits. Hence, the cohort study may have missed certain population groups with worse health behaviors. Thus, it is necessary to consider various measures to increase the participation rate in the disaster cohort study to understand the long-term health effects of disasters on younger residents in evacuation zones.

Impact of Evacuation on the Long-Term Trend of Metabolic Syndrome after the Great East Japan Earthquake

There has been an increase in lifestyle-related diseases in Fukushima Prefecture since the Great East Japan Earthquake. However, the overall long-term trends of lifestyle-related diseases in the Fukushima Prefecture according to the evacuation and other area are not reported. Therefore, we examined the long-term trends in the prevalence of metabolic syndrome before and after the Great East Japan Earthquake in Fukushima Prefecture according to these areas using a national database. The target population was approximately 330,000–440,000 per year; Fukushima Prefecture residents aged 40–74 years who underwent specific health check-ups during 2008–2017 participated in the study. Fukushima was divided into mountainous, central, coastal and evacuation areas. Using the Poisson regression model, the prevalence of metabolic syndrome in each fiscal year was determined by gender and age group for each location and compared before and after the disaster as well as between areas. Prevalence increased significantly throughout the observation period, particularly in the evacuation area. Age- and gender-adjusted prevalence rates significantly increased from 16.2% in 2010 to 19.5% in 2012 (prevalence ratios = 1.21) and 20.4% in 2017 in the evacuation area. Among other areas, coastal areas showed the highest increase with 17.9% (2017), followed by central areas with 16.5% (2017) and mountainous areas with 18.3% (2016). These increases were particularly high among men and the elderly. The prevalence of metabolic syndrome increased rapidly after the disaster, especially in evacuation area, and continued for subsequent 6–7 year. Long-term monitoring and measures to prevent lifestyle-related diseases are needed after major disasters, especially in evacuation areas, among men and the elderly.

Impact of lifestyle and psychosocial factors on the onset of hypertension after the Great East Japan earthquake: a 7-year follow-up of the Fukushima Health Management Survey

Natural disasters force many evacuees to change several aspects of their lifestyles. This longitudinal study aimed to investigate whether factors such as living environment and lifestyle factors were related to new-onset hypertension in survivors of the Great East Japan Earthquake over a long-term follow-up of up to 7 years after the earthquake. The present study examined data collected from 29,025 Japanese participants aged 39-89 years, sourced from general health checkups and the Fukushima Mental Health and Lifestyle Survey, which was conducted in 13 communities between 2011 and 2018. A total of 10,861 participants received follow-up examinations. During a median follow-up of 4.3 years, 3744 participants (1588 men, 41.4%; 2,156 women, 30.7%) had newly developed hypertension. Heavy drinking (adjusted hazard ratio 1.38, 95% confidence interval 1.21-1.57, p < 0.001) and obesity (adjusted hazard ratio 1.27, 95% confidence interval 1.19-1.37, p < 0.001) were significantly associated with new-onset hypertension after the disaster in multivariate-adjusted analysis. Furthermore, experiencing evacuation after the disaster was also significantly associated with the risk of new-onset hypertension in men (adjusted hazard ratio 1.14, 95% confidence interval 1.02-1.27, p = 0.016). The present study indicated that lifestyle factors, such as drinking and obesity, and evacuation experience in men had significant effects on the risk of new-onset hypertension in the long term after the earthquake.

Changes in the proportion of anemia among young women after the Great East Japan Earthquake: the Fukushima health management survey

This study aimed to evaluate the sequential changes in the proportion of anemia among young women over eight years after the Great East Japan Earthquake in 2011 using a prospective study of the Fukushima Health Management Survey. This study focused on the women aged between 20 and 44 who lived in the evacuation area of the nuclear power plant accident. The yearly age-adjusted proportion of anemia was accessed with data between July 2011 and March 2019. A total of 9,198 women participated in the health checkup in 2011, albeit the participation was decreased to 1,241 in 2018. The age-adjusted proportion of anemia was 16.7% in 2012 and then declined after 2013 (p with Cochran-Armitage trend test = 0.03). The multivariate regression analysis identified < 23 kg/m² of body mass index (BMI), no history of smoking, and no habitual alcohol use as independent baseline characteristics predictive of temporality anemic condition after the disaster (Adjusted odds ratios [95% confidence interval]; 1.98 [1.43-2.74], 1.85 [1.21-2.83], and 1.42 [1.07-1.90], respectively). Thus, women with low BMI and healthier habits might risk temporarily anemic status after the disaster. Our findings signal the importance of preventing anemia in young women after the disaster.

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.

What's better for our health? Conducting protective actions during a nuclear emergency or accepting a certain radiation dose?

The threat caused by ionising radiation has resulted in the establishment of strict radiation protection guidelines. This is especially true for severe nuclear power plant (NPP) accident scenarios, which may involve the release of significant amounts of ionising radiation. However, we believe that the fine balance between the benefit of a certain protective action (e.g. evacuation) and its risks is not always accounted for properly. Deaths and mental health problems have been associated with protective actions (e.g. evacuation) implemented in the response to the Fukushima Daiichi (NPP) accident in 2011. The protective actions were implemented consistent with international recommendations, to reduce radiation-induced health effects, even though the off-site effective doses were too low to indicate that there would be any discernible radiation-induced health effects. In this paper, we will provide a first step for the development of tools to evaluate the risk of protective actions versus the radiation-induced health risk. Over 50 papers were selected as useful from more than 600 reviewed papers to characterise the health impact of protective actions taken during different emergencies (including, technical and natural emergencies). An analysis was performed comparing the radiation-induced health effects averted by protective actions with the health effects associated with the protective actions. We concentrated our analysis on deaths and mental health problems associated with protective actions compared with the inferred radiation-induced deaths averted by the protective actions. Our analysis is stated in terms of absolute risk (cases per 1000) of health effects to allow for a direct comparison. It indicates that taking protective actions consistent with dose criteria typically used in many countries could result in more excess deaths than the inferred radiation-induced deaths prevented, as well as resulting in mental health problems. We identified that residents of facilities for long stays and the elderly are particularly vulnerable and a significant number of the deaths among the general public are associated with a lack of emergency preparedness provisions.

Lifestyle Factors Associated with Undernutrition in Older People after the Great East Japan Earthquake: A Prospective Study in the Fukushima Health Management Survey

We conducted a longitudinal examination to assess the relationship between lifestyle habits, including exercise habits, and the incidence of undernutrition after the Great East Japan Earthquake in March 2011. Of the 31,411 participants aged ≥60 years who lived in the municipalities’ evacuation areas before the disaster and had undergone health examinations, 17,622 persons with a body mass index of 20–25 kg/m² were followed up through the FY 2017 (a mean follow-up of 6.9 years). The analysis involved 13,378 individuals who could be followed. The associations between undernutrition after the disaster and lifestyle factors were estimated via multivariable-adjusted analysis using the Cox proportional hazard regression model. The dependent variable was the proportion of undernutrition after the disaster, whereas independent variables included evacuation, exercise habits/physical activity, alcohol consumption, smoking, meals before bedtime, gastrointestinal surgery history, history of lifestyle-related diseases, and two or more subjective symptoms. In total, 1712 of the 13,378 participants were newly undernourished after the disaster. The statistically significant variables influencing the occurrence of undernutrition were non-evacuation (hazard ratio (HR), 1.31; 95% confidence index (CI) 1.17–1.47), poor exercise habits (HR, 1.14; 95% CI 1.03–1.50), and poor physical activity (HR, 1.12; 95% CI 1.01–1.25). Other significant related variables were drinking habits, surgical history, lifestyle-related diseases, and two or more subjective symptoms. These results suggest that regular exercise and/or physical activity might be important in preventing undernutrition following a disaster, regardless of sex, other lifestyle habits, or past medical history.

Association between Psychosocial Factors and Oral Symptoms among Residents in Fukushima after the Great East Japan Earthquake: A Cross-Sectional Study from the Fukushima Health Management Survey

Oral health is closely related to subjective general health and systemic diseases. This cross-sectional study aimed to identify the factors related to oral symptoms and their worsening in relation to psychosocial factors after the Great East Japan Earthquake. In this study, 64,186 residents aged 15–101 years old, who experienced the earthquake on 11 March 2011, were surveyed regarding their oral symptoms; psychological factors, such as post-traumatic reactions and psychological distress; and social factors such as evacuation, work change, and loss of a close person; history of systemic diseases; and lifestyle. Binomial logistic regression analysis was used to calculate odds ratios, and 95% confidence intervals were established for each factor associated with prevalent and exacerbated oral symptoms. The proportions of participants with prevalent and exacerbated oral symptoms were 10.3% and 1.6%, respectively. The multivariate odds ratios and 95% CI of psychosocial factors associated with exacerbated oral symptoms were as follows: post-traumatic stress disorder symptoms, 2.24 (1.64–3.06); work changes, 1.88 (1.34–2.65); history of dyslipidemia, 1.74 (1.27–2.39); and subjective current poor health condition, 2.73 (2.00–3.75). Psychological factors, social factors, and physical factors were associated with both prevalent and exacerbated oral symptoms.

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.

Relationship between physical activity/exercise habits and the frequency of new onset of lifestyle-related diseases after the Great East Japan Earthquake among residents in Fukushima: the Fukushima Health Management Survey

The effect of exercise habits on the increased incidence of lifestyle-related diseases among residents of the evacuation area in Fukushima Prefecture after the Great East Japan Earthquake is not well characterized. This study examined the influence of exercise habits on the frequency of new onset of lifestyle-related diseases in the aftermath of the earthquake using data from the Fukushima Health Management Survey (FHMS). Of the 32 289 individuals (14 004 men and 18 285 women) aged 40-90 years who underwent one or more health examinations in both 2011-12 and 2014-15, those who knew whether they had any lifestyle diseases and who responded to a questionnaire about their exercise and physical activity habits were included (dyslipidemia, 8017; hypertension, 7173; and diabetes mellitus, 13140 individuals). The association between the frequency of new onset of lifestyle-related diseases in 2014-15 and the presence or absence of persistent exercise and physical activity habits (active lifestyle) was examined using the FHMS data. The frequency of new onset of dyslipidemia was significantly lower in the active lifestyle group than in the sedentary lifestyle group (P = 0.008). On univariate and multivariate logistic regression analyses, the presence of active lifestyle, obesity and the experience of evacuation showed a significant association with new onset of dyslipidemia, independent of age, sex or follow-up period. Thus maintaining physical activity and exercise habits may help prevent the new onset of dyslipidemia among residents of the evacuation area in the Fukushima Prefecture after the earthquake.

Relationship between risk of hyper- low-density lipoprotein cholesterolemia and evacuation after the Great East Japan Earthquake

BackgroundThe Great East Japan Earthquake and the Fukushima Daiichi nuclear disaster forced the evacuation of residents and led to many changes in lifestyle for the evacuees. The Comprehensive Health Check was implemented to support the prevention of lifestyle-related disease and we analyzed the effect of prolonged evacuation (average of 3.0 years) on the new onset of hyper-LDL cholesterolemia.MethodsThe study participants were Japanese adults living near the Fukushima Daiichi nuclear power plant in Fukushima Prefecture. Annual health checkups focusing on metabolic syndromes were conducted for persons ≥ 40 years by the Specific Health Checkup. Based on data from annual checkups from 2011 or 2012, we followed 18,670 non-hyper-LDL cholesterolemia who underwent at least one other annual checkup during 2013-2015.ResultsWe found that the new onset of hyper-LDL cholesterolemia was significantly by 31% higher in evacuees than in non-evacuees. Evacuees had a significantly higher prevalence of obesity, hypertension, and diabetes, and higher frequency of weight change. Furthermore, logistic regression model analysis showed that the evacuation was significantly associated with the new onset of hyper-LDL cholesterolemia after adjusting age, gender, body mass index (BMI), smoking habit, alcohol consumption, diabetes, weight change, sleep deprivation, and exercise.ConclusionsThe findings of the present study suggest that prolonged evacuation after a disaster is a risk factor for the new onset of hyper-LDL cholesterolemia, and lead to an increase in cardiovascular disease. It is therefore important to follow-up evacuees and recommend lifestyle changes where necessary.

Association between post-traumatic stress disorder symptoms and bone fractures after the Great East Japan Earthquake in older adults: a prospective cohort study from the Fukushima Health Management Survey

Background

It has been reported that psychological stress affects bone metabolism and increases the risk of fracture. However, the relationship between bone fractures and post-traumatic stress disorder (PTSD) is unclear. This study aimed to evaluate the effects of disaster-induced PTSD symptoms on fracture risk in older adults.

Methods

This study evaluated responses from 17,474 individuals aged ≥ 65 years without a history of fractures during the Great East Japan Earthquake who answered the Mental Health and Lifestyle Survey component of the Fukushima Health Management Survey conducted in 2011. The obtained data could determine the presence or absence of fractures until 2016. Age, sex, physical factors, social factors, psychological factors, and lifestyle factors were subsequently analyzed. Survival analysis was then performed to determine the relationship between the fractures and each factor. Thereafter, univariate and multivariate Cox proportional hazard models were constructed to identify fracture risk factors.

Results

In total, 2,097 (12.0%) fractures were observed throughout the follow-up period. Accordingly, univariate and multivariate Cox proportional hazard models showed that PTSD symptoms (total PTSD checklists scoring ≥ 44) [hazard ratio (HR): 1.26; 95% confidence interval (CI): 1.10–1.44; P = 0.001], history of cancer (HR: 1.49; 95% CI: 1.24–1.79; P < 0.001), history of stroke (HR: 1.25; 95% CI: 1.03–1.52; P = 0.023), history of heart disease (HR: 1.30; 95% CI: 1.13–1.50; P < 0.001), history of diabetes (HR: 1.23; 95% CI: 1.09–1.39; P < 0.001), current smoking (HR: 1.29; 95% CI: 1.02–1.63; P = 0.036), and high dissatisfaction with sleep or no sleep at all (HR: 1.33; 95% CI: 1.02–1.74; P = 0.035) promoted a significant increase in fracture risk independent of age and sex.

Conclusions

The present study indicates that disaster-induced PTSD symptoms and insomnia contribute to increased fracture risk among older adults residing in evacuation areas within the Fukushima Prefecture.

Association between Psychological Factors and Evacuation Status and the Incidence of Cardiovascular Diseases after the Great East Japan Earthquake: A Prospective Study of the Fukushima Health Management Survey

Evidence regarding the effect of psychological factors and evacuation on cardiovascular disease occurrence after large-scale disasters is limited. This prospective study followed up a total of 37,810 Japanese men and women aged 30–89 years from the Fukushima Prefecture with no history of stroke or heart disease at baseline (2012), until 2017. This period included 3000 cardiovascular events recorded through questionnaires and death certificates. The participants’ psychological distress, trauma reaction, and evacuation status were defined, and divided into four groups based on combinations of psychological factors and evacuation status. We calculated the hazard ratios and 95% confidence intervals for only psychological, only evacuation, or both of them compared with neither using Cox proportional hazard models. Psychological factors along with evacuation resulted in approximately 5% to 25% higher magnitude of stroke and heart disease risk than psychological factors only among men. Compared to neither, the multivariable hazard ratios of those with both psychological distress and evacuation were 1.75 for stroke and 1.49 for heart disease, and those of both trauma reaction and evacuation were 2.01 and 1.57, respectively, among men. Evacuation combined with psychological factors increased the risk of stroke and heart disease risks especially in men after the Great East Japan Earthquake.

Effect of temporary housing on incidence of diabetes mellitus in survivors of a tsunami-stricken area in 2011 Japan disaster: a serial cross-sectional RIAS study

The association between incidence of diabetes mellitus (DM) and living conditions has not been studied after natural disasters. We compared the incidence of DM between individuals living in temporary housing (TH) and those living in other types of accommodation (non-TH) five years after the 2011 Great East Japan Earthquake. Longitudinal follow-up was conducted from 2011 to 2015 in a cohort of 7,491 residents of coastal communities in Iwate Prefecture directly impacted by the 2011 disaster (mean age, 61.6 years; men, 36.0%). We calculated the odds ratio of new onset of DM in the TH group (n = 2,372) compared with the non-TH group (n = 5,119) using discrete-time logit models stratified by sex and age classes (64 years or younger and older than 65 years). The TH group showed a significantly higher odds ratio (OR) for DM in men aged 64 years or younger (OR [95% confidence interval (CI)], 1.71 [1.03–2.85]; P-value = 0.040). In women, living conditions were not significantly associated DM. Survivors relocated to TH appeared to be at an increased risk of new onset DM.

Nationwide Increase in Complex Congenital Heart Diseases After the Fukushima Nuclear Accident

Background After the Chernobyl nuclear accident in 1986, an increase in the incidence of congenital heart disease ( CHD s) in the neighboring countries was reported. In 2011, Japan experienced the Great East Japan Earthquake and the nuclear accidents at Fukushima. However, a nationwide study of their effects has not been conducted yet. Methods and Results We used data covering the period between 2007 and 2014 from the annual surveys conducted by the Japanese Association for Thoracic Surgery, which included almost all of the operations pertaining to 46 types of CHD s in Japan. CHD s were divided into 2 groups based on complexity, the time of occurrence during heart development, and age at operation. We estimated the change in the number of the operations per 100 000 live births between pre- and postdisaster using a negative binomial generalized linear mixed model. Overall, a significant 14.2% (95% CI, 9.3-19.4) increase in the number of operations for complex CHD s in neonates and infants per 100 000 live births was found, whereas those performed for patients of 1 to 17 years old showed no significant change during the study period. Conclusions The number of operations for complex CHD s in neonates and infants in Japan significantly increased after the massive disaster, and its level was maintained thereafter. The number of operations for complex CHD was not equal but closely correlated to the live birth prevalence of complex CHD s. Therefore, some meaningful increase in the live birth prevalence can be assumed; however, the precise cause of the increase is unknown.

The incidence of diabetes among the non-diabetic residents in Kawauchi village, Fukushima, who experienced evacuation after the 2011 Fukushima Daiichi nuclear power plant disaster

Objectives

After the Fukushima Daiichi nuclear power plant disaster in 2011, residents of Kawauchi village who experienced evacuation had a high risk of suffering from diabetes and metabolic syndrome compared with non-evacuees. In addition to evacuation, lifestyle characteristics can be important factors influencing the development and prognosis of diabetes or glucose tolerance. The current study aimed to evaluate the effects of evacuation (i.e., lifestyle changes) on the incidence of diabetes among the non-diabetic residents of Kawauchi village.

Methods

Design is retrospective cohort study. Annual health examination data of residents of Kawauchi village and control area (Ono town) in Fukushima prefecture from 2008 to 2017, as available from the Japanese National Health Insurance system. Participants were classified into three groups: “Diabetes (DM)” (FBG ≥ 126 mg/dL or HbA1c ≥ 6.5% or hospital visit for DM or usage of diabetic medication), “Borderline DM” (126 mg/dL > FBG ≥ 110 mg/dL or 6.5% > HbA1c ≥ 6.0%, and without hospital visit, and without diabetic medication), and “Normoglycemic” (FBG < 110 mg/dL and HbA1c < 6.0%, and without hospital visit, and without diabetic medication). New onset of diabetes was evaluated and the events or missing data were occurred at health checkup. For this survival analysis, 339 residents in Kawauchi and 598 residents in Ono were included. Average follow-up periods after 2010 were 3.9 years in Kawauchi village and 3.6 years in Ono town.

Results

Compared with the normoglycemic group, incidence of DM was much greater in the borderline DM group, where DM occurred among 38.2% of the group in 2012 and increased to over 60% cumulatively through 2017 in Kawauchi village. DM had a prevalence of 16.3% in 2012, and below 30% in 2017 in borderline DM group of Ono town. Cox proportional hazard regression analysis was applied to non-DM groups at both study sites separately to evaluate the effects of lifestyle changes at each site. While BMI, BMI change, and the lack of regular exercise (HR = 1.29, 1.72, and 5.04, respectively) showed significant associations with the onset of diabetes in Ono town, only BMI and late-night dinner (HR = 1.21 and 4.86, respectively) showed significant associations with diabetes onset in Kawauchi village.

Conclusions

The current results confirmed that diabetes incidence was increased 6 years after the Daiichi nuclear power plant disaster in Kawauchi. We also found changes in lifestyle habits, suggesting that diabetes prevention with promotion of healthy lifestyle behaviors is an urgent priority.

Effects of Psychological and Lifestyle Factors on Metabolic Syndrome Following the Fukushima Daiichi Nuclear Power Plant Accident: The Fukushima Health Management Survey

Aim: The Fukushima Daiichi Nuclear Power Plant accident dramatically changed the lifestyle of residents who lived near the plant. We evaluated the association of metabolic syndrome (MetS) with specific lifestyle- and disaster-related factors in residents following the accident.

Methods: This cross-sectional study included 20,920 residents who underwent both the Comprehensive Health Check and the Mental Health and Lifestyle Survey from June 2011 to March 2012. Associations between MetS and lifestyle- and disaster-related factors, including psychological distress (post-traumatic stress disorder [PTSD]), were estimated using logistic regression analysis, adjusted for demographic and lifestyle factors, in 2019.

Results: MetS was present in 30.4% of men and 11.5% of women. There were significant differences in smoking, drinking status, and PTSD prevalence between subjects with and without MetS. Multivariable logistic regression analysis showed that age, quitting smoking, and low physical activity were significantly associated with MetS. Moreover, PTSD and light to moderate drinking were also significantly associated with MetS in women.

Conclusions: Lifestyle- and disaster-related factors, including PTSD, were associated with MetS among subjects who lived near the Fukushima Daiichi Nuclear Power Plant accident.

Diabetes and Disasters: Recent Studies and Resources for Preparedness

PURPOSE OF REVIEW

Studies have shown that disasters may exacerbate the comorbidities in vulnerable populations such as those with a pre-existing chronic medical condition like diabetes. This article highlights recent studies that look at the impact of disasters on people with diabetes and also shows recent resources for consumers, health care providers, and policy makers to improve resiliency in people with diabetes.

RECENT FINDINGS

Recent articles have looked at the short-term impact of disasters upon people with diabetes and its comorbidities such as Hurricane Sandy in 2012, the triple disaster of 2011 in Japan (earthquake, tsunami, and nuclear accident), and the 2016 Kumamoto earthquake in Japan as well as the long-term impact of disasters such as Hurricane Katrina in 2005. Several public and private partners have used the past and recent findings to develop resources that help consumers with diabetes and the people who care for them, prepare for a disaster BEFORE the event.

Long-Term Public Health Responses in High-Impact Weather Events: Hurricane Maria and Puerto Rico as a Case Study

This statement responds to the public health challenges in Puerto Rico in the wake of Hurricane Maria during September 2017. As a result of Maria, and to a certain extent Hurricane Irma, the territory sustained unprecedented damage. We call for a mid- and long-term public health response and research to assess the long-term impacts of high-impact weather events, such as Maria's effects on Puerto Rico, including impacts on vulnerable populations' environmental health and well-being.

Living in the Restoration Public Housing after the Great East Japan Earthquake Correlates with Lower Subjective Well-Being of Older Adults

We aimed to (1) describe the subjective well-being (SWB) of older residents in Fukushima Prefecture seven years and seven months after the Great East Japan Earthquake (GEJE) and examine the effect of relocation to the restoration public housing (RPH) on SWB, social capital, and health indicators; and (2) investigate the association between social capital and SWB. Questionnaires were administered to collect data of both RPH and non-RPH residents (≥65 years). Respondents' SWB was collected via the Japanese version of the World Health Organization Five Well-Being Index. Additionally, residents' social capital (trust, reciprocity, and participation), physical activity level, social network, functional health, history of chronic disease, and demographic data were collected. We analyzed 101 responses (valid response rate: approximately 34%) from RPH and 158 (53%) from non-RPH residents. SWB was lower in RPH compared to non-RPH residents but not statistically significant. Older RPH residents may demonstrate lower social capital and health indicators after the GEJE. Mistrust was found to be positively associated with low SWB in RPH residents. Future studies should examine the effectiveness of support for enhancing the trust of older RPH residents regarding, for example, the involvement of scientists-including medical professionals-in risk communications in promoting SWB.

Autoimmune hepatitis, fatty liver, and Fukushima

The use of direct antiviral agents (DAAs) for hepatitis C virus has led to a paradigm shift from viral hepatitis to non-viral disease. Autoimmune hepatitis (AIH) remains to be an issue in liver disease after the DAAs era. Moreover, fatty liver had been increasing in incidence and has attracted attention because of its risk for hepatocellular carcinoma. In 2011, the Great East Japan Earthquake, with the associated tsunami and accident at Fukushima Daiichi Nuclear Power Plant, has changed the lifestyle of residents in Fukushima prefecture. In this manuscript, we outlined the recent topics about AIH, fatty liver, and Fukushima.

Risk Factor for Incident Functional Disability and the Effect of a Preventive Exercise Program: A 4-Year Prospective Cohort Study of Older Survivors from the Great East Japan Earthquake and Nuclear Disaster

Objective: The aim of this study is to assess the risk factors for incident functional disability among long-term evacuees of Iitate village after Great East Japan Earthquake and nuclear disaster (GEJE). We also investigated the effectiveness of exercise classes as an intervention measure in this situation. Methods: 1159 subjects (75.2 ± 5.8 years, 57.5% female) were included at baseline, and followed-up for four years. Cox proportional hazard regression analysis was used to estimate the hazard ratio (HR) of incident functional disability according to the presence of risk factors evaluated by the municipality’s self-assessment Basic Checklist (BCL). Evacuees from Iitate who participated in the exercise classes and those who did not were matched using the propensity scores, which were then used to obtain the HR of incident functional disability. Results: New functional disability occurred in 280 (24.2%) participants during the follow-up. Participants who scored negative for the “Physical function” domain in the BCL had a HR of 2.04 (95% CI: 1.54–2.69) for incident functional disability when compared to those who scored positive for this domain. Similarly, the HR for “Cognitive function” was 1.37 (CI: 1.06–1.77), and 1.60 (CI: 1.24–2.08) for “Depression”. Using a Cox proportional hazard regression model, both the group with low-participation in the exercise program and the group with high-participation in the exercise program had a significantly lower rate of incident functional disability compared to those who did not participate at all (HR = 0.27, CI: 0.16–0.46; HR = 0.30, CI: 0.12–0.74, respectively). Conclusions: Pre-disaster BCL domains were useful to identify individuals at risk of functional disability after a major socio-technical disaster. Therefore, this instrument can be used to identify at-risk older adults who would benefit from early exercise programs to prevent incident functional disability.

Peptic Ulcers in Fukushima Prefecture Related to the Great East Japan Earthquake, Tsunami and Nuclear Accident

Objective Due to the Great East Japan Earthquake, which occurred in March 2011, many residents of Fukushima Prefecture were affected by a radiation accident in addition to suffering loss or damage from the earthquake and the subsequent tsunami. The aim of this study was to evaluate the actual condition of patients with peptic ulcers related to the disaster. Methods Patients with peptic ulcers at six hospitals in three different regions of Fukushima Prefecture during the two months following the disaster and the corresponding period of the year before and the year after the disaster were enrolled in this study. Changes by period and region in the number of esophagogastroduodenoscopy (EGD) examinations and the number of peptic ulcer patients were evaluated as the primary endpoints. Changes in the frequencies of hemorrhagic ulcers were evaluated by period and by region as secondary endpoints. Results The numbers of EGDs and peptic ulcer cases compared to the previous year decreased in 2011 and then increased in 2012. However, the ratio of hemorrhagic ulcers to peptic ulcers was higher in 2011 (51.9%) than in 2010 (38.1%) and 2012 (31.1%), and the 2011 hemorrhagic ulcer ratio was the highest at 63.6% in the coastal area. Regarding bleeding cases during 2011, the rate at 1 month after the disaster (64.1%) was higher than the rate at 2 months after the disaster (40.5%) (p=0.033). Conclusion The number of patients with peptic ulcers did not increase immediately following the disaster in Fukushima Prefecture. However, the rate of bleeding patients increased soon after the disaster, especially in the coastal area.

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

OBJECTIVE

To assess the medium-term indirect impact of the 2011 Fukushima Daiichi nuclear accident on cardiovascular disease (CVD) risks and to identify whether risk factors for CVD changed after the accident.

PARTICIPANTS

Residents aged 40 years and over participating in annual public health check-ups from 2009 to 2012, administered by Minamisoma city, located about 10 to 40 km from the Fukushima Daiichi nuclear plant.

METHODS

The sex-specific Framingham CVD risk score was considered as the outcome measure and was compared before (2009-2010) and after the accident (2011-2012). A multivariate regression analysis was employed to evaluate risk factors for CVD.

RESULTS

Data from 563 individuals (60.2% women) aged 40 to 74 years who participated in the check-ups throughout the study period was analysed. After adjusting for covariates, no statistically significant change was identified in the CVD risk score postaccident in both sexes, which may suggest no obvious medium-term health impact of the Fukushima nuclear accident on CVD risk. The risk factors for CVD and their magnitude and direction (positive/negative) did not change after the accident.

CONCLUSIONS

There was no obvious increase in CVD risks in Minamisoma city, which may indicate successful management of health risks associated with CVD in the study sample.

Roles of children and their parents in the reduction of radiation risk after the 2011 Fukushima Daiichi Nuclear Power Plant accident

Introduction

On March 11, 2011, Japan experienced its largest recorded earthquake with a magnitude of 9.0. The resulting tsunami caused massive damage to the Fukushima Daiichi Nuclear Power Plant reactors, and the surrounding environment was contaminated with radioactive materials. During this period, some residents were exposed to high levels of radiation (up to 5 millisieverts [mSv]), but since then, many residents have been exposed to low levels of radiation (<1 mSv). This study was conducted to assess the effects of lifestyle and attitude factors on external radiation exposure among Fukushima residents.

Methods

This community-based, cross-sectional study was conducted in Nihonmatsu City of the Fukushima Prefecture from May to July 2014. The population survey targeted 6,884 children between the ages of 0–15 years, and a personal radiation badge and questionnaire were administered to each of the residences. Multiple linear regression analysis was used to assess the impact of lifestyle and attitude factors on external radiation dose.

Results

The study participants (population size [n] = 4,571) had an additional mean radiation dose of 0.65 mSv/year, which is small as compared to the mean radiation dose 6 months after the disaster (1.5 mSv/year), in 2012 (1.5 mSv/year), and in 2013 (1.0 mSv/year). External radiation doses statistically varied by socio-demographic and lifestyle factors. Participants living in wooden residences (p-value<0.001) and within 100 meters of a forest (p = 0.001) had higher radiation exposure. Conversely, participants with a cautious attitude towards radiation had lower radiation exposure (beta [b] = -0.124, p = 0.003).

Conclusion

Having a cautious attitude towards radiation and being aware of exposure risks proved to be significant in the reduction of external radiation dose. Therefore, in the event of future radiation disasters, attitudes towards and awareness of radiation should be considered in the reduction of exposure risk and implementation of radiation protection.

Additional risk of diabetes exceeds the increased risk of cancer caused by radiation exposure after the Fukushima disaster

The 2011 Fukushima disaster led to increases in multiple risks (e.g., lifestyle diseases and radiation exposure) and fear among the public. Here, we assessed the additional risks of cancer caused by radiation and diabetes related to the disaster and the cost-effectiveness of countermeasures against these conditions. Our study included residents of the cities of Minamisoma and Soma (10-40 km and 35-50 km north of the Fukushima Daiichi (N° 1) Nuclear Power Station, respectively). We used the loss of life expectancy (LLE) as an indicator to compare risks between radiation exposure and diabetes. We also estimated the cost-effectiveness of radiation-related countermeasures, including restricted food distribution, decontamination, and whole-body counter tests and interventions. Metformin therapy was selected as a representative management for diabetes. The diabetes-related LLEs among residents were 4.1 (95% confidence interval: 1.4-6.8) ×10-2 years for the whole population and 8.0 (2.7-13.2) ×10-2 years for 40s to 70s in a scenario that considered the additional incidence of diabetes during the first 10 years. The cancer-related LLEs caused by lifetime exposure to radiation were 0.69 (2.5-97.5 percentile: 0.61-0.79) ×10-2 years for the whole population and 0.24 (0.20-0.29) ×10-2 years for 40s to 70s. The diabetes-related LLEs among residents in the above-mentioned scenario were 5.9-fold and 33-fold higher than those attributed to average radiation among the whole population and among the 40s to 70s age groups, respectively. The costs per life-years saved of the radiation countermeasures (i.e., restricted food distribution, decontamination, and whole-body counter tests and interventions) were >1 to >4 orders of magnitude higher than those of general heath checkups and conventional management for diabetes. Our findings indicate that countermeasures to mitigate diabetes are warranted. Policy-makers' and individuals' understanding of multiple risks after any disaster will be essential to saving the lives of victims.

Effects of socioeconomic factors on cardiovascular-related symptoms among residents in Fukushima after the Great East Japan Earthquake: a cross-sectional study using data from the Fukushima Health Management Survey

OBJECTIVE

To investigate the association between socioeconomic factors and the exacerbation of cardiovascular symptoms among evacuees after the Great East Japan Earthquake.

METHODS

A sample of 73 433 individuals was included in the Fukushima Health Management Survey. Self-report questionnaires were used to determine the influence of socioeconomic factors including living arrangements, loss of employment and decreased income on the exacerbation of headache, dizziness, palpitations and shortness of breath. Odds ratios (ORs) and 95% CIs of the effect of socioeconomic factors were estimated for each symptom using multiple logistic regression analyses.

RESULTS

Exacerbation of headaches was reported by 1893 individuals, dizziness by 1229, palpitations by 1085 and shortness of breath by 626 individuals. Evacuation accommodation was associated with all of these symptoms. Compared with participants living in their own home (OR=1.00), individuals living in relatives' homes had increased probability of experiencing exacerbation of headache (1.58; 95% CI 1.19 to 2.09) and dizziness (1.42; 95% CI 1.02 to 1.98); those living in rental housing or apartments experienced exacerbation of headache (1.54; 95% CI 1.32 to 1.80), dizziness (1.45; 95% CI 1.20 to 1.75), palpitations (1.25; 95% CI 1.03 to 1.51) and shortness of breath (1.76; 95% CI 1.35 to 2.28); participants living in evacuation shelters experienced exacerbation of headache (1.80; 95% CI 1.09 to 2.96); and refugees living in temporary housing also experienced exacerbation of headache (1.42; 95% CI 1.15 to 1.72), dizziness (1.40; 95% CI 1.09 to 1.79) and shortness of breath (1.49; 95% CI 1.07 to 2.08). Compared with the evacuees who retained their jobs, unemployed individuals showed increased probability of exacerbation of headache (1.28, 95% CI 1.12 to 1.46), dizziness (1.26, 95% CI 1.07 to 1.48) and palpitations (1.21, 95% CI 1.01 to 1.45). Decreased income was associated with exacerbation of headache (1.39, 95% CI 1.22 to 1.60).

CONCLUSION

After the earthquake, living in non-home conditions was more likely to result in exacerbated cardiovascular symptoms among evacuees. Loss of employment was another risk factor related to exacerbated headache and dizziness.

The impact of evacuation on the incidence of chronic kidney disease after the Great East Japan Earthquake: The Fukushima Health Management Survey

Background

About 146,000 people were forced into long-term evacuation due to the nuclear power plant accident caused by the Great East Japan Earthquake in 2011. Disaster is known to induce hypertension in survivors for a certain period, but it is unclear whether prolonged disaster stress influences chronic kidney disease (CKD). We conducted an observational cohort study to elucidate the effects of evacuation stress on CKD incidence.

Methods

Participants were individuals living in communities near the Fukushima nuclear power plant, aged 40–74 years without CKD as of their 2011 general health checkup (non-evacuees: n = 9780, evacuees: n = 4712). We followed new-onset CKD [estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m² or proteinuria] using general annual health checkup data from 2012 to 2014. Association between evacuation and CKD incidence was analyzed using the Cox proportional hazard model.

Results

Mean age of the participants at baseline was 65 years, 46.7% were men, and baseline eGFR was 75.7 ml/min/1.73 m². During the mean follow-up period of 2.46 years, CKD incidence rate was 80.8/1000 and 100.2/1000 person-years in non-evacuees and evacuees, respectively. Evacuation was a significant risk factor of CKD incidence after adjusting for age, gender, obesity, hypertension, diabetes, dyslipidemia, smoking, and baseline eGFR [hazard ratio (HR): 1.45; 95% confidence interval (CI) 1.35–1.56]. Evacuation was significantly associated with the incidence of eGFR <60 ml/min/1.73 m² (HR: 1.48; 95% CI 1.37–1.60), but not with the incidence of proteinuria (HR: 1.21; 95% CI 0.93–1.56).

Conclusion

Evacuation was a risk factor associated with CKD incidence after the disaster.

Influence of Post-disaster Evacuation on Incidence of Metabolic Syndrome

AIM

After the Great East Japan Earthquake, over 160,000 residents near the Fukushima Daiichi Nuclear Power Plant were forced to evacuate due to a nuclear accident. Health problems in these evacuees have since become major issues. We examined the association between evacuation and incidence of metabolic syndrome (METS) among residents in Fukushima.

METHODS

We conducted a cohort study among residents aged 40-74 years without METS at the time of the disaster in Fukushima. Among 20,269 residents who met the inclusion criteria before the disaster, 8,547 residents (3,697 men and 4,850 women; follow-up proportion: 42.2%) remained available for follow-up examinations after the disaster by the end of March 2013. The main outcome was incidence of METS, defined by guidelines from the Japanese committee, using data from the Comprehensive Health Check before and after the disaster. We divided participants by evacuation status and compared outcomes between groups. Using a logistic regression model, we estimated the odds ratio for incidence of METS, adjusting for potential confounders, age, gender, waist circumference, exercise habit, and alcohol consumption.

RESULTS

Incidence of METS was higher in evacuees (men 19.2%, women 6.6%) than in non-evacuees (men 11.0%, women 4.6%). Evacuees had higher body mass index, waist circumference, triglycerides, and fasting plasma glucose after the disaster than non-evacuees. We found a significant association between evacuation and incidence of METS (adjusted odds ratio 1.72, 95% confidence interval; 1.46-2.02).

CONCLUSION

This is the first study to demonstrate that evacuation after a disaster is associated with increased incidence of METS.

Systemization of the Establishment of Standards and Future Prospects: Toward the Establishment of Standards in Nonstationary States

Although public interest on safety standards is increasing, the evidence and protocols associated with the standards are not known well to the public and even experts. Discussing the evidence of standards is essential for risk communication, and interdisciplinary and systematical understanding on how to establish standards are also beneficial for considering the set-up of new standards. In this article, on the basis of examples in environmental science, industrial health and safety, and radiological protection, I overview and systemize the establishment of the standards from the perspectives of three principles of risk management: 1) "zero-risk-like" standards, 2) "acceptable-risk-based" standards, and 3) "cost-balanced" standards. In this view, I point out the differences in uncertainty factors or acceptable-risk levels among individual standards and demonstrate the role of the "as low as reasonably achievable (ALARA)" concept. Then, on the basis of the problem on lack of environmental standards in nonstationary states such as disasters, I summarize elements necessary for establishing the standards. As perspectives for further study, I suggest the needs for risk assessment of chemicals having a threshold, full considerations of risk trade-offs and ethical aspects, and applications of processes to the establishment of standards through stakeholder consensus.

Persistent prevalence of polycythemia among evacuees 4 years after the Great East Japan Earthquake: A follow-up study

We previously reported that the lifestyle of evacuees significantly increased the prevalence of polycythemia compared with non-evacuees at an average of 1.6 years (2011–2012) from the previous annual health checkup before the Great East Japan Earthquake (GEJE). Here we analyzed how the prolonged evacuation affected the prevalence of polycythemia an average of 2.5 years (2013–2014) after the previous data. Subjects were individuals aged 40–90 years living in the vicinity of the Fukushima Daiichi Nuclear Power Plant in Fukushima Prefecture who had attended the annual health checkups since 2008. The prevalence of polycythemia and changes in its defining factors of red blood cell count (RBC), hemoglobin (Hb) level, hematocrit (Ht) level were compared between before and after the GEJE in 7713 individuals (3349 men and 4364 women) receiving follow-up examinations both 2011–2012 and 2013–2014. RBC, Hb levels and Ht levels in 2011–2012 were higher among evacuees than non-evacuees in both men and women. However, all levels in 2013–2014 were on the decline from those in 2011–2012. On the other hand, among evacuees, Hb and Ht levels continued to be higher than before the GEJE in both men and women evacuees. The prevalence of polycythemia, which was diagnosed if one of the defining factors was beyond the standard value, was significantly higher among evacuees than non-evacuees regardless of the presence or the absence of overweight/obesity, smoking, and hypertension. Therefore, prolonged evacuation is a cause of polycythemia even 3 to 4 years after the GEJE and regular health management of evacuees is important.

•

Evacuation after the Great East Japan Earthquake (GEJE) causes polycythemia.

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Evacuation is an independent factor of polycythemia.

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Prevalence of polycythemia among evacuees persists even after 4 years of the GEJE.

Radiation-related anxiety among public health nurses in the Fukushima Prefecture after the accident at the Fukushima Daiichi Nuclear Power Station: a cross-sectional study

OBJECTIVE

In Japan, public health nurses (PHNs) play important roles in managing the health of local residents, especially after a disaster. In this study, we assessed radiation anxiety and the stress processing capacity of PHNs in the Fukushima Prefecture in Japan, after the accident at the Fukushima Daiichi Nuclear Power Station (FDNPS).

METHODS

We conducted a questionnaire survey among the PHNs (n=430) in July of 2015 via postal mail. The questions included demographic factors (sex, age and employment position), knowledge about radiation, degree of anxiety about radiation at the time of the FDNPS accident (and at present), by asking them to answer questions about radiation and the Sense of Coherence-13 (SOC-13). We classified the low and high levels of anxiety by asking them to answer questions about radiation, and compared the anxiety-negative (-) group with the anxiety-positive (+) group.

RESULTS

Of the PHNs, 269 (62.6%) were classified in the anxiety (-) group and 161 (37.4%) were in the anxiety (+) group. When the multivariate logistic regression analysis was conducted, the PHNs at the time of the accident (OR: 2.37, p=0.007), current general anxieties about radiation (OR: 3.56, p<0.001), current possession of materials to obtain knowledge about radiation (OR: 2.11, p=0.006) and knowledge of the childhood thyroid cancer increase after the Chernobyl accident (OR: 1.69, p=0.035) were significantly associated with anxiety after the FDNPS accident. The mean SOC-13 was 43.0±7.7, with no significant difference between the anxiety (-) group and anxiety (+) group (p=0.47).

CONCLUSIONS

Our study suggested that anxiety about radiation was associated with materials and knowledge about radiation in the PHNs in the Fukushima Prefecture 4 years after the FDNPS accident. It is important for PHNs to obtain knowledge and teaching materials about radiation, and radiation education programmes for PHNs must be established in areas that have nuclear facilities.

School restrictions on outdoor activities and weight status in adolescent children after Japan's 2011 Fukushima Nuclear Power Plant disaster: a mid-term to long-term retrospective analysis

OBJECTIVE

Radiation fears following Japan's 2011 Fukushima nuclear disaster affected levels of physical activity in local children. We assessed the postdisaster versus predisaster weight status in school children and evaluated to what extent school restrictions on outdoor activities that were intended to reduce radiation exposure risk affected child weight.

PARTICIPANTS

We considered children aged 13-15 years from 4 of the 5 secondary schools in Soma City (n=1030, 99.1% of all children in the city), located in 35-50 km from the Fukushima nuclear plant, postdisaster (2012 and 2015) and predisaster (2010).

METHODS

Weight status, in terms of body mass index (BMI), percentage of overweight (POW) and incidence of obesity and underweight (defined as a POW ≥20% and ≤-20%, respectively) were examined and compared predisaster and postdisaster using regression models. We also constructed models to assess the impact of school restrictions on outdoor activity on weight status.

RESULTS

After adjustment for covariates, a slight decrease in mean BMI and POW was detected in females in 2012 (-0.37, 95% CI -0.68 to -0.06; and -1.97, 95% CI -3.57 to -0.36, respectively). For male children, obesity incidence increased in 2012 (OR for obesity: 1.45, 95% CI 1.02 to 2.08). Compared with predisaster weight status, no significant weight change was identified in 2015 in either males or females. School restrictions on outdoor activities were not significantly associated with weight status.

CONCLUSIONS

4 years following the disaster, weight status has recovered to the predisaster levels for males and females; however, a slight decrease in weight in females and a slight increase in risk of obesity were observed in males 1 year following the disaster. Our findings could be used to guide actions taken during the early phase of a radiological disaster to manage the postdisaster health risks in adolescent children.

Lifestyle-related diseases following the evacuation after the Fukushima Daiichi nuclear power plant accident: a retrospective study of Kawauchi Village with long-term follow-up

OBJECTIVES

Kawauchi Village lies 20 km west of the Fukushima Daiichi nuclear power plant. On 16 March 2011, evacuation was ordered due to the threat of radiological exposure, and was lifted in April 2012. In this study, we aimed to evaluate the predisaster and postdisaster health status of the Kawauchi Villagers, measured by routine yearly physical examinations.

METHODS

We analysed the annual health examination data of residents of Kawauchi Village from 2008 to 2013, as available from the Japanese National Health Insurance system. Data from 2011 were not available due to the disaster. Since the health data included the same participants repeatedly from year to year, the sample was non-independent and generalised estimated equation modelling was used. A predisaster time period (2008-2010) was categorised for comparison with postdisaster 2012 and 2013. The outcome examined was the prevalence of metabolic disease, and was adjusted for confounding factors.

RESULTS

Data for 20.6%-25.9% of the total residents were available in this period. In 2013, the prevalence of metabolic syndrome (from 17.0% to 25.2%, p<0.001), diabetes (from 11.3% to 17.0%, p<0.001), dyslipidaemia (from 43.2% to 56.7%, p<0.0001), hyperuricaemia (from 5.2% to 8.4%, p=0.006) and chronic kidney disease (from 16.1% to 26.7%, p<0.001) was found to be elevated significantly compared to predisaster years, while that of obesity or hypertension did not change.

CONCLUSIONS

The present follow-up study for Kawauchi Village revealed an increase in lifestyle-related disease following the March 2011 disaster and subsequent evacuation, and this trend still continues 2 years later.

Sociodemographic patterning of long-term diabetes mellitus control following Japan's 3.11 triple disaster: a retrospective cohort study

OBJECTIVE

To assess the sociodemographic patterning of changes in glycaemic control of patients with diabetes affected by the 2011 triple disaster in Japan (earthquake, tsunami and nuclear accident).

METHODS

A retrospective cohort study was undertaken with 404 patients with diabetes at a public hospital in Minamisoma City, Fukushima Prefecture. Glycated haemoglobin (HbA1c) levels were measured in 2010, 2011 and 2012 to capture changes in glycaemic control postdisaster. Age, sex, urban/rural residency, evacuation status and medication use were also assessed.

RESULTS

There was an overall deterioration in glycaemic control after the disaster, with the mean HbA1c rising from 6.77% in 2010 to 6.90% in 2012 (National Glycohemoglobin Standardization Program, NGSP). Rural residency was associated with a lower likelihood of deteriorating control (OR 0.34, 95% CI 0.13 to 0.84), compared with urban residency. Older age (OR 0.95, 95% CI 0.91 to 0.98) was also slightly protective against increased HbA1c. Evacuation and sex were not significant predictors.

CONCLUSIONS

Patients with diabetes who were affected by Japan's triple disaster experienced a deterioration in their glycaemic control following the disasters. The extent of this deterioration was mediated by sociodemographic factors, with rural residence and older age protective against the effects of the disaster on glycaemic control. These results may be indicative of underlying social determinants of health in rural Japan.

Association between psychological distress and dietary intake among evacuees after the Great East Japan Earthquake in a cross-sectional study: the Fukushima Health Management Survey

OBJECTIVE

Psychological distress is generally associated with poor dietary intake, but this has never been investigated among residents after a major disaster. We attempted to reveal the associations between dietary intake and non-specific mental health distress as well as traumatic symptoms among evacuees after the Great East Japan Earthquake of 2011.

METHODS

In this cross-sectional analysis of 63 047 evacuees (27 901 men, 35 146 women) who responded to The Fukushima Health Management Survey in 2012, non-specific mental health distress was assessed using the Kessler-6 (K6) scale, while traumatic symptoms were evaluated using the Post-traumatic Stress Disorder (PTSD) Checklist-Stressor-Specific Version (PCL-S). The outcome was 'low frequency'-meaning a daily consumption in the 25th centile or less according to the food frequency questionnaire (FFQ)-of 19 targeted food items. Logistic regression analysis was used to estimate ORs and 95% CIs adjusted for demographic, lifestyle-related and disaster-related factors.

RESULTS

Of the participants, 14.7% suffered non-specific mental health distress, and 21.2% exhibited traumatic symptoms. Multivariable adjusted logistic regression analysis showed that the former were likely to have a low intake frequency of certain foods, such as rice and bread, fish, meat, vegetables or fruit (non-juice), soya bean products, milk, and yogurt or lactobacillus drinks; the latter were also likely to have a low intake frequency of certain foods, including rice and bread, fish, meat, vegetables (non-juice), milk and yogurt or lactobacillus drinks, but conversely consumed vegetable and fruit juices more often. These associations between dietary intake and non-specific mental health distress, as well as traumatic symptoms, were predominantly observed in women.

CONCLUSIONS

Psychological distress after the Great East Japan Earthquake among evacuees was associated with a low intake frequency of certain foods, and the association was predominantly observed in women.

The Tohoku Medical Megabank Project: Design and Mission

The Great East Japan Earthquake (GEJE) and resulting tsunami of March 11, 2011 gave rise to devastating damage on the Pacific coast of the Tohoku region. The Tohoku Medical Megabank Project (TMM), which is being conducted by Tohoku University Tohoku Medical Megabank Organization (ToMMo) and Iwate Medical University Iwate Tohoku Medical Megabank Organization (IMM), has been launched to realize creative reconstruction and to solve medical problems in the aftermath of this disaster. We started two prospective cohort studies in Miyagi and Iwate Prefectures: a population-based adult cohort study, the TMM Community-Based Cohort Study (TMM CommCohort Study), which will recruit 80 000 participants, and a birth and three-generation cohort study, the TMM Birth and Three-Generation Cohort Study (TMM BirThree Cohort Study), which will recruit 70 000 participants, including fetuses and their parents, siblings, grandparents, and extended family members. The TMM CommCohort Study will recruit participants from 2013 to 2016 and follow them for at least 5 years. The TMM BirThree Cohort Study will recruit participants from 2013 to 2017 and follow them for at least 4 years. For children, the ToMMo Child Health Study, which adopted a cross-sectional design, was also started in November 2012 in Miyagi Prefecture. An integrated biobank will be constructed based on the two prospective cohort studies, and ToMMo and IMM will investigate the chronic medical impacts of the GEJE. The integrated biobank of TMM consists of health and clinical information, biospecimens, and genome and omics data. The biobank aims to establish a firm basis for personalized healthcare and medicine, mainly for diseases aggravated by the GEJE in the two prefectures. Biospecimens and related information in the biobank will be distributed to the research community. TMM itself will also undertake genomic and omics research. The aims of the genomic studies are: 1) to construct an integrated biobank; 2) to return genomic research results to the participants of the cohort studies, which will lead to the implementation of personalized healthcare and medicine in the affected areas in the near future; and 3) to contribute the development of personalized healthcare and medicine worldwide. Through the activities of TMM, we will clarify how to approach prolonged healthcare problems in areas damaged by large-scale disasters and how useful genomic information is for disease prevention.

Postnuclear disaster evacuation and chronic health in adults in Fukushima, Japan: a long-term retrospective analysis

OBJECTIVE

Japan's 2011 Fukushima Daiichi Nuclear Power Plant incident required the evacuation of over a million people, creating a large displaced population with potentially increased vulnerability in terms of chronic health conditions. We assessed the long-term impact of evacuation on diabetes, hyperlipidaemia and hypertension.

PARTICIPANTS

We considered participants in annual public health check-ups from 2008 to 2014, administrated by Minamisoma City and Soma City, located about 10-50 km from the Fukushima nuclear plant.

METHODS

Disease risks, measured in terms of pre-incident and post-incident relative risks, were examined and compared between evacuees and non-evacuees/temporary-evacuees. We also constructed logistic regression models to assess the impact of evacuation on the disease risks adjusted for covariates.

RESULTS

Data from a total of 6406 individuals aged 40-74 years who participated in the check-ups both at baseline (2008-2010) and in one or more post-incident years were analysed. Regardless of evacuation, significant post-incident increases in risk were observed for diabetes and hyperlipidaemia (relative risk: 1.27-1.60 and 1.12-1.30, respectively, depending on evacuation status and post-incident year). After adjustment for covariates, the increase in hyperlipidaemia was significantly greater among evacuees than among non-evacuees/temporary-evacuees (OR 1.18, 95% CI 1.06 to 1.32, p<0.01).

CONCLUSIONS

The singularity of this study is that evacuation following the Fukushima disaster was found to be associated with a small increase in long-term hyperlipidaemia risk in adults. Our findings help identify discussion points on disaster planning, including preparedness, response and recovery measures, applicable to future disasters requiring mass evacuation.

Acute post-disaster medical needs of patients with diabetes: emergency department use in New York City by diabetic adults after Hurricane Sandy

OBJECTIVE

To evaluate the acute impact of disasters on diabetic patients, we performed a geospatial analysis of emergency department (ED) use by New York City diabetic adults in the week after Hurricane Sandy.

RESEARCH DESIGN AND METHODS

Using an all-payer claims database, we retrospectively analyzed the demographics, insurance status, and medical comorbidities of post-disaster ED patients with diabetes who lived in the most geographically vulnerable areas. We compared the patterns of ED use among diabetic adults in the first week after Hurricane Sandy's landfall to utilization before the disaster in 2012.

RESULTS

In the highest level evacuation zone in New York City, postdisaster increases in ED visits for a primary or secondary diagnosis of diabetes were attributable to a significantly higher proportion of Medicare patients. Emergency visits for a primary diagnosis of diabetes had an increased frequency of certain comorbidities, including hypertension, recent procedure, and chronic skin ulcers. Patients with a history of diabetes visited EDs in increased numbers after Hurricane Sandy for a primary diagnosis of myocardial infarction, prescription refills, drug dependence, dialysis, among other conditions.

CONCLUSIONS

We found that diabetic adults aged 65 years and older are especially at risk for requiring postdisaster emergency care compared to other vulnerable populations. Our findings also suggest that there is a need to support diabetic adults particularly in the week after a disaster by ensuring access to medications, aftercare for patients who had a recent procedure, and optimize their cardiovascular health to reduce the risk of heart attacks.

Pain, quality of life and activity in aged evacuees living in temporary housing after the Great East Japan earthquake of 11 March 2011: a cross-sectional study in Minamisoma City, Fukushima prefecture

BACKGROUND

The aim of this study was to clarify pain, quality of life and activity in the aged evacuees living in temporary housing after the Great East Japan Earthquake on 11 March 2011.

METHODS

The study was a cross-sectional study performed in Minamisoma City, Fukushima Prefecture 1 year and 6 months after the disaster. Inclusion criteria were the ability to walk independently and consent to answer questionnaires. Seventy-one evacuees who met the inclusion criteria were included in this study. There were 16 men and 55 women with a mean age of 75.9 years. Sixty evacuees were surveyed when they gathered at the assembly hall in the temporary housing (Assembled group) and 11 evacuees were surveyed through individual visits to their residences (Individual group). Evacuees in the Individual group agreed to participate in this study, but refused to visit the assembly hall to engage in exercise and recreation. Pain, quality of life (QOL) and level of activity were assessed with the Numeric Rating Scale (NRS), the MOS Short-Form 36 item Health Survey (SF-36) and a pedometer, respectively. Student's t-test, Mann-Whitney U test, and Fisher's exact test were used for statistical analysis.

RESULTS

Forty-four (62.0 %) residents had chronic pain with a mean NRS of 2.74. Twenty-one (29.6 %) of these residents had relatively severe pain rated 5 or above on the NRS. QOL was significantly lower for the subscales of "physical functioning," "role physical", "general health", "social functioning", "role emotional" and "mental health", when compared with the national standard values. Values were also visibly lower for "physical component summary" in the summary score. On comparing the Assembled group and the Individual group, "physical function", "role physical", "social functioning" and "physical component summary" were found to be significantly lower in the Individual group. The mean daily number of steps was 1,892 in the Individual group and 4,579 in the Assembled group. The Individual group thus significantly took less mean daily number of steps compared with the Assembled group.

CONCLUSIONS

This study quantified the state of pain, QOL and activity of aged evacuees living in temporary housing after the Great East Japan Earthquake. The evacuees frequently had chronic pain and lower physical and mental QOL scores compared to the national standard values.