Why Do They Not Come Home? Three Cases of Fukushima Nuclear Accident Evacuees

Many people wish to return to where they used to live after evacuation due to disaster. After the Fukushima nuclear accident in 2011, many residents were forced to evacuate due to concerns about radiation. Subsequently, the evacuation order was lifted, and the government promoted a return policy. However, it has been reported that a considerable number of residents living in evacuation sites or other areas wish to return but are unable to do so. Here, we report three cases of Japanese men and one woman who evacuated after the 2011 nuclear accident in Fukushima. These cases reveal the rapid aging of residents and their health issues. These issues suggest that enhancing medical supply systems and access to medical care can aid in post-disaster reconstruction and residents' returning.

Effects of 2018 Japan floods on healthcare costs and service utilization in Japan: a retrospective cohort study

BACKGROUND

Floods and torrential rains are natural disasters caused by climate change. Unfortunately, such events are more frequent and are increasingly severe in recent times. The 2018 Japan Floods in western Japan were one of the largest such disasters. This study aimed to evaluate the effect of the 2018 Japan Floods on healthcare costs and service utilization.

METHODS

This retrospective cohort study included all patients whose receipts accrued between July 2017 and June 2019 in Hiroshima, Okayama, and Ehime prefectures using the National Database of Health Insurance Claims. We used Generalized Estimating Equations (GEEs) to investigate yearly healthcare costs during the pre-and post-disaster periods, quarterly high-cost patients (top 10%), and service utilization (outpatient care, inpatient care, and dispensing pharmacy) during the post-disaster period. After the GEEs, we estimated the average marginal effects as the attributable disaster effect.

RESULTS

The total number of participants was 5,534,276. Victims accounted for 0.65% of the total number of participants (n = 36,032). Although there was no significant difference in pre-disaster healthcare costs (p = 0.63), post-disaster costs were $3,382 (95% CI: 3,254-3,510) for victims and $3,027 (95% CI: 3,015-3,038) for non-victims (p < 0.001). The highest risk difference among high-cost patients was 0.8% (95% CI: 0.6-1.1) in the fourth quarter. In contrast, the highest risk difference of service utilization was in the first quarter (outpatient care: 7.0% (95% CI: 6.7-7.4), inpatient care: 1.3% (95% CI: 1.1-1.5), and dispensing pharmacy: 5.9% (95% CI: 5.5-6.4)).

CONCLUSION

Victims of the 2018 Japan Floods had higher medical costs and used more healthcare services than non-victims. In addition, the risk of higher medical costs was highest at the end of the observation period. It is necessary to estimate the increase in healthcare costs according to the disaster scale and plan for appropriate post-disaster healthcare service delivery.

Demographic Change of the Kawauchi Special Nursing Home Occupants in a Former Evacuation Area After the Nuclear Power Plant Accident: A Retrospective Observational Study

OBJECTIVE

This retrospective observational study aimed to look into the social demographic change of the occupants of a long-term care (LTC) facility that was constructed in 2015 as a restoration support after the Fukushima Daiichi nuclear power plant accident.

METHODS

The social demographic information during 2015-2021 of occupants in the Kawauchi Special Nursing Home was analyzed.

RESULTS

A total of 172 participants were included in the analysis. The number (proportion) of evacuees was 37 (69.8%) in 2015, then gradually decreased to 7 (31.8%) in 2018, yet increased to 21 (58.3%) in 2019. There were 121 occupants (70.4%) who were from Kawauchi Village and other municipalities of the former evacuation area.

CONCLUSION

The Kawauchi Special Nursing Home initially received people who hoped to return to the former evacuation zone; however, its role changed to receive people who became in need of LTC after returning to Kawauchi Village. The construction of LTC facilities in the former evacuation area may help enhance the local LTC service where returnees are rapidly aging.

Long‐term care issues in a municipality affected by the great East Japan earthquake: A case of Katsurao Village, Fukushima prefecture

Information regarding the proposed measures addressing long‐term care problems during disasters at a municipal level is scarce. Thus, this study reviewed the long‐term care insurance measures taken in the Katsurao Village after the Fukushima nuclear accident and summarized the measures that municipalities can take against such issues in the future.

Long-term Care Utilization Discrepancy Among the Elderly in Former Evacuation Areas, Fukushima

OBJECTIVE

It is crucial to determine the health status of returnees to former evacuation areas. We aimed to examine the long-term care (LTC) utilization rate among elderly returnees as the indicator of care needs.

METHODS

This study used a resident registration database to collect information on LTC utilization rate among elderly returnees to former evacuation areas in Fukushima, Japan, following the 2011 Fukushima Daiichi Nuclear Power Plant accident. LTC utilization rates were descriptively analyzed.

RESULTS

For all age groups, the LTC utilization rates were lower among returnees than evacuees. The LTC utilization rate among returnees in each age group (chi-square test results compared to evacuees) were as follows: 0.78% (P = 0.194) for those aged 65-69, 0.69% (P = 0.003) for those aged 70-74, 3.23% (P = 0.007) for those aged 75-79, 6.79% (P < 0.001) for those aged 80-84, 22.84% (P = 0.011) for those aged 85-89, and 44.09% (P = 0.089) for those aged 90 and over.

CONCLUSION

Elderly returnees had fewer LTC needs than elderly evacuees. Nevertheless, the proportion of aging people is high in evacuation area, meaning the number of elderly returnees would increase at an enormous rate. Therefore, LTC utilization rate would increase in the future.

Progress of Disaster Medicine during Ten Years after the 2011 Great East Japan Earthquake

The 2011 Great East Japan Earthquake (GEJE) has renewed the paradigm of disaster medicine. The Tohoku Journal of Experimental Medicine (TJEM) widened its scope to include the disaster science from the health perspectives. TJEM has been accumulating 76 articles related with "disaster" or "pandemic" out of which 69 were published after 2011. Tohoku University established the International Research Institute of Disaster Science (IRIDeS) that took initiative to impact the Sendai Framework for Disaster Risk Reduction 2015-2030 (Sendai Framework) to include health aspect. Sendai Framework provided the platform for collaboration of different sectors, including the terminology that defines the concept of disaster, risk, hazard & exposure, vulnerability and coping capacity. Disaster medicine covers the diverse causes and damages of disasters by various hazards in this globalized and rapidly changing world. TJEM articles range the physical and mental health damage after the GEJE and other disasters with approved ethical consideration of investigations from the view point of affected area, mechanisms of hazard to affect human health including the radiation, virus or hazardous materials, proposal of refinement of health system to cope with disasters such as mental health support, risk communication, disaster medical coordination and hospital business continuity plan and future perspectives with reconstruction including Tohoku Medical Megabank Project. TJEM scope on disaster medicine had been widened during the 10 years after GEJE and IRIDeS can be the bridging hub not only between the health sector and other sectors, but also between disaster medicine and other medical disciplines.

Did the Number of Older People Requiring Long-Term Care and Expenditure Increase after the 2011 Great East Japan Earthquake? Analysis of Changes over Six Years

On 11 March 2011, the great earthquake hit Japan, resulting in 15,895 deaths, 6156 serious injuries, and 2539 missing persons. This event affected the health and lives of older residents, and reports showed an increase in the number of people eligible for long-term care afterward. In this study, among the places affected by the 2011 Great East Japan Earthquake and tsunami, we focused on 15 municipalities, including designated municipalities based on the Special Act on Nuclear Evacuation in Fukushima Prefecture, and aimed to clarify the medium-term effects (six years post-disaster) on the long-term care certification rate and expenditure for provision of services. We used the Ministry of Health, Labour, and Welfare Monthly Status Report on Long-Term Care Insurance and the Ministry of Internal Affairs and Communications Population Register for 2011, 2014, and 2017. In 2011, we found no intergroup differences among the 15 Fukushima municipalities and other municipalities in either the long-term care certification rate or the per-person expenditure for use of services. In 2014, after the earthquake, the long-term care certification rate was 5.4% higher in the 15 Fukushima municipalities than in other municipalities for those aged 75 years or older. The rate of 2014-2017 has not increased significantly, partly because of stability after the disaster and change in the population structure. Nevertheless, the long-term care certification rate in the 15 Fukushima municipalities is higher than that of the other two groups even after six years since the earthquake. Similarly, the per-person expenditure for use of services for one month was 11,800 yen higher in the 15 Fukushima municipalities than in other municipalities in 2014, and this trend continued into 2017. Strong, ongoing governmental support is needed, especially for those aged 75 or older, following a disaster.