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Adams GG, MacMillan L, Smith T, Sharp A, Casagrande R. Meta-Analysis on the Health Effects Resulting from Evacuation or Relocation. Disaster Med Public Health Prep 2023; 17:e538. [PMID: 37994037 DOI: 10.1017/dmp.2023.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
OBJECTIVE Evacuation and relocation are key actions used to protect the public in response to natural or technological disasters, but there are inherent risks to both. Unfortunately, these risks have not been fully quantified, which limits the ability of emergency managers and the public to effectively balance the risks and benefits of evacuation or relocation. This work provides quantitative data on the risks of health effects from displacement following evacuation or relocation. METHODS Researchers performed a literature review and meta-analysis of published studies and quantified risks of 14 different health effects, including both physical and socio-behavioral outcomes, from studies of 9 different disaster types. RESULTS The findings show statistically significant increases in 9 of the 14 health effects in displaced populations, indicating an increased likelihood of experiencing detrimental health effects compared with nondisplaced populations. A pooled analysis of all negative health effects found an odds ratio of 1.49 (95% confidence interval: 1.24-1.79), which shows a significant relationship between displacement and negative health outcomes. CONCLUSIONS These findings demonstrate that evacuated or relocated populations have an increased risk of experiencing negative health effects associated with displacement. The broad number of disaster types included mean that findings are applicable to any emergency evacuation or relocation.
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Affiliation(s)
| | | | - Todd Smith
- US Nuclear Regulatory Commission, Washington, DC, USA
| | - Amy Sharp
- US Nuclear Regulatory Commission, Washington, DC, USA
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2
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Hosoya M, Nakano H, Hashimoto K, Ohira T, Sakai A, Shimabukuro M, Yasumura S, Ohto H, Kamiya K. Influence of post-disaster evacuation on childhood obesity and liver dysfunction: The Fukushima Health Management Survey. Pediatr Int 2023; 65:e15663. [PMID: 38009919 DOI: 10.1111/ped.15663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/10/2023] [Accepted: 08/23/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND After the Great East Japan Earthquake and subsequent Fukushima Daiichi Nuclear Power Plant accident in 2011, the Fukushima Prefectural Government launched a long-term health management survey for the population of Fukushima. Results of the Comprehensive Health Check (CHC) showed that some children aged 6-15 years, who resided in the evacuation area at the time of the disaster, had obesity, hyperlipidemia, liver dysfunction, and/or renal dysfunction from as early as 2011. The aim of the present study was to determine the long-term trend of obesity and hepatic enzyme abnormalities in Fukushima children. METHODS We evaluated the changes in body mass index standard deviation score (BMI-SDS), aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transpeptidase from 2011 to 2018. RESULTS Obesity (BMI-SDS ≥ 2) was significantly associated with hepatobiliary enzyme abnormalities. The mean BMI-SDS was significantly higher in 2011 after the disaster, but then soon showed a gradual decrease. The frequency of obesity did not increase significantly after the disaster. There were no significant differences in the prevalence of hepatobiliary enzyme abnormalities in the children aged 6-15 years of either sex from 2011 to 2018. CONCLUSIONS In the present study, we found that the increase in the mean BMI-SDS after the disaster was temporary, suggesting that the frequency of obesity and liver dysfunction might not have been significantly influenced by the disaster.
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Affiliation(s)
- Mitsuaki Hosoya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima, Japan
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hironori Nakano
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima, Japan
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Koichi Hashimoto
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima, Japan
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tetsuya Ohira
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima, Japan
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Akira Sakai
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima, Japan
- Department of Radiation Life Science, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Michio Shimabukuro
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima, Japan
- Department of Diabetes, Endocrinology and Metabolism, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Seiji Yasumura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima, Japan
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hitoshi Ohto
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima, Japan
| | - Kenji Kamiya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima, Japan
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3
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Ohira T, Nakano H, Okazaki K, Hayashi F, Nagao M, Sakai A, Hosoya M, Shimabukuro M, Takahashi A, Kazama JJ, Hashimoto S, Kawasaki Y, Satoh H, Kobashi G, Yasumura S, Ohto H, Kamiya K. 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. J Epidemiol 2022; 32:S36-S46. [PMID: 36464299 PMCID: PMC9703921 DOI: 10.2188/jea.je20210386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/21/2021] [Indexed: 12/07/2022] Open
Abstract
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.
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Affiliation(s)
- Tetsuya Ohira
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hironori Nakano
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kanako Okazaki
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
- Department of Physical Therapy, Fukushima Medical University School of Health Sciences, Fukushima, Japan
| | - Fumikazu Hayashi
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Masanori Nagao
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Akira Sakai
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
- Department of Radiation Life Sciences, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mitsuaki Hosoya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Michio Shimabukuro
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
- Department of Diabetes, Endocrinology and Metabolism, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Atsushi Takahashi
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Junichiro J. Kazama
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
- Department of Nephrology and Hypertension, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shigeatsu Hashimoto
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
- Department of Endocrinology, Metabolism, Diabetology and Nephrology, Fukushima Medical University Aizu Medical Center, Fukushima, Japan
| | - Yukihiko Kawasaki
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiroaki Satoh
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
- Department of Diabetes and Metabolism, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Gen Kobashi
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
- Department of Public Health, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Seiji Yasumura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hitoshi Ohto
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
| | - Kenji Kamiya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
- Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
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Kamiya K. Health management and care following the Fukushima nuclear power plant accident: overview of Fukushima Health Management Survey. Ann ICRP 2021; 50:82-89. [PMID: 34218678 DOI: 10.1177/01466453211015402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Following the accident at Fukushima Daiichi nuclear power plant, Fukushima Prefecture is conducting the Fukushima Health Management Survey, which has been contracted out to Fukushima Medical University. The purpose of this survey is to investigate the exposure doses and health conditions of the residents of Fukushima Prefecture in order to prevent, diagnose, and treat diseases at an early stage, and to maintain and improve the health of residents in the future.This survey consists of a basic survey to estimate external exposure doses and detailed surveys to investigate health conditions. The detailed surveys comprise: (i) thyroid ultrasound examination; (ii) comprehensive health check; (iii) mental health and lifestyle survey; and (iv) pregnancy and birth survey.In the basic survey, the external exposure dose was estimated for >466,000 people during the first 4 months after the accident; it was estimated to be <5 mSv for 99.8% of residents.The thyroid ultrasound examination included four rounds of echo examinations covering approximately 380,000 children aged <18 years at the time of the accident in each round. The first, second, third, and fourth examinations identified 116, 71, 31, and 21 children with thyroid cancer/suspected cancer, respectively. The Fukushima Prefectural Oversight Committee analysed the results from the first and second examinations, and evaluated that 'the detected increased rate is unlikely to be the impact of radiation'. However, the Oversight Committee is deliberating the future direction of thyroid examination, taking into consideration the advantages and disadvantages of the examination as well as ethical viewpoints.In the comprehensive health check, approximately 210,000 people in the evacuation area were examined, and increased rates of lifestyle-related diseases [e.g. obesity, hypertension, diabetes, and dyslipidaemia (low high-density-lipoprotein cholesterol)] were confirmed. In the mental health and lifestyle survey, approximately 210,000 people, including residents in the evacuation area, were examined. A deterioration in general mental health was found for the period immediately after the accident across a wide range of age groups, and although recovery was seen over the years, the rate of mental health issues remains above the national average. The pregnancy and birth survey revealed that the pre-term birth rate, low-birthweight rate, and rate of congenital anomalies did not differ from the national average.The purpose of Fukushima Health Management Survey is not only to collect data on the health of the residents of Fukushima Prefecture, but to provide direct support to residents regarding the health issues clarified by the survey. Moreover, various initiatives are being implemented in cooperation with various local government authorities with the aim of maintaining and promoting the health of the residents.
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Affiliation(s)
- Kenji Kamiya
- Fukushima Medical University Radiation Medical Science Centre for the Fukushima Health Management Survey, 1 Hikarigaoka, Fukushima City 960-1295, Japan.,Hiroshima University Radiation Emergency Medicine Promotion Centre, Japan
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Keasley J, Oyebode O, Shantikumar S, Proto W, McGranahan M, Sabouni A, Kidy F. A systematic review of the burden of hypertension, access to services and patient views of hypertension in humanitarian crisis settings. BMJ Glob Health 2021; 5:bmjgh-2020-002440. [PMID: 33168520 PMCID: PMC7654140 DOI: 10.1136/bmjgh-2020-002440] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Globally, a record number of people are affected by humanitarian crises caused by conflict and natural disasters. Many such populations live in settings where epidemiological transition is underway. Following the United Nations high level meeting on non-communicable diseases, the global commitment to Universal Health Coverage and needs expressed by humanitarian agencies, there is increasing effort to develop guidelines for the management of hypertension in humanitarian settings. The objective was to investigate the prevalence and incidence of hypertension in populations directly affected by humanitarian crises; the cascade of care in these populations and patient knowledge of and attitude to hypertension. METHODS A literature search was carried out in five databases. Grey literature was searched. The population of interest was adult, non-pregnant, civilians living in any country who were directly exposed to a crisis since 1999. Eligibility assessment, data extraction and quality appraisal were carried out in duplicate. RESULTS Sixty-one studies were included in the narrative synthesis. They reported on a range of crises including the wars in Syria and Iraq, the Great East Japan Earthquake, Hurricane Katrina and Palestinian refugees. There were few studies from Africa or Asia (excluding Japan). The studies predominantly assessed prevalence of hypertension. This varied with geography and age of the population. Access to care, patient understanding and patient views on hypertension were poorly examined. Most of the studies had a high risk of bias due to methods used in the diagnosis of hypertension and in the selection of study populations. CONCLUSION Hypertension is seen in a range of humanitarian settings and the burden can be considerable. Further studies are needed to accurately estimate prevalence of hypertension in crisis-affected populations throughout the world. An appreciation of patient knowledge and understanding of hypertension as well as the cascade of care would be invaluable in informing service provision.
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Affiliation(s)
- James Keasley
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - William Proto
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Amar Sabouni
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Farah Kidy
- Warwick Medical School, University of Warwick, Coventry, UK
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6
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Satoh H, Okazaki K, Ohira T, Sakai A, Hosoya M, Yasumura S, Kawasaki Y, Hashimmoto K, Ohtsuru A, Takahashi A, Watanabe K, Shimabukuro M, Kazama JJ, Hashimoto S, Kobashi G, Ohira H, Ohto H, Kamiya K. Relationship between risk of hyper- low-density lipoprotein cholesterolemia and evacuation after the Great East Japan Earthquake. J Epidemiol 2021; 32:277-282. [PMID: 33441506 PMCID: PMC9086304 DOI: 10.2188/jea.je20200267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Hiroaki Satoh
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine.,Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
| | - Kanako Okazaki
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Department of Epidemiology, Fukushima Medical University
| | - Tetsuya Ohira
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Department of Epidemiology, Fukushima Medical University
| | - Akira Sakai
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Department of Radiation Life Sciences, Fukushima Medical University
| | - Mitsuaki Hosoya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Department of Pediatrics, Fukushima Medical University
| | - Seiji Yasumura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Department of Public Health, Fukushima Medical University
| | - Yukihiko Kawasaki
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Department of Pediatrics, Fukushima Medical University.,Department of Pediatrics, Sapporo Medical University
| | - Koichi Hashimmoto
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Department of Pediatrics, Fukushima Medical University
| | - Akira Ohtsuru
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Department of Radiation Health Management, Fukushima Medical University
| | - Atsushi Takahashi
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Department of Gastroenterology, Fukushima Medical University
| | - Kazuyuki Watanabe
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Department of Orthopedic Surgery, Fukushima Medical University
| | - Michio Shimabukuro
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Department of Diabetes, Endocrinology, and Metabolism, Fukushima Medical University
| | - Junichiro James Kazama
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Department of Neurology, Fukushima Medical University
| | - Shigeatsu Hashimoto
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Department of Metabolism, Diabetes and Nephrology, Aizu Medical Center, Fukushima Medical University
| | - Gen Kobashi
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Department of Public Health, Dokkyo Medical University
| | - Hiromasa Ohira
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Department of Gastroenterology, Fukushima Medical University
| | - Hitoshi Ohto
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
| | - Kenji Kamiya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Research Institute for Radiation Biology and Medicine, Hiroshima University
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Tsukinoki R, Murakami Y, Kawado M, Hashimoto S. Comparison of standardised mortality ratios for renal failure before and after the 2011 Great East Japan Earthquake and Tsunami: an analysis of national vital statistics. BMJ Open 2018; 8:e023435. [PMID: 30593549 PMCID: PMC6318511 DOI: 10.1136/bmjopen-2018-023435] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE The impact of the 2011 Great East Japan Earthquake on renal failure (RF) risk remains unclear. We examined the 1-year impact of this disaster on RF mortality. SETTING This ecological study focused on the year before and after the earthquake. The data sources were national vital statistics (2010-2012), the national census (2010) and the Basic Resident Registration (2010-2012). PARTICIPANTS Our study included all residents in Iwate, Miyagi and Fukushima, 1 year before and after the earthquake. PRIMARY AND SECONDARY OUTCOME MEASURES We calculated standardised mortality ratios (SMRs) for RF, chronic RF and acute RF. Postearthquake weekly SMRs were calculated using the number of RF deaths for the corresponding weeks in 2010 as a reference. The SMRs for RF were compared between the coastal and inland municipalities using kernel-weighted polynomial smoothing. RESULTS There were 1290 RF deaths in the three prefectures during the year after the earthquake (chronic RF: 804 and acute RF: 236). The SMR for RF increased significantly in the first week after the earthquake in coastal areas (3.11; 95% CI: 1.84 to 4.37), but did not increase in inland areas (0.93; 95% CI: 0.47 to 1.38). A similar trend was observed for chronic RF (coastal: 4.0; 95% CI: 2.0 to 6.0; inland: 1.1; 95% CI: 0.4 to 1.7). SMRs for RF and chronic RF decreased over time and reached 1.0 approximately 20 weeks after the disaster. Changes in SMRs for acute RF were not apparent due to the low number of deaths. CONCLUSIONS Mortality due to RF and chronic RF, but not acute RF, increased in coastal areas after the earthquake. Chronic RF may have been exacerbated by disaster-induced sympathetic activation and poor management of renal dysfunction. Increased hypertension and damage to essential infrastructure and medical equipment may also have increased mortality in people with kidney disease.
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Affiliation(s)
- Rumi Tsukinoki
- Department of Public Health Nursing, Japanese Red Cross College of Nursing, Tokyo, Japan
| | | | - Miyuki Kawado
- Department of Hygiene, Fujita Health University School of Medicine, Aichi, Japan
| | - Shuji Hashimoto
- Department of Hygiene, Fujita Health University School of Medicine, Aichi, Japan
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Takahashi A, Ohira T, Okazaki K, Yasumura S, Sakai A, Maeda M, Yabe H, Hosoya M, Ohtsuru A, Kawasaki Y, Suzuki H, Shimabukuro M, Sugiura Y, Shishido H, Hayashi Y, Nakano H, Kobashi G, Kamiya K, Ohira H. Effects of lifestyle on hepatobiliary enzyme abnormalities following the Fukushima Daiichi nuclear power plant accident: The Fukushima health management survey. Medicine (Baltimore) 2018; 97:e12890. [PMID: 30335013 PMCID: PMC6211895 DOI: 10.1097/md.0000000000012890] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 09/25/2018] [Indexed: 01/12/2023] Open
Abstract
Dramatic lifestyle changes due to the Fukushima Daiichi Nuclear Power Plant accident increased the prevalence of hepatobiliary enzyme abnormalities (HEA). We aimed to evaluate associations of HEA with specific lifestyle- and disaster-related factors in residents who lived near the Fukushima Daiichi Nuclear Power Plant.This cross-sectional study included 22,246 residents who underwent a Comprehensive Health Check and the Mental Health and Lifestyle Survey from June 2011 to March 2012. Residents were divided into 2 groups based on residential area and housing status after the accident. Associations between HEA and lifestyle- and disaster-related factors, including psychological distress, were estimated using logistic regression analysis adjusted for demographic and lifestyle factors.HEA was present in 27.3% of subjects. The prevalence of HEA was significantly higher in evacuees than controls (29.5% vs 25.7%, P < .001). There were significant differences in various lifestyle characteristics and the prevalence of post-traumatic stress disorder between evacuees and controls. Multivariable logistic regression analysis showed that age, sex, moderate to heavy drinking, and low/no physical activity were significantly associated with HEA regardless of evacuation status. Changes in jobs and unemployment were significantly associated with HEA in controls and evacuees, respectively.Lifestyle and disaster-related factors, but not psychological distress, were associated with HEA among subjects who lived near the Fukushima Daiichi Nuclear Power Plant accident.
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Affiliation(s)
- Atsushi Takahashi
- Department of Gastroenterology, Fukushima Medical University School of Medicine
- Radiation Medical Science Center for the Fukushima Health Management Survey
| | - Tetsuya Ohira
- Radiation Medical Science Center for the Fukushima Health Management Survey
- Department of Epidemiology
| | - Kanako Okazaki
- Radiation Medical Science Center for the Fukushima Health Management Survey
- Department of Epidemiology
| | - Seiji Yasumura
- Radiation Medical Science Center for the Fukushima Health Management Survey
- Department of Public Health
| | - Akira Sakai
- Radiation Medical Science Center for the Fukushima Health Management Survey
- Department of Radiation Life Sciences
| | - Masaharu Maeda
- Radiation Medical Science Center for the Fukushima Health Management Survey
- Department of Disaster Psychiatry
| | - Hirooki Yabe
- Radiation Medical Science Center for the Fukushima Health Management Survey
- Department of Neuropsychiatry
| | - Mitsuaki Hosoya
- Radiation Medical Science Center for the Fukushima Health Management Survey
- Department of Pediatrics
| | - Akira Ohtsuru
- Radiation Medical Science Center for the Fukushima Health Management Survey
- Department of Radiation Health Management
| | - Yukihiko Kawasaki
- Radiation Medical Science Center for the Fukushima Health Management Survey
- Department of Pediatrics
| | - Hitoshi Suzuki
- Radiation Medical Science Center for the Fukushima Health Management Survey
- Department of Cardiology
| | - Michio Shimabukuro
- Radiation Medical Science Center for the Fukushima Health Management Survey
- Department of Diabetes, Endocrinology and Metabolism
| | - Yoshihiro Sugiura
- Radiation Medical Science Center for the Fukushima Health Management Survey
- Department of Neurology
| | - Hiroaki Shishido
- Radiation Medical Science Center for the Fukushima Health Management Survey
- Department of Orthopaedic Surgery
| | - Yoshimitsu Hayashi
- Radiation Medical Science Center for the Fukushima Health Management Survey
- Department of Nephrology and Hypertension, Fukushima Medical University School of Medicine, Fukushima
| | - Hironori Nakano
- Radiation Medical Science Center for the Fukushima Health Management Survey
- Department of Epidemiology
| | - Gen Kobashi
- Radiation Medical Science Center for the Fukushima Health Management Survey
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsuga, Japan
| | - Kenji Kamiya
- Radiation Medical Science Center for the Fukushima Health Management Survey
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine
- Radiation Medical Science Center for the Fukushima Health Management Survey
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9
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Noncommunicable Diseases After the Great East Japan Earthquake: Systematic Review, 2011-2016. Disaster Med Public Health Prep 2017; 12:396-407. [PMID: 29032775 DOI: 10.1017/dmp.2017.63] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Noncommunicable diseases (NCDs), including mental disorders, have become major threats to human health worldwide. People with NCDs are particularly vulnerable to disasters. We systematically reviewed reports describing studies of NCDs at the time of the Great East Japan Earthquake (GEJE) to clarify the circumstances of people with NCDs and to build strong measures to support them. METHODS Relevant articles published from March 2011 through December 2016 were collected by searching the PubMed database (National Library of Medicine). We specifically examined reports describing NCDs and including the key words "East Japan Earthquake." NCDs included every disease type aside from injury and infectious disease. RESULTS We collected 160 relevant articles, 41 of which described NCDs that existed in residents before the GEJE. Articles describing respiratory diseases and mental illnesses were found most frequently. Interruption of regular treatment was the most frequent problem, followed by lack of surveillance capacity. We found 101 reports describing NCDs that had developed after the GEJE, of which 60% were related to mental health issues. CONCLUSIONS NCDs pose major health issues after large-scale disasters. Establishment of strong countermeasures against interruption of treatment and surveillance systems to ascertain medical needs for NCDs are necessary to prepare for future disasters. (Disaster Med Public Health Preparedness. 2018; 12: 396-407).
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Bellés M, Gonzalo S, Serra N, Esplugas R, Arenas M, Domingo JL, Linares V. Environmental exposure to low-doses of ionizing radiation. Effects on early nephrotoxicity in mice. ENVIRONMENTAL RESEARCH 2017; 156:291-296. [PMID: 28371757 DOI: 10.1016/j.envres.2017.03.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 03/22/2017] [Accepted: 03/23/2017] [Indexed: 06/07/2023]
Abstract
Nuclear accidents of tremendous magnitude, such as those of Chernobyl (1986) and Fukushima (2011), mean that individuals living in the contaminated areas are potentially exposed to ionizing radiation (IR). However, the dose-response relationship for effects of low doses of radiation is not still established. The present study was aimed at investigating in mice the early effects of low-dose internal radiation exposure on the kidney. Adult male (C57BL/6J) mice were divided into three groups. Two groups received a single subcutaneous (s.c.) doses of cesium (137Cs) with activities of 4000 and 8000Bq/kg bw. A third group (control group) received a single s.c. injection of 0.9% saline. To evaluate acute and subacute effects, mice (one-half of each group) were euthanized at 72h and 10 days post-exposure to 137Cs, respectively. Urine samples were collected for biochemical analysis, including the measurement of F2-isoprostane (F2-IsoP) and kidney injury molecule-1 (KIM-1) levels. Moreover, the concentrations of 8-hydroxy-2'-deoxyguanosine (8-OHdG), a sensitive marker of oxidative DNA damage, were measured in renal tissue. Urinary excretion of total protein significantly increased at 72h in mice exposed to Cs4000. Uric acid and lactate dehydrogenase (LDH) decreased significantly at both times post-exposure in animals exposed to Cs8000. After 72h and 10d of exposure to Cs4000, a significant increase in the γ-glutamil transferase (GGT) and N-acetyl-β-D-glucosaminidase (NAG) activities was observed. In turn, F2-IsoP levels increased -mainly in the Cs4000 group- at 72h post-exposure. Following irradiation (137Cs), the highest level of KIM-1 was corresponded to the Cs4000 group at 72h. Likewise, the main DNA damage was detected in mice exposed to Cs4000, mainly at 10d after irradiation. The alterations observed in several biomarkers suggest an immediate renal damage following exposure to low doses of IR (given as 137Cs). Further investigations are required to clarify the mechanisms involved in the internal IR-induced nephrotoxicity.
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Affiliation(s)
- Montserrat Bellés
- Physiology Unit, School of Medicine, IISPV, Rovira i Virgili University, Reus, Spain; Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Rovira i Virgili University, Reus, Spain
| | - Sergio Gonzalo
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Rovira i Virgili University, Reus, Spain
| | - Noemí Serra
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Rovira i Virgili University, Reus, Spain
| | - Roser Esplugas
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Rovira i Virgili University, Reus, Spain
| | - Meritxell Arenas
- Radiation Oncology Department, Sant Joan University Hospital, IISPV, Rovira i Virgili University, Reus, Spain
| | - José Luis Domingo
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Rovira i Virgili University, Reus, Spain
| | - Victoria Linares
- Physiology Unit, School of Medicine, IISPV, Rovira i Virgili University, Reus, Spain; Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Rovira i Virgili University, Reus, Spain.
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11
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Takahashi A, Ohira T, Uemura M, Hosoya M, Yasumura S, Hashimoto S, Ohira H, Sakai A, Ohtsuru A, Satoh H, Kawasaki Y, Suzuki H, Sugiura Y, Shishido H, Hayashi Y, Takahashi H, Nakano H, Kobashi G, Ozasa K, Ohto H, Abe M. Changes in Hepatobiliary Enzyme Abnormality After the Great East Japan Earthquake: The Fukushima Health Management Survey. Sci Rep 2017; 7:710. [PMID: 28386098 PMCID: PMC5429598 DOI: 10.1038/s41598-017-00776-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 03/14/2017] [Indexed: 12/20/2022] Open
Abstract
Although the incidence of hepatobiliary enzyme abnormality increased immediately after the Great East Japan Earthquake and subsequent Fukushima Daiichi Nuclear Power Plant accident, longer-term trends remain unclear. The aims of this study were to determine longer-term trends in hepatobiliary enzyme abnormality and to elucidate lifestyle factors associated with such changes among residents of a nuclear-disaster-affected area. This longitudinal survey enrolled 20,395 adults living in the vicinity of Fukushima Daiichi Nuclear Power Plant. Data were obtained from the records of annual health checkups of adults aged ≥40 years between 2011 and 2012. Follow-up examinations were conducted from June 2013 to March 2014. Associations were assessed between changes in hepatobiliary enzyme abnormality immediately and 3–4 years after the disaster and lifestyle factors. The overall prevalence of hepatobiliary enzyme abnormality significantly decreased over the study period, from 29.9% to 27.1%. Multivariate logistic regression analysis revealed significant associations between improved hepatobiliary enzyme abnormality and improvements in daily physical activity and frequency of breakfast consumption. The results suggest that improvements in daily physical activity and frequency of breakfast consumption significantly reduced the incidence of hepatobiliary enzyme abnormality 3–4 years after the Great East Japan Earthquake and Fukushima Daiichi Nuclear Power Plant accident.
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Affiliation(s)
- Atsushi Takahashi
- Radiation Medical Science Center for the Fukushima Health Management Survey, Office of the Comprehensive Health Check and Health Promotion, Fukushima, Japan. .,Fukushima Medical University School of Medicine, Fukushima, Japan. .,Department of Gastroenterology, Fukushima Medical University, Fukushima, Japan.
| | - Tetsuya Ohira
- Radiation Medical Science Center for the Fukushima Health Management Survey, Office of the Comprehensive Health Check and Health Promotion, Fukushima, Japan.,Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Epidemiology, Fukushima Medical University, Fukushima, Japan
| | - Mayu Uemura
- Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Epidemiology, Fukushima Medical University, Fukushima, Japan
| | - Mitsuaki Hosoya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Office of the Comprehensive Health Check and Health Promotion, Fukushima, Japan.,Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Pediatrics, Fukushima Medical University, Fukushima, Japan
| | - Seiji Yasumura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Office of the Comprehensive Health Check and Health Promotion, Fukushima, Japan.,Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Public Health, Fukushima Medical University, Fukushima, Japan
| | - Shigeatsu Hashimoto
- Radiation Medical Science Center for the Fukushima Health Management Survey, Office of the Comprehensive Health Check and Health Promotion, Fukushima, Japan.,Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Nephrology, Hypertension, Diabetology, and Endocrinology, Fukushima Medical University, Fukushima, Japan
| | - Hiromasa Ohira
- Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Gastroenterology, Fukushima Medical University, Fukushima, Japan
| | - Akira Sakai
- Radiation Medical Science Center for the Fukushima Health Management Survey, Office of the Comprehensive Health Check and Health Promotion, Fukushima, Japan.,Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Radiation Life Sciences, Fukushima Medical University, Fukushima, Japan
| | - Akira Ohtsuru
- Radiation Medical Science Center for the Fukushima Health Management Survey, Office of the Comprehensive Health Check and Health Promotion, Fukushima, Japan.,Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Radiation Health Management, Fukushima Medical University, Fukushima, Japan
| | - Hiroaki Satoh
- Radiation Medical Science Center for the Fukushima Health Management Survey, Office of the Comprehensive Health Check and Health Promotion, Fukushima, Japan.,Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Nephrology, Hypertension, Diabetology, and Endocrinology, Fukushima Medical University, Fukushima, Japan
| | - Yukihiko Kawasaki
- Radiation Medical Science Center for the Fukushima Health Management Survey, Office of the Comprehensive Health Check and Health Promotion, Fukushima, Japan.,Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Pediatrics, Fukushima Medical University, Fukushima, Japan
| | - Hitoshi Suzuki
- Radiation Medical Science Center for the Fukushima Health Management Survey, Office of the Comprehensive Health Check and Health Promotion, Fukushima, Japan.,Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Cardiology, Fukushima Medical University, Fukushima, Japan
| | - Yoshihiro Sugiura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Office of the Comprehensive Health Check and Health Promotion, Fukushima, Japan.,Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Neurology, Fukushima Medical University, Fukushima, Japan
| | - Hiroaki Shishido
- Radiation Medical Science Center for the Fukushima Health Management Survey, Office of the Comprehensive Health Check and Health Promotion, Fukushima, Japan.,Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Orthopaedic Surgery, Fukushima Medical University, Fukushima, Japan
| | - Yoshimitsu Hayashi
- Radiation Medical Science Center for the Fukushima Health Management Survey, Office of the Comprehensive Health Check and Health Promotion, Fukushima, Japan.,Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Nephrology, Hypertension, Diabetology, and Endocrinology, Fukushima Medical University, Fukushima, Japan
| | - Hideto Takahashi
- Radiation Medical Science Center for the Fukushima Health Management Survey, Office of the Comprehensive Health Check and Health Promotion, Fukushima, Japan.,Information Management and Statistics Office, Fukushima Medical University, Fukushima, Japan
| | - Hironori Nakano
- Radiation Medical Science Center for the Fukushima Health Management Survey, Office of the Comprehensive Health Check and Health Promotion, Fukushima, Japan.,Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Epidemiology, Fukushima Medical University, Fukushima, Japan
| | - Gen Kobashi
- Radiation Medical Science Center for the Fukushima Health Management Survey, Office of the Comprehensive Health Check and Health Promotion, Fukushima, Japan.,Department of Public Health, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Kotaro Ozasa
- Radiation Medical Science Center for the Fukushima Health Management Survey, Office of the Comprehensive Health Check and Health Promotion, Fukushima, Japan.,Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Hitoshi Ohto
- Radiation Medical Science Center for the Fukushima Health Management Survey, Office of the Comprehensive Health Check and Health Promotion, Fukushima, Japan.,Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Masafumi Abe
- Radiation Medical Science Center for the Fukushima Health Management Survey, Office of the Comprehensive Health Check and Health Promotion, Fukushima, Japan.,Fukushima Medical University School of Medicine, Fukushima, Japan
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12
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Hayashi Y, Nagai M, Ohira T, Satoh H, Sakai A, Ohtsuru A, Hosoya M, Kawasaki Y, Suzuki H, Takahashi A, Sugiura Y, Shishido H, Takahashi H, Yasumura S, Kazama JJ, Hashimoto S, Kobashi G, Ozasa K, Abe M. The impact of evacuation on the incidence of chronic kidney disease after the Great East Japan Earthquake: The Fukushima Health Management Survey. Clin Exp Nephrol 2017; 21:995-1002. [PMID: 28299459 PMCID: PMC5698380 DOI: 10.1007/s10157-017-1395-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 02/15/2017] [Indexed: 12/26/2022]
Abstract
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.
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Affiliation(s)
- Yoshimitsu Hayashi
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan. .,Department of Nephrology and Hypertension, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, 960-1295, Japan.
| | - Masato Nagai
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Epidemiology, Fukushima Medical University, Fukushima, Japan
| | - Tetsuya Ohira
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Epidemiology, Fukushima Medical University, Fukushima, Japan
| | - Hiroaki Satoh
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Diabetology, Endocrinology, and Metabolism, Fukushima Medical University, Fukushima, Japan
| | - Akira Sakai
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Radiation Life Sciences, Fukushima Medical University, Fukushima, Japan
| | - Akira Ohtsuru
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Radiation Health Management, Fukushima Medical University, Fukushima, Japan
| | - Mitsuaki Hosoya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Pediatrics, Fukushima Medical University, Fukushima, Japan
| | - Yukihiko Kawasaki
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Pediatrics, Fukushima Medical University, Fukushima, Japan
| | - Hitoshi Suzuki
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Cardiology, Fukushima Medical University, Fukushima, Japan
| | - Atsushi Takahashi
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Gastroenterology, Fukushima Medical University, Fukushima, Japan
| | - Yoshihiro Sugiura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Neurology, Fukushima Medical University, Fukushima, Japan
| | - Hiroaki Shishido
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Orthopedics, Fukushima Medical University, Fukushima, Japan
| | - Hideto Takahashi
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
| | - Seiji Yasumura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Public Health, Fukushima Medical University, Fukushima, Japan
| | - Junichiro James Kazama
- Department of Nephrology and Hypertension, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, 960-1295, Japan
| | - Shigeatsu Hashimoto
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
| | - Gen Kobashi
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Public Health, Dokkyo Medical University, Mibu, Japan
| | - Kotaro Ozasa
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Epidemiology, Radiation Effects Research Foundation, Fukushima, Japan
| | - Masafumi Abe
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
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