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Disasters & health
Excess mortality due to indirect health effects of the 2011 triple disaster in Fukushima, Japan: a retrospective observational study
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  1. Tomohiro Morita1,2,
  2. Shuhei Nomura3,4,
  3. Masaharu Tsubokura1,2,
  4. Claire Leppold5,6,
  5. Stuart Gilmour4,
  6. Sae Ochi1,
  7. Akihiko Ozaki6,7,
  8. Yuki Shimada6,
  9. Kana Yamamoto6,
  10. Manami Inoue8,
  11. Shigeaki Kato9,10,
  12. Kenji Shibuya4,
  13. Masahiro Kami2,11
  1. 1 Internal Medicine, Soma Central Hospital, Fukushima, Japan
  2. 2 Division of Social Communication System for Advanced Clinical Research, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
  3. 3 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
  4. 4 Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
  5. 5 Global Public Health Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
  6. 6 Department of Research, Minamisoma Municipal General Hospital, Fukushima, Japan
  7. 7 Department of Surgery, Minamisoma Municipal General Hospital, Fukushima, Japan
  8. 8 Department of Health and Human Security, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
  9. 9 Research Institute of Innovative Medicine, Tokiwa Foundation, Fukushima, Japan
  10. 10 Center for regional cooperation, Iwaki Meisei University, Fukushima, Japan
  11. 11 Department of Medical Research, Medical Governance Research Institute, Tokyo, Japan
  1. Correspondence to Dr Tomohiro Morita, Soma Central Hospital, 3-5-18, Okinouchi, Soma City, Fukushima, 976-0016, Japan; t.morita526{at}gmail.com

Abstract

Background Evidence on the indirect health impacts of disasters is limited. We assessed the excess mortality risk associated with the indirect health impacts of the 2011 triple disaster (earthquake, tsunami and nuclear disaster) in Fukushima, Japan.

Methods The mortality rates in Soma and Minamisoma cities in Fukushima from 2006 to 2015 were calculated using vital statistics and resident registrations. We investigated the excess mortality risk, defined as the increased mortality risk between postdisaster and predisaster after excluding direct deaths attributed to the physical force of the disaster. Multivariate Poisson regression models were used to estimate the relative risk (RR) of mortality after adjusting for city, age and year.

Results There were 6163 and 6125 predisaster and postdisaster deaths, respectively. The postdisaster mortality risk was significantly higher in the first month following the disaster (March 2011) than in the same month during the predisaster period (March 2006–2010). RRs among men and women were 2.64 (95% CI 2.16 to 3.24) and 2.46 (95% CI 1.99 to 3.03), respectively, demonstrating excess mortality risk due to the indirect health effects of the disaster. Age-specific subgroup analyses revealed a significantly higher mortality risk in women aged ≥85 years in the third month of the disaster compared with predisaster baseline, with an RR (95% CI) of 1.73 (1.23 to 2.44).

Conclusions Indirect health impacts are most severe in the first month of the disaster. Early public health support, especially for the elderly, can be an important factor for reducing the indirect health effects of a disaster.

  • PUBLIC HEALTH
  • DISASTER RELIEF
  • EPIDEMIOLOGY
  • HEALTH POLICY
  • AGEING

https://doi.org/10.1136/jech-2016-208652

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    Footnotes

    • Contributors TM, MI, KS, SK and MK developed the study concept and design. TM, SO, AO, YS, KY and MT collected and managed the data, including quality control. SN and SG provided statistical advice on the study design and analysed the data. TM, SN and CL drafted the manuscript, and all authors contributed substantially to its revision. SN and TM take responsibility for the paper as a whole.

    • Competing interests MI is the beneficiary of a financial contribution from the AXA Research Fund as chair holder of the AXA Department of Health and Human Security, Graduate School of Medicine, The University of Tokyo. The AXA Research Fund has no role in this work. The authors declare no other conflicts of interest.

    • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

    • Ethics approval Soma Central Hospital.

    • Provenance and peer review Not commissioned; externally peer reviewed.