title: Impact of the Tohoku earthquake and tsunami on pneumonia hospitalisations and mortality among adults in northern Miyagi, Japan: a multicentre observational study.
abstract: BACKGROUND
  On 11 March 2011, the Tohoku earthquake and tsunami struck off the coast of northeastern Japan. Within 3 weeks, an increased number of pneumonia admissions and deaths occurred in local hospitals.
  
  
  METHODS
  A multicentre survey was conducted at three hospitals in Kesennuma City (population 74 000), northern Miyagi Prefecture. All adults aged ≥18 years hospitalised between March 2010 and June 2011 with community-acquired pneumonia were identified using hospital databases and medical records. Segmented regression analyses were used to quantify changes in the incidence of pneumonia.
  
  
  RESULTS
  A total of 550 pneumonia hospitalisations were identified, including 325 during the pre-disaster period and 225 cases during the post-disaster period. The majority (90%) of the post-disaster pneumonia patients were aged ≥65 years, and only eight cases (3.6%) were associated with near-drowning in the tsunami waters. The clinical pattern and causative pathogens were almost identical among the pre-disaster and post-disaster pneumonia patients. A marked increase in the incidence of pneumonia was observed during the 3-month period following the disaster; the weekly incidence rates of pneumonia hospitalisations and pneumonia-associated deaths increased by 5.7 times (95% CI 3.9 to 8.4) and 8.9 times (95% CI 4.4 to 17.8), respectively. The increases were largest among residents in nursing homes followed by those in evacuation shelters.
  
  
  CONCLUSIONS
  A substantial increase in the pneumonia burden was observed among adults after the Tohoku earthquake and tsunami. Although the exact cause remains unresolved, multiple factors including population aging and stressful living conditions likely contributed to this pneumonia outbreak.
authors: Kesennuma City Hospital, , Kesennuma, Japan.
authors: Hisayoshi
authors: H
authors: Daito
authors: Motoi
authors: M
authors: Suzuki
authors: Jun
authors: J
authors: Shiihara
authors: Paul E
authors: PE
authors: Kilgore
authors: Hitoshi
authors: H
authors: Ohtomo
authors: Konosuke
authors: K
authors: Morimoto
authors: Masayuki
authors: M
authors: Ishida
authors: Taro
authors: T
authors: Kamigaki
authors: Hitoshi
authors: H
authors: Oshitani
authors: Masahiro
authors: M
authors: Hashizume
authors: Wataru
authors: W
authors: Endo
authors: Koichi
authors: K
authors: Hagiwara
authors: Koya
authors: K
authors: Ariyoshi
authors: Shoji
authors: S
authors: Okinaga
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004190:Disasters / Q000706:statistics & numerical data*; D055866:Earthquakes; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015701:Near Drowning / Q000150:complications; D011014:Pneumonia / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D057192:Tsunamis; D055815:Young Adult
keywords: Bacterial Infection; Pneumonia; Respiratory Infection