title: Mortality risk amongst nursing home residents evacuated after the Fukushima nuclear accident: a retrospective cohort study.
abstract: BACKGROUND
  Safety of evacuation is of paramount importance in disaster planning for elderly people; however, little effort has been made to investigate evacuation-related mortality risks. After the Fukushima Daiichi Nuclear Plant accident we conducted a retrospective cohort survival survey of elderly evacuees.
  
  
  METHODS
  A total of 715 residents admitted to five nursing homes in Minamisoma city, Fukushima Prefecture in the five years before 11th March 2011 joined this retrospective cohort study. Demographic and clinical characteristics were drawn from facility medical records. Evacuation histories were tracked until the end of 2011. The evacuation's impact on mortality was assessed using mortality incidence density and hazard ratios in Cox proportional hazards regression.
  
  
  RESULTS
  Overall relative mortality risk before and after the earthquake was 2.68 (95% CI: 2.04-3.49). There was a substantial variation in mortality risks across the facilities ranging from 0.77 (95% CI: 0.34-1.76) to 2.88 (95% CI: 1.74-4.76). No meaningful influence of evacuation distance on mortality was observed although the first evacuation from the original facility caused significantly higher mortality than subsequent evacuations, with a hazard ratio of 1.94 (95% CI: 1.07-3.49).
  
  
  CONCLUSIONS
  High mortality, due to initial evacuation, suggests that evacuation of the elderly was not the best life-saving strategy for the Fukushima nuclear disaster. Careful consideration of the relative risks of radiation exposure and the risks and benefits of evacuation is essential. Facility-specific disaster response strategies, including in-site relief and care, may have a strong influence on survival. Where evacuation is necessary, careful planning and coordination with other nursing homes, evacuation sites and government disaster agencies is essential to reduce the risk of mortality.
authors.affiliation: Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Nomura
authors.forename: Stuart
authors.initials: S
authors.lastname: Gilmour
authors.forename: Masaharu
authors.initials: M
authors.lastname: Tsubokura
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yoneoka
authors.forename: Amina
authors.initials: A
authors.lastname: Sugimoto
authors.forename: Tomoyoshi
authors.initials: T
authors.lastname: Oikawa
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kami
authors.forename: Kenji
authors.initials: K
authors.lastname: Shibuya
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D062406:Fukushima Nuclear Accident; D006801:Humans; D008875:Middle Aged; D009026:Mortality; D009735:Nursing Homes / Q000706:statistics & numerical data*; D012189:Retrospective Studies
references.citation: J Am Med Dir Assoc. 2008 Oct;9(8):599-604
references.pmid: 19083295
references.citation: Am J Med Sci. 2008 Aug;336(2):124-7
references.pmid: 18703905
references.citation: Home Healthc Nurse. 2012 Jun;30(6):355-62; quiz 363-4
references.pmid: 21987023
references.citation: Int J Aging Hum Dev. 1982-1983;16(4):283-96
references.pmid: 7184870
references.citation: Age Ageing. 1999 Mar;28(2):153-9
references.pmid: 10350412
references.citation: Disaster Med Public Health Prep. 2009 Oct;3(3):144-50
references.pmid: 19713855
references.citation: J Am Med Dir Assoc. 2007 Mar;8(3):142-9
references.pmid: 17349942
references.citation: Biosecur Bioterror. 2012 Jun;10(2):228-36
references.pmid: 22578018
references.citation: South Med J. 1995 Jun;88(6):603-8
references.pmid: 7777873
references.citation: Lancet. 2012 Jun 16;379(9833):2240-1
references.pmid: 22704167
references.citation: Int J Epidemiol. 2000 Jun;29(3):449-55
references.pmid: 10869316
references.citation: Dig Endosc. 2012 May;24 Suppl 1:3-7
references.pmid: 22533744
references.citation: Nature. 2011 Mar 17;471(7338):273-5
references.pmid: 21412302
references.citation: Lancet. 2012 Mar 10;379(9819):889-891
references.pmid: 22405787
references.citation: J Am Med Dir Assoc. 2012 Feb;13(2):190.e1-7
references.pmid: 21885350
references.citation: J Am Med Dir Assoc. 2009 Nov;10(9):639-43
references.pmid: 19883887
references.citation: Heart. 2009 Dec;95(24):2009-13
references.pmid: 19541690
references.citation: JAMA. 2012 Aug 15;308(7):669-70
references.pmid: 22893159
references.citation: Am J Public Health. 2008 Jul;98(7):1235-40
references.pmid: 18511739
references.citation: BMJ. 1996 Nov 2;313(7065):1133-5
references.pmid: 8916704
references.citation: Lancet. 2011 Sep 17;378(9796):1061-2
references.pmid: 21936110