Impact of the 2011 Great East Japan Earthquake on community health: ecological time series on transient increase in indirect mortality and recovery of health and long-term-care system.
BACKGROUND
The objectives were to clarify the trend in the cause-specific mortality rate and changes in health and long-term-care use after the Great East Japan Earthquake in 2011.


METHODS
We obtained the following data from national sources: the number of deaths by cause, age and month; the amount of healthcare insurance expenditures by type of services, age and month; the amount of long-term-care insurance expenditures by type of services, age, care need and month. We estimated increase in standardised mortality rate postearthquake compared with pre-earthquake, and change in the standardised amount of health and long-term-care insurance expenditures post-earthquake compared with pre-earthquake in three severely affected prefectures, Iwate, Miyagi and Fukushima, by the adjustment for trends in the other prefectures.


RESULTS
The risk of indirect mortality increased in the month of the earthquake (relative risk (RR) with 95% CI 1.20 (1.13 to 1.28) for those 60-69 years of age, 1.25 (1.17 to 1.32) for 70-79 years, and 1.33 (1.27 to 1.38) for 80 years and older). The amount of health and long-term-care insurance expenditures decreased among elderly persons in the month of the earthquake, and recovered to 95% of usual level within 1-5 months. Among cities and towns hit by tsunami, higher percentage of households flooded was associated with higher risk of indirect mortality (p<0.001), lower expenditures for outpatient medical care (p<0.001), and lower expenditures for home-care services (p<0.001).


CONCLUSIONS
This study showed transient increase in indirect mortality and recovery of health and long-term-care system after the earthquake.
Department of Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
Mari
M
Uchimura
Department of Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
Masashi
M
Kizuki
Department of Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
Takehito
T
Takano
Department of Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
Ayako
A
Morita
Department of International Health and Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
Kaoruko
K
Seino
D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D055866:Earthquakes; D005260:Female; D005102:Health Expenditures; D006301:Health Services Needs and Demand; D006801:Humans; D007348:Insurance, Health / Q000191:economics*; D007564:Japan / Q000453:epidemiology; D008134:Long-Term Care / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D012306:Risk
Disaster Relief; Elderly; Health Services; Mortality