title: Distance to retail stores and risk of being homebound among older adults in a city severely affected by the 2011 Great East Japan Earthquake.
abstract: BACKGROUND
  after the Great East Japan Earthquake in 2011, inactivity and the homebound status of older victims in affected areas have been a serious public health concern owing to the victims' prolonged existence as evacuees in mountainous areas.
  
  
  OBJECTIVE
  to evaluate the association between distances to retail stores and risks of being homebound.
  
  
  METHODS
  secondary analysis of cross-sectional interview survey data with a geographical information analysis.
  
  
  METHODS
  Rikuzentakata, Iwate, a municipality seriously damaged by the 2011 earthquake and tsunami.
  
  
  METHODS
  all Rikuzentakata residents aged 65 or older except for those living in temporary housing (n = 2,327).
  
  
  METHODS
  we calculated road distances between each residential address and retail stores, hawker sites and shopping bus stops, accounting for the extra load caused by walking on slopes. The prevalence ratio of being homebound adjusted for age, source of income and morbidity by road distance was estimated using Poisson regression with a generalised estimating equation.
  
  
  RESULTS
  those living at distances of 1,200 m or more were 1.78 (95% confidence intervals, 1.03-3.08) times more likely to be homebound (going out only every 4 or more days a week) among men and 1.85 (1.13-3.02) among women, compared with those residing in places <400 m from retail stores or shopping bus stops. The distances were reduced by new hawker and shopping bus services, but the improvements varied greatly across the districts.
  
  
  CONCLUSIONS
  access to daily needs is essential to prevent homebound status. Post-disaster community diagnosis in terms of the built environment is important for strategic community restoration.
authors.affiliation: Department of Civil and Environmental Engineering, Faculty of Engineering, Iwate University, Morioka, Iwate, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hirai
authors.affiliation: Department of Health and Social Behaviour, School of Public Health, The University of Tokyo, 7-3-1 Hongo Building #3, Bunkyo-ku, Tokyo 113-0033, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Kondo
authors.affiliation: Iwate Tohoku Medical Megabank Organization, Iwate Medical University, Yahaba, Japan.
authors.forename: Ryohei
authors.initials: R
authors.lastname: Sasaki
authors.affiliation: Health Promotion Research Center, Chiyoda-ku, Tokyo, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Iwamuro
authors.affiliation: Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Kanako
authors.initials: K
authors.lastname: Masuno
authors.affiliation: Department of Home Care Coordinators, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.
authors.forename: Rika
authors.initials: R
authors.lastname: Ohtsuka
authors.affiliation: Department of Home Care Coordinators, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.
authors.forename: Hisayuki
authors.initials: H
authors.lastname: Miura
authors.affiliation: Department of Hygiene and Preventive Medicine, School of Medicine, Iwate Medical University, Morioka, Iwate, Japan.
authors.forename: Kiyomi
authors.initials: K
authors.lastname: Sakata
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D002947:Cities / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D004190:Disasters; D055866:Earthquakes; D005260:Female; D018577:Homebound Persons / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007407:Interviews as Topic; D007564:Japan / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors
keywords: Japan; built environment; disaster; homebound; older people