title: Unemployment risk among individuals undergoing medical treatment for chronic diseases.
abstract: BACKGROUND
  Chronic diseases increase the risk of unemployment even in non-disaster settings; therefore, in post-disaster settings, special attention needs to be paid to the employment status of those suffering from chronic diseases.
  
  
  OBJECTIVE
  To examine the association between chronic disease and the risk of unemployment in a disaster area.
  
  
  METHODS
  This cross-sectional study was conducted in Shichigahama Town, Miyagi, north-eastern Japan, where had been severely inundated by the 2011 tsunami. Logistic regression analyses were used to evaluate the association between undergoing medical treatment for a combination of chronic diseases (stroke, cancer, myocardial infarction and angina) and unemployment risk. Confounders such as psychological distress and levels of daily life activity were considered.
  
  
  RESULTS
  Among the 2588 individuals studied, there was a statistically significant association between undergoing medical treatment for chronic disease and the risk of unemployment [odds ratio (OR) = 1.7, 95% confidence interval (CI) 1.02-2.7, P < 0.05]. In participants with a lower degree of psychological distress and better levels of daily life activity (n = 1967), no significant associations were observed (OR = 1.1, 95% CI 0.6-2.1). Conversely, in 536 participants with a higher degree of psychological distress and/or poorer levels of daily life activity, statistically significant associations were found (OR = 2.6, 95% CI 1.01-6.6, P < 0.05).
  
  
  CONCLUSIONS
  The association between undergoing medical treatment for chronic disease and unemployment risk was observed only in participants with a higher degree of psychological distress and/or poorer levels of daily life activity.
authors.affiliation: Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai 980-8573, Japan, nakaya-thk@umin.ac.jp.
authors.forename: N
authors.initials: N
authors.lastname: Nakaya
authors.affiliation: Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai 980-8573, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai 980-8573, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Tsuchiya
authors.affiliation: Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai 980-8573, Japan, Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai 980-8573, Japan.
authors.forename: I
authors.initials: I
authors.lastname: Tsuji
authors.affiliation: Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai 980-8573, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Hozawa
authors.affiliation: Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai 980-8573, Japan, Department of Disaster Psychiatry, International Research Institute of Disaster Science, Tohoku University, Sendai 980-8573, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Tomita
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000523:psychology* / Q000534:rehabilitation; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004651:Employment; D005260:Female; D006293:Health Promotion / Q000458:organization & administration; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016272:Occupational Health; D016017:Odds Ratio; D057192:Tsunamis; D014478:Unemployment / Q000523:psychology* / Q000706:statistics & numerical data
keywords: Chronic diseases; daily life activity; earthquake; psychological distress; unemployment.