title: Post-nuclear disaster evacuation and survival amongst elderly people in Fukushima: A comparative analysis between evacuees and non-evacuees.
abstract: BACKGROUND
  Considering the health impacts of evacuation is fundamental to disaster planning especially for vulnerable elderly populations; however, evacuation-related mortality risks have not been well-investigated. We conducted an analysis to compare survival of evacuated and non-evacuated residents of elderly care facilities, following the Great East Japan Earthquake and subsequent Fukushima Dai-ichi nuclear power plant incident on 11th March 2011.
  
  
  OBJECTIVE
  To assess associations between evacuation and mortality after the Fukushima nuclear incident; and to present discussion points on disaster planning, with reference to vulnerable elderly populations.
  
  
  METHODS
  The study population comprised 1,215 residents admitted to seven elderly care facilities located 20-40km from the nuclear plant in the five years before the incident. Demographic and clinical characteristics were obtained from medical records. Evacuation histories were tracked until mid 2013. Main outcome measures are hazard ratios in evacuees versus non-evacuees using random-effects Cox proportional hazards models, and pre- and post-disaster survival probabilities and relative mortality incidence.
  
  
  RESULTS
  Experiencing the disasters did not have a significant influence on mortality (hazard ratio 1.10, 95% confidence interval: 0.84-1.43). Evacuation was associated with 1.82 times higher mortality (95% confidence interval: 1.22-2.70) after adjusting for confounders, with the initial evacuation from the original facility associated with 3.37 times higher mortality risk (95% confidence interval: 1.66-6.81) than non evacuation.
  
  
  CONCLUSIONS
  The government should consider updating its requirements for emergency planning for elderly facilities and ensure that, in a disaster setting, these facilities have the capacity and support to shelter in place for at least sufficient time to adequately prepare initial evacuation.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, United Kingdom. Electronic address: s.nomura13@imperial.ac.uk.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Nomura
authors.affiliation: MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, United Kingdom.
authors.forename: Marta
authors.initials: M
authors.lastname: Blangiardo
authors.affiliation: Division of Social Communication System for Advanced Clinical Research, The Institute of Medical Science, University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo 108-8639, Japan.
authors.forename: Masaharu
authors.initials: M
authors.lastname: Tsubokura
authors.affiliation: Department of Internal Medicine, Soma Central Hospital, 3-5-18 Okinouchi, Soma, Fukushima 976-0016, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Nishikawa
authors.affiliation: Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
authors.forename: Stuart
authors.initials: S
authors.lastname: Gilmour
authors.affiliation: Division of Social Communication System for Advanced Clinical Research, The Institute of Medical Science, University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo 108-8639, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kami
authors.affiliation: MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, United Kingdom.
authors.forename: Susan
authors.initials: S
authors.lastname: Hodgson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004189:Disaster Planning / Q000379:methods*; D004190:Disasters; D055866:Earthquakes; D005260:Female; D062406:Fukushima Nuclear Accident; D006801:Humans; D007564:Japan; D009735:Nursing Homes; D016016:Proportional Hazards Models; D018635:Rescue Work / Q000458:organization & administration*; D015996:Survival Rate
keywords: Elderly people; Evacuation; Fukushima nuclear incident; Mortality