title: Sociodemographic patterning of long-term diabetes mellitus control following Japan's 3.11 triple disaster: a retrospective cohort study.
abstract: To assess the sociodemographic patterning of changes in glycaemic control of patients with diabetes affected by the 2011 triple disaster in Japan (earthquake, tsunami and nuclear accident).
  
  
  
  A retrospective cohort study was undertaken with 404 patients with diabetes at a public hospital in Minamisoma City, Fukushima Prefecture. Glycated haemoglobin (HbA1c) levels were measured in 2010, 2011 and 2012 to capture changes in glycaemic control postdisaster. Age, sex, urban/rural residency, evacuation status and medication use were also assessed.
  
  
  
  There was an overall deterioration in glycaemic control after the disaster, with the mean HbA1c rising from 6.77% in 2010 to 6.90% in 2012 (National Glycohemoglobin Standardization Program, NGSP). Rural residency was associated with a lower likelihood of deteriorating control (OR 0.34, 95% CI 0.13 to 0.84), compared with urban residency. Older age (OR 0.95, 95% CI 0.91 to 0.98) was also slightly protective against increased HbA1c. Evacuation and sex were not significant predictors.
  
  
  
  Patients with diabetes who were affected by Japan's triple disaster experienced a deterioration in their glycaemic control following the disasters. The extent of this deterioration was mediated by sociodemographic factors, with rural residence and older age protective against the effects of the disaster on glycaemic control. These results may be indicative of underlying social determinants of health in rural Japan.
authors.affiliation: Department of Research, Minamisoma Municipal General Hospital, Minamisoma, Japan Global Public Health Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Leppold
authors.affiliation: Department of Radiation Protection, Minamisoma Municipal General Hospital, Minamisoma, Japan.
authors.forename: Masaharu
authors.initials: M
authors.lastname: Tsubokura
authors.affiliation: Department of Surgery, Minamisoma Municipal General Hospital, Minamisoma, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Ozaki
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Nomura
authors.affiliation: Department of Neurosurgery, Minamisoma Municipal General Hospital, Minamisoma, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Shimada
authors.affiliation: Department of Internal Medicine, Soma Central Hospital, Fukushima, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Morita
authors.affiliation: Department of Internal Medicine, Soma Central Hospital, Fukushima, Japan.
authors.forename: Sae
authors.identifier: 0000-0003-4133-3170
authors.initials: S
authors.lastname: Ochi
authors.affiliation: Department of Internal Medicine, Jyoban Hospital of Tokiwakai Group, Iwaki, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Tanimoto
authors.affiliation: Medical Governance Research Institute, Tokyo, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kami
authors.affiliation: Department of Radiation Protection, Minamisoma Municipal General Hospital, Minamisoma, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Kanazawa
authors.affiliation: Department of Radiation Protection, Minamisoma Municipal General Hospital, Minamisoma, Japan.
authors.forename: Tomoyoshi
authors.initials: T
authors.lastname: Oikawa
authors.affiliation: Global Public Health Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK.
authors.forename: Sarah
authors.identifier: 0000-0003-3555-433X
authors.initials: S
authors.lastname: Hill
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000378:metabolism*; D004190:Disasters; D055866:Earthquakes; D005260:Female; D062406:Fukushima Nuclear Accident; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007564:Japan; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population; D057192:Tsunamis; D014505:Urban Population
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human
keywords: DIABETES & ENDOCRINOLOGY; PUBLIC HEALTH; SOCIAL MEDICINE