title: The impact of evacuation on the incidence of chronic kidney disease after the Great East Japan Earthquake: The Fukushima Health Management Survey.
abstract: BACKGROUND
  About 146,000 people were forced into long-term evacuation due to the nuclear power plant accident caused by the Great East Japan Earthquake in 2011. Disaster is known to induce hypertension in survivors for a certain period, but it is unclear whether prolonged disaster stress influences chronic kidney disease (CKD). We conducted an observational cohort study to elucidate the effects of evacuation stress on CKD incidence.
  
  
  METHODS
  Participants were individuals living in communities near the Fukushima nuclear power plant, aged 40-74 years without CKD as of their 2011 general health checkup (non-evacuees: n = 9780, evacuees: n = 4712). We followed new-onset CKD [estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2or proteinuria] using general annual health checkup data from 2012 to 2014. Association between evacuation and CKD incidence was analyzed using the Cox proportional hazard model.
  
  
  RESULTS
  Mean age of the participants at baseline was 65 years, 46.7% were men, and baseline eGFR was 75.7 ml/min/1.73 m2. During the mean follow-up period of 2.46 years, CKD incidence rate was 80.8/1000 and 100.2/1000 person-years in non-evacuees and evacuees, respectively. Evacuation was a significant risk factor of CKD incidence after adjusting for age, gender, obesity, hypertension, diabetes, dyslipidemia, smoking, and baseline eGFR [hazard ratio (HR): 1.45; 95% confidence interval (CI) 1.35-1.56]. Evacuation was significantly associated with the incidence of eGFR <60 ml/min/1.73 m2(HR: 1.48; 95% CI 1.37-1.60), but not with the incidence of proteinuria (HR: 1.21; 95% CI 0.93-1.56).
  
  
  CONCLUSIONS
  Evacuation was a risk factor associated with CKD incidence after the disaster.
authors.affiliation: Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan. caco@fmu.ac.jp.|Department of Nephrology and Hypertension, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, 960-1295, Japan. caco@fmu.ac.jp.
authors.forename: Yoshimitsu
authors.initials: Y
authors.lastname: Hayashi
authors.affiliation: Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.|Department of Epidemiology, Fukushima Medical University, Fukushima, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Nagai
authors.affiliation: Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.|Department of Epidemiology, Fukushima Medical University, Fukushima, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ohira
authors.affiliation: Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.|Department of Diabetology, Endocrinology, and Metabolism, Fukushima Medical University, Fukushima, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Satoh
authors.affiliation: Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.|Department of Radiation Life Sciences, Fukushima Medical University, Fukushima, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Sakai
authors.affiliation: Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.|Department of Radiation Health Management, Fukushima Medical University, Fukushima, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Ohtsuru
authors.affiliation: Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.|Department of Pediatrics, Fukushima Medical University, Fukushima, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Hosoya
authors.affiliation: Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.|Department of Pediatrics, Fukushima Medical University, Fukushima, Japan.
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Kawasaki
authors.affiliation: Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.|Department of Cardiology, Fukushima Medical University, Fukushima, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.|Department of Gastroenterology, Fukushima Medical University, Fukushima, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takahashi
authors.affiliation: Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.|Department of Neurology, Fukushima Medical University, Fukushima, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sugiura
authors.affiliation: Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.|Department of Orthopedics, Fukushima Medical University, Fukushima, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shishido
authors.affiliation: Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.
authors.forename: Hideto
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.|Department of Public Health, Fukushima Medical University, Fukushima, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Yasumura
authors.affiliation: Department of Nephrology and Hypertension, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, 960-1295, Japan.
authors.forename: Junichiro James
authors.initials: JJ
authors.lastname: Kazama
authors.affiliation: Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.
authors.forename: Shigeatsu
authors.initials: S
authors.lastname: Hashimoto
authors.affiliation: Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.|Department of Public Health, Dokkyo Medical University, Mibu, Japan.
authors.forename: Gen
authors.initials: G
authors.lastname: Kobashi
authors.affiliation: Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.|Department of Epidemiology, Radiation Effects Research Foundation, Fukushima, Japan.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Ozasa
authors.affiliation: Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Abe
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D062406:Fukushima Nuclear Accident; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*
keywords: Chronic kidney disease; Disaster; Earthquake; Evacuation; Hypertension; Nuclear powerplant