6th International Disaster and Risk Conference IDRC 2016 Integrative Risk Management - Towards Resilient Cities. 28 August - 01 September 2016 in Davos, Switzerland

1. Post-nuclear Disaster Evacuation and
Chronic Health in Adults in Fukushima,
Japan: A Long-term Retrospective Analysis
Shuhei NOMURA1, Marta BLANGIARDO2, Masaharu TSUBOKURA3,
Akihiko OZAKI3, Tomohiro MORITA4, Susan HODGSON2
1. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK
2. MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School
of Public Health, Imperial College London, UK
3. Department of Radiation Protection, Minamisoma Municipal General Hospital, Japan
4. Department of Radiation Protection, Soma Central Hospital, Japan
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org

2. Education
Imperial College London, UK (2013–present)
– PhD, Dept. of Epidemiology and Biostatistics, School of Public Health
The University of Tokyo, Japan (2007–2013)
– MSc, Dept. of Global Health Policy, Graduate School of Medicine
– BSc, Faculty of Pharmaceutical Sciences
Disaster work experiences
– World Health Organization, Switzerland (2014), Intern
– United Nations Development Programme, Tajikistan (2012), Intern
– National Diet of Japan Fukushima Nuclear Accident Independent
Investigation Commission, Japan (2012), Research Assistant
2

4. Background
Evacuation instructions issued by the central government

5. Background
Evacuation instructions issued by the central government

6. Background
Evacuation instructions issued by the central government

7.  Of 850 patients who evacuated from the seven hospitals located in the
evacuation-zone, 60 people died within one month following the incident,
of which 48 cases occurred during the transportations. (NAIIC 2012)
 Of 1,770 residents who evacuated from 32 nursing homes located in the
evacuation-zone, 263 people died within eight months following the
incident. The mortality rate was 2.4 times higher than in the previous
year. (Yasumura et al. Public Health. 2012)
 Of 328 residents who evacuated from five nursing homes located 20-30
km from the nuclear plant, 75 people died within one year following the
incident. The mortality rate was 2.68 times higher than in the past five
years. (Nomura et al. PLOS ONE. 2013)
 One and half years after the incident, the death toll due to evacuation
exceeded that due to tsunami (1,605 and 1,603, respectively). (Kiura
2013)
Mortality in relation to evacuation after the incident
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8. Increased risk of chronic diseases
Background
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9.  Data source: annual public health check-ups (available
only for those aged 40–74 years)
- physical examination
- blood sample test
- self-report medical history and lifestyle survey
 Study period: 2008–2010 (pre-incident) and 20012–2014
(post-incident)
 Target diseases*:
- diabetes
- hyperlipidemia
- hypertension
* based on the clinical guidelines for disease diagnosis or self-reported
medication use
Methods 1
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10.  Subgroup classification
- Evacuees
- Non-evacuees (including temporary evacuees)
The red circles show the geographical distribution of the health check-up participants in
2010, where the circles are proportional to the number of subjects living in each district
Methods 2
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11.  Subgroup classification
- Evacuees
- Non-evacuees (including temporary evacuees)
 Comparison of disease risks between
1) before and after the incident
2) evacuees and non-evacuees
Methods 2
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12. Evacuees (95% CI) Non-evacuees (95% CI)
Diabetes
2011 1.12 (0.70–1.79) 0.94 (0.81–1.10)
2012 1.21 (0.88–1.67) 1.11 (0.97–1.27)
2013 1.55 (1.15–2.09)** 1.33 (1.17–1.52)***
2014 1.60 (1.18–2.16)** 1.27 (1.11–1.45)***
Hyperlipidemia
2011 1.10 (0.94–1.27) 1.00 (0.95–1.05)
2012 1.16 (1.05–1.29)** 1.03 (0.98–1.08)
2013 1.30 (1.18–1.43)*** 1.12 (1.07–1.17)***
2014 1.20 (1.08–1.32)** 1.14 (1.09–1.20)**
Hypertension
2011 1.05 (0.91–1.21) 1.05 (1.01–1.10)
2012 1.04 (0.94–1.14) 1.03 (0.99–1.07)
2013 1.10 (1.00–1.21)* 1.01 (0.97–1.05)
2014 0.94 (0.85–1.05) 0.95 (0.91–0.99)*
* p<0.05, ** p<0.01, and *** p<0.001 for given year versus baseline (2008–2010), adjusted for age
(Nomura S, et al. BMJ Open. 2016)
Pre- and post-incident relative risk of the diseases
(versus baseline: 2008–2010)
Results 1
12

13. Evacuees (95% CI) Non-evacuees (95% CI)
Diabetes
2011 1.12 (0.70–1.79) 0.94 (0.81–1.10)
2012 1.21 (0.88–1.67) 1.11 (0.97–1.27)
2013 1.55 (1.15–2.09)** 1.33 (1.17–1.52)***
2014 1.60 (1.18–2.16)** 1.27 (1.11–1.45)***
Hyperlipidemia
2011 1.10 (0.94–1.27) 1.00 (0.95–1.05)
2012 1.16 (1.05–1.29)** 1.03 (0.98–1.08)
2013 1.30 (1.18–1.43)*** 1.12 (1.07–1.17)***
2014 1.20 (1.08–1.32)** 1.14 (1.09–1.20)**
Hypertension
2011 1.05 (0.91–1.21) 1.05 (1.01–1.10)
2012 1.04 (0.94–1.14) 1.03 (0.99–1.07)
2013 1.10 (1.00–1.21)* 1.01 (0.97–1.05)
2014 0.94 (0.85–1.05) 0.95 (0.91–0.99)*
* p<0.05, ** p<0.01, and *** p<0.001 for given year versus baseline (2008–2010), adjusted for age
(Nomura S, et al. BMJ Open. 2016)
Pre- and post-incident relative risk of the diseases
(versus baseline: 2008–2010)
Results 1
13

14. Evacuees (95% CI) Non-evacuees (95% CI)
P-value of the
difference in row
Diabetes
2011 1.12 (0.70–1.79) 0.94 (0.81–1.10) p=0.5
2012 1.21 (0.88–1.67) 1.11 (0.97–1.27) p=0.6
2013 1.55 (1.15–2.09)** 1.33 (1.17–1.52)*** p=0.3
2014 1.60 (1.18–2.16)** 1.27 (1.11–1.45)*** p=0.1
Hyperlipidemia
2011 1.10 (0.94–1.27) 1.00 (0.95–1.05) p=0.3
2012 1.16 (1.05–1.29)** 1.03 (0.98–1.08) p<0.05
2013 1.30 (1.18–1.43)*** 1.12 (1.07–1.17)*** p<0.01
2014 1.20 (1.08–1.32)** 1.14 (1.09–1.20)** p=0.6
Hypertension
2011 1.05 (0.91–1.21) 1.05 (1.01–1.10) p=1.0
2012 1.04 (0.94–1.14) 1.03 (0.99–1.07) p=1.0
2013 1.10 (1.00–1.21)* 1.01 (0.97–1.05) p=0.1
2014 0.94 (0.85–1.05) 0.95 (0.91–0.99)* p=0.8
(Nomura S, et al. BMJ Open. 2016)
Comparison of the pre- and post-incident relative risk
between evacuees and non-evacuees
* p<0.05, ** p<0.01, and *** p<0.001 for given year versus baseline (2008–2010), adjusted for age
Results 2
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15. Evacuees (95% CI) Non-evacuees (95% CI)
P-value of the
difference in row
Diabetes
2011 1.12 (0.70–1.79) 0.94 (0.81–1.10) p=0.5
2012 1.21 (0.88–1.67) 1.11 (0.97–1.27) p=0.6
2013 1.55 (1.15–2.09)** 1.33 (1.17–1.52)*** p=0.3
2014 1.60 (1.18–2.16)** 1.27 (1.11–1.45)*** p=0.1
Hyperlipidemia
2011 1.10 (0.94–1.27) 1.00 (0.95–1.05) p=0.3
2012 1.16 (1.05–1.29)** 1.03 (0.98–1.08) p<0.05
2013 1.30 (1.18–1.43)*** 1.12 (1.07–1.17)*** p<0.01
2014 1.20 (1.08–1.32)** 1.14 (1.09–1.20)** p=0.6
Hypertension
2011 1.05 (0.91–1.21) 1.05 (1.01–1.10) p=1.0
2012 1.04 (0.94–1.14) 1.03 (0.99–1.07) p=1.0
2013 1.10 (1.00–1.21)* 1.01 (0.97–1.05) p=0.1
2014 0.94 (0.85–1.05) 0.95 (0.91–0.99)* p=0.8
(Nomura S, et al. BMJ Open. 2016)
* p<0.05, ** p<0.01, and *** p<0.001 for given year versus baseline (2008–2010), adjusted for age
Results 2
Comparison of the pre- and post-incident relative risk
between evacuees and non-evacuees
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16.  Regardless of evacuation, there was significantly increased risk of
diabetes and hyperlipidemia more than three years after the
Fukushima incident.
 The persistent impact on chronic health indicates the necessity of
paying particular attention to the mid- to long-term effects of a
disaster on diabetes and hyperlipidemia.
 This is the first study to demonstrate that evacuees had a greater risk
of hyperlipidemia than non evacuees.
 All parties involved in local health care should pay more attention to
hyperlipidemia control among evacuees.
(Nomura S, et al. BMJ Open. 2016) 16
Summary

17. Conclusions
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 For local residents, evacuation was NOT avoidable after
the Fukushima incident.
 My intention is not to question the evacuation decision, but
to show that there is considerable latitude for reducing
evacuation risk to protect human health.
 The Fukushima incident offers an historic opportunity to
inform future response and resilience in nuclear disasters.

18. • Minamisoma and Soma City employees and care home staff
• Minamisoma and Soma City Medical Association
• Marta Blangiardo, Stuart Gilmour, Susan Hodgson,
Masahiro Kami, Yukio Kanazawa, Tomohiro Morita,
Yoshitaka Nishikawa, Tomoyoshi Oikawa, Akihiko Ozaki,
Kenji Shibuya, Amina Sugimoto, Hidekio Tachiya, Masaharu
Tsubokura, and Daisuke Yoneoka (in alphabetical order)
Acknowledgements

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