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. 2013 Dec 20;2(2):e31.
doi: 10.2196/ijmr.2585.

Aftershocks Associated With Impaired Health Caused by the Great East Japan Disaster Among Youth Across Japan: A National Cross-Sectional Survey

Free PMC article

Aftershocks Associated With Impaired Health Caused by the Great East Japan Disaster Among Youth Across Japan: A National Cross-Sectional Survey

Takashi Sugimoto et al. Interact J Med Res. .
Free PMC article


Background: The Great East Japan earthquake, subsequent tsunamis and the Fukushima nuclear incident had a tremendous impact on Japanese society. Although small-scale surveys have been conducted in highly affected areas, few have elucidated the disaster's effect on health from national perspective, which is necessary to prepare national policy and response.

Objective: The aim of the present study was to describe prefecture-level health status and investigate associations with number of aftershocks, seismic intensity, a closer geographical location to the Fukushima Nuclear Power Plant, or higher reported radiation dose in each prefecture even after adjusting for individual socioeconomic factors, by utilizing individual-level data acquired from a national cross-sectional Internet survey as well as officially reported prefecture-level data.

Methods: A Japanese government research institute obtained 12,000 participants by quota sampling and 7335 participants were eligible for the analysis in an age range between 17 and 27 years old. We calculated the percentage of people with decreased subjective health in each prefecture after the earthquake. Variability introduced by a small sample size for some prefectures was smoothed using empirical Bayes estimation with a random-intercept logistic model, with and without demographic factors. Multilevel logistic regression was used to calculate adjusted odds ratios (ORs) for change of subjective health associated with prefecture-level and individual-level factors.

Results: Adjusted empirical Bayes estimates were higher for respondents commuting in the northeast region (Iwate 14%, Miyagi 19%, and Fukushima 28%), which faces the Pacific Ocean, while the values for Akita (10%) and Yamagata (8%) prefectures, which do not face the Pacific Ocean, were lower than those of Tokyo (12%). The values from the central to the western region were clearly lower. The number of aftershocks was coherently associated with decreased health (OR 1.05 per 100 times, 95% CI 1.04-1.06; P<.001) even after adjusting for covariates (OR 1.02 per 100 times, 95% CI 1.00-1.05; 1.32 per 1000 times, 95% CI 1.03-1.71; P=.049). In contrast, seismic intensity of the initial earthquake (OR 0.87, 95% CI 0.65-1.17; P=.36), radiation dose (OR 1.16, 95% CI 0.82-1.64; P=.41), and distance from the Fukushima Nuclear Power Plant (OR 1.00, 95% CI 0.99-1.00; P=.66) were not. Change in job condition (OR 2.05, 95% CI 1.72-2.45; P<.001), female (OR 1.43, 95% CI 1.19-1.69; P<.001), higher age (OR 1.06 per year, 95% CI 1.02-1.11; P=.005), and duration of evacuation longer than 4 weeks (OR 1.44, 95% CI 1.06-1.97; P=.02) seemed to decrease perceived health status.

Conclusions: We found nationwide differences that show decreased health status because of the Great East Japan disaster according to prefecture. The number of aftershocks, change in work conditions, being female, a higher age, and duration of the evacuation were risk factors for the population after the major earthquake, tsunamis, and nuclear incident.

Keywords: Internet; earthquakes; health communication; nuclear power plants; risk management.

Conflict of interest statement

Conflicts of Interest: None declared.


Figure 1
Figure 1
Map of Japan divided into six area indicators. The black square indicates the epicentre of the earthquake. The black star indicates the location of the Fukushima NPP.
Figure 2
Figure 2
Percentage of respondents reporting decreased self-perceived health status and empirical Bayes estimates in each prefecture. JMA-SI, Japan Meteorological Agency Seismic Intensity. For the same JMA-SI levels, we determined the rank order of prefectures based on the values of adjusted empirical Bayes estimates. In adjusted empirical Bayes estimates, percentages were also adjusted according to demographic factors (gender, age, education, marital and employment status, changed job condition, income, death of family member[s], being a parent, family separation, and evacuation).
Figure 3
Figure 3
Map of Japan depicting adjusted empirical Bayes estimates for percentage of people with decreased self-perceived health status. Red (>21%), orange (18%–21%), yellow (15%–18%), chartreuse green (12%–15%), aquamarine (9%–12%), blue (6%–9%), and gray (<6%). The black square indicates the epicenter of the earthquake. The black star indicates the location of the Fukushima NPP.

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    1. Shibuya K, Hashimoto H, Ikegami N, Nishi A, Tanimoto T, Miyata H, Takemi K, Reich MR. Future of Japan's system of good health at low cost with equity: beyond universal coverage. Lancet. 2011 Oct 1;378(9798):1265–73. doi: 10.1016/S0140-6736(11)61098-2. - DOI - PubMed
    1. Ohnishi T. The disaster at Japan's Fukushima-Daiichi nuclear power plant after the March 11, 2011 earthquake and tsunami, and the resulting spread of radioisotope contamination. Radiat Res. 2012 Jan;177(1):1–14. - PubMed
    1. Tanigawa K, Hosoi Y, Hirohashi N, Iwasaki Y, Kamiya K. Loss of life after evacuation: lessons learned from the Fukushima accident. Lancet. 2012 Mar 10;379(9819):889–91. doi: 10.1016/S0140-6736(12)60384-5. - DOI - PubMed
    1. Buesseler KO, Jayne SR, Fisher NS, Rypina II, Baumann H, Baumann Z, Breier CF, Douglass EM, George J, Macdonald AM, Miyamoto H, Nishikawa J, Pike SM, Yoshida S. Fukushima-derived radionuclides in the ocean and biota off Japan. Proc Natl Acad Sci U S A. 2012 Apr 17;109(16):5984–8. doi: 10.1073/pnas.1120794109. - DOI - PMC - PubMed
    1. Nagaoka K, Sato S, Araki S, Ohta Y, Ikeuchi Y. Changes of radionuclides in the environment in Chiba, Japan, after the Fukushima nuclear power plant accident. Health Phys. 2012 Apr;102(4):437–42. doi: 10.1097/HP.0b013e31823bc2d3. - DOI - PubMed

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