Mortality risk amongst nursing home residents evacuated after the Fukushima nuclear accident: a retrospective cohort study.
Mortality risk amongst nursing home residents evacuated after the Fukushima nuclear accident: a retrospective cohort study.
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DOI：
10.1371/journal.pone.0060192
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Shibuya K
中科院分区：
文献类型：
--
作者：
Nomura S;Gilmour S;Tsubokura M;Yoneoka D;Sugimoto A;Oikawa T;Kami M;Shibuya K
在针对老年人的灾害规划中，疏散安全至关重要；然而，对于调查与疏散相关的死亡风险却鲜有努力。福岛第一核电站事故发生后，我们对老年疏散者进行了一项回顾性队列生存调查。
2011年3月11日之前的五年内，福岛县南相马市五家养老院的共715名居民参与了这项回顾性队列研究。人口统计学和临床特征来自养老院的医疗记录。对疏散历史的追踪持续到2011年底。使用死亡率发病密度和考克斯比例风险回归中的风险比来评估疏散对死亡率的影响。
地震前后的总体相对死亡风险为2.68（95%置信区间：2.04 - 3.49）。各养老院之间的死亡风险存在很大差异，从0.77（95%置信区间：0.34 - 1.76）到2.88（95%置信区间：1.74 - 4.76）不等。虽然从原养老院的首次疏散导致的死亡率明显高于后续疏散，风险比为1.94（95%置信区间：1.07 - 3.49），但未观察到疏散距离对死亡率有显著影响。
因首次疏散导致的高死亡率表明，对于福岛核灾难而言，疏散老年人并非最佳的救命策略。仔细考虑辐射暴露的相对风险以及疏散的风险和益处至关重要。针对养老院的特定灾害应对策略，包括现场救援和护理，可能对生存产生重大影响。在必须疏散的情况下，精心规划并与其他养老院、疏散地点和政府救灾机构进行协调对于降低死亡风险至关重要。
Safety of evacuation is of paramount importance in disaster planning for elderly people; however, little effort has been made to investigate evacuation-related mortality risks. After the Fukushima Daiichi Nuclear Plant accident we conducted a retrospective cohort survival survey of elderly evacuees. A total of 715 residents admitted to five nursing homes in Minamisoma city, Fukushima Prefecture in the five years before 11th March 2011 joined this retrospective cohort study. Demographic and clinical characteristics were drawn from facility medical records. Evacuation histories were tracked until the end of 2011. The evacuation's impact on mortality was assessed using mortality incidence density and hazard ratios in Cox proportional hazards regression. Overall relative mortality risk before and after the earthquake was 2.68 (95% CI: 2.04–3.49). There was a substantial variation in mortality risks across the facilities ranging from 0.77 (95% CI: 0.34–1.76) to 2.88 (95% CI: 1.74–4.76). No meaningful influence of evacuation distance on mortality was observed although the first evacuation from the original facility caused significantly higher mortality than subsequent evacuations, with a hazard ratio of 1.94 (95% CI: 1.07–3.49). High mortality, due to initial evacuation, suggests that evacuation of the elderly was not the best life-saving strategy for the Fukushima nuclear disaster. Careful consideration of the relative risks of radiation exposure and the risks and benefits of evacuation is essential. Facility-specific disaster response strategies, including in-site relief and care, may have a strong influence on survival. Where evacuation is necessary, careful planning and coordination with other nursing homes, evacuation sites and government disaster agencies is essential to reduce the risk of mortality.
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影响因子：
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作者：
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通讯作者：
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