Characteristics of Physician Outflow from Disaster Areas following the Great East Japan Earthquake.
Characteristics of Physician Outflow from Disaster Areas following the Great East Japan Earthquake.
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DOI：
10.1371/journal.pone.0169220
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Matsumoto M
中科院分区：
文献类型：
--
作者：
Kashima S;Inoue K;Matsumoto M
重大灾难后医生短缺是一个关键问题。本研究的目的是对2011年3月11日东日本大地震导致的福岛第一核电站事故后离开灾区的医生的特征进行评价。利用2010年（灾前）和2012年（灾后）进行的医生普查数据，我们评估了受灾地区医生数量的变化。然后，我们使用逻辑回归模型计算比值比和95%置信区间，以评估医生特征和流出之间的关联。我们还根据医生特征进行了分层分析。医师人数在福岛县减少（-5.3%），在宫城县增加（2.8%）。即使考虑到县内人口的变化（医生与人口比率的变化分别为-1.9%和3.2%），福岛的减少和宫城的增加也很明显。与居住在距离核电站>100 km的地区的医生相比，居住在20-50 km和50-100 km的医生迁移到偏远地区的可能性分别为3.9倍（95%置信区间，2.6-5.7）和2.6倍（95%置信区间，1.7-3.8）。在分层分析中，年轻的医生和职业生涯较早的医生比其他医生有更高的流出优势比（相互作用P分别为0.02和<0.01）。在电厂周围地区，年轻和职业生涯初期的医生外流的风险更大。可能需要政治支持来招募和留住这些医生，他们将负责灾区未来的社区卫生。
The shortage of physicians after a major disaster is a crucial issue. We aimed to evaluate the characteristics of physicians who left affected areas following the accident at Fukushima Daiichi Nuclear Power Plant caused by the Great East Japan Earthquake on March 11, 2011. Using data from a physician census conducted in 2010 (pre-disaster) and 2012 (post-disaster), we evaluated changes in the number of physicians in affected areas. We then calculated the odds ratios and 95% confidence intervals using a logistic regression model to evaluate the association between physician characteristics and outflow. We also conducted stratified analyses based on physician characteristics. The number of physicians decreased in Fukushima Prefecture (–5.3%) and increased in Miyagi Prefecture (2.8%). The decrease in Fukushima and increase in Miyagi were evident even after taking the prefecture’s population change into account (change in physician to population ratios: –1.9% and 3.2%, respectively). Compared with physicians who lived in areas >100 km from the nuclear power plant, physicians living 20–50 km and 50–100 km were, respectively, 3.9 times (95% confidence interval, 2.6–5.7) and 2.6 times (95% confidence interval, 1.7–3.8) more likely to migrate to distant areas. In the stratified analysis, younger physicians and those earlier in their careers had higher odds ratios for outflow than other physicians (P for interaction = 0.02 and <0.01, respectively). The risk of outflow was greater among younger and early-career physicians in areas around the power plant. Political support may be necessary to recruit and retain such physicians, who will be responsible for future community health in the disaster area.
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