Impact of social cohesion on functional recovery after earthquake and tsunami

描述（由申请人提供）：我们建议调查2011年3月11日日本东北部地震和海啸幸存者的功能状态轨迹（流动性，日常生活活动，残疾发作）。我们的研究是响应PA-11-263的要求，该要求要求“研究灾害对老年人健康的影响，最终目标是预防和减轻有害后果”。我们提出的研究将利用作为国家队列研究（J-AGES -日本老年学评估研究）的一部分收集的基线数据，这些数据是在3月11日事件发生前7个月从位于灾区的一个城镇收集的。宫城县岩沼镇靠近海岸的一些地区被海啸淹没，而内陆部分地区幸免于难。据报道，在44184名居民中，约有180人死亡或失踪，6600人被疏散到临时避难所。海啸发生前的基线数据来自岩沼县5060名65岁及以上的居民。研究小组已获准在2014年重复这项调查。这一设计将使我们能够解决两个具体目标：1)检查暴露于灾害（亲人的丧失、财产的损失/损害、获得医疗服务的中断）对老年人功能状态和残疾发病轨迹的影响；2)在3年的时间里，研究灾前社区凝聚力变化对受灾居民功能衰退轨迹的影响。我们的提案在三个方面具有创新性：1)强大的因果设计。我们解决了灾害研究的两个主要限制：灾前的可用性

DESCRIPTION (provided by applicant): We propose to investigate the trajectories of functional status (mobility, activities of daily living, onset of disability) among survivors of th March 11, 2011 earthquake and tsunami in northeast Japan. Our study is in response to PA-11-263 which calls for "research on the consequences of disaster for the health of the elderly with the ultimate goal of preventing and mitigating harmful consequences". Our proposed study will leverage baseline data that were collected as part of a national cohort study (the J-AGES - the JApan Gerontological Evaluation Study) from a town located in the disaster zone seven months prior to the March 11 event. Some areas of the town of Iwanuma, Miyagi Prefecture, which were close to the shore were inundated by the tsunami, while parts that were further inland were spared. Of the population of 44,184, about 180 residents have been reported dead or missing, while 6,600 were evacuated to temporary shelters. Baseline data prior to the tsunami were obtained from 5,060 residents of Iwanuma who were 65 years and older. The research team has permission to repeat the survey in 2014. This design will allow us to address two specific aims: 1) to examine the impact of exposure to disaster (loss of loved ones, loss/damage to property, disruptions in access to health services) on the trajectory of functional status and disability onset among elders; and 2) to examine the impact of pre- disaster variations in community social cohesion on the trajectory of functional decline among disaster-exposed residents over a period of 3 years. Our proposal is innovative in three ways: 1) Strong causal design. We address the two major limitations of disaster research: the availability of pre-disaster information on health status as well as predictors; and the use of appropriate comparison groups, i.e. residents living in the same town who happened to be in locations that the tsunami did not reach; 2) Focus on the long-term physical health sequelae of disaster in the elderly - in addition to gathering information about mental health; 3) Focus on community-level social determinants of recovery in addition to studying individual-level predictors. We bring together an experienced team of investigators from the United States and Japan noted for their expertise in social epidemiology, multilevel analysis, gerontology and aging.