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Predictors of Hypertension in Survivors of the Great East Japan Earthquake, 2011: A Cross-sectional Study
- Reiichiro Tanaka, Motohisa Okawa, Yoshihito Ujike
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- Journal:
- Prehospital and Disaster Medicine / Volume 31 / Issue 1 / February 2016
- Published online by Cambridge University Press:
- 26 January 2016, pp. 17-26
- Print publication:
- February 2016
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Introduction
Many survivors of a major disaster die shortly after the event. Hypertension (HT) is one of the most important risk factors for these disaster-related diseases. An urgent need exists to establish methods to detect disaster survivors with HT and start medication immediately, as those with no injuries or symptoms may not be examined and medical teams cannot measure all survivors’ blood pressure (BP) because they often do not have sufficient time.
ObjectiveThe goals of this report were: (1) to evaluate the importance of taking antihypertensive drugs continuously for patients with HT during the sub-acute phase after a major earthquake, when patients cannot attend a clinic because of destruction of the local infrastructure; and (2) to establish simple and reliable predictors to detect evacuees with HT, who require clinical examination and treatment at evacuation shelters or in their homes after a major earthquake.
MethodsMedical rounds were performed at evacuation shelters in Iwate Prefecture after the Great East Japan Earthquake. Forty evacuees were enrolled in a cross-sectional study. The effect of taking antihypertensive drugs continuously was evaluated and predictors of HT in evacuees were identified using multiple logistic regression analysis.
ResultsTwenty-eight evacuees were hypertensive (70%), nine of whom were asymptomatic (32%). Most evacuees who had discontinued antihypertensive medication (92%; 11/12) had very high BP, while those who had continued antihypertensive medication (80%; 8/10) were mildly hypertensive. The systolic BP of those who had discontinued antihypertensive drugs was significantly higher than that of those who had continued hypertensive drugs in the whole cohort (n=40), and also in evacuees diagnosed as having HT at evacuation shelters (n=28; P<.01 for both comparisons). A history of HT (adjusted odds ratio [aOR], 11.40; 95% confidence interval [CI], 1.03-126.08) or age >55 years (aOR, 1.10; 95% CI, 1.01-1.21) predicted HT with a sensitivity of 0.96 and specificity of 0.80.
ConclusionsThe results of this study suggest that continuity of antihypertensive medication prevents serious HT at evacuation shelters in the first 10 days after a major earthquake. Onsite medical rounds focusing on simple predictors in an early stage after disasters may be an effective means of detecting and treating hypertensive disaster victims before they succumb to a fatal disease.
,Tanaka R ,Okawa M .Ujike Y Predictors of Hypertension in Survivors of the Great East Japan Earthquake, 2011: A Cross-sectional Study . Prehosp Disaster Med.2016 ;31 (1 ):17 –26 .
Prolonged Living as a Refugee from the Area Around a Stricken Nuclear Power Plant Increases the Risk of Death
- Reiichiro Tanaka
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- Journal:
- Prehospital and Disaster Medicine / Volume 30 / Issue 4 / August 2015
- Published online by Cambridge University Press:
- 21 July 2015, pp. 425-430
- Print publication:
- August 2015
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Although it is well known that the Great East Japan Earthquake (March 11, 2011) resulted in a large number of disaster-related deaths, it is not common knowledge that the number of disaster-related deaths continues to increase, even four years after the earthquake, in Fukushima Prefecture, where the nuclear power plant accident occurred. There has been a lack of a minute and critical analysis for the causes for this continuous increase. In this report, the causes for the increase in disaster-related deaths in Fukushima Prefecture were analyzed by aggregating and comparing multiple data released by public organizations (the Reconstruction Agency, the National Police Agency, and Fukushima Prefecture), which may also have implications for developing response strategies to other disasters. The disaster-related death rate, the dead or missing rate, and the refugee rate (the number of disaster-related deaths, dead or missing persons, and refugees per 1,000 people) in each prefecture in stricken areas, and also each city, county, town, and village in Fukushima Prefecture, were calculated and compared with each other. The populations which were used for the calculation of each death rate in the area were based on the number of dead victims who had lived in the area when the earthquake occurred, regardless of where they were at the time of their death. The disaster-related death rate was higher than the dead or missing rate in the area around a stricken nuclear power plant in Fukushima Prefecture. These areas coincide exactly with the Areas under Evacuation Orders because of unsafe radiation levels. The external and internal radiation doses of most of the victims of the Great East Japan Earthquake have appeared not to be so high to harm their health, until now. The psychological stress associated with being displaced from one’s home for a long time with an uncertain future may be the cause for these disaster-related deaths. There is an urgent need to recognize refugees’ stressful situations, which could even cause death, and to provide them with high-quality medical treatment, including care for their long-term mental health.
.Tanaka R Prolonged Living as a Refugee from the Area Around a Stricken Nuclear Power Plant Increases the Risk of Death . Prehosp Disaster Med.2015 ;30 (4 ):1 -6 .