Sasabuchi Yusuke, Matsui Hiroki, Yasunaga Hideo, Fushimi Kiyohide
Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
J Epidemiol Community Health. 2017 Mar;71(3):248-252. doi: 10.1136/jech-2016-207413. Epub 2016 Sep 9.
The Great East Japan Earthquake and subsequent tsunami and nuclear disaster on 11 March 2011 had a short-term influence on the increase in emergency department visits and hospital admissions due to various diseases. However, it remains unclear whether the earthquake and tsunami disaster affected the long-term health conditions of people in the affected areas.
Using a national inpatient database in Japan, we investigated people's ambulatory care sensitive conditions (ACSCs), which are defined as conditions for which effective management and treatment should prevent admission to a hospital. We compared the number of admissions for ACSCs before-quake (July 2010 to February 2011) with after-quake (July 2012 to February 2013) periods in the disaster area compared with other areas using a difference-in-differences design. Linear regression models with the interaction between periods and areas were used to estimate the impact of the earthquake on admissions for ACSCs.
No significant difference in difference was seen in preventable ACSCs (where immunisation and other interventions can prevent illness) or chronic ACSCs (where effective care can prevent flare-ups), while acute ACSCs (where early intervention can prevent more serious progression) increased significantly (3.3 admissions per 100 000 population; 95% CI 0.4 to 6.3; p=0.028).
Preventable and chronic ACSCs may have increased just after the earthquake and then immediately decreased. However, avoidable admissions due to acute ACSCs remained high in the long term after the earthquake and tsunami disaster.
2011年3月11日的东日本大地震及随后的海啸和核灾难对因各种疾病导致的急诊科就诊人数和住院人数增加产生了短期影响。然而，地震和海啸灾难是否影响了受灾地区民众的长期健康状况仍不清楚。
我们利用日本的一个全国住院患者数据库，调查了人们的非卧床护理敏感疾病（ACSCs），即那些通过有效管理和治疗应可预防住院的疾病。我们采用双重差分设计，将灾区地震前（2010年7月至2011年2月）和地震后（2012年7月至2013年2月）期间ACSCs的住院人数与其他地区进行了比较。使用时期与地区之间相互作用的线性回归模型来估计地震对ACSCs住院人数的影响。
在可预防的ACSCs（免疫接种和其他干预措施可预防疾病）或慢性ACSCs（有效护理可预防病情发作）方面，未观察到显著的差异，而急性ACSCs（早期干预可预防更严重进展）显著增加（每10万人口中有3.3例住院；95%可信区间为0.4至6.3；p=0.028）。
可预防和慢性ACSCs可能在地震后立即增加，然后迅速下降。然而，在地震和海啸灾难发生后的长期内，因急性ACSCs导致的可避免住院人数仍然居高不下。
