Kashima Saori, Inoue Kazuo, Matsumoto Masatoshi
Department of Public Health and Health Policy, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Department of Community Medicine, Chiba Medical Center, Teikyo University School of Medicine, Chiba, Japan.
PLoS One. 2017 Jan 3;12(1):e0169220. doi: 10.1371/journal.pone.0169220. eCollection 2017.
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.
重大灾难后医生短缺是一个关键问题。我们旨在评估在2011年3月11日东日本大地震导致福岛第一核电站事故后离开受灾地区的医生的特征。
利用2010年（灾难前）和2012年（灾难后）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优势比和95%置信区间，以评估医生特征与流出之间的关联。我们还根据医生特征进行了分层分析。
福岛县的医生数量减少了（-5.3%），而宫城县的医生数量增加了（2.8%）。即使考虑到各县的人口变化，福岛县的减少和宫城县的增加仍然很明显（医生与人口比例的变化分别为-1.9%和3.2%）。与居住在距离核电站100公里以上地区的医生相比，居住在20-50公里和50-100公里地区的医生分别有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）的可能性迁移到遥远地区。在分层分析中，年轻医生和职业生涯早期的医生流出的优势比高于其他医生（交互作用的P值分别为0.02和<0.01）。
核电站周边地区年轻和职业生涯早期的医生流出风险更大。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健康。
