Department of Public Health Nursing, Japanese Red Cross College of Nursing, Tokyo, Japan.
Department of Medical Statistics, Toho University, Tokyo, Japan.
BMJ Open. 2018 Dec 28;8(12):e023435. doi: 10.1136/bmjopen-2018-023435.
The impact of the 2011 Great East Japan Earthquake on renal failure (RF) risk remains unclear. We examined the 1-year impact of this disaster on RF mortality.
This ecological study focused on the year before and after the earthquake. The data sources were national vital statistics (2010-2012), the national census (2010) and the Basic Resident Registration (2010-2012).
Our study included all residents in Iwate, Miyagi and Fukushima, 1 year before and after the earthquake.
We calculated standardised mortality ratios (SMRs) for RF, chronic RF and acute RF. Postearthquake weekly SMRs were calculated using the number of RF deaths for the corresponding weeks in 2010 as a reference. The SMRs for RF were compared between the coastal and inland municipalities using kernel-weighted polynomial smoothing.
There were 1290 RF deaths in the three prefectures during the year after the earthquake (chronic RF: 804 and acute RF: 236). The SMR for RF increased significantly in the first week after the earthquake in coastal areas (3.11; 95% CI: 1.84 to 4.37), but did not increase in inland areas (0.93; 95% CI: 0.47 to 1.38). A similar trend was observed for chronic RF (coastal: 4.0; 95% CI: 2.0 to 6.0; inland: 1.1; 95% CI: 0.4 to 1.7). SMRs for RF and chronic RF decreased over time and reached 1.0 approximately 20 weeks after the disaster. Changes in SMRs for acute RF were not apparent due to the low number of deaths.
Mortality due to RF and chronic RF, but not acute RF, increased in coastal areas after the earthquake. Chronic RF may have been exacerbated by disaster-induced sympathetic activation and poor management of renal dysfunction. Increased hypertension and damage to essential infrastructure and medical equipment may also have increased mortality in people with kidney disease.
2011 年东日本大地震对肾衰竭（RF）风险的影响仍不清楚。我们研究了这场灾难对 RF 死亡率的 1 年影响。
这项生态研究集中在地震前后的一年。数据来源是国家生命统计数据（2010-2012 年）、国家人口普查（2010 年）和基本居民登记（2010-2012 年）。
我们的研究包括地震前一年和后一年岩手、宫城和福岛的所有居民。
我们计算了 RF、慢性 RF 和急性 RF 的标准化死亡率比（SMR）。使用 2010 年相应周的 RF 死亡人数作为参考，计算了震后每周的 SMR。使用核加权多项式平滑比较了沿海和内陆城市的 RF 死亡率。
地震后一年，三个县共有 1290 例 RF 死亡（慢性 RF：804 例，急性 RF：236 例）。地震后第一周，沿海地区 RF 的 SMR 显著升高（3.11；95%置信区间：1.84 至 4.37），但内陆地区没有升高（0.93；95%置信区间：0.47 至 1.38）。慢性 RF 也出现了类似的趋势（沿海：4.0；95%置信区间：2.0 至 6.0；内陆：1.1；95%置信区间：0.4 至 1.7）。随着时间的推移，RF 和慢性 RF 的 SMR 逐渐下降，大约在灾难发生后 20 周达到 1.0。由于死亡人数较少，急性 RF 的 SMR 变化不明显。
地震后，沿海地区 RF 和慢性 RF 的死亡率上升，但急性 RF 没有上升。慢性 RF 可能因灾害引起的交感神经激活和肾功能障碍管理不善而恶化。高血压增加以及基本基础设施和医疗设备受损也可能增加肾病患者的死亡率。
