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Lifestyle-related factors that explain disaster-induced changes in socioeconomic status and poor subjective health: a cross-sectional study from the Fukushima health management survey

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      Abstract

      Background

      Socioeconomic status (SES) and lifestyle-related factors are determinants of subjective health. However, changes in SES are inevitable in times of natural disaster, while lifestyle-related factors remain modifiable. The aim of this study was to use a cross-sectional approach to examine lifestyle-related factors that may attenuate the negative impact of disaster-induced changes in SES on poor subjective health.

      Methods

      We analyzed 33,350 men and women aged 20–64 years who were living in evacuation zones due to the radiation accident in Fukushima, Japan. Disaster-induced changes in SES were defined by living arrangements and working conditions. Using Poisson regression analysis adjusted for confounders (model 1) and lifestyle-related factors as intermediate variables (model 2), we compared the prevalence ratios (PRs) of poor subjective health of participants who did not undergo disaster-induced changes in SES (did not become unemployed, income did not decrease, and living in relative’s home/own home) with that of participants who did undergo disaster-induced changes in SES (became unemployed, decreased income, or lived in an evacuation shelter, temporary housing, or rental housing/apartment). We calculated the percentage of excess risks explained by lifestyle-related factors as follows: ((PR model 1 − PR model 2)/(PR model 1–1)) × 100.

      Results

      Disaster-induced changes in SES were significantly associated with poor subjective health. The PRs (95% CIs) among participants who underwent disaster-induced changes in SES were 2.02 (1.81–2.24) for men and 1.80 (1.65–1.97) for women. After adjusting for lifestyle-related factors, we found that the PRs in men and women were remarkably attenuated, decreasing to 1.56 (1.40–1.73) and 1.43 (1.31–1.55), respectively. Controlling for lifestyle-related factors resulted in PR attenuation by 45.1% (men) and 46.3% (women). Satisfaction of sleep and participation in recreation and community activity particularly contributed to this attenuation.

      Conclusions

      While disaster-induced changes in SES are unavoidable, lifestyle-related factors have the potential to attenuate the impact of these changes on poor subjective health.

      Electronic supplementary material

      The online version of this article (doi:10.1186/s12889-017-4247-2) contains supplementary material, which is available to authorized users.

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      Most cited references 35

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      Self-Rated Health and Mortality: A Review of Twenty-Seven Community Studies

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        Easy SAS calculations for risk or prevalence ratios and differences.

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          Study Protocol for the Fukushima Health Management Survey

            (2012)
          Background The accidents that occurred at the Fukushima Daiichi Nuclear Power Plant after the Great East Japan Earthquake on 11 March 2011 have resulted in long-term, ongoing anxiety among the residents of Fukushima, Japan. Soon after the disaster, Fukushima Prefecture launched the Fukushima Health Management Survey to investigate long-term low-dose radiation exposure caused by the accident. Fukushima Medical University took the lead in planning and implementing this survey. The primary purposes of this survey are to monitor the long-term health of residents, promote their future well-being, and confirm whether long-term low-dose radiation exposure has health effects. This report describes the rationale and implementation of the Fukushima Health Management Survey. Methods This cohort study enrolled all people living in Fukushima Prefecture after the earthquake and comprises a basic survey and 4 detailed surveys. The basic survey is to estimate levels of external radiation exposure among all 2.05 million residents. It should be noted that internal radiation levels were estimated by Fukushima Prefecture using whole-body counters. The detailed surveys comprise a thyroid ultrasound examination for all Fukushima children aged 18 years or younger, a comprehensive health check for all residents from the evacuation zones, an assessment of mental health and lifestyles of all residents from the evacuation zones, and recording of all pregnancies and births among all women in the prefecture who were pregnant on 11 March. All data have been entered into a database and will be used to support the residents and analyze the health effects of radiation. Conclusions The low response rate (<30%) to the basic survey complicates the estimation of health effects. There have been no cases of malignancy to date among 38 114 children who received thyroid ultrasound examinations. The importance of mental health care was revealed by the mental health and lifestyle survey and the pregnancy and birth survey. This long-term large-scale epidemiologic study is expected to provide valuable data in the investigation of the health effects of low-dose radiation and disaster-related stress.
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            Author and article information

            Affiliations
            [1 ]ISNI 0000 0001 1017 9540, GRID grid.411582.b, Radiation Medical Science Center for the Fukushima Health Management Survey, , Fukushima Medical University, ; Fukushima, Japan
            [2 ]ISNI 0000 0001 1017 9540, GRID grid.411582.b, Department of Epidemiology, , Fukushima Medical University School of Medicine, ; Fukushima, Japan
            [3 ]ISNI 0000 0001 1017 9540, GRID grid.411582.b, Department of Disaster Psychiatry, , Fukushima Medical University School of Medicine, ; Fukushima, Japan
            [4 ]ISNI 0000 0001 1017 9540, GRID grid.411582.b, Department of Public Health, , Fukushima Medical University School of Medicine, ; Fukushima, Japan
            Contributors
            ORCID: http://orcid.org/0000-0003-0818-3158, +81-22-717-8104 , m-nagai@med.tohoku.ac.jp
            Journal
            BMC Public Health
            BMC Public Health
            BMC Public Health
            BioMed Central (London )
            1471-2458
            20 April 2017
            20 April 2017
            2017
            : 17
            28427361 5397819 4247 10.1186/s12889-017-4247-2
            © The Author(s). 2017

            Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

            Funding
            Funded by: The National Health Fund for Children and Adults Affected by the Nuclear Incident
            Categories
            Research Article
            Custom metadata
            © The Author(s) 2017

            Public health

            subjective health, socioeconomic status, disaster, lifestyle

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