Discussion Paper No.445

Relocation after the Great East Japan Earthquake andCognitive Decline Among Affected Residents
Fengming CHEN

Feburary, 2021

TOHOKU ECONOMICS RESEARCH GROUPGRADUATE SCHOOL OF ECONOMICS AND
MANAGEMENT TOHOKU UNIVERSITY
27-1 KAWAUCHI, AOBA-KU, SENDAI,
980-8576 JAPANTERG, Discussion Paper No.445

Relocation after the Great East Japan Earthquake
and Cognitive Decline Among Affected Residents
Fengming CHEN†

2021.2TOHOKU ECONOMICS RESEARCH GROUP
Abstract
The survey aimed to clarify the factors affecting the health status of the elderly living in
Miyagi and Fukushima prefectures, based on residents’ living conditions and recovery
after the Great East Japan Earthquake in March 2011. I analyzed the impact of relocationon the cognitive abilities of residents in the affected areas of the Great East Japan
Earthquake using the results of an original questionnaire survey. Tohoku University’s
Research Center for Aged Economy and Society surveyed the health status of elderly
adults eight years after the disaster from March 26–28, 2019. In this paper, I compared
the group means concerning those who did and did not relocate using three variables: thedementia risk index, professionally diagnosed dementia, and symptoms of dementia.
Eight years after the Great East Japan Earthquake, several residents of the affected areas
relocated. The results of our analysis indicated a close relationship between relocationand cognitive ability. Specifically, the group that relocated had worse health than those
who did not. According to the regression analysis results, the relocation dummy wassignificant, and positively affected the cognitive ability (dementia risk index andprofessionally diagnosed dementia) of the elderly. In addition, the interaction between therelocation dummy and dummies who visited friends more than once a week wassignificantly negative. For older adults who relocated, visiting friends at least once a week
was associated with improved cognitive performance. Therefore, it is crucial to create anenvironment that is conducive to interaction between residents.

Keywords: Relocation, the Great East Japan Earthquake, cognitive ability, survey data†

Assistant Professor, Graduate School of Economics and Management, Tohoku University.

✉:cfmdbdx@gmail.com
11. Introduction
In 2011, the Great East Japan Earthquake (GEJE) struck the Tohoku region in Japan,
claiming the lives of more than 20 thousand, and destroying numerous houses andbuildings (The Extreme Disaster Management Headquarters, 2020). Among the evacuees,
most fixed or rebuilt their damaged homes and returned to their hometowns. However,some had to relocate to other places because they could not afford to fix or rebuild theirhouses. Relocation based on individuals’ willingness is an excellent way to select asatisfying environment to reside in. Although the GEJE occurred more than nine years
ago, people’s health status is still affected owing to the damage to buildings, types of
support activities, and relocation caused by the disaster (Chen, 2019; Hikichi et al., 2016,2017).
The GEJE and sequent tsunami destroyed thousands of houses. Extensive housing
damage means that the owners must invest more time and money to fix or rebuild.
Therefore, the extent of housing damage caused by the GEJE was a key factor during
recovery. Empirical studies also showed that housing damage significantly decreased thehealth status of the evacuees, including hindering cognitive ability (Hikichi et al., 2019),
increasing psychological distress (Tsuchiya et al., 2017), and worsening theircardiometabolic profiles (Shiba et al., 2020). For example, Hikichi et al.(2019) applied arandom-effects model with panel data from Iwanuma City and found that the experienceof housing loss was related to declined cognitive ability. Therefore, how to deal with theissue of housing damage not only correlates to resilience in daily activities but also relates
to the resilience of health status.
Among the evacuees that could not afford to fix or reconstruct their homes, most had
to move to temporary emergency housings or live with relatives. In most cases, relocation
was decided by a lottery. Therefore, they had to give up the social capital they had
accumulated, such as living in a good neighborhood. Maintaining community social
capital is a challenge for local governments. Group relocation is one possible way to deal
with this issue. According to Hikichi et al. (2017), group relocation was related to
improved informal socializing and social participation, while individual relocation
declined as to these two indicators. However, group relocation would take more time andenergy expenditures from the local government than would individual relocation.; inwhich case, the relocation schedule would be drastically postponed, resulting in thedeterioration evacuees’ health status. Therefore, individual relocation was much more
popular than group relocation among the affected areas.
In February 2019, Nippon Hoso Kyokai (NHK; Japan Broadcasting Corporation)2

surveyed eight towns and villages in Futaba County and Minamisoma City in the vicinityof the Fukushima Daiichi nuclear power plant regarding the status of disaster-related
deaths. A majority of the respondents (58%) reported that they had relocated between fiveand nine times (mean = 6.7 times; NHK, 2019). The health of the elderly is particularly
likely to deteriorate as they are repeatedly relocated. According to the NHK results, of the
195 people who died, the main causes were pneumonia (28%) and heart disease (20%).
Malignant neoplasms accounted for just 2%. In contrast, the ranking and percentage ofdeaths (overall) in Japan in 2017 shows that malignant neoplasm is the main cause ofdeath (27.8%), while cardiac disease and senility are the second and fourth leading causesof death at 15.2% and 7.6%, respectively (Ministry of Health, Labour and Welfare, 2019).
There are two kinds of temporary emergency housings provided for evacuees:
prefabricated temporary emergency housing and privately rented temporary housing.
Empirical studies showed that housing type significantly contributed to contracting badhabits such as excessive alcohol consumption (Murakami et al., 2017). Housing type isalso related to decreased health, including hindered cognitive ability (Ishiki et al., 2016),
increased depressive symptoms (Sasaki et al., 2018; and decreased motor function (Ito etal., 2016), subjective health (Kusama et al., 2020), and subjective well-being (Moriyama
et al., 2019). However, these studies did not provide enough evidence concerning why
housing damage and housing types are associated with declined health among evacuees.
A few previous studies showed that social capital is significantly associated withcognitive ability. It is challenging for evacuees to keep existing social capital andaccumulate new social capital in a new environment. Both the deaths of residents andchanges in environments caused by the GEJE contributed to the decline in communitylevel social capital. However, few previous studies examined the impacts of the declineof social capital caused by the GEJE on cognitive ability (Hikichi et al., 2020). Therefore,
the purpose of this paper was to investigate the effects of relocation on the cognitive
abilities of the elderly using questionnaire survey data. It focused on older adult evacuees’
cognitive ability (dementia) and discussed the possible social capital mechanisms.

2. Method
2.1 Data
The CAES conducted a questionnaire survey of elderly people living in Miyagi and
Fukushima prefectures, following a review by the Research Ethics Review Committee of
the Graduate School of Economics and Management, Tohoku University. This academic
survey was designed to clarify the factors affecting the health status of the elderly, basedon the living conditions and recovery of the residents since the GEJE.
3

The methods of this study were as follows: 1) screening selected monitors livingwith elderly people aged 65 years or older; 2) asking the monitors to answer about thesituation of the oldest elderly person living with them after obtaining the oldest elderly
person’s consent. I targeted Miyagi and Fukushima prefectures, and 734 respondents (435in Miyagi and 299 in Fukushima) were requested to cooperate in the survey throughInternet member survey agencies (Chen and Yoshida, 2019).
Table 1 shows the distribution of relocations among the respondents. The highest
frequency of relocations was only once, accounting for 9.7% of the total number ofrelocations. This differs from the results of the NHK survey, which showed that the
number of relocations ranged from 5 to 9 times. This is owing to the fact that theparticipants of the two surveys were very different.
Table 1. Number of relocations after the Great East Japan Earthquake
Number of relocations
n
%
One
71
9.7
Two
36
4.9
Three
17
2.3
Four
3
0.4
Five
0
0.0
Six
0
0.0
Seven and more
1
0.1
Never
606
82.6
Total
734 100.0
Note: Based on the individual data of “A Questionnaire on the Health Status of the Elderly Eight Years after
the Great East Japan Earthquake.”

Table 2 summarizes the reasons for the first relocation among those who had
relocated. Most (58.6%) moved for reasons related to the earthquake. In contrast, 23.4%
of respondents moved for reasons unrelated to the earthquake, such as buying a home orfamily reasons. Since the decision concerning where to live was primarily a matter of
personal choice, there was no room for the involvement of others. However, owing to thedisaster, many residents were forced to leave their familiar towns. For elderly residents,
it is quite difficult for them to solve their housing problems on their own; thus,
government assistance was essential.
Table 2. Reasons for the first relocation
Reasonn%

1. Houses were damaged or destroyed in the GEJE

36

28.1

2. Houses were damaged or destroyed by the tsunami in the GEJE

23

18.0

3. Houses are safe; but the dangers of radiation are still there

13

10.2

4. Other reasons for relocating owing to the GEJE

3

2.3

4

5. Other reasons regardless of the GEJE (e.g., purchase of a home, family reasons)

30

23.4

6. An elderly person had become ill and needed care

75.5

7. An elderly person started cohabitating with his/her children

8

6.3

8. Other

8

6.3

Total

128

100.0

Note: Based on the individual data of “A Questionnaire on the Health Status of the Elderly Eight Years after
the Great East Japan Earthquake.” GEJE = Great East Japan Earthquake.

2.2 Dependent Variables
I used three indicators to measure the cognitive abilities of the elderly. The firstindicator was the dementia risk index based on the “Dementia Awareness Checklist,”
which was initially created by the Tokyo Metropolitan Health and Longevity Medical
Center Research Institute. The higher the scores, the more likely respondents had
problems with their cognitive abilities and social lives. The center’s validation showed
that, among the 131 respondents identified as high-risk on the checklist, 76% weresuspected to have dementia, which was determined in a post-professional interview. Table
3 provides a breakdown of the ten questions used to calculate the dementia risk index inthis paper.
Table 3. Questions for calculating individuals’ dementia risk

1. Do you always lose track of where you put things, such as your wallet and keys?
2. Do you fail to remember a story from five minutes ago?
3. Are you told that you always ask the same things?
4. Do you fail to answer questions regarding information about the current day?
5. Do the words you are trying to say not come out immediately?
6. Can you manage daily financial matters alone?
7. Can you go shopping alone?
8. Can you go out using a bus, train, or private car alone?
9. Can you clean your bedroom using a vacuum cleaner or broom?
10. Can you look up a phone number and make a call?
Note: These questions were based on the checklist for dementia diagnosis, developed by the Tokyo
Metropolitan Health and Longevity Medical Center Research Institute. Response options for the first fivequestions include “not at all” (1 point), “a little” (2 points), “often” (3 points), and “always” (4 points).
Response options for the remaining questions include “I can do it” (1 point), “I can do it with a little help”(2 points), “I can do it with much help” (3 points), and “I cannot do it” (4 points). Summed scores indicatedindividuals’ dementia risk.

The second indicator was whether the respondent was diagnosed with dementia by5

a specialist. Regarding the question, “Does the elderly person currently have doctordiagnosed dementia such as Alzheimer’s disease,” the dummy variable “diagnosed
dementia” was assigned a value of 1 when the response was “yes.” “No” was assigned avalue of 0.
The third indicator was the number of symptoms of dementia. The symptoms ofdementia can be broadly divided into two types: core symptoms, which are the main
symptoms of dementia, depending on the part of the cortex where the neuronaldegeneration occurs; and behavioral and psychological symptoms, which are also known
as peripheral symptoms. Here, I measured older adults’ cognitive abilities by adding thenumber of core and peripheral symptoms of dementia (Table 4).

Table 4. Symptoms of dementia
1. The respondent often does not know his/her age
2. Cohabitating children or spouse could be mistaken as strangers
3. It is possible that the respondent forgets the meal that he/she ate just before
4. Sometimes, the respondent does not answer the number of children correctly
5. The respondent walks around the house aimlessly
6. The respondent is rambling continuously all day
7. The respondent eats whatever he/she can eat
8. The respondent does not want to bathe or change clothes for no particular reason
9. Waking up at night and making a lot of noise for no reason
10. The respondent puts something in his/her mouth that is not foodNote: Based on the individual data of “A Questionnaire on the Health Status of the Elderly Eight Years
after the Great East Japan Earthquake.”

2.3 Explanatory Variables
The explanatory variables used in this paper included not only individual attributes
but also the recovery status of the community. The definition of each variable is presented
in Table 5.
Table 5. Definitions of variables
Variables
Dementia Risk Index
Diagnosed dementia dummy
Number of symptoms ofdementia

Definitions
Based on the “Dementia Awareness Checklist,” adding ten items as a
total score
Regarding the question, “Does the elderly person currently havedoctor-diagnosed dementia such as Alzheimer’s disease,” the dummy
variable “diagnosed dementia” was assigned a value of 1 when the
respondence was “yes.” “No” was assigned a value of 0.
The number of symptoms of dementia that the elderly person has

6

If the number of relocations after the GEJE exceeded one, therelocation dummy was assigned a value of 1. Otherwise, this dummy
was assigned a value of 0
Male dummyMale = 1, Female = 0
Cohabitating with spouse dummy Cohabitating with spouse＝1, other＝0
Aged ≥ 85 years dummy
Aged ≥ 85 years＝1, other＝0
Higher education dummyMore than an undergraduate degree = 1, Other = 0
Total activities of daily living score was calculated based on ten items:
Total activities of daily living
independent (1 point), partially assisted (2 points), and fully assisted (3scorepoints)Support needed dummy
Support needed level 1–2 = 1, Other = 0
Care needed dummy
Care needed level 1–5 = 1, Other = 0
Income and economic living
Self-reported as 1. very poor, 2. poor, 3. normal, 4. good, or 5. very
conditions
good
Access to medical and welfare Self-reported as 1. very poor, 2. poor, 3. normal, 4. good, or 5. very
facilities
good
Relationship with family
Self-reported as 1. very poor, 2. poor, 3. normal, 4. good, or 5. very
members
good
Visiting friends more than once a
Visiting friend more than once a week = 1, Other = 0
week dummy
Recovery of municipalities after Self-reported as 1. very poor, 2. poor, 3. normal, 4. good, or 5. very
the GEJE
good
Note: Based on the individual data of “A Questionnaire on the Health Status of the Elderly Eight Years
after the Great East Japan Earthquake.” GEJE = Great East Japan Earthquake.
Relocation dummy

2.4 Descriptive Statistics
Table 6 shows the descriptive statistics of the variables. Overall, 16.1% of the study
population had moved to a new location and 8.2% had professionally diagnosed dementia.
The average number of symptoms of dementia was 0.768. The elderly aged ≥ 85 years
accounted for 23.8% of the study population, and 5.7% and 14.2%, respectively, wereidentified as needing support or care. About one-third visited their friends at least once a
week.
Table 6. Descriptive statistics
Dementia Risk Indicator
Diagnosed dementia dummy
Number of symptoms of dementia
Relocation dummyMale dummy
Cohabitating with spouse dummy
Aged ≥ 85 years dummyHigher education dummy
Total activities of daily living score
Support needed dummy
Care needed dummy
Income and economic living conditions
Access to medical and welfare facilities
Relationship with family members
Visiting friend more than once a week dummy
Recovery of municipalities after the GEJE

Mean
16.740
0.082
0.768
0.161
0.496
0.521
0.238
0.153
11.178
0.057
0.142
2.857
3.213
3.294
0.338
3.228

7

SD
7.272
0.274
1.838
0.368
0.500
0.499
0.426
0.360
3.137
0.232
0.349
0.876
0.902
0.877
0.473
0.712

Min
10.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
10.000
0.000
0.000
1.000
1.000
1.000
0.000
1.000

Max
40.0001.000
10.000
1.000
1.000
1.000
1.000
1.000
30.000
1.000
1.000
5.000
5.000
5.000
1.000
5.000

Note: Based on the individual data of “A Questionnaire on the Health Status of the Elderly Eight Years
after the Great East Japan Earthquake.” GEJE = Great East Japan Earthquake, SD = standard deviation.

3. Empirical Results
3.1 Mean Difference Test Results
Two subsamples were created here, A and B, depending on the presence or absenceof relocation. Table 7 shows the results of the test of the difference between the means ofeach indicator of older adults’ cognitive ability. The group mean values of three indicators
were significantly higher for the group that relocated (vs. did not), indicating relatively
low cognitive ability. This was consistent with our hypothesis. In other words, relocation
history was associated with negative effects on older adults’ cognitive abilities.

Table 7. Mean difference test results
A (have a history of B (without a history

A–B

relation)of relocation)

116

604

-

Dementia Risk Indicator

17.87916.522

1.358**

Diagnosed dementia dummy

0.138

0.071

0.067***

Number of symptoms of dementia

0.991

0.725

0.266*

Note: Based on the individual data of “A Questionnaire on the Health Status of the Elderly Eight Years after
the Great East Japan Earthquake.” *p < .10, **p < .05, ***p < .01 (t-tests).

3.2 Regression results
I analyzed the relationship between relocation and cognitive ability without
controlling for the effects of other variables in 3.1. Here, I further look into therelationship between relocation and cognitive ability through regression analysis. The
dependent variables in estimating equations A1, B1, and C1 were dementia risk,
diagnosed dementia dummy, and the number of symptoms of dementia, respectively.
Table 8 shows the details of the estimation results. First, based on the results of A1, thecoefficient for the relocation dummy was significantly positive. Compared to older adults
without a history of relocation, older adults with a history of relocation had a higher riskof developing dementia, leading to lower cognitive performance. This result wasconsistent with our expectations. The control variables showed that older adults aged 85
years and older had significantly lower cognitive abilities than those aged younger than85 years. The coefficient on the total ADL score was significant, with an average increaseof one point in the total ADL score raising the risk index for developing dementia by8

0.971 points. Concerning income and economic living conditions, the result wassignificant at the 5% level. As the income and economic living conditions of older adults
improved, their cognitive ability also improved. A similar result was obtained for the
relationship with family members. Next, the estimation results for B1 showed that theresult was significant at the 5% level for the relocation dummy. Compared to older adults
with no history of relocation, older adults with a history of relocation were more likely tohave professionally diagnosed dementia. In other words, a history of relocation was
negatively associated with older adults’ cognitive abilities. Finally, looking at the C1
estimates, the regression coefficient for the relocation dummy was positive, but nonsignificant.
Table 8. The estimated results (1)A1Dementia risk
Relocation dummyMale dummy
Cohabitating with spouse dummy
Aged ≥ 85 years dummyHigher education dummy
Total activities of daily living score
Support needed dummy
Care needed dummy
Income and economic living conditions
Access to medical and welfare facilities
Relationship with family members
Visiting friend more than once a week
dummy
Recovery of municipalities after the GEJE
Adjusted R2
Observations

B1
Diagnosed dementia
dummy

C1
Number ofsymptoms ofdementia
0.144-0.356**0.317**
0.096
0.038
0.198***-0.1090.723***
0.035
0.114
-0.176**0.186

0.902*-0.7250.203
2.633***-0.696
0.971***
2.712***
5.550***-0.519**-0.166-1.104***-0.4640.052**-0.0120.001
0.025-0.0130.017***
0.083**
0.251***-0.0050.025**-0.020*
0.017

0.225

-0.010-0.262**

0.535
720

0.231
720

0.211
720

Note: Author’s estimates; *p < .10, **p < .05, ***p < .01 (OLS analysis); GEJE = Great East Japan
Earthquake.

The results of the above analyses indicated that relocation history has a negative
impact on older adults’ cognitive abilities. Here, I further added the intersection term forrelocation dummy and visiting a friend more than once a week dummy to examine
possible mechanisms. Table 9 presents detailed results. The estimated coefficient for theintersection term was significantly negative, according to the A2 estimation results. For
older adults with a history of relocation, visiting a friend at least once a week significantly
reduced their risk of developing dementia and improved their cognitive abilities. Similarly,
the estimation results for B2 and C2 showed similar results for the intersection term (the9

result in B2 was non-significant).
Table 9. The estimated results (2)
A2

B2

C2

Dementia Risk

Diagnosed

Number ofdementia dummy

symptoms ofdementia

Relocation dummy

1.640***

0.075**

0.346*

Visiting friend more than once a week dummy-0.099

0.028

0.286

Relocation × visiting friend-2.347**-0.072-0.642*

Male dummy-0.732-0.012-0.358**

Cohabitating with spouse dummy

0.194

0.001

0.315**

Aged ≥ 85 years dummy

2.624***

0.025

0.093

Higher education dummy-0.609-0.011

0.062

Total activities of daily living score0.975***

0.017***

0.199***

Support needed dummy

2.732***

0.083**-0.103Care needed dummy

5.484***

0.249***

0.705***

Income and economic living conditions-0.512**-0.0050.037

Access to medical and welfare facilities-0.1540.025**

0.117

Relationship with family members-1.155***-0.021*-0.190**Visiting friend more than once a week dummy

0.241-0.009-0.258**Recovery of municipalities after the GEJE

0.538

0.232

0.213

Adjusted R2

720

720

720

Note: Author’s estimates; *p < .10, **p < .05, ***p < .01 (OLS analysis); GEJE = Great East Japan
Earthquake.

4. Conclusion and Discussion
This paper presents an empirical analysis of the relationship between relocation
history and the cognitive abilities of the elderly, using individual data from an originalquestionnaire. The results of the regression analysis are summarized as follows. First,
compared to older adults with a history of relocation, cognitive ability (dementia risk anddiagnosed dementia dummy) was significantly lower for older adults without a history of
relocation. Second, for older people with a history of relocation, visiting friends at least
once a week significantly increased their cognitive ability.
Since relocation is a decision made by the individual, there is no room for
involvement from the government. However, owing to earthquakes and secondary
10

disasters, many residents are forced to leave their familiar towns and move to distantlocations. In this case, they lose the social capital they have built over the years, such asneighborhood relationships. The estimates in this paper suggest that social capital, suchas visiting friends at least once a week, plays a vital role in maintaining older adults’cognitive abilities. Therefore, during recovery, sufficient emphasis should be placed not
only on restoring visible infrastructure and lifelines but also on restoring invisible social
capital.
References
Chen, F., 2019. Support activities after the Great east Japan earthquake and health status of affected
residents. J. Household Economics 50, 35–49.(in Japanese).
Chen, F., Yoshida, H., 2019. A Questionnaire on the Health Status of the Elderly Eight Years after theGreat East Japan Earthquake, TERG Discussion Papers, No. 403.
Available online: https://www.mhlw.go.jp/toukei/saikin/hw/jinkou/kakutei17/index.html.
(Accessed 12.11.2020)
Hikichi, H., Aida, J., Kondo, K., Kawachi, I., 2019. Persistent impact of housing loss on cognitive
decline after the 2011 Great East Japan earthquake and tsunami: Evidence from a 6-year
longitudinal study. Alzheimer’s Dem. 15, 1009–1018. https://doi.org/10.1016/j.jalz.2019.04.016.
Hikichi, H., Aida, J., Kondo, K., Tsuboya, T., Matsuyama, Y., Subramanian, S.V., Kawachi, I., 2016.
Increased risk of dementia in the aftermath of the 2011 Great East Japan earthquake and tsunami.
Proc. Natl. Acad. Sci. U. S. A. 113, E6911–E6918.
Hikichi, H., Aida, J., Matsuyama, Y., Tsuboya, T., Kondo, K., Kawachi, I., 2020. Community-levelsocial capital and cognitive decline after a natural disaster: A natural experiment from the 2011
Great East Japan Earthquake and tsunami. Soc. Sci. Med. 257, 111981.
https://doi.org/10.1016/j.socscimed.2018.09.057.
Hikichi, H., Sawada, Y., Tsuboya, T., Aida, J., Kondo, K., Koyama, S., Kawachi, I., 2017. Residential
relocation and change in social capital: A natural experiment from the 2011 Great East Japan
Earthquake and tsunami. Sci. Adv. 3, e1700426. https://doi.org/10.1126/sciadv.1700426.
Ishiki, A., Okinaga, S., Tomita, N., Kawahara, R., Tsuji, I., Nagatomi, R., Taki, Y., Takahashi, T.,
Kuzuya, M., Morimoto, S., Iijima, K., Koseki, T., Arai, H., Furukawa, K., 2016. Changes incognitive functions in the elderly living in temporary housing after the Great East Japan
Earthquake. PLOS ONE 11, e0147025. https://doi.org/10.1371/journal.pone.0147025.
Ito, K., Tomata, Y., Kogure, M., Sugawara, Y., Watanabe, T., Asaka, T., Tsuji, I., 2016. Housing typeafter the Great East Japan Earthquake and loss of motor function in elderly victims: A prospective
observational study. BMJ Open 6, e012760. https://doi.org/10.1136/bmjopen-2016-012760.
Kusama, T., Aida, J., Higashi, D., Sato, Y., Onodera, T., Sugiyama, K., Tsuboya, T., Takahashi, T.,
11

Osaka, K., 2020. Trajectory of evacuees’ health condition after the Great East Japan Earthquake:
Health survey of residents in prefabricated temporary housing and private rented housing in the
Miyagi prefecture. Nihon Koshu Eisei Zasshi 67, 26–32https://doi.org/10.11236/jph.67.1_26.
Ministry of Health, Labour and Welfare, 2019. Vital Statistics of Japan(2017 Year).
Moriyama, N., Iwasa, H., Tsubokura, M., Kuroda, Y., Yasumura, S., 2019. Living in the Restoration
Public Housing after the Great East Japan Earthquake correlates with lower subjective well-beingof older adults. Int. J. Environ. Res. Public Health 16, 2696.
https://doi.org/10.3390/ijerph16152696.
Murakami, A., Sugawara, Y., Tomata, Y., Sugiyama, K., Kaiho, Y., Tanji, F., Tsuji, I., 2017.
Association between housing type and γ-GTP increase after the Great East Japan Earthquake. Soc.
Sci. Med. 189, 76–85. https://doi.org/10.1016/j.socscimed.2017.07.020.
NHK Survey, 2019.
Available online: https://www3.nhk.or.jp/news/html/20190306/k10011837541000.html. [accessed
12 11, 2020].
The extreme disaster management Headquarters. “Oncol. Ther., 2011 earthquake off the Pacificcoast of Tohoku” (in Japanese). Available online:
https://www.fdma.go.jp/disaster/higashinihon/items/160.pdf [accessed 12 11, 2020].
Sasaki, Y., Aida, J., Tsuji, T., Miyaguni, Y., Tani, Y., Koyama, S., Matsuyama, Y., Sato, Y., Tsuboya,
T., Nagamine, Y., Kameda, Y., Saito, T., Kakimoto, K., Kondo, K., Kawachi, I., 2018. Does typeof residential housing matter for depressive symptoms in the aftermath of a disaster? Insights fromthe Great East Japan Earthquake and tsunami. Am. J. Epidemiol. 187, 455–464.
https://doi.org/10.1093/aje/kwx274.
Shiba, K., Aida, J., Kondo, K., Nakagomi, A., Arcaya, M., James, P., Kawachi, I., 2020. Mediation of
the relationship between home loss and worsened cardiometabolic profiles of older disastersurvivors by post-disaster relocation: A natural experiment from the Great East Japan earthquake
and tsunami. Health Place 66, 102456. https://doi.org/10.1016/j.healthplace.2020.102456.
Tsuchiya, N., Nakaya, N., Nakamura, T., Narita, A., Kogure, M., Aida, J., Tsuji, I., Hozawa, A.,
Tomita, H., 2017. Impact of social capital on psychological distress and interaction with house
destruction and displacement after the Great East Japan Earthquake of 2011. Psychiatry Clin.
Neurosci. 71, 52–60. https://doi.org/10.1111/pcn.12467.

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