保健医療科学

2018Vol.67 No.1 p.34－41

Topics: Lessons learned on public health from the Fukushima Daiichi Nuclear Power Plant accident＜ Review ＞
Trends in lifestyle-related diseases before and after the Great East
Japan Earthquake: the Fukushima Health Management Survey
Tetsuya Ohira 1,2), Hironori Nakano 1,2), Kanako Okazaki 1,2), Fumikazu Hayashi 1,2),
Yui Yumiya 1,2), Akira Sakai 1,3), for the Fukushima Health Management Survey Group
1)

Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University

2)

Department of Epidemiology, Fukushima Medical University School of Medicine

3)

Department of Radiation Life Sciences, Fukushima Medical University School of Medicine
Abstract
The Great East Japan Earthquake that occurred on March 11, 2011, was followed by a nuclear accident
at the Fukushima Daiichi Nuclear Power Plant. Many residents of the surrounding areas were forced toevacuate their homes and change their lifestyle. The potential influence of the evacuation on the risk
factors for cardiovascular diseases (CVD) was investigated through the Fukushima Health Management
Survey (FHMS). In the present study, we have reviewed the results of longitudinal studies of lifestylerelated diseases that are based on the FHMS. After the disaster, evacuated residents presented anincreased proportion of overweight/obese people and a higher prevalence of hypertension, diabetes
mellitus, dyslipidemia, liver dysfunction, atrial fibrillation, and polycythemia than those before the disaster.
Furthermore, the prevalence of diabetes mellitus and dyslipidemia increased between FY2011–2012 andFY2013–2014, after the disaster. Results show that disaster evacuees may be more predisposed to CVDs,
such as myocardial infarction and stroke. Preventive programs for obesity, hypertension, diabetes mellitus,and dyslipidemia should be implemented in collaboration with local governments and communities.
keywords: disaster, epidemiology, non-communicable diseases, population studies, psycho-social factors(accepted for publication, 22nd January 2018)

I．Introduction
The Great East Japan Earthquake occurred on March 11,
2011. As a consequence of the earthquake and a subsequenttsunami, the Fukushima Daiichi Nuclear Power Plant (NPP)
was affected and released radioactive elements causing a
nuclear accident. Many residents living in the surrounding
areas were forced to evacuate their homes and change
their lifestyle. The Fukushima disaster involved a major
earthquake, a tsunami, and a nuclear accident. The numberof disaster-related deaths was considerably high (morethan twice the number of deaths in the Miyagi and Iwate
disasters (Fukushima: 2,202; Miyagi: 926; and Iwate: 464.

See http://www.reconstruction.go.jp/topics/main-cat2/subcat2-6/20140526131634.html), whereas the number ofdeaths directly related to the earthquake and tsunami wasless than half those of previous occurrences (Fukushima:
1,613; Miyagi: 9,541; and Iwate: 4,673). It has therefore
been hypothesized that lifestyle changes caused by theevacuation, together with the stress and anxiety causedby the NPP accident, may have been associated with anincreased risk of disaster-related diseases and/or deaths,
given that peopleʼs fear of radiation exposure is likely tolast longer than their fear of natural disasters, such as
earthquakes and tsunamis. Currently, few longitudinalstudies have investigated the effects of disaster-related

Corresponding author: Tetsuya Ohira
1 Hikarigaoka, Fukushima, Fukushima 960-1295, Japan.
E-mail: teoohira@fmu.ac.jp.

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J. Natl. Inst. Public Health, 67 (1) : 2018

Trends in lifestyle-related diseases before and after the Great East Japan Earthquake
evacuation on the risk of cardiovascular diseases.
We addressed this issue, as a part of the Comprehensive
Health Check in the Fukushima Health Management
Survey (FHMS) [1], by investigating a possible association
between evacuation and changes in the risk factors forlifestyle-related diseases in the residents of the Fukushima
Prefecture evacuation area. We previously reviewed
changes in cardiovascular risk factors before and after thedisaster in Fukushima [2]. In the present study, in addition
to the review of short-term changes in lifestyle-relateddiseases, we review the results of four-year longitudinalstudies based on the Comprehensive Health Check in the
FHMS and discuss future strategies to prevent lifestylerelated diseases in the residents of Fukushima.

II．Methods
1. Study population
The subjects comprised 278,276 Japanese men andwomen living in communities near the Fukushima Daiichi
NPP in Fukushima Prefecture. This area includes 13
municipalities: Hirono-machi, Naraha-machi, Tomiokamachi, Kawauchi-mura, Okuma-machi, Futaba-machi,
Namie-machi, Katsurao-mura, Iitate-mura, Kawamatamachi, Tamura City, Minami-Soma City, and Date City.
Following the disaster, the government ordered all
residents of Hirono-machi, Naraha-machi, Tomiokamachi, Kawauchi-mura, Okuma-machi, Futaba-machi,
Namie-machi, Katsurao-mura, and Iitate-mura—and someresidents of Tamura City, Minami-Soma City, Kawamatamachi, and Date City—to evacuate their homes (Figure
1, Evacuation zone). Other areas of Tamura City, MinamiSoma City, Kawamata-machi, and Date City were defined as
non-evacuation zones (Figure 1, Non-evacuation zone) [3,4].
Within these communities, people insured by the National

Health Insurance and aged 40–74 years and all people aged
≥75 years (the target population for check-ups consistedof 91,554 men and women in 2010) have had annual healthcheck-ups for metabolic syndrome since 2008. This number
includes 41,633 subjects (18,745 men and 22,888 women;mean age, 67 years) who had health check-ups during a“baseline” period (2008–2010). The rates of participationin check-ups for the initial Census population and for thetarget population were 25.3% and 45.5%, respectively.
2. Follow-up examinations
According to the Comprehensive Health Check and
FHMS, annual health check-ups have been conductedamong residents of all ages in these communities since2011. The detailed methodology of the Comprehensive
Health Check and the FHMS has been previously reported.
[1,2,3,4] A follow-up survey was conducted countrywide, as
evacuation led the subjects to various parts of the country.
The number of participants aged 16 years or older before
March 2015 was 56,399 in FY2011, 47,009 in FY2012,
43,040 in FY2013, and 41,874 in FY2014. As a result, 27,486
participants (12,432 men and 15,054 women; follow-up
proportion: 66%) received follow-up examinations between
FY2011 and FY2012, with an average follow-up period of 1.6
years. The participants have been divided into two groups
for analysis: evacuees (n = 9,671) and non-evacuees (n =17,815). We have used this data set to analyze changes in
the prevalence of lifestyle-related diseases before and after
the disaster. In addition, we have calculated the prevalenceof lifestyle-related diseases for each year (FY2011–FY2014),
stratifying the results by age groups.
3. Measures and definitions
Each subjectʼs history of cigarette smoking and weekly
alcohol intake was obtained by a trained interviewer.

Figure 1 Geographic details of the evacuation zone, non-evacuation zone, and the
Fukushima Daiichi Nuclear Power Plant [4]J. Natl. Inst. Public Health, 67 (1) : 201835

Tetsuya Ohira et al., for the Fukushima Health Management Survey Group
Participants who consumed ≥ 44 g ethanol per day were classified
as current excessive drinkers.
Several physical characteristics and blood parameters
were analyzed, including the subjectʼs height, body weight,
waist circumference, body mass index (BMI), blood pressure,aspartate aminotransferase (AST), alanine aminotransferase(ALT),γglutamyl transpeptidase (γ-GT), triglyceride(TG), high-density lipoprotein cholesterol (HDL-C), lowdensity lipoprotein cholesterol (LDL-C), HbA1c, fasting
plasma glucose, and urine protein and sugar levels. Additional
measurements included serum creatinine levels, the estimatedglomerular filtration rate, uric acid levels, and peripheral
blood counts, which evaluated the number of red blood cells,
platelets, and white blood cells. Overweight/obese individuals
were defined as having a BMI≥ 25 kg/m2. Hypertension was
defined as a systolic blood pressure (BP)≥ 140 mmHg, adiastolic BP≥ 90 mmHg, or the use of an antihypertensive
medication. Diabetes was defined as a fasting plasma glucose
level ≥ 126 mg/dL (7.0 mmol/L), an HbA1c (NGSP) level ≥
6.5%, or the use of an antihyperglycemic medication. A hypoHDL cholesterolemia was defined as HDL-C < 40 mg/dL,
and dyslipidemia was defined as HDL-C < 40 mg/dL and/or
LDL cholesterol ≥ 140mg/dL and/or fasting serum TG ≥ 150
mg/dL, or being treated for dyslipidemia. The diagnosis of
metabolic syndrome (MetS) was based on the definition of theJapanese Committee for Establishing Diagnostic Criteria for
MetS, as follows: visceral obesity (waist circumference ≥ 85 cm
in men and≥ 90 cm in women) and the presence of at least
two of the following three abnormalities: fasting serumTG ≥ 150 mg/dL and/or HDL-C < 40 mg/dL or being treatedfor dyslipidemia; systolic BP≥ 130 mmHg and/or diastolicBP ≥ 85 mmHg or being treated for hypertension; and fasting

plasma glucose ≥ 110 mg/dL or being treated for diabetes.

III．Prevalence of lifestyle-related diseases
before and after the disaster1. Overweight/obese [3]Figure 2 shows changes in the proportion of overweight/
obese people and the prevalence of hypertension, diabetes
mellitus, and dyslipidemia among evacuees before and after
the Great East Japan Earthquake. After the disaster, boththe mean body weight and the proportion of overweight/
obese people increased significantly, among both evacuee
and non-evacuee subjects. Those changes were higher
in evacuees than non-evacuees (body weight: +1.2 kg
for evacuees and +0.3 kg for non-evacuees (p < 0.001);
proportion of overweight/obese people: +7.2% forevacuees and +2.3% for non-evacuees (p < 0.001)). Amongevacuees, the changes were more significant in men thanin women (body weight: +1.8 kg for men and +0.8 kg
for women (p < 0.001); proportion of overweight/obese
people: +9.8% for men and +5.4% for women (p < 0.001)[3]. Furthermore, a prospective analysis using the Cox
proportional hazard model revealed that evacuation was
significantly associated with an increased risk of becoming
overweight/obese (multivariable-adjusted hazard ratio (HR):1.82 (95% CI = 1.61, 2.07, p < 0.001) for men, and 1.52 forwomen (1.34, 1.74, p < 0.001)) [3].
2. Hypertension [4]Following the disaster, the prevalence of hypertension
increased significantly in both the evacuee and nonevacuee groups. For subjects (both evacuee and non-Figure 2 Changes in proportion of overweight/obese people and prevalence of hypertension, diabetes
mellitus, and dyslipidemia among evacuees before and after the Great East Japan Earthquake

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J. Natl. Inst. Public Health, 67 (1) : 2018

Trends in lifestyle-related diseases before and after the Great East Japan Earthquake
evacuee) who were non-hypertensive before the disaster,
the mean systolic and diastolic BP levels increased
significantly after the disaster. Changes in diastolic
BP were greater in evacuees than non-evacuees, andgreater in men than in women [4]. For men, the changes
in diastolic BP among evacuees and non-evacuees were
+3.4 mmHg vs +2.1 mmHg (p < 0.0001), respectively.
For women, these changes were +2.8 mmHg vs +1.7
mmHg (p < 0.0001) among evacuees and non-evacuees,
respectively. Furthermore, evacuation was significantly
associated with the incidence of hypertension among men(multivariable-adjusted HRs: 1.24 (95% CI = 1.10, 1.39, p< 0.001) for men and 1.06 (0.94, 1.18, p = 0.35) for women,
respectively) [4].

= 1.55, 2.31) for men, and 1.45 (1.10, 1.92) for women.
Furthermore, these associations were also observed whenresults were stratified by age group, where the adjusted
odds ratios were 1.72 (1.46, 2.02) for < 65 years of age, and1.60 (1.26, 2.03) for ≥ 65 years of age [7].
6. Liver dysfunction [8]T h e p re v a l e n c e o f l i v e r d y s f u n c t i o n i n c re a s e dsignificantly among the participants (16.4% vs 19.2% (p< 0.001) [8], with a higher incidence in evacuees thanin non-evacuees, regardless of the drinking status. The
multivariable-adjusted odds ratios for evacuation were 1.38
(95%CI = 1.20, 1.58) for non-drinkers, 1.43 (1.29, 1.59)
for light drinkers, and 1.24 (1.09, 1.42) for moderate/heavy
drinkers [8].

3. Diabetes mellitus [5]After the disaster, the prevalence of diabetes mellitus
increased significantly, from 9.3% to 11.0% (p < 0.0001),
with greater changes in HbA1c levels for evacuees thannon-evacuees, especially in the normal glucose group [5].
In the non-diabetes group, the post-disaster incidence ofdiabetes mellitus was significantly higher among evacuees(3.6%) than among non-evacuees (2.6%) (p = 0.0002).
Furthermore, an adjustment for confounding factors
revealed that evacuation was significantly associated withan increased risk of diabetes mellitus. The multivariableadjusted HR for the evacuation group was 1.40 (95%CI =1.20, 1.63, p < 0.001) [5].
4. Dyslipidemia [6]Concerning dyslipidemia, the prevalence of hypo-HDL
cholesterolemia increased significantly, from 6.0% to 7.2%
after the disaster. Moreover, HDL-C levels significantly
decreased, from 56.2 mg/dL to 55.1 mg/dL (p < 0.0001) for
men, and 62.1 mg/dL to 61.5 mg/dL (p < 0.0001) for women[6]. A significant association between evacuation and theincidence of hypo-HDL cholesterolemia was observed forboth men and women. The multivariable-adjusted odds
ratios for evacuation were 1.41 (95%CI = 1.20, 1.67, p <0.001) for men, and 1.35 (1.08, 1.69, p < 0.01) for women[6].

7．Other lifestyle-related diseases and variables [9,10]
The prevalence of atrial fibrillation increased significantly
after the disaster in both men and women (1.9% vs 2.4%
(p < 0.001) [9]. The RBC, Hb, and Ht levels also increased
significantly after the disaster [10]. In addition, amongevacuees, the prevalence of polycythemia increased
significantly, from 0.89% to 1.54% (p < 0.001), whereas
the same increase was not observed for non-evacuees:
0.79% and 1.16% before and after the disaster (p = 0.10),
respectively [10].
Among lifestyle-related variables, participantsʼ drinking
and smoking statuses remained unchanged before andafter the disaster [4]. The proportion of evacuees having
sufficient sleep decreased significantly after the disaster,changing from 75.8% to 67.5% in men and from 69.9% to57.4% in women. Among non-evacuees, the proportion ofsubjects getting enough sleep also decreased, changing
from 77.5% to 75.0% in men and from 71.7% to 69.7%, in
women. These changes were higher in evacuees than in
non-evacuees [4].

IV．Trends in the prevalence of lifestylerelated diseases after the disaster,
FY2011 to FY2014
1. Overweight/obese [11]5. Metabolic syndrome [7]Among men and women who, prior to the disaster, did
not present MetS components, the post-disaster crude
incidence rate of MetS was significantly greater in theevacuee group (men: 19.2%, women: 6.6%), than in the
non-evacuee group (men: 11.0%, women: 4.6%) [7].
Evacuation was significantly associated with an increased
risk of MetS in both men and women. The multivariableadjusted odds ratios for evacuation were 1.89 (95%CI

Both the mean levels of BMI and the proportion of
overweight/obese people remained practically unchanged
among men and women between FY2011 and FY2014. For
men, the age-stratified proportion of overweight/obese
people in FY2011, FY2012, FY2013, and FY2014 was
29.8%, 30.7%, 30.0%, and 29.0%, respectively, for men
aged 16–39; 41.6%, 40.3%, 40.9%, and 39.3%, respectively,
for men aged 40–64; and 39.1%, 36.4%, 36.3%, and 35.8%
for men aged 65 and older. For women, the age-stratified

J. Natl. Inst. Public Health, 67 (1) : 201837

Tetsuya Ohira et al., for the Fukushima Health Management Survey Group
proportion of overweight/obese people in FY2011, FY2012,
FY2013, and FY2014 was 17.2%, 17.1%, 17.3%, and 17.6%,
respectively, for women aged 16–39; 28.4%, 29.2%, 28.9%,
and 27.9%, respectively, for women aged 40–64; and 35.4%,
34.3%, 34.4%, and 33.0%, respectively, for women aged 65
and older [11].
2. Hypertension [12]The age-stratified prevalence of hypertension peaked
one year after the disaster, then started to decrease after
2012. The prevalence of hypertension in FY2011, FY2012,
FY2013, and FY2014 was 47.2%, 48.8%, 47.4%, and 45.5%
for men and 38.6%, 39.0%, 37.8%, and 35.6%, for women,
respectively [12]. At the same time, the age-stratified
proportions of patients with treated hypertension andcontrol of hypertension increased after the disaster in both
men and women. The proportions of treated hypertension
among hypertensives for 2011, 2012, 2013, and 2014 were
55.8%, 59.2%, 65.2%, and 66.3% for men and 61.7%, 63.3%,
69.2%, and 70.6% for women, respectively [12].
3. Diabetes mellitus [11]The proportion of people with high glucose (HbA1c≥6.0) increased for both men and women between FY2011
and FY2014. The age-stratified proportion of men withhigh glucose in FY2011, FY2012, FY2013, and FY2014
was 2.1%, 2.6%, 2.8%, and 2.6% for men aged 16–39;
16.1%, 17.2%, 18.9%, and 18.1% for men aged 40–64; and22.4%, 22.9%, 26.7%, and 23.5% for men aged 65 and older,
respectively. The age-stratified proportion of women withhigh glucose in FY2011, FY2012, FY2013, and FY2014
was 1.2%, 1.6%, 1.8%, and 2.1% for women aged 16–39;
8.9%, 10.6%, 13.2%, and 12.2% for women aged 40–64; and15.8%, 18.2%, 21.8%, and 21.0% for women aged 65 andolder, respectively. Four years after the disaster, the risk of
diabetes mellitus was 1.8-fold higher in evacuees than in
non-evacuees [13].
4. Liver dysfunction and dyslipidemia [14]The prevalence of liver dysfunction decreased
significantly among the participants, changing from 29.9%
to 27.1% between FY2011–FY2012 and FY2013–FY2014(p < 0.001) [14]. The incidence of liver dysfunction was
significantly higher among evacuees than non-evacuees.
Furthermore, an increased level of daily physical activity
and the frequency of breakfast consumption were lifestylefactors significantly associated with improved hepatobiliary
enzyme abnor mality [14]. On the other hand, theprevalence of dyslipidemia significantly increased among
the participants—from 49.8% to 53.3% between 2011–2012
and 2013–2014 (p < 0.001) [14].

38

V．Discussion
The main findings of this longitudinal study were
the increases in cardiovascular risk factors, such as
overweight/obesity, hypertension, diabetes mellitus, anddyslipidemia after the disaster. In addition, the adjustment
for confounding factors revealed that evacuation was
significantly associated with an increased risk of becoming
overweight/obese and presenting other cardiovascularrisk factors. Furthermore, 4 years after the disaster, theprevalence of diabetes mellitus and dyslipidemia increased
further, whereas the proportion of overweight/obese
individuals remained unchanged and the prevalence of liver
dysfunction and hypertension decreased. Taken together,
these results show that people experiencing disasterrelated evacuation may be more predisposed to CVDs, suchas myocardial infarction and stroke.
In Fukushima, the Great East Japan Earthquake was acomplex disaster that consisted of three incidents: a major
earthquake, a tsunami, and the nuclear accident. Although
the fear of earthquakes and tsunamis may gradually
decrease over time, the fear of radiation exposure effects
from the time of the nuclear accident may persist longer[15]. Indeed, the proportion of high levels of psychologicaldistress, evaluated using the Kessler Psychological Distress
Scale, (K6) was greater in Fukushima than in Miyagi [16].
Furthermore, in Fukushima, although the proportion ofpeople with high levels of psychological distress gradually
decreased between 2011 and 2015 [15], the proportion,even in 2015, was twice as high as in other areas. This may
result in long-lasting psychological stress and increasestress-related diseases, such as metabolic syndrome
and diabetes mellitus [17]. Furthermore, the long-term
evacuation that followed the NPP accident may haveforced peopleʼs lifestyles to change, in areas such as dietand physical activity. This could lead to future incidence oflifestyle-related diseases including hypertension, diabetes
mellitus, and dyslipidemia.
Although the mechanisms by which evacuation increases
cardiovascular risk factors are not yet fully understood, theincrease in body weight observed in evacuees may haveplayed a role. In the FHMS, the post-disaster increasein body weight was significantly associated with anincreased risk of hypertension [4], diabetes mellitus [5],and dyslipidemia [6]. Furthermore, decreases in physicalactivity may also be associated with a higher incidence of
cardiovascular risk factors in the evacuation areas [18].
Given that most evacuees who worked before the disaster
lost their jobs, the consequent decrease in physical activity
may have contributed to an increase in cardiovascular risk
factors, via an increase in body weight. The results of a

J. Natl. Inst. Public Health, 67 (1) : 2018

Trends in lifestyle-related diseases before and after the Great East Japan Earthquake
mental health and lifestyle survey by the FHMS showedthat approximately 70% of the 73,433 evacuees had trouble
sleeping, with consequent harmful effects on daytime
activities, while 51% did not exercise regularly [19,20].
Thus, health-related behaviors could be an importantfactor, mediating the influence of evacuation on increased
cardiovascular risk factors. Further studies are needed toconfirm the association between lifestyle and psychologicalfactors with future incidence of CVD, including stroke andmyocardial infarction, in Fukushima residents.
This study has some limitations. First, the number ofparticipants in the FHMS was not high, which may imply
that the sample is not representative of the population.
Second, this study did not evaluate socioeconomic factors
other than evacuation, which may have influenced theassociation between evacuation and CVD risk factors.
Finally, although the mean follow-up time was over 4 years,
this may have been insufficient to examine the long-term
effects of the evacuation on the incidence of cardiovasculardiseases, such as stroke and myocardial infarction. It istherefore necessary to evaluate these effects through afurther long-term follow-up, using a larger cohort.
Following the Great East Japan Earthquake, Fukushimaʼsresidents have experienced a higher incidence of both
physical and psychological problems, including lifestylerelated diseases and anxiety and psychological distress, thanresidents of other areas. These physical and psychologicalissues may lead to a future incidence of CVD. Therefore,
continuous support in terms of health status management
is required from researchers, working together with local
governments and communities.

VI．Conclusions
After the Great East Japan Earthquake, the prevalenceof people with cardiovascular risk factors, including
hypertension, diabetes mellitus, and dyslipidemia, increased
among community residents and more so among evacuees
from Fukushima Prefecture. Furthermore, evacuation was
associated with increased cardiovascular risk factors in thefour years following the disaster. As of 2017, more than
50,000 former residents of Fukushima remain evacuated.
The prevention of future CVDs among evacuees from
Fukushima requires continuous preventive programs for
CVD risk factors, carried out in collaboration with local
governments and communities.

Confrict of Interests
No financial disclosures were reported by the authors of
this paper.

Acknowledgements
The authors thank the staff of the Fukushima HealthManagement Survey for their important contributions.
The findings and conclusions of this article are solely the
responsibility of the authors and do not represent theofficial views of the Fukushima Prefecture government.

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J. Natl. Inst. Public Health, 67 (1) : 2018

Trends in lifestyle-related diseases before and after the Great East Japan Earthquake

東日本大震災前後における生活習慣病の推移：福島県県民健康調査
大平哲也 1,2），中野裕紀 1,2），岡崎可奈子 1,2），林史和 1,2），弓屋結 1,2），坂井晃 1,3），
福島県県民健康調査グループ1）

福島県立医科大学放射線医学県民健康管理センター2）

福島県立医科大学医学部疫学講座

3）

福島県立医科大学医学部放射線生命科学講座

抄録
2011年 3 月11日，東日本大震災が発生し，それに引き続き福島第一原子力発電所の放射線事故が起こった．原子力発電所周辺の多くの住民が避難を余儀なくされ，生活習慣に変化が起こってきた．そこで，各市町村で実施している健康診査、及び福島県で実施している県民健康調査のデータを用いて、震災後の避難が循環器疾患危険因子及び生活習慣病に影響する可能性を検討した。本稿では，震災前後における健康診査結果の変化及び県民健康調査の生活習慣病に関する縦断的検討の結果を概説する．
震災前後において健康診査データを比較した結果，震災後，避難区域住民においては過体重・肥満の人の割合，及び高血圧，糖尿病，脂質異常，肝機能異常，心房細動，多血症有病率の上昇がみられた．
さらに，震災後 1 ～ 2 年間と 3 ～ 4 年間の健診データを比較したところ，糖尿病，脂質異常についてはさらなる増加がみられた．したがって，避難区域住民，特に実際に避難した人においては心筋梗塞や脳卒中などの循環器疾患が震災後に起こりやすくなる可能性が考えられた．また、これらの要因としては震災後の仕事状況の変化、避難による住居の変化などによる身体活動量の低下、心理的ストレスの増加などが考えられた．今後，避難者の循環器疾患を予防するために，地域行政と地域住民が協働して肥満，高血圧，糖尿病，脂質異常の予防事業に取り組む必要がある．
キーワード：災害，疫学，非感染性疾患，ポピュレーションスタディ，心理社会的因子

J. Natl. Inst. Public Health, 67 (1) : 201841