OBJECTIVES: We determined whether crowding at emergency shelters is associated with a higher incidence of @entity25 among disaster evacuees and identified the minimum required personal space at shelters. DESIGN: Retrospective review of medical charts. SETTING: 30 shelter-based medical clinics in Ishinomaki, Japan, during the 46 days following the Great Eastern Japan Earthquake and Tsunami in 2011. @entity1 : Shelter residents who visited eligible clinics. OUTCOME MEASURES: Based on the result of a locally weighted scatter-plot smoothing technique assessing the relationship between the mean space per evacuee and cumulative incidence of @entity25 at the shelter, eligible shelters were classified into crowded and non-crowded shelters. The cumulative incidence per 1000 evacuees was compared between groups, using a Mann-Whitney U test. To assess the association between shelter crowding and the daily incidence of @entity25 per 1000 evacuees, quasi-least squares method adjusting for potential confounders was used. RESULTS: The 30 shelters were categorised as crowded (mean space per evacuee <5.0 m(2), 9 shelters) or non-crowded (>=  5.0 m(2), 21 shelters). The study included 9031 @entity1 . Among the eligible @entity1 , 1079 @entity1 (11.9%) were diagnosed with @entity25 . Mean space per evacuee during the study period was 3.3 m(2) (SD, 0.8 m(2)) at crowded shelters and 8.6 m(2) (SD, 4.3 m(2)) at non-crowded shelters. The median cumulative incidence of @entity25 did not differ between the crowded shelters (2.3/1000 @entity1 -days (IQR, 1.6-5.4)) and non-crowded shelters (1.9/1000 @entity1 -days (IQR, 1.0-2.8); p=0.20). In contrast, after adjusting for potential confounders, crowded shelters had an increased daily incidence of @entity25 (2.6 per 1000 @entity1 -days; 95% CI 0.2 to 5.0/1000 @entity1 -days, p=0.03) compared to that at non-crowded shelters. CONCLUSIONS: Crowding at shelters may exacerbate @entity25 in disaster evacuees; therefore, appropriate evacuation space requirements should be considered.

Association between shelter crowding and incidence of XXXX among disaster evacuees: a retrospective medical chart review study.

@entity1 :: ('9606', 'Species') :: ['patients', 'person', 'PARTICIPANTS'] @entity25 :: ('MESH:D012893', 'Disease') :: ['sleep disruptions', 'sleep disturbance']
@entity25 :: (MESH:D012893,Disease) :: ['sleep disturbance']
