Abstract
Objectives
Design
Setting and Participants
Methods
Results
Conclusions and Implications
Keywords
Catastrophic Rainfall in Western Japan: the 2018 Japan Floods
Summary: the damage situations caused by the heavy rain in July (in Japanese).
Summary: the damage situations caused by the heavy rain in July (in Japanese).
Study Objectives
Methods
Study Design and Setting
LTCI Claims in Japan
Inclusion Criteria
Outcomes
The city of Hiroshima, Hiroshima list of applicants for admission to special nursing homes for the elderly in Hiroshima city, 2022. Accessed May 13, 2022. https://www.city.hiroshima.lg.jp/site/kaigo/2432.html
Identifying Disaster-Affected Individuals
Potential Confounding Factors
Statistical Methods
Results
Individuals

Total (N = 187,861) | Disaster-Affected (n = 2156) | Unaffected (n = 185,705) | P Value | |
---|---|---|---|---|
Age, categorical (%) | .27 | |||
45‒64 | 3810 (2.0) | 52 (2.4) | 3758 (2.0) | |
65‒69 | 7721 (4.1) | 83 (3.8) | 7638 (4.1) | |
70‒74 | 13,206 (7.0) | 153 (7.0) | 13,053 (7.0) | |
75‒79 | 22,768 (12.1) | 281 (13.0) | 22,487 (12.1) | |
80‒84 | 40,697 (21.7) | 453 (21.0) | 40,244 (21.7) | |
85‒90 | 51,743 (27.5) | 614 (28.5) | 51,129 (27.5) | |
90‒94 | 34,941 (18.6) | 374 (17.3) | 34,567 (18.6) | |
>94 | 12,975 (6.9) | 146 (6.8) | 12,829 (6.9) | |
Sex | ||||
Men, n (%) | 58,172 (31.0) | 691 (32.1) | 57,481 (31.0) | .27 |
Eating dependence (%) | .02 | |||
Partial or unassisted | 180,260 (96.0) | 2087 (96.8) | 178,173 (95.9) | |
Fully assisted | 7601 (4.0) | 69 (3.2) | 7532 (4.1) | |
Cognitive skills (%) | .15 | |||
1 | 66,180 (35.2) | 766 (35.5) | 65,414 (35.2) | |
2 | 65,077 (34.6) | 784 (36.4) | 64,293 (34.6) | |
3 | 42,125 (22.4) | 462 (21.4) | 41,663 (22.4) | |
4 | 14,479 (7.7) | 144 (6.7) | 14,335 (7.7) | |
ADL (%) | .3 | |||
1 | 35,967 (19.1) | 410 (19.0) | 35,557 (19.1) | |
2 | 42,487 (22.6) | 505 (23.4) | 41,982 (22.6) | |
3 | 26,621 (14.2) | 317 (14.7) | 26,304 (14.2) | |
4 | 37,168 (19.8) | 419 (19.4) | 36,749 (19.8) | |
5 | 25,512 (13.6) | 300 (13.9) | 25,212 (13.6) | |
6 | 8366 (4.5) | 99 (4.6) | 8267 (4.5) | |
7 | 9533 (5.1) | 88 (4.1) | 9445 (5.1) | |
8 | 2207 (1.2) | 18 (0.8) | 2189 (1.2) | |
Number of users by type of LTC services (%) | <.001 | |||
In-home | 57,504 (30.6) | 525 (24.4) | 56,979 (30.7) | |
Day care | 112,042 (59.3) | 1236 (57.3) | 110,806 (59.7) | |
Short stay | 22,129 (11.8) | 425 (19.7) | 21,704 (11.7) | |
Number of days per month using the facilities, mean (SD) | ||||
Home visit services | 11.03 (7.95) | 7.21 (7.10) | 11.07 (7.95) | <.001 |
Day care | 8.74 (6.28) | 7.06 (6.64) | 8.75 (6.28) | <.001 |
Short stay | 11.55 (9.05) | 14.76 (8.6) | 11.49 (9.05) | <.001 |
The Disaster-NHA Association

Crude (95% CI) | Age- and Sex-Adjusted (95% CI) | Multivariable-Adjusted (95% CI) | P Value for Multivariable-Adjusted Model | |
---|---|---|---|---|
Disaster status | ||||
Unaffected | Ref | Ref | Ref | |
Disaster-affected | 3.75 (3.34‒4.21) | 3.79 (3.37‒4.26) | 3.23 (2.88‒3.64) | <.001 |
Age, categorical | ||||
45‒64 | 0.70 (0.51‒0.95) | 0.76 (0.56‒1.04) | .09 | |
65‒69 | Ref | Ref | ||
70‒74 | 1.14 (0.94‒1.39) | 1.10 (0.91‒1.34) | .33 | |
75‒79 | 1.46 (1.22‒1.74) | 1.35 (1.13‒1.61) | .001 | |
80‒84 | 1.82 (1.54‒2.16) | 1.60 (1.35‒1.89) | <.001 | |
85‒90 | 2.49 (2.12‒2.94) | 2.02 (1.71‒2.39) | <.001 | |
90‒94 | 3.07 (2.60‒3.62) | 2.29 (1.93‒2.70) | <.001 | |
>94 | 3.55 (2.99‒4.22) | 2.27 (1.91‒2.70) | <.001 | |
Sex | ||||
Women | Ref | Ref | ||
Men | 1.13 (1.08‒1.18) | 0.96 (0.92‒1.01) | .13 | |
Cognitive functions | ||||
1 | Ref | Ref | Ref | |
2 | 2.07 (1.94‒2.20) | 1.88 (1.77‒2.00) | 1.29 (1.20‒1.40) | <.001 |
3 | 2.94 (2.76‒3.13) | 2.64 (2.48‒2.81) | 1.43 (1.31‒1.57) | <.001 |
4 | 3.08 (2.84‒3.33) | 2.74 (2.54‒2.98) | 1.40 (1.25‒1.57) | <.001 |
ADL | ||||
1 | Ref | Ref | Ref | |
2 | 1.75 (1.59‒1.92) | 1.55 (1.40‒1.70) | 1.38 (1.25‒1.53) | <.001 |
3 | 2.64 (2.40‒2.91) | 2.27 (2.06‒2.50) | 1.83 (1.63‒2.06) | <.001 |
4 | 3.25 (2.97‒3.55) | 2.76 (2.52‒3.02) | 2.06 (1.84‒2.31) | <.001 |
5 | 4.11 (3.75‒4.50) | 3.45 (3.14‒3.78) | 2.32 (2.05‒2.62) | <.001 |
6 | 4.52 (4.05‒5.05) | 3.75 (3.36‒4.19) | 2.44 (2.13‒2.81) | <.001 |
7 | 4.07 (3.65‒4.54) | 3.49 (3.12‒3.89) | 2.26 (1.95‒2.61) | <.001 |
8 | 3.33 (2.75‒4.03) | 3.17 (2.62‒3.84) | 2.27 (1.83‒2.70) | <.001 |
Eating dependence | ||||
Partial or unassisted | Ref | Ref | Ref | |
Fully assisted | 1.28 (1.16‒1.41) | 1.29 (1.17‒1.42) | 0.93 (0.84‒1.04) | .23 |
Number of days used per month (adjusted HR per 10 d) | ||||
Home visit services | 0.86 (0.84‒0.89) | 0.88 (0.85‒0.90) | 0.91 (0.89‒0.93) | <.001 |
Day care | 0.98 (0.94‒1.03) | 0.97 (0.92‒1.07) | 0.86 (0.83‒0.89) | <.001 |
Short stay | 1.61 (1.59‒1.62) | 1.58 (1.57‒1.60) | 1.50 (1.48‒1.52) | <.001 |
Subgroup Analysis

Discussion
Building a European Health Union: Reinforcing the EU’s resilience for cross-border health threats.
ASEAN Disaster Management Reference Handbooks.
Conclusions and Implications
Appendix
Crude (95% CI) | Age- and Sex-Adjusted (95% CI) | Multivariable-Adjusted (95% CI) | P Value for Multivariable-Adjusted Model | |
---|---|---|---|---|
Disaster status | ||||
Unaffected | Ref | Ref | Ref | |
Disaster-affected | 4.02 (3.42‒4.75) | 4.06 (3.45‒4.80) | 3.45 (2.92‒4.07) | <.001 |
Age, categorical | ||||
45‒64 | 0.80 (0.51‒1.26) | 0.86 (0.55‒1.36) | .09 | |
65‒69 | Ref | Ref | ||
70‒74 | 1.41 (1.60‒1.88) | 1.34 (1.01‒1.80) | .333 | |
75‒79 | 1.61 (1.23‒2.10) | 1.47 (1.13‒1.92) | .001 | |
80‒84 | 2.10 (1.63‒2.71) | 1.82 (1.42‒2.09) | <.001 | |
85‒90 | 2.61 (2.04‒3.36) | 2.09 (1.62‒2.68) | <.001 | |
90‒94 | 3.16 (2.46‒4.06) | 2.32 (1.80‒2.99) | <.001 | |
>94 | 3.57 (2.75‒4.64) | 2.28 (1.75‒2.97) | <.001 | |
Sex | ||||
Women | Ref | Ref | ||
Men | 1.13 (1.06‒1.22) | 0.96 (0.92‒1.01) | .12 | |
Cognitive functions | ||||
1 | Ref | Ref | Ref | |
2 | 2.17 (1.98‒2.37) | 2.00 (1.83‒2.19) | 1.38 (1.23‒1.55) | <.001 |
3 | 3.04 (2.77‒3.34) | 2.78 (2.53‒3.05) | 1.50 (1.31‒1.72) | <.001 |
4 | 2.9 (2.56‒3.27) | 2.63 (2.33‒2.97) | 1.43 (1.20‒1.70) | <.001 |
ADL | ||||
1 | Ref | Ref | Ref | |
2 | 1.68 (1.46‒1.94) | 1.51 (1.31‒1.74) | 1.30 (1.12‒1.51) | <.001 |
3 | 2.64 (2.30‒3.05) | 2.32 (2.01‒2.67) | 1.72 (1.45‒2.04) | <.001 |
4 | 3.22 (2.82‒3.67) | 2.80 (2.45‒3.20) | 1.90 (1.60‒2.26) | <.001 |
5 | 4.13 (3.62‒4.72) | 3.56 (3.11‒4.07) | 2.20 (1.84‒2.64) | <.001 |
6 | 4.42 (3.76‒5.20) | 3.77 (3.20‒4.44) | 2.32 (1.89‒2.85) | <.001 |
7 | 3.63 (3.08‒4.28) | 3.17 (2.69‒3.75) | 2.07 (1.66‒2.57) | <.001 |
8 | 3.09 (2.31‒4.13) | 2.97 (2.22‒3.97) | 2.12 (1.54‒2.94) | <.001 |
Eating dependence | ||||
Partial or unassisted | Ref | Ref | Ref | |
Fully assisted | 0.94 (0.80‒1.11) | 0.95 (0.80‒1.12) | 0.69 (0.57‒0.83) | .23 |
Number of days used per month (adjusted HR per 10 d) | ||||
Home visit services | 0.91 (0.88‒0.94) | 0.92 (0.89‒0.95) | 0.96 (0.93‒0.99) | <.001 |
Day care | 0.98 (0.95‒1.03) | 0.97 (0.93‒1.01) | 0.95 (0.91‒1.00) | <.001 |
Short stay | 1.59 (1.56‒1.61) | 1.56 (1.54‒1.60) | 1.50 (1.48‒1.53) | <.001 |
References
- Predicting admission to long-term care and mortality among community-based, dependent older people in Ireland.Int J Geriatr Psychiatry. 2019; 34: 999-1007
- Predictors of early mortality among hospitalized nursing home residents.QJM. 2013; 106: 51-57
- The care continues: Responsibility for elderly relatives before and after admission to a long term care facility.Fam Relat. 2000; 49: 235-244
- Change in quality of life of people with dementia recently admitted to long-term care facilities.J Adv Nurs. 2015; 71: 1435-1447
- A national examination of long-term care setting, outcomes, and disparities among elderly dual eligibles.Health Aff. 2019; 38: 1110-1118
- Polypharmacy and medication regimen complexity as risk factors for hospitalization among residents of long-term care facilities: A prospective cohort study.J Am Med Dir Assoc. 2016; 17
- The impacts of climate change on the risk of natural disasters.Disasters. 2006; 30: 5-18
- Peer reviewed: disaster preparedness and the chronic disease needs of vulnerable older adults.Prev Chronic Dis. 2008; 5: A27
- Summary: the damage situations caused by the heavy rain in July (in Japanese).http://www.bousai.go.jp/updates/h30typhoon7/pdf/300905_1700_h30typhoon7.pdfDate: 2018Date accessed: January 12, 2021
- Torrential rains in July 2008 caused the largest amount of damage since statistics began.
- Correlation between the Barthel Index and care need levels in the Japanese long-term care insurance system.Geriatr Gerontol Int. 2019; 19: 1186-1187
- Care-needs certification in the long-term care insurance system of Japan.J Am Geriatr Soc. 2005; 53: 522-527
- Long-term care insurance in Japan: implications for U.S. long-term care policy.J Gerontol Nurs. 2007; 33: 7-13
- Vital statistics vital statistics of Japan final data summary volume 1 3-3-1 summary tables of vital statistics:Japan, each prefecture and 21 major cities.
- An international definition for "nursing home".J Am Med Dir Assoc. 2015; 16: 181-184
- An international survey of nursing homes.J Am Med Dir Assoc. 2013; 14: 459-462
The city of Hiroshima, Hiroshima list of applicants for admission to special nursing homes for the elderly in Hiroshima city, 2022. Accessed May 13, 2022. https://www.city.hiroshima.lg.jp/site/kaigo/2432.html
- The role and perspective of the geriatric health services facilities.Jpn J Geriatr. 2021; 58: 533-539
- The 2018 Japan Floods Exemption Requirement For Affected Residents.Ministry of Health, Labor and Welfare, Tokyo2021
- Predicting falls from behavioral and psychological symptoms of dementia in older people residing in facilities.Geriatr Gerontol Int. 2018; 18: 1573-1577
- Effects of Hurricane Katrina on nursing facility resident mortality, hospitalization, and functional decline.Disaster Med Public Health Prep. 2010; 4 Suppl 1: S28-S32
- The effect of the 2018 Japan Floods on cognitive decline among long-term care insurance users in Japan: a retrospective cohort study.Environ Health Prev Med. 2021; 26: 113
- The vulnerability of cities: natural disasters and social resilience. Routledge, London2012
- Longitudinal assessment of cognitive and psychosocial functioning after Hurricanes Katrina and Rita: exploring disaster impact on middle-aged, older, and oldest-old adults.J Appl Biobehav Res. 2011; 16: 187-211
- Nutrition interventions for children aged less than 5 years following natural disasters: a systematic review.BMJ Open. 2016; 6e011238
- Identifying, weighting and causality modeling of social and economic barriers to rapid infrastructure recovery from natural disasters: A study of hurricanes Harvey, Irma and Maria.2019, National Academy of Sciences, Washington, DC
- To evacuate or shelter in place: implications of universal hurricane evacuation policies on nursing home residents.J Am Med Dir Assoc. 2012;13; 190: e191-e197
- Predicting nursing home admission in the US: a meta-analysis.BMC Geriatr. 2007; 7: 1-14
- A prospective study of long-term care institutionalization among the aged.Am J Public Health. 1982; 72: 1373-1379
- Predictors of nursing home admission for persons with dementia.Med Care. 2009; 47: 191-198
- Driving status and risk of entry into long-term care in older adults.Am J Public Health. 2006; 96: 1254-1259
- Does early intervention reduce the number of elderly people with dementia admitted to institutions for long term care?.BMJ. 1991; 302: 871-875
- Less money, less care: How nurses in long-term care allocate hours of needed care in a context of chronic shortage.Int J Nurs Pract. 2005; 11: 214-220
- Incidence of certified need of care in the long-term care insurance system and its risk factors in the elderly of Japanese population-based cohorts: The ROAD study.Geriatr Gerontol Int. 2014; 14: 695-701
- Improving the long-term care workforce serving older adults.Health Aff. 2010; 29: 109-115
- Report on research and studyproject on cooperation between long-term care health facilities for the elderly and family physicians.
- Nutritional management in long-term care: development of a clinical guideline.J Gerontol A Biol Sci Med Sci. 2000; 55: M725-M734
- Management of diabetes in long-term care and skilled nursing facilities: a position statement of the American Diabetes Association.Diabetes Care. 2016; 39: 308-318
- The importance of oral health in long-term care.J Am Med Dir Assoc. 2009; 10: 667-671
- Long-term healthcare provider availability following large-scale hurricanes: A difference-in-differences study.PLoS One. 2020; 15e0242823
- Long-Term Care Planning, Preparedness, and Response Among Rural Long-Term Care Providers.Disaster Med Public Health Prep. 2020; : 1-4
- Improving long-term care facility disaster preparedness and response: A literature review.Disaster Med Public Health Prep. 2017; 11: 140-149
- Health emergency and disaster risk management framework. World Health Organization, Geneva2019
- Office of long-term care ombudsman programs administration on aging administration for community living. Emergencyy preparedness and response: Model policies and procesures for state long-term care ombudsman programs.https://ltcombudsman.org/uploads/files/issues/EmResponse_ModelPPLTCO-11-23-15_Final.pdfDate: 2015Date accessed: September 12, 2021
- Building a European Health Union: Reinforcing the EU’s resilience for cross-border health threats.(2020)https://ec.europa.eu/info/sites/default/files/communication-european-health-union-resilience_en.pdfDate: 2020Date accessed: October 11, 2021
- ASEAN Disaster Management Reference Handbooks.https://reliefweb.int/sites/reliefweb.int/files/resources/ASEAN%20Disaster%20Management%20Reference%20Handbooks.pdfDate: 2015Date accessed: October 8, 2021
- State policies concerning disaster preparedness for home-and community-based service providers.J Appl Gerontol. 2022; 41: 1520-1527
- Long-term outcomes of patients evacuated from hospitals near the Fukushima Daiichi nuclear power plant after the Great East Japan Earthquake.PLoS One. 2018; 13e0195684
- All-cause hospital admissions among older adults after a natural disaster.Ann Emerg Med. 2018; 71: 746-754.e742
- National long-term care insurance policy in Japan a decade after implementation: some lessons for aging countries.Ageing Int. 2012; 37: 271-284
- Alcohol abuse as a potential risk factor of solitary death among people living alone: a cross-sectional study in Kyoto, Japan.BMC Public Health. 2022; 22: 545
- The mortality impact of the August 2003 heat wave in France: investigating the ‘harvesting’effect and other long-term consequences.Popul Stud. 2008; 62: 39-53
- The impact of the 2011 Great East Japan Earthquake on hospitalisation for respiratory disease in a rapidly aging society: a retrospective descriptive and cross-sectional study at the disaster base hospital in Ishinomaki.BMJ Open. 2013; 3e000865
- An international review of the long-term care workforce: policies and shortages.J Aging Soc Policy. 2005; 17: 75-94
Article info
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In Press Corrected ProofFootnotes
This work was supported by JSPS KAKENHI Grant Number JP19K19388. This study was also supported by grant-in-aid from Japanese Society of Hospital General Medicine. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
The authors confirm contribution to the manuscript as follows: study conception and design: D.M. and M.M.; project supervision: M.M.; data acquisition: S.Y. and M.M.; fund acquisition: D.M., S.Y. and M.M.; analysis and interpretation of results: D.M., S.K., S.Y., S.K., S.I., K.I., Y.O., and M.M; draft manuscript preparation: D.M., M.M. All authors reviewed the results and approved the final version of the manuscript.
The study was conducted according to the guidelines of the Declaration of Helsinki, and the study protocol was approved by the Ethical Committee for Epidemiology of Hiroshima University (approval no. E-1389). The need to obtain informed consent from each individual was waived as this was a retrospective review of the individual's records according to the Ethical Guidelines for Medical and Health Research Involving Human Subjects in Japan.
The datasets generated and analyzed during the current study are not publicly available due to legal reasons but are available from the corresponding author on reasonable request.
The authors declare no conflicts of interest.
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