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. 2014 May 8;3(3):e000798.
doi: 10.1161/JAHA.114.000798.

Population-based incidence of sudden cardiac and unexpected death before and after the 2011 earthquake and tsunami in Iwate, northeast Japan

Masanobu Niiyama  1 , Fumitaka Tanaka, Satoshi Nakajima, Tomonori Itoh, Tatsuya Matsumoto, Mikio Kawakami, Yujiro Naganuma, Shinichi Omama, Takashi Komatsu, Toshiyuki Onoda, Kiyomi Sakata, Takashi Ichikawa, Motoyuki Nakamura
Affiliations

Population-based incidence of sudden cardiac and unexpected death before and after the 2011 earthquake and tsunami in Iwate, northeast Japan

Masanobu Niiyama et al. J Am Heart Assoc. .

Abstract

Background: The aim of this study was to evaluate the temporal impact of the 2011 Japan earthquake and tsunami on the incidence of sudden cardiac and unexpected death (SCUD).

Methods and results: We surveyed the impact of the disaster on the incidence and clinical characteristics of SCUD in Iwate. To perform complete identification of SCUD for 8 weeks before and 40 weeks after the disaster, medical records and death certificates relevant to SCUD were surveyed in the study area. Compared with the previous year's rate, the incidence (per 10 000 person-year) of SCUD for the initial 4 weeks after the disaster (acute phase) was double (33.5 vs 18.9), and thereafter the rate returned to the previous level. Significant relationships were found between weekly numbers of SCUD and seismic activity (intensity, r=0.43; P<0.005: frequency, r=0.46; P<0.002). The standardized incidence ratio (SIR) of SCUD in the acute phase was significantly increased compared with that of previous years (1.71, 95% CI 1.33 to 2.16). Increased SIRs were predominantly found in female subjects (1.73, 95% CI 1.22 to 2.37), the elderly (1.73, 95% CI 1.29 to 2.27), and residents living in the tsunami-stricken area (1.83, 95% CI 1.33 to 2.46). In addition, SIRs for weekdays (1.71, 95% CI 1.28 to 2.24) and nights-mornings (2.09, 95% CI 1.48 to 2.86) were amplified.

Conclusions: The present results suggest that the magnitude of a disaster, related stress, and population aging may cause a temporary increase in the incidence of SCUD with amplification of ordinary weekly and circadian variations.

Keywords: disaster; general population; incidence; sudden death.

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Figures

Figure 1.
Figure 1.
Map of the Iwate study area. The epicenter is denoted by the bull's eye. The adult population of the area was approximately 280×103, and the elderly population (aged >65 years) was 32% before the disaster.
Figure 2.
Figure 2.
Secular trend in weekly numbers of SCUD cases before (mean for 2009 and 2010) and after the disaster (2011) in the study area. The day of the disaster is shown by the arrow. SCUD indicates sudden cardiac and unexpected death.
Figure 3.
Figure 3.
Comparison of incidence (per 10 000 person‐years) of SCUD cases before (2009–2010) and after (2011) the disaster in 3 phases (prior phase, 8 weeks before March 11; acute phase, the first 4 weeks after March 11; recovering phase, from 5 to 40 weeks after March 11). Left: Incidence of SCUD occurring within 24 hours after onset. Right: Incidence of SCUD occurring within 1 hour after onset. SCUD indicates sudden cardiac and unexpected death.
Figure 4.
Figure 4.
Scatter diagrams and regression lines between number of SCUD cases and seismic intensity (left) or seismic frequency (right) during the study period in 2011. SCUD indicates sudden cardiac and unexpected death.
See this image and copyright information in PMC

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