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Seismic Intensity and Risk ofCerebrovascular Stroke: 1995 Hanshin-AwajiEarthquake

Published online by Cambridge University Press:  28 June 2012

Shigeru Sokejima ,
Yoshimi Nakatani ,
Kazuomi Kario ,
Kazunori Kayaba ,
Masumi Minowa  and
Sadanobu Kagamimori
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Abstract

Introduction:No epidemiological data exist concerningthe influence of an earthquake on the risk ofstroke. Whether the incidence of cerebrovascularstroke increased after the 1995 Hanshin-Awajiearthquake (EQ) in Japan and whether seismicintensity affected stroke risk dose-dependently wasexamined.

Methods:A retrospective cohort study was conductedamong residents, who were living in two towns on theisland of Awaji and were participants of theNational Health Insurance (NHI) program. The twotowns were divided into 11 districts and theirrespective damage and socioeconomic states wereinvestigated. Reviewing the NHI documents issuedbefore and after the EQ, people who had strokes (9thInternational Classification of Diseases, codes430–431 or 433–434.9) were identified. Risk ofstroke in relation to the seismic intensities, wasassessed with the Cox proportional hazard model.

Results:Among subjects aged 40 to 99 years, 45 of 8,758(0.514%) had a stroke the year before the EQ, 72 of8,893 (0.810%) had a stroke in the first yearfollowing the EQ, and 49 of 8,710 (0.566%) had astroke in the second year following the EQ. Indistricts where the earthquake's intensity was ≤9.5on the modified Mercalli intensity (MMI), comparedwith the year prior to the EQ, the relative risk(RR) of stroke was 2.4 (95% confidence interval (CI)1.1, 5.0) in the first year following the EQ, afteradjusting for age, gender, and income. In that year,compared with MMI of <8.5–9.0, RRs for 9.0–9.5and ≥9.5 were 1.6 (CI 0.9, 2.1) and 2.0 (CI 1.1,3.7), respectively (p for trend0.02). No trend for the RR was observed in the yearbefore the EQ or in the second year following theEQ.

Conclusion Stroke increased in the first year followingthe EQ. The increase was associated with seismicintensity in a dose-response manner. Results suggesta potential threshold for RR of >2.0 in areasnear 9.5 on the MMI scale.

Keywords

1995 Hanshin-Awaji earthquakecohort studyepidemiologymultivariate analysisNational Health Insuranceretrospectiveseismic intensitystroke risk

Information

Type
Research Article
Information
Prehospital and Disaster Medicine , Volume 19 , Issue 4 , December 2004 , pp. 297 - 306
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2004

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