Abstract
The 2011 Fukushima disaster led to increases in multiple risks (e.g., lifestyle diseases and radiation exposure) and fear among the public. Here, we assessed the additional risks of cancer caused by radiation and diabetes related to the disaster and the cost-effectiveness of countermeasures against these conditions. Our study included residents of the cities of Minamisoma and Soma (10–40 km and 35–50 km north of the Fukushima Daiichi (N° 1) Nuclear Power Station, respectively). We used the loss of life expectancy (LLE) as an indicator to compare risks between radiation exposure and diabetes. We also estimated the cost-effectiveness of radiation-related countermeasures, including restricted food distribution, decontamination, and whole-body counter tests and interventions. Metformin therapy was selected as a representative management for diabetes. The diabetes-related LLEs among residents were 4.1 (95% confidence interval: 1.4–6.8) ×10−2 years for the whole population and 8.0 (2.7–13.2) ×10−2 years for 40s to 70s in a scenario that considered the additional incidence of diabetes during the first 10 years. The cancer-related LLEs caused by lifetime exposure to radiation were 0.69 (2.5–97.5 percentile: 0.61–0.79) ×10−2 years for the whole population and 0.24 (0.20–0.29) ×10−2 years for 40s to 70s. The diabetes-related LLEs among residents in the above-mentioned scenario were 5.9-fold and 33-fold higher than those attributed to average radiation among the whole population and among the 40s to 70s age groups, respectively. The costs per life-years saved of the radiation countermeasures (i.e., restricted food distribution, decontamination, and whole-body counter tests and interventions) were >1 to >4 orders of magnitude higher than those of general heath checkups and conventional management for diabetes. Our findings indicate that countermeasures to mitigate diabetes are warranted. Policy-makers’ and individuals’ understanding of multiple risks after any disaster will be essential to saving the lives of victims.
Highlights
The concepts of risk and risk comparison were first introduced in the 1660s through two publications that offered insights into unreasonable fears: Natural and Political Observations Made upon the Bills of Mortality by John Graunt and Port-Royal Logic by Arnauld and Nicole [1,2]
The loss of life expectancy (LLE) and lifetime attributable risks (LARs) of cancer caused by radiation exposure and diabetes for the whole population and for the 40s to 70s age groups were compared (Table 1, S5–S9 Tables)
Because the LLEs due to radiation exposure decreased with increasing age at the time of the disaster (S5 Table), the total lifetime LLEs were lower for the 40s to 70s age groups (0.24 × 10−2 years), compared to those for the whole population
Summary
The concepts of risk and risk comparison were first introduced in the 1660s through two publications that offered insights into unreasonable fears: Natural and Political Observations Made upon the Bills of Mortality by John Graunt and Port-Royal Logic by Arnauld and Nicole [1,2]. Citizens perceive radiation risk to be the most dreadful of various hazards [15], anxieties regarding lifestyle diseases, including diabetes, did not increase in Japan after the disaster [16]. A comparison of various potential risks and the cost-effectiveness of countermeasures against those risks would help to protect the public from real dangers. Decision-making and risk communication processes that are supported by a better understanding of risk comparison and cost-effectiveness will save lives in Fukushima and improve emergency preparedness. Despite these advantages, a multiple risk comparison that includes cancer mortality caused by radiation and medical risks has not been performed because of the lack of interdisciplinary scientific research. Part of Minamisoma City was placed under an evacuation order, whereas Soma City was not
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