Abstract
BackgroundClimate change has increased the frequency and severity of torrential rains and floods around the world. Estimating the costs of these disasters is one of the five global research priorities identified by WHO. The 2018 Japan Floods hit western Japan causing extensive destruction and many deaths, especially among vulnerable elderly. Such affected elderly would need long-term care due to the various health problems caused by the disaster. A Long-Term Care Insurance (LTCI) system provides care services in Japan. The aim of this study was to evaluate the effect of the 2018 Japan Floods on LTCI costs and service utilization.MethodsThe participants of this retrospective cohort study were all verified persons utilizing LTCI services in Hiroshima, Okayama and Ehime prefectures. The observation period was from 2 months before to 6 months after the disaster. We used Generalized Estimating Equations (GEEs) to examine the association between disaster status (victims or non-victims) and the monthly total costs of LTCI service (with gamma-distribution/log-link) by residential environment (home or facility). Among home residents, we also examined each service utilization (home-based service, short-stay service and facility service), using the GEEs. After the GEEs, we estimated Average Marginal Effects (AME) over all observation periods by months as the attributable disaster effect.ResultsThe total number of participants was 279,578. There were 3024 flood victims. The disaster was associated with significantly higher total costs. The AME for home residents at 2 months after was $214 (Standard Error (SE): 12, p < 0.001), which was the highest through the observation period. Among facility residents, the AME immediately after the disaster increased by up to $850 (SE: 29, p < 0.001). The service utilization among home residents showed a different trend for each service. The AME of home-based services decreased by up to − 15.2% (SE:1.3, p < 0.001). The AME for short-stay service increased by up to 8.2% (SE: 0.9, p < 0.001) and the AME for facility service increased by up to 7.4% (SE: 0.7, p < 0.001), respectively.ConclusionsThe 2018 Japan Floods caused an increase in LTCI costs and the utilization of short-stay and facility services, and a decrease in utilization of home-based services.
Highlights
Climate change has increased the frequency and severity of torrential rains and floods around the world
We examined the impact of torrential rains or floods, which are increasing due to climate change, on the costs of elderly long-term care and provide insights for other countries considering the introduction of a public LongTerm Care Insurance (LTCI) system
Because the utilization of facility service did not accrue for the first month of the observation period (2 months before the disaster) as per our definition, we examined the utilization from 1 month before to 6 months after the disaster
Summary
Climate change has increased the frequency and severity of torrential rains and floods around the world. The 2018 Japan Floods hit western Japan causing extensive destruction and many deaths, especially among vulnerable elderly. Such affected elderly would need long-term care due to the various health problems caused by the disaster. The World Health Organization (WHO) reported that climate change is expected to cause approximately 250,000 additional deaths per year. Due to the effects of climate change, the frequency and magnitude of disasters caused by floods or torrential rains have increased in recent years around the world [3]. Estimating the costs of these climate change-related disasters is one of the five global research priorities identified by WHO [4]. The amount of damage caused by the 2018 Japan Floods was approximately US$9.86 billion (\1158 billion), which was the largest amount of damage ever caused by a single incidence of torrential rains or floods in Japan [11]
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