Kawano, TakahisaNishiyama, KeiMorita, HiroshiYamamura, OsamuHiraide, AtsuchiHasegawa, Kohei2016-03-012016Kawano, Takahisa, Kei Nishiyama, Hiroshi Morita, Osamu Yamamura, Atsuchi Hiraide, and Kohei Hasegawa. 2016. “Association between shelter crowding and incidence of sleep disturbance among disaster evacuees: a retrospective medical chart review study.” BMJ Open 6 (1): e009711. doi:10.1136/bmjopen-2015-009711. http://dx.doi.org/10.1136/bmjopen-2015-009711.2044-6055http://nrs.harvard.edu/urn-3:HUL.InstRepos:25658545Objectives: We determined whether crowding at emergency shelters is associated with a higher incidence of sleep disturbance among disaster evacuees and identified the minimum required personal space at shelters. Design: Retrospective review of medical charts. Setting: 30 shelter-based medical clinics in Ishinomaki, Japan, during the 46 days following the Great Eastern Japan Earthquake and Tsunami in 2011. Participants: Shelter residents who visited eligible clinics. Outcome measures Based on the result of a locally weighted scatter-plot smoothing technique assessing the relationship between the mean space per evacuee and cumulative incidence of sleep disturbance at the shelter, eligible shelters were classified into crowded and non-crowded shelters. The cumulative incidence per 1000 evacuees was compared between groups, using a Mann-Whitney U test. To assess the association between shelter crowding and the daily incidence of sleep disturbance per 1000 evacuees, quasi–least squares method adjusting for potential confounders was used. Results: The 30 shelters were categorised as crowded (mean space per evacuee <5.0 m2, 9 shelters) or non-crowded (≥5.0 m2, 21 shelters). The study included 9031 patients. Among the eligible patients, 1079 patients (11.9%) were diagnosed with sleep disturbance. Mean space per evacuee during the study period was 3.3 m2 (SD, 0.8 m2) at crowded shelters and 8.6 m2 (SD, 4.3 m2) at non-crowded shelters. The median cumulative incidence of sleep disturbance did not differ between the crowded shelters (2.3/1000 person-days (IQR, 1.6–5.4)) and non-crowded shelters (1.9/1000 person-days (IQR, 1.0–2.8); p=0.20). In contrast, after adjusting for potential confounders, crowded shelters had an increased daily incidence of sleep disturbance (2.6 per 1000 person-days; 95% CI 0.2 to 5.0/1000 person-days, p=0.03) compared to that at non-crowded shelters. Conclusions: Crowding at shelters may exacerbate sleep disruptions in disaster evacuees; therefore, appropriate evacuation space requirements should be considered.en-USPUBLIC HEALTHSLEEP MEDICINEMENTAL HEALTHACCIDENT & EMERGENCY MEDICINEJournal Article2016-03-0110.1136/bmjopen-2015-009711