Article Text

Download PDFPDF

Long-term trends of hospital admissions among patients with cancer following the 2015 earthquake: a single institution observational study in Kathmandu, Nepal
  1. Anup Uprety1,
  2. Akihiko Ozaki2,3,
  3. Asaka Higuchi4,5,
  4. Bikal Ghimire6,
  5. Toyoaki Sawano5,7,
  6. Kenji Tsuda8,
  7. Shuhei Nomura9,10,
  8. Claire Leppold11,
  9. Masaharu Tsubokura2,5,
  10. Tetsuya Tanimoto12,
  11. Yogendra Prasad Singh6
  1. 1 Department of Anesthesiology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
  2. 2 Research Center for Community Health, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan
  3. 3 Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan
  4. 4 Medical Governance Research Institute, Minato-ku, Tokyo, Japan
  5. 5 Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan
  6. 6 Department of Gastrointestinal and General Surgery, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
  7. 7 Department of Surgery, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan
  8. 8 Department of Hematology and Rheumatology, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
  9. 9 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
  10. 10 Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
  11. 11 Global Public Health Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
  12. 12 Department of Internal Medicine, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan
  1. Correspondence to Ms. Asaka Higuchi; a.higuchi1025{at}


Objectives Little is known regarding how natural disasters affect patients with cancer in low-income and middle-income countries. The objective of the present study was to assess the impact of the 2015 Nepal earthquake on the admission of patients with cancer at a core medical institution in Kathmandu.

Design, setting and participants We considered all 3520 cancer patient admissions to Tribhuvan University Teaching Hospital, from 25 April 2013 to 24 April 2017 (2 years before and 2 years after the earthquake).

Outcome measures The number of cancer patient admissions was calculated for each month. Using a negative binomial model, we estimated the incidence rate ratio (IRR) for admission numbers each month after the earthquake compared with the pre-earthquake baseline and investigated chronological change.

Results The total admission number in the first month after the earthquake was decreased compared with that of the predisaster baseline (IRR=0.66, 95% CI 0.43 to 1.00), which largely reflected decreased admissions of patients from outside of the most disaster-affected districts. From the second month, the admission number consistently exceeded the predisaster baseline for the remaining postdisaster period. In contrast to the month of the disaster, the continuation of increased admissions was most prominent among those from outside of the most affected districts.

Conclusions After a transient decrease immediately following the 2015 Nepal earthquake, there was a long-term increase in cancer patient admissions in a core hospital in Kathmandu. These changes were seen most prominently in patients from outside the most disaster affected areas.

  • health services accessibility
  • developing countries
  • natural disasters
  • healthcare disparities
  • oncology service

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors All the authors conceived and designed the study and take responsibility for the integrity of the data and the accuracy of the data analysis. AU, BG, and YPS acquired the data. AU, AO and AH analysed and interpreted the data. AO, AH, KT and SN conducted statistical analysis. AU, AO, AH, TS, CL, MT and TT drafted the article. All the authors made critical revisions to the manuscript for important intellectual content and gave final approval of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AO and TT report personal fees from MNES Inc., outside of the submitted work.

  • Ethics approval The ethics committee of the Tribhuvan University Teaching Hospital granted approval for this study (approval number: 417 (6–11-E)2/073/074).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Additional unpublished data are not publicly available.

  • Patient consent for publication Not required.

  • Map disclaimer The depiction ofboundaries on the map(s) in this article do not imply the expression of anyopinion whatsoever on the part of BMJ (or any member of its group) concerningthe legal status of any country, territory, jurisdiction or area or of itsauthorities. The map(s) are provided without any warranty of any kind, eitherexpress or implied.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.