Considering the health impacts of evacuation is fundamental to disaster planning especially for vulnerable elderly populations; however, evacuation-related mortality risks have not been well-investigated. This analysis compared survival of evacuated and non-evacuated residents of elderly care facilities, following the Great East Japan Earthquake and subsequent Fukushima Daiichi nuclear incident on March 11, 2011. The research objectives are two-fold: to assess associations between evacuation and mortality after the Fukushima nuclear incident; and to present discussion points on disaster planning, with reference to vulnerable elderly populations. The study population comprised 1,215 residents admitted to seven elderly care facilities located 20-40 km from the nuclear plant in the five years before the incident. Demographic and clinical characteristics were obtained from medical records. Evacuation histories were tracked until mid 2013. Main outcome measures are hazard ratios in evacuees versus non-evacuees using random-effects Cox hazards models, and pre- and post-disaster survival probabilities and relative mortality incidence. Experiencing the disasters did not have a significant influence on mortality (hazard ratio 1.10, 95% CI: 0.84-1.43). Evacuation was associated with 1.82 times higher mortality (95% CI: 1.22-2.70) after adjusting for confounders, with the initial evacuation from the original facility associated with 3.37 times higher mortality risk (95% CI: 1.66-6.81) than non evacuation. The government should consider updating its requirements for emergency planning for elderly facilities and ensure that, in a disaster setting, these facilities have the capacity and support to shelter in place for at least sufficient time to adequately prepare initial evacuation.