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Do V, McBrien HK, Edmondson D, Kioumourtzoglou MA, Casey JA. The Impact of Power Outages on Cardiovascular Hospitalizations Among Medicare Fee-for-service Enrollees in New York State, 2017-2018. Epidemiology 2025; 36:458-466. [PMID: 40125837 PMCID: PMC12122235 DOI: 10.1097/ede.0000000000001853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2025]
Abstract
BACKGROUND Power outages are common. They can result in exposure to extreme temperatures by shutting off temperature-controlling devices, and thereby also cause stress. Consequently, outages may precipitate cardiovascular disease (CVD)-related hospitalizations. We assessed this relationship among older adults. METHODS We leveraged 2017-2018 data from 245,452 New York State Medicare Fee-for-Service beneficiaries (65+ years) with 390,530 CVD hospitalizations. Using NY Department of Public Services data, we calculated total hours without power 1 day, 1-2 days, and 1-3 days before case and control periods, with an outage ZIP Code Tabulation Area (ZCTA)-hour defined based on ≥10% of customers in a ZCTA-hour without power in primary analyses. We used a case-crossover study design and ran conditional logistic regression to assess associations separately within each urbanicity level: New York City (NYC), non-NYC urban, and rural areas. We additionally stratified models by warm versus cool season, individual-level age and sex, and ZCTA-level socioeconomic factors. Secondarily, we considered emergency (n = 298,910) and nonemergency hospitalizations separately. RESULTS We generally observed null associations between power outages and all CVD hospitalizations across New York State and within subgroups. For example, in NYC, we observed a rate ratio of 1.05 (95% confidence interval: 0.85, 1.30) for each additional power outage hour 1 day prior. CONCLUSIONS The case-crossover design we used eliminated time-fixed confounding, but there were a limited number of exposed cases, limiting statistical power. Future studies should investigate co-occurring severe weather, span additional years, and evaluate other and broader geographic areas.
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Affiliation(s)
- Vivian Do
- Columbia Mailman School of Public Health, Department of Environmental Health Sciences
| | | | - Donald Edmondson
- Columbia Mailman School of Public Health, Department of Medicine
| | | | - Joan Allison Casey
- Columbia Mailman School of Public Health, Department of Environmental Health Sciences
- University of Washington School of Public Health, Department of Environmental and Occupational Health Sciences
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Yang Z, Huang W, McKenzie JE, Xu R, Yu P, Wu Y, Liu Y, Wen B, Zhang Y, Yu W, Ye T, Zhang Y, Ju K, Hales S, Coelho MDSZS, Matus P, Tantrakarnapa K, Guo YL, Kliengchuay W, Lavigne E, Phung D, Saldiva PHN, Guo Y, Li S. Hospitalization risks associated with floods in a multi-country study. NATURE WATER 2025; 3:561-570. [PMID: 40417424 PMCID: PMC12098117 DOI: 10.1038/s44221-025-00425-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 03/12/2025] [Indexed: 05/27/2025]
Abstract
Floods of unprecedented intensity and frequency have been observed. However, evidence regarding the impacts of floods on hospitalization remains limited. Here we collected daily hospitalization counts during 2000-2019 from 747 communities in Australia, Brazil, Canada, Chile, New Zealand, Taiwan, Thailand and Vietnam. For each community, flooded days were defined as days from the start dates to the end dates of flood events. Lag-response associations between flooded day and daily hospitalization risks were estimated for each community using a quasi-Poisson regression model with a distributed lag nonlinear function. The community-specific estimates were then pooled using a random-effects meta-analysis. Based on the pooled estimates, attributable fractions of hospitalizations due to floods were calculated. We found that hospitalization risks increased and persisted for up to 210 days after flood exposure, with the overall relative risks being 1.26 (95% confidence interval 1.15-1.38) for all causes, 1.35 (1.21-1.50) for cardiovascular diseases, 1.30 (1.13-1.49) for respiratory diseases, 1.26 (1.10-1.44) for infectious diseases, 1.30 (1.17-1.45) for digestive diseases, 1.11 (0.98-1.25) for mental disorders, 1.61 (1.39-1.86) for diabetes, 1.35 (1.21-1.50) for injury, 1.34 (1.21-1.48) for cancer, 1.34 (1.20-1.50) for nervous system disorders and 1.40 (1.22-1.60) for renal diseases. The associations were modified by climate types, flood severity, age, population density and socioeconomic status. Flood exposure contributed to hospitalizations by up to 0.27% from all causes. This study revealed that flood exposure was associated with increased all-cause and ten cause-specific hospitalization risks within up to 210 days after exposure.
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Affiliation(s)
- Zhengyu Yang
- Climate Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria Australia
| | - Wenzhong Huang
- Climate Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria Australia
| | - Joanne E. McKenzie
- Methods in Evidence Synthesis Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria Australia
| | - Rongbin Xu
- Climate Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria Australia
| | - Pei Yu
- Climate Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria Australia
| | - Yao Wu
- Climate Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria Australia
| | - Yanming Liu
- Climate Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria Australia
| | - Bo Wen
- Climate Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria Australia
| | - Yiwen Zhang
- Climate Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria Australia
| | - Wenhua Yu
- Climate Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria Australia
| | - Tingting Ye
- Climate Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria Australia
| | - Yuxi Zhang
- School of Life and Environmental Sciences, University of Sydney, Sydney, New South Wales Australia
| | - Ke Ju
- Climate Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria Australia
| | - Simon Hales
- Department of Public Health, University of Otago, Wellington, New Zealand
| | | | - Patricia Matus
- School of Medicine, University of the Andes (Universidad de los Andes), Las Condes, Chile
| | - Kraichat Tantrakarnapa
- Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Krung Thep Maha Nakhon, Bangkok, Thailand
| | - Yue Leon Guo
- Environmental and Occupational Medicine, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
| | - Wissanupong Kliengchuay
- Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Krung Thep Maha Nakhon, Bangkok, Thailand
| | - Eric Lavigne
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario Canada
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario Canada
| | - Dung Phung
- School of Public Health, University of Queensland, Brisbane, Queensland Australia
| | | | - Yuming Guo
- Climate Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria Australia
| | - Shanshan Li
- Climate Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria Australia
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Friedman S, Fang C, Yang TC, Li R, Mithu IH, Manganello JA, Romeiko X, Lin S. Mapping the Vulnerability of Older-Adult Neighborhoods: An Ecological Study of New York State. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2025; 22:332. [PMID: 40238277 PMCID: PMC11942220 DOI: 10.3390/ijerph22030332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 02/14/2025] [Accepted: 02/18/2025] [Indexed: 04/18/2025]
Abstract
We examined neighborhood-level demographic, economic, and social characteristics and food and health-services access to gauge the vulnerability of older-adult neighborhoods in New York State (NYS), which is understudied and is significant given the rapid aging of populations worldwide. We conducted descriptive ecological analyses using data from the American Community Survey, historical redlining maps, Social Capital Instruments, U.S. Department of Agriculture food access atlas, ESRI businesses, and Social Determinants of Health. We compared census tracts classified as having high and low levels of older-adult population; among those identified as high-older-adult neighborhoods, we then examined tracts with high and low levels of adult population living alone and in poverty. Our results showed that NYS neighborhoods with large shares of the older adult population are generally faring well in terms of their socioeconomic status, social capital, lack of social isolation, and health services access. However, the older-adult neighborhoods with larger shares of the population living alone and in poverty fare worse, living in areas with poorer socioeconomic status, lower social capital, and considered medically underserved. NYS older adult communities are projected to increase by 2030. Resources should be invested in such areas with vulnerable groups so populations may age in equitable and accessible communities.
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Affiliation(s)
- Samantha Friedman
- Department of Sociology, University at Albany, State University of New York, 348 Arts & Sciences Building 1400 Washington Avenue, Albany, NY 12222, USA; (S.F.); (C.F.); (T.-C.Y.)
| | - Chunxu Fang
- Department of Sociology, University at Albany, State University of New York, 348 Arts & Sciences Building 1400 Washington Avenue, Albany, NY 12222, USA; (S.F.); (C.F.); (T.-C.Y.)
| | - Tse-Chuan Yang
- Department of Sociology, University at Albany, State University of New York, 348 Arts & Sciences Building 1400 Washington Avenue, Albany, NY 12222, USA; (S.F.); (C.F.); (T.-C.Y.)
| | - Rui Li
- Department of Geography and Planning, University at Albany, State University of New York, 348 Arts & Sciences Building 1400 Washington Avenue, Albany, NY 12222, USA;
| | - Imran Hossain Mithu
- Community, Environment and Policy Division, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85721, USA;
| | - Jennifer A. Manganello
- Department of Health Policy, Management, and Behavior, College of Integrated Health Sciences, University at Albany, State University of New York, 1 University Place, Rensselaer, NY 12144, USA;
| | - Xiaobo Romeiko
- Department of Environmental Health Sciences, College of Integrated Health Sciences, University at Albany, State University of New York, 1 University Place, Rensselaer, NY 12144, USA;
| | - Shao Lin
- Department of Environmental Health Sciences, College of Integrated Health Sciences, University at Albany, State University of New York, 1 University Place, Rensselaer, NY 12144, USA;
- Department of Epidemiology and Biostatistics, College of Integrated Health Sciences, University at Albany, State University of New York, 1 University Place, Rensselaer, NY 12144, USA
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Yang Z, Huang W, McKenzie JE, Yu P, Ju K, Wu Y, Wen B, Guo Y, Li S. Mortality and morbidity risks associated with floods: A systematic review and meta-analysis. ENVIRONMENTAL RESEARCH 2024; 263:120263. [PMID: 39481788 DOI: 10.1016/j.envres.2024.120263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 10/22/2024] [Accepted: 10/28/2024] [Indexed: 11/02/2024]
Abstract
BACKGROUND Flood disasters are projected to increase in severity, duration, and frequency in the context of climate change, and the risks of mortality and morbidity may increase after floods, which will overwhelm health systems. OBJECTIVE This study aims to synthesize current epidemiological evidence about the impacts of floods on mortality and morbidity. METHOD After performing a systematic literature search from 2000 to 2023, we included studies involving human participants, with exposures of floods, and with outcomes of mortality or morbidity. RESULTS In total, 37 studies were included in evidence syntheses. Meta-analyses yielded an overall relative risk of 1.26 (95% confidence interval [CI]: 1.10, 1.46), 1.10 (1.08, 1.13), 1.11 (1.04, 1.20), and 1.38 (1.18, 1.62) for all-cause mortality and morbidities of overall gastrointestinal diseases, diarrhea diseases, and dysentery, respectively. Although meta-analyses were not conducted, evidence from at least three studies consistently supported that exposure to floods was associated with increased risks of malaria and respiratory diseases. The evidence for other outcomes was reported but either limited or uncertain. CONCLUSION This study suggests that exposure to floods is associated with increased risks of all-cause mortality and morbidities of overall gastrointestinal diseases, diarrhea diseases, dysentery, malaria, and respiratory diseases, while further research is urgently called.
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Affiliation(s)
- Zhengyu Yang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, VIC, Australia
| | - Wenzhong Huang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, VIC, Australia
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, VIC, Australia
| | - Pei Yu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, VIC, Australia
| | - Ke Ju
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, VIC, Australia
| | - Yao Wu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, VIC, Australia
| | - Bo Wen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, VIC, Australia
| | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, VIC, Australia
| | - Shanshan Li
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, VIC, Australia.
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Lin S, Qi Q, Liu H, Deng X, Trees I, Yuan X, Gallant MP. The Joint Effects of Thunderstorms and Power Outages on Respiratory-Related Emergency Visits and Modifying and Mediating Factors of This Relationship. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:67002. [PMID: 38829734 PMCID: PMC11166412 DOI: 10.1289/ehp13237] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 04/27/2024] [Accepted: 05/10/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND While limited studies have evaluated the health impacts of thunderstorms and power outages (POs) separately, few have assessed their joint effects. We aimed to investigate the individual and joint effects of both thunderstorms and POs on respiratory diseases, to identify disparities by demographics, and to examine the modifications and mediations by meteorological factors and air pollution. METHODS Distributed lag nonlinear models were used to examine exposures during three periods (i.e., days with both thunderstorms and POs, thunderstorms only, and POs only) in relation to emergency department visits for respiratory diseases (2005-2018) compared to controls (no thunderstorm/no PO) in New York State (NYS) while controlling for confounders. Interactions between thunderstorms and weather factors or air pollutants on health were assessed. The disparities by demographics and seasons and the mediative effects by particulate matter with aerodynamic diameter ≤ 2.5 μ m (PM 2.5 ) and relative humidity (RH) were also evaluated. RESULTS Thunderstorms and POs were independently associated with total and six subtypes of respiratory diseases in NYS [highest risk ratio (RR) = 1.12; 95% confidence interval (CI): 1.08, 1.17], but the impact was stronger when they co-occurred (highest RR = 1.44; 95% CI: 1.22, 1.70), especially during grass weed, ragweed, and tree pollen seasons. The stronger thunderstorm/PO joint effects were observed on chronic obstructive pulmonary diseases, bronchitis, and asthma (lasted 0-10 d) and were higher among residents who lived in rural areas, were uninsured, were of Hispanic ethnicity, were 6-17 or over 65 years old, and during spring and summer. The number of comorbidities was significantly higher by 0.299-0.782/case. Extreme cold/heat, high RH, PM 2.5 , and ozone concentrations significantly modified the thunderstorm-health effect on both multiplicative and additive scales. Over 35% of the thunderstorm effects were mediated by PM 2.5 and RH. CONCLUSION Thunderstorms accompanied by POs showed the strongest respiratory effects. There were large disparities in thunderstorm-health associations by demographics. Meteorological factors and air pollution levels modified and mediated the thunderstorm-health effects. https://doi.org/10.1289/EHP13237.
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Affiliation(s)
- Shao Lin
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Albany, New York, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Albany, New York, USA
| | - Quan Qi
- Department of Economics, University at Albany, State University of New York, Albany, New York, USA
| | - Han Liu
- Population Studies and Training Center, Brown University, Providence, Rhode Island, USA
| | - Xinlei Deng
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, North Carolina, USA
| | - Ian Trees
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland, USA
| | - Xiaojun Yuan
- Department of Information Sciences and Technology, College of Emergency Preparedness, Homeland Security and Cybersecurity, University at Albany, State University of New York, Albany, New York, USA
| | - Mary P. Gallant
- Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts, USA
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Salas RN, Burke LG, Phelan J, Wellenius GA, Orav EJ, Jha AK. Impact of extreme weather events on healthcare utilization and mortality in the United States. Nat Med 2024; 30:1118-1126. [PMID: 38424213 DOI: 10.1038/s41591-024-02833-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024]
Abstract
Climate change is intensifying extreme weather events. Yet a systematic analysis of post-disaster healthcare utilization and outcomes for severe weather and climate disasters, as tracked by the US government, is lacking. Following exposure to 42 US billion-dollar weather disasters (severe storm, flood, flood/severe storm, tropical cyclone and winter storm) between 2011 and 2016, we used a difference-in-differences (DID) approach to quantify changes in the rates of emergency department (ED) visits, nonelective hospitalizations and mortality between fee-for-service Medicare beneficiaries in affected compared to matched control counties in post-disaster weeks 1, 1-2 and 3-6. Overall, disasters were associated with higher rates of ED utilization in affected counties in post-disaster week 1 (DID of 1.22% (95% CI, 0.20% to 2.25%; P < 0.020)) through week 2. Nonelective hospitalizations were unchanged. Mortality was higher in affected counties in week 1 (DID of 1.40% (95% CI, 0.08% to 2.74%; P = 0.037)) and persisted for 6 weeks. Counties with the greatest loss and damage experienced greater increases in ED and mortality rates compared to all affected counties. Thus, billion-dollar weather disasters are associated with excess ED visits and mortality in Medicare beneficiaries. Tracking these outcomes is important for adaptation that protects patients and communities, health system resilience and policy.
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Affiliation(s)
- Renee N Salas
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Harvard Global Health Institute, Cambridge, MA, USA.
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Laura G Burke
- Harvard Medical School, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, MA, USA
| | - Jessica Phelan
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Gregory A Wellenius
- Boston University School of Public Health, Center for Climate and Health, Boston, MA, USA
| | - E John Orav
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ashish K Jha
- Brown University School of Public Health, Providence, RI, USA
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Aitken WW, Brown SC, Comellas AP. Climate Change and Cardiovascular Health. J Am Heart Assoc 2022; 11:e027847. [PMID: 36533640 PMCID: PMC9798823 DOI: 10.1161/jaha.122.027847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Affiliation(s)
- William W. Aitken
- Division of Cardiology, Department of MedicineUniversity of Miami Miller School of MedicineMiamiFL
| | - Scott C. Brown
- Division of Cardiology, Department of MedicineUniversity of Miami Miller School of MedicineMiamiFL
- Department of Public Health SciencesUniversity of Miami School of ArchitectureCoral GablesFL
| | - Alejandro P. Comellas
- Division of Pulmonary, Critical Care, and Occupational MedicineUniversity of IowaIowa CityIA
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