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Sever MS, Luyckx V, Tonelli M, Kazancioglu R, Rodgers D, Gallego D, Tuglular S, Vanholder R. Disasters and kidney care: pitfalls and solutions. Nat Rev Nephrol 2023; 19:672-686. [PMID: 37479903 DOI: 10.1038/s41581-023-00743-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 07/23/2023]
Abstract
Patients with kidney disease, especially those with kidney failure, are particularly susceptible to the adverse effects of disasters because their survival depends on functional infrastructure, advanced technology, the availability of specific drugs and well-trained medical personnel. The risk of poor outcomes across the entire spectrum of patients with kidney diseases (acute kidney injury, chronic kidney disease and kidney failure on dialysis or with a functioning transplant) increases as a result of disaster-related logistical challenges. Patients who are displaced face even more complex problems owing to additional threats that arise during travel and after reaching their new location. Overall, risks may be mitigated by pre-disaster preparedness and training. Emergency kidney disaster responses depend on the type and severity of the disaster and include medical and/or surgical treatment of injuries, treatment of mental health conditions, appropriate diet and logistical interventions. After a disaster, patients should be evaluated for problems that were not detected during the event, including those that may have developed as a result of the disaster. A retrospective review of the disaster response is vital to prevent future mistakes. Important ethical concerns include fair distribution of limited resources and limiting harm. Patients with kidney disease, their care-givers, health-care providers and authorities should be trained to respond to the medical and logistical problems that occur during disasters to improve outcomes.
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Affiliation(s)
- Mehmet Sukru Sever
- Istanbul University, Istanbul School of Medicine, Department of Nephrology, Istanbul, Turkey.
| | - Valerie Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Renal Division, Brigham and Women's Hospital, Harvard, Medical School, Boston, MA, USA
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Rumeyza Kazancioglu
- Division of Nephrology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Darlene Rodgers
- Independent Nurse Consultant, American Society of Nephrology, Washington, DC, USA
| | - Dani Gallego
- European Kidney Health Alliance, Brussels, Belgium
- European Kidney Patient Federation, Wien, Austria
| | - Serhan Tuglular
- Marmara University, School of Medicine, Department of Nephrology, Istanbul, Turkey
| | - Raymond Vanholder
- European Kidney Health Alliance, Brussels, Belgium
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital Ghent, Ghent, Belgium
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Remigio RV, Song H, Raimann JG, Kotanko P, Maddux FW, Lasky RA, He X, Sapkota A. Inclement Weather and Risk of Missing Scheduled Hemodialysis Appointments among Patients with Kidney Failure. Clin J Am Soc Nephrol 2023; 18:01277230-990000000-00130. [PMID: 37071662 PMCID: PMC10356145 DOI: 10.2215/cjn.0000000000000174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/03/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Nonadherence to hemodialysis appointments could potentially result in health complications that can influence morbidity and mortality. We examined the association between different types of inclement weather and hemodialysis appointment adherence. METHODS We analyzed health records of 60,135 patients with kidney failure who received in-center hemodialysis treatment at Fresenius Kidney Care clinics across the Northeastern US counties during 2001-2019. County-level daily meteorological data on rainfall, hurricane and tropical storm events, snowfall, snow depth, and wind speed were extracted using National Oceanic and Atmosphere Agency data sources. A time-stratified case-crossover study design with conditional Poisson regression was used to estimate the effect of inclement weather exposures within the Northeastern US region. We applied a distributed lag nonlinear model framework to evaluate the delayed effect of inclement weather for up to 1 week. RESULTS We observed positive associations between inclement weather and missed appointment (rainfall, hurricane and tropical storm, snowfall, snow depth, and wind advisory) when compared with noninclement weather days. The risk of missed appointments was most pronounced during the day of inclement weather (lag 0) for rainfall (incidence rate ratio [RR], 1.03 per 10-mm rainfall; 95% confidence interval [CI], 1.02 to 1.03) and snowfall (RR, 1.02; 95% CI, 1.01 to 1.02). Over 7 days (lag 0-6), hurricane and tropical storm exposures were associated with a 55% higher risk of missed appointments (RR, 1.55; 95% CI, 1.22 to 1.98). Similarly, 7-day cumulative exposure to sustained wind advisories was associated with 29% higher risk (RR, 1.29; 95% CI, 1.25 to 1.31), while wind gusts advisories showed a 34% higher risk (RR, 1.34; 95% CI, 1.29 to 1.39) of missed appointment. CONCLUSIONS Inclement weather was associated with higher risk of missed hemodialysis appointments within the Northeastern United States. Furthermore, the association between inclement weather and missed hemodialysis appointments persisted for several days, depending on the inclement weather type.
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Affiliation(s)
- Richard V. Remigio
- Maryland Institute for Applied Environmental Health, University of Maryland, School of Public Health, College Park, Maryland
| | - Hyeonjin Song
- Maryland Institute for Applied Environmental Health, University of Maryland, School of Public Health, College Park, Maryland
- Department of Epidemiology and Biostatistics, University of Maryland, School of Public Health, College Park, Maryland
| | | | - Peter Kotanko
- Research Division, Renal Research Institute, New York, New York
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Frank W. Maddux
- Fresenius Medical Care North America, Waltham, Massachusetts
| | - Rachel A. Lasky
- Fresenius Medical Care North America, Waltham, Massachusetts
| | - Xin He
- Department of Epidemiology and Biostatistics, University of Maryland, School of Public Health, College Park, Maryland
| | - Amir Sapkota
- Department of Epidemiology and Biostatistics, University of Maryland, School of Public Health, College Park, Maryland
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Kim I, Locascio JJ, Sarin R, Hart A, Ciottone GR. Time Series Analysis of Congestive Heart Failure Discharges in Florida (USA) Post Tropical Cyclones. Prehosp Disaster Med 2023; 38:207-215. [PMID: 36691696 DOI: 10.1017/s1049023x23000067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The aim of this study was to analyze congestive heart failure (CHF) discharges in Florida (USA) post tropical cyclones from 2007 through 2017. METHODS This was a retrospective longitudinal time series analysis of hospital CHF quarterly discharges across Florida using the Healthcare Cost and Utilization Project (HCUP) database. The autoregressive integrated moving average (ARIMA) model was used with correlated seasonal regressor variables such as cyclone frequency, maximum cyclone wind speed, average temperature, and reports of influenza-like illness (ILI). RESULTS A total of 3,372,993 patients were identified, with average age in each quarter ranging 72.2 to 73.9 years and overall mortality ranging 4.3% to 6.4%. The CHF discharges within each year peaked from October through December and nadired from April through June with an increasing overall time trend. Significant correlation was found between CHF discharge and the average temperature (P <.001), with approximately 331.8 less CHF discharges (SE = 91.7) per degree of increase in temperature. However, no significant correlation was found between CHF discharges and frequency of cyclones, the maximum wind speed, and reported ILI. CONCLUSIONS This study suggests that with the current methods and the HCUP dataset, there is no significant increase in overall CHF discharges in Florida as a result of recent previous cyclone occurrences.
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Affiliation(s)
- Inkyu Kim
- Harvard Medical School, Boston, MassachusettsUSA; currently: Harvard-Affiliated Emergency Medicine Residency at Massachusetts General Hospital and Brigham and Women's Hospital, Boston, Massachusetts USA
| | | | - Ritu Sarin
- Beth Israel Deaconess Medical Center, Disaster Medicine Fellowship, Boston, MassachusettsUSA
| | - Alexander Hart
- Beth Israel Deaconess Medical Center, Disaster Medicine Fellowship, Boston, MassachusettsUSA
| | - Gregory R Ciottone
- Beth Israel Deaconess Medical Center, Disaster Medicine Fellowship, Boston, MassachusettsUSA
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Gopolan T, Ornelas-Brauer CM, Barbar T, Mithani Z, Silberzweig J. Conflict Nephrology: War and Natural Disasters. KIDNEY360 2023; 4:405-408. [PMID: 36763799 PMCID: PMC10103227 DOI: 10.34067/kid.0000000000000071] [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: 08/11/2022] [Accepted: 01/04/2023] [Indexed: 02/12/2023]
Abstract
Access to care for patients with ESKD is frequently disrupted after natural disasters, public health crises, and human conflict. Emergency preparation can mitigate the risk of harm and improve outcomes. Before Hurricane Katrina in 2005, the United States was unprepared to assist patients facing disaster. We evaluate responses to Hurricane Katrina which caused unprecedented damage to health and property in the Gulf Coast. As a result of the multitude of identified problems with the national, local, and kidney-specific responses to Katrina, new systems were created that mitigated loss after Hurricane Sandy in 2012. The improved disaster response system was no match for the coronavirus disease 2019 pandemic; real-time changes worsened the effect on highly vulnerable populations, including patients with ESKD. Similarly, preparation can only mitigate the difficulties faced by patients with ESKD living in a war zone. Government agencies need to provide tools and dialysis centers need to educate patients. Beginning with steps implemented in the aftermath of Hurricane Katrina and augmented after Hurricane Sandy, every patient with ESKD and those who care for them must begin emergency preparations before the need arises. Recognizing that it is not possible to prepare for every possible emergency, our health care systems must be ready to adapt to our ever-changing world. After reviewing the responses to previous events, we suggest steps that should be considered to improve preparations for our uncertain future.
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Affiliation(s)
- Tulasi Gopolan
- University of Texas Southwestern School of Medicine, Dallas, Texas
| | | | | | - Zain Mithani
- Division of Nephrology, Department of Medicine, Leonard Miller School of Medicine at the University of Miami, Miami, Florida
| | - Jeffrey Silberzweig
- Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medicine, New York, New York
- The Rogosin Institute, New York, New York
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Yoshida M, Sawano T, Kobashi Y, Hori A, Nishikawa Y, Ozaki A, Nonaka S, Tsuboi M, Tsubokura M. Importance of continuing health care before emergency hospital evacuation: a fatal case of a hospitalized patient in a hospital within 5 km radius of Fukushima Daiichi Nuclear Power Plant: a case report. J Med Case Rep 2023; 17:37. [PMID: 36747281 PMCID: PMC9903404 DOI: 10.1186/s13256-022-03744-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/27/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND After a disaster, it is essential to maintain the health care supply levels to minimize the health impact on vulnerable populations. During the 2011 Fukushima Daiichi Nuclear Power Plant accident, hospitals within a 20 km radius were forced to make an immediate evacuation, causing a wide range of short- and long-term health problems. However, there is limited information on how the disaster disrupted the continuity of health care for hospitalized patients in the acute phase of the disaster. CASE PRESENTATION An 86-year-old Japanese man who needed central venous nutrition, oxygen administration, care to prevent pressure ulcers, skin and suctioning care of the trachea, and full assistance in the basic activities of daily living had been admitted to a hospital within 5 km radius of Fukushima Daiichi Nuclear Power Plant and experienced Fukushima Daiichi Nuclear Power Plant accident. After the accident, the hospital faced a manpower shortage associated with hospital evacuation, environmental changes caused by infrastructure and medical supply disruptions, and the difficulty of evacuating seriously ill patients. As a result, antibiotics and suction care for aspiration pneumonia could not be appropriately provided to the patient due to lack of caregivers and infrastructure shortages. The patient died before his evacuation was initiated, in the process of hospital evacuation. CONCLUSIONS This case illustrates that decline in health care supply levels to hospitalized patients before evacuation during the acute phase of a radiation-released disaster may lead to patient fatalities. It is important to maintain the health care supply level even in such situations as the radiation-released disaster; otherwise, patients may experience negative health effects.
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Affiliation(s)
- Makoto Yoshida
- grid.264706.10000 0000 9239 9995Faculty of Medicine, Teikyo University, Itabashi-Ku, Tokyo, Japan
| | - Toyoaki Sawano
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan. .,Research Center for Community Health, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan. .,Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan.
| | - Yurie Kobashi
- grid.411582.b0000 0001 1017 9540Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan ,Department of Internal Medicine, Serireikai Group Hirata Central Hospital, Ishikawa District, Fukushima, Japan
| | - Arinobu Hori
- Department of Psychiatry, Hori Mental Clinic, Minamisoma, Fukushima Japan
| | - Yoshitaka Nishikawa
- Department of Internal Medicine, Serireikai Group Hirata Central Hospital, Ishikawa District, Fukushima, Japan
| | - Akihiko Ozaki
- grid.507981.20000 0004 5935 0742Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima Japan
| | - Saori Nonaka
- Research Center for Community Health, Minamisoma Municipal General Hospital, Minamisoma, Fukushima Japan
| | - Motohiro Tsuboi
- grid.264706.10000 0000 9239 9995Graduate School of Public Health, Teikyo University, Itabashi-Ku, Tokyo, Japan ,grid.410775.00000 0004 1762 2623Emergency and Critical Care Medicine, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Masaharu Tsubokura
- Research Center for Community Health, Minamisoma Municipal General Hospital, Minamisoma, Fukushima Japan ,grid.411582.b0000 0001 1017 9540Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan ,Department of Internal Medicine, Serireikai Group Hirata Central Hospital, Ishikawa District, Fukushima, Japan
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Delays and declines in seasonal influenza vaccinations due to Hurricane Harvey narrow annual gaps in vaccination by race, income and rurality. Infect Control Hosp Epidemiol 2022; 43:1833-1839. [PMID: 35292125 PMCID: PMC9753087 DOI: 10.1017/ice.2022.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Temporal overlap of the Atlantic hurricane season and seasonal influenza vaccine rollout has the potential to result in delays or disruptions of vaccination campaigns. We documented seasonal influenza vaccination behavior over a 5-year period and explored associations between flooding following Hurricane Harvey and timing and uptake of vaccines, as well as how the impacts of Hurricane Harvey on vaccination vary by race, wealth, and rurality. DESIGN Retrospective cohort analysis. SETTING Texas counties affected by Hurricane Harvey. PATIENTS Active users of the Veterans' Health Administration in 2017. METHODS We used geocoded residential address data to assess flood exposure status following Hurricane Harvey. Days to receipt of seasonal influenza vaccines were calculated for each year from 2014 to 2019. Proportional hazards models were used to determine how likelihood of vaccination varied according to flood status as well as the race, wealth, and rural-urban residence of patients. RESULTS The year of Hurricane Harvey was associated with a median delay of 2 weeks to vaccination and lower overall vaccination than in prior years. Residential status in flooded areas was associated with lower hazards of influenza vaccination in all years. White patients had higher proportional hazards of influenza vaccination than non-White patients, though this attenuated to 6.39% (hazard ratio [HR], 1.0639; 95% confidence interval [CI], 1.034-1.095) in the hurricane. year. CONCLUSIONS Receipt of seasonal influenza vaccination following regional exposure to the effects of Hurricane Harvey was delayed among US veterans. White, non-low-income, and rural patients had higher likelihood of vaccination in all years of the study, but these gaps narrowed during the hurricane year.
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Tarabochia‐Gast AT, Michanowicz DR, Bernstein AS. Flood Risk to Hospitals on the United States Atlantic and Gulf Coasts From Hurricanes and Sea Level Rise. GEOHEALTH 2022; 6:e2022GH000651. [PMID: 36203949 PMCID: PMC9521195 DOI: 10.1029/2022gh000651] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 08/16/2022] [Accepted: 09/05/2022] [Indexed: 06/16/2023]
Abstract
Hurricanes have caused major healthcare system disruptions. No systematic assessment of hurricane risk to United States hospital-based healthcare delivery has been performed. Here, we show that 25 of 78 metropolitan statistical areas (MSAs) on the United States Atlantic and Gulf Coasts have half or more of their hospitals at risk of flooding from relatively weak hurricanes. 0.82 m of sea level rise expected within this century from climate change increases the odds of hospital flooding 22%. Furthermore, in 18 MSAs at least half of the roads within 1.6 km of hospitals were at risk of flooding from a category 2 storm. These findings identify previously undescribed risks to hospital-based care delivery in Atlantic and Gulf Coast communities. They suggest that lower intensity hurricanes can have outsized impacts on healthcare access, particularly in places where per capita bed availability is low.
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Affiliation(s)
- A. T. Tarabochia‐Gast
- Center for Climate, Health and the Global EnvironmentHarvard T.H. Chan School of Public HealthBostonMAUSA
- Department of Family MedicineBoston University School of MedicineBostonMAUSA
| | - D. R. Michanowicz
- Center for Climate, Health and the Global EnvironmentHarvard T.H. Chan School of Public HealthBostonMAUSA
- Physicians, Scientists, and Engineers for Healthy EnergyOaklandCAUSA
| | - A. S. Bernstein
- Center for Climate, Health and the Global EnvironmentHarvard T.H. Chan School of Public HealthBostonMAUSA
- Boston Children's HospitalBostonMAUSA
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Blum MF, Feng Y, Anderson GB, Segev DL, McAdams-DeMarco M, Grams ME. Hurricanes and Mortality among Patients Receiving Dialysis. J Am Soc Nephrol 2022; 33:1757-1766. [PMID: 35835459 PMCID: PMC9529177 DOI: 10.1681/asn.2021111520] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 05/15/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Hurricanes are severe weather events that can disrupt power, water, and transportation systems. These disruptions may be deadly for patients requiring maintenance dialysis. We hypothesized that the mortality risk among patients requiring maintenance dialysis would be increased in the 30 days after a hurricane. METHODS Patients registered as requiring maintenance dialysis in the United States Renal Data System who initiated treatment between January 1, 1997 and December 31, 2017 in one of 108 hurricane-afflicted counties were followed from dialysis initiation until transplantation, dialysis discontinuation, a move to a nonafflicted county, or death. Hurricane exposure was determined as a tropical cyclone event with peak local wind speeds ≥64 knots in the county of a patient's residence. The risk of death after the hurricane was estimated using time-varying Cox proportional hazards models. RESULTS The median age of the 187,388 patients was 65 years (IQR, 53-75) and 43.7% were female. There were 27 hurricanes and 105,398 deaths in 529,339 person-years of follow-up on dialysis. In total, 29,849 patients were exposed to at least one hurricane. Hurricane exposure was associated with a significantly higher mortality after adjusting for demographic and socioeconomic covariates (hazard ratio, 1.13; 95% confidence interval, 1.05 to 1.22). The association persisted when adjusting for seasonality. CONCLUSIONS Patients requiring maintenance dialysis have a higher mortality risk in the 30 days after a hurricane.
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Affiliation(s)
- Matthew F. Blum
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Yijing Feng
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - G. Brooke Anderson
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado
| | - Dorry L. Segev
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Mara McAdams-DeMarco
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Morgan E. Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
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Rivera-Hernandez M, Kim D, Nguyen KH, Thorsness R, Lee Y, Swaminathan S, Mehrotra R, Trivedi AN. Changes in Migration and Mortality Among Patients With Kidney Failure in Puerto Rico After Hurricane Maria. JAMA HEALTH FORUM 2022; 3:e222534. [PMID: 36200633 PMCID: PMC9375170 DOI: 10.1001/jamahealthforum.2022.2534] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Importance On September 20, 2017, one of the most destructive hurricanes in US history made landfall in Puerto Rico. Anecdotal reports suggest that many persons with kidney failure left Puerto Rico after Hurricane Maria; however, empirical estimates of migration and health outcomes for this population are scarce. Objective To assess the changes in migration and mortality among patients with kidney failure in need of dialysis treatment in Puerto Rico after Hurricane Maria. Design, Setting, and Participants This cross-sectional study used an interrupted time-series design of 6-month mortality rates and migration of 11 652 patients who received hemodialysis or peritoneal dialysis care in Puerto Rico before Hurricane Maria (before October 1, 2017) and/or during and after Hurricane Maria (on/after October 1, 2017). Data analyses were performed from February 12, 2019, to June 16, 2022.. Main Outcomes and Measures Number of unique persons dialyzed in Puerto Rico per quarter; receipt of dialysis treatment outside Puerto Rico per quarter; and 6-month mortality rate per person-quarter for all persons undergoing dialysis. Exposures Hurricane Maria. Results The entire study sample comprised 11 652 unique persons (mean [SD] age, 59 [14.7] years; 7157 [61.6%] men and 4465 [38.4%] women; 10 675 [91.9%] Hispanic individuals). There were 9022 patients with kidney failure and dialysis treatment before and 5397 patients after Hurricane Maria. Before the hurricane, the mean quarterly number of unique persons dialyzed in Puerto Rico was 2834 per quarter (95% CI, 2771-2897); afterwards it dropped to 261 (95% CI, -348 to -175; relative change, 9.2%). The percentage of persons who had 1 or more dialysis sessions outside of Puerto Rico in the next quarter following a previous dialysis in Puerto Rico was 7.1% before Hurricane Maria (95% CI, 4.8 to 9.3). There was a significant increase of 5.8 percentage points immediately after the hurricane (95% CI, 2.7 to 9.0). The 6-month mortality rate per person-quarter was 0.08 (95% CI, 0.08 to 0.09), and there was a nonsignificant increase in level of mortality rates and a nonsignificant decreasing trend in mortality rates. Conclusions and Relevance The findings of this cross-sectional study suggest there was a significant increase in the number of people receiving dialysis outside of Puerto Rico after Hurricane Maria. However, no significant differences in mortality rates before and after the hurricane were found, which may reflect disaster emergency preparedness among dialysis facilities and the population with kidney failure, as well as efforts from other stakeholders.
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Affiliation(s)
- Maricruz Rivera-Hernandez
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Daeho Kim
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Kevin H. Nguyen
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Rebecca Thorsness
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Yoojin Lee
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Shailender Swaminathan
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island,Providence Veterans Affairs Medical Center, Providence, Rhode Island
| | - Rajnish Mehrotra
- Department of Medicine, University of Washington School of Medicine, Seattle
| | - Amal N. Trivedi
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island,Providence Veterans Affairs Medical Center, Providence, Rhode Island
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10
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Bell SA, Donnelly JP, Li W, Davis MA. Hospitalizations for chronic conditions following hurricanes among older adults: A self-controlled case series analysis. J Am Geriatr Soc 2022; 70:1695-1703. [PMID: 35171505 DOI: 10.1111/jgs.17702] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND/PURPOSE Extreme events such as hurricanes adversely impact healthcare systems and the communities they serve. The degree to which hurricanes affect healthcare use among high need groups such as older adults with chronic conditions has not been well examined, nor has the impact of hurricane severity on health outcomes. We characterized hospitalizations among older adults by chronic condition after eight large-scale hurricanes in the United States. METHODS Using a combination of administrative healthcare data and the Federal Emergency Management Agency's Disaster Declaration database we conducted a self-controlled case series analysis. We identified Medicare beneficiaries who were exposed to one of eight hurricanes and compared hospitalizations in the 30-days after a hurricane to hospitalizations in the rest of the calendar year of the hurricane. We examined hospitalizations (1) in total, (2) separately for diabetes, congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) admissions, and (3) by hurricane damage category. RESULTS Among all older adults exposed, hospitalizations in the 30-day period after each disaster increased for all three chronic conditions; diabetes (incidence rate ratio [IRR] = 1.06, 95% confidence interval [CI] 1.03, 1.10), COPD (IRR = 1.06, 95% CI 1.04, 1.08), and CHF (IRR = 1.19, 95% CI 1.17, 1.21. In the 30-to-60-day period hospitalizations also increased for each chronic condition; diabetes (IRR = 1.06, 95% CI 1.03, 1.10), COPD (IRR = 1.12, 95% CI 1.10, 1.15), and CHF (IRR = 1.32, 95% CI 1.30, 1.34). Substantial differences in hospitalizations were observed according to individual hurricane and by the chronic disease examined. CONCLUSION Exposure to hurricanes is associated with an increase in hospitalizations for chronic conditions across all hurricane damage categories. As disasters are expected to increase in strength and frequency, our results underscore the need for response strategies and health policy planning for healthcare systems designed to address the health needs of older Americans with chronic conditions.
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Affiliation(s)
- Sue Anne Bell
- University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - John P Donnelly
- University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Wang Li
- University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Matthew A Davis
- University of Michigan School of Nursing, Ann Arbor, Michigan, USA.,University of Michigan School of Medicine, Ann Arbor, Michigan, USA
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11
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Avilés Mendoza GJ, Finne KP, Torre Leon F, Burke LM, Cabrera-Marquez J, Mercado Casillas AM, Malave G, Brown C, Kelman J, Kopp JB. Observations from the emergency management of dialysis patients evacuated from the US Virgin Islands to Puerto Rico following hurricane Irma. BMC Health Serv Res 2021; 21:1239. [PMID: 34784905 PMCID: PMC8593631 DOI: 10.1186/s12913-021-07194-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 10/19/2021] [Indexed: 11/21/2022] Open
Abstract
Two category 5 hurricanes, Irma and Maria, arrived in the Caribbean in September 2017 in rapid succession. On September 6, Irma devastated the islands of St. Thomas and St. John, in the Virgin Islands of the United States (USVI). Most medical infrastructure was damaged, including hemodialysis facilities, paralyzing dialysis operations. After Irma’s landfall, Puerto Rico served as a safehaven for thousands of displaced and repatriated persons from the impacted islands. These included a cohort of 129 hemodialysis patients evacuated from St. Thomas, USVI to San Juan, Puerto Rico from September 9−11, 2017. The hemodialysis patients arrived first at hotels in San Juan and were then transferred to a Special Needs Shelter, run by the Commonwealth of Puerto Rico and located in the Puerto Rico Convention Center. With the imminent arrival of Hurricane Maria, most patients were evacuated on September 19 to a special needs shelter on the campus of the Florida International University, in Miami, Florida. While in San Juan, hemodialysis treatments were provided by local nephrologists working with local hemodialysis centers. Here, we describe the challenges and the emergency management actions taken to ensure continuity of care, including providing dialysis, general medical care, shelter, food and transportation for USVI dialysis patients during their stay in San Juan, Puerto Rico. We describe here the experiences of federal and host state/territorial officials in the special needs shelter, in the context of the state/territorial and federal response to disasters, in order to provide ideas about challenges, solutions, and approaches to coordinating care for dialysis patients evacuated from a disaster.
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Affiliation(s)
| | - Kristen P Finne
- Department of Health and Human Services, 200 C Street SW, Washington, DC, 20515, USA.
| | - Francisco Torre Leon
- Atlantis Health Care Group, CARR, 199 Avenue Las Cumbres, #140, Guaynabo Medical Mall, Bldg STE 107, Guaynabo, PR, 00969, USA
| | - Lisandro Montalvo Burke
- Medical Advisory Board, Fresenius Kidney Care, FMC San Juan Dialysis Center, 461 Calle Francia STE, A-101, Antillas Warehouse, San Juan, PR, 00917, USA
| | - Jessica Cabrera-Marquez
- Office of Biosecurity, Puerto Rico Department of Health, 199 Ave Las Cumbres, #140, Guaynabo, Medical Mall Building Suite 107, Guaynabo, PR, 00969, USA
| | - Ana M Mercado Casillas
- Office of Biosecurity, Puerto Rico Department of Health, 199 Ave Las Cumbres, #140, Guaynabo, Medical Mall Building Suite 107, Guaynabo, PR, 00969, USA
| | - Grasiela Malave
- Office of Biosecurity, Puerto Rico Department of Health, 199 Ave Las Cumbres, #140, Guaynabo, Medical Mall Building Suite 107, Guaynabo, PR, 00969, USA
| | | | - Jeffrey Kelman
- Center for Medicare, Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services, Washington, DC, USA
| | - Jeffrey B Kopp
- Department of Health and Human Services, Kidney Diseases Branch, National Institute Diabetes and Digestive and Kidney Diseases, National Institute of Health, Bethesda, MD, 20892-1268, USA.
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Powerless in the Virgin Islands: Emergency Department and Wound Care Clinic Utilization Following the 2017 Hurricanes Irma and Maria on St. Thomas, U.S. Virgin Islands. Disaster Med Public Health Prep 2021; 17:e50. [PMID: 34674786 DOI: 10.1017/dmp.2021.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The main objective of this work was to characterize the prevalence of acute medical needs by examining emergency department (ED) and outpatient wound care clinic (WCC) visits before, during, and after the 2017 Hurricanes Irma and Maria, in St. Thomas, United States (U.S.) Virgin Islands. METHODS Descriptive statistics and logistic regression were used to assess associations between the occurrence of the storms and visits due to injuries and chronic conditions presented to the ED and WCC from September 1, 2016 to May 31, 2018. RESULTS ED visits increased and the rate of injury care was higher during the storms (12 patient visits per day) than before or after the storms (9 patient visits per day). WCC visits increased during (12%) and after the storms (45%), and were associated with patients 60 years and older. The odds of ED and WCC visits due to injury during the storms were significantly higher (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 1.17, 1.40) than prior to the storms. The odds for visits due to injuries were 1.19 (95% CI: 1.12, 1.28) times higher after the storms. CONCLUSIONS Increases occurred in ED and WCC visits for injury care during the storms and in WCC visits after the storms. Public health preparedness mandates understanding how major hurricanes impact the prevalence of acute medical needs, and the factors that influence decisions to seek medical care, in their wake.
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Weinberger KR, Kulick ER, Boehme AK, Sun S, Dominici F, Wellenius GA. Association Between Hurricane Sandy and Emergency Department Visits in New York City by Age and Cause. Am J Epidemiol 2021; 190:2138-2147. [PMID: 33910231 DOI: 10.1093/aje/kwab127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 11/12/2022] Open
Abstract
The magnitude, timing, and etiology of morbidity associated with tropical cyclones remains incompletely quantified. We examined the relative change in cause-specific emergency department (ED) visits among residents of New York City during and after Hurricane Sandy, a tropical cyclone that affected the northeastern United States in October 2012. We used quasi-Poisson constrained distributed lag models to compare the number of ED visits on and after Hurricane Sandy with all other days, 2005-2014, adjusting for temporal trends. Among residents aged ≥65 years, Hurricane Sandy was associated with a higher rate of ED visits due to injuries and poisoning (relative risk (RR) = 1.19, 95% confidence interval (CI): 1.10, 1.28), respiratory disease (RR = 1.35, 95% CI: 1.21, 1.49), cardiovascular disease (RR = 1.10, 95% CI: 1.02, 1.19), renal disease (RR = 1.44, 95% CI: 1.22, 1.72), and skin and soft tissue infections (RR = 1.20, 95% CI: 1.03, 1.39) in the first week following the storm. Among adults aged 18-64 years, Hurricane Sandy was associated with a higher rate of ED visits for renal disease (RR = 2.15, 95% CI: 1.79, 2.59). Among those aged 0-17 years, the storm was associated with lower rates of ED visits for up to 3 weeks. These results suggest that tropical cyclones might result in increased health-care utilization due to a wide range of causes, particularly among older adults.
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Chang CM, Chao TYS, Huang YT, Tu YF, Sung TC, Wang JD, Shih HI. Maintaining Quality of Care among Dialysis Patients in Affected Areas after Typhoon Morakot. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147400. [PMID: 34299851 PMCID: PMC8305479 DOI: 10.3390/ijerph18147400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/16/2022]
Abstract
Natural disasters have negative health impacts on patients who need dialysis in affected areas. Severely affected areas are usually rural, with limited basic infrastructure and a population without optimal dialysis-specific care after a disaster. A population-based longitudinal case–cohort study enrolled 715,244 adults from the National Health Insurance Registry who lived in areas affected by a major natural disaster, Typhoon Morakot, in 2009. The observation period was from 2008 to 2011. A total of 13,268 patients (1.85%) had a history of end-stage renal disease (ESRD). Of the ESRD patients, 1264 patients (9.5%) received regular dialysis. Only eight patients missed dialysis sessions in the first month after the disaster. Compared to the moderately affected areas, the incidences of acute cerebrovascular and cardiovascular diseases were higher in patients in severely affected areas. Male dialysis patients aged 45–75 years had a higher mortality rate than that of the general population. Among the affected adults receiving regular dialysis, patients with diabetes (adjusted hazard ratio (aHR): 1.58, 95% confidence interval (CI): 1.20–2.08) or a history of cerebrovascular disease (aHR: 1.58, 95% CI: 1.12–2.21), chronic obstructive pulmonary disease (COPD) or asthma (aHR: 1.99, 95% CI: 1.24–3.17) in moderately affected areas had significantly elevated mortality rates. Additionally, among dialysis patients living in severely affected areas, those with a history of cerebrovascular disease (aHR: 4.52 95% CI: 2.28–8.79) had an elevated mortality rate. Early evacuation plans and high-quality, accessible care for cardiovascular and cerebrovascular diseases are essential to support affected populations before and after disasters to improve dialysis patients’ health outcomes.
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Affiliation(s)
- Chia-Ming Chang
- Department of Geriatrics & Gerontology, National Cheng Kung University Hospital, Tainan 70403, Taiwan;
- School of Medicine, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; (Y.-T.H.); (Y.-F.T.)
| | - Tzu-Yuan Stessa Chao
- Department of Urban Planning, National Cheng Kung University, Tainan 70101, Taiwan;
| | - Yi-Ting Huang
- School of Medicine, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; (Y.-T.H.); (Y.-F.T.)
- Department of Urban Planning, National Cheng Kung University, Tainan 70101, Taiwan;
| | - Yi-Fang Tu
- School of Medicine, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; (Y.-T.H.); (Y.-F.T.)
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Tzu-Ching Sung
- School of Medicine for International Students, I-Shou University, Kaohsiung 82445, Taiwan;
| | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan;
| | - Hsin-I Shih
- School of Medicine, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; (Y.-T.H.); (Y.-F.T.)
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan;
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
- Correspondence:
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15
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Breuer F, Brettschneider P, Kleist P, Poloczek S, Pommerenke C, Dahmen J. [Knowledge gained from a 31-h power outage in Berlin Köpenick-medical problems and challenges]. Anaesthesist 2021; 70:507-514. [PMID: 33620509 PMCID: PMC8189958 DOI: 10.1007/s00101-021-00930-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 11/14/2022]
Abstract
On 19 February 2019 the severance of a 110kW cable caused an extensive electrical power cut in the Treptow-Köpenick district of Berlin. Subsequently, ca. 30,000 households were without electricity and ca. 70,000 people were affected. The power cut lasted more than 24h and all those involved were faced with a multitude of challenges. An operational command post was set up in which medical problems had to be continuously identified and re-evaluated. These included the identification of patients particularly at risk, such as home-ventilated patients and patients with artificial hearts. Furthermore, individual nursing homes had to be evacuated. During the procedure it was necessary to evacuate an intensive care ward or intermediate care ward with 23 patients due to the loss of power supply in the affected area. Hospitals must be prepared for such scenarios within the framework of preliminary planning. Furthermore, preliminary planning containing the special needs of vulnerable groups must be carried out on the part of the responsible authorities.
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Affiliation(s)
- Florian Breuer
- Berliner Feuerwehr, Voltairestr. 2, 10179, Berlin, Deutschland.
- Ärztliche Leitung, Rettungsdienst im Land Berlin, Berlin, Deutschland.
| | | | - Per Kleist
- Berliner Feuerwehr, Voltairestr. 2, 10179, Berlin, Deutschland
| | - Stefan Poloczek
- Berliner Feuerwehr, Voltairestr. 2, 10179, Berlin, Deutschland
- Ärztliche Leitung, Rettungsdienst im Land Berlin, Berlin, Deutschland
| | | | - Janosch Dahmen
- Berliner Feuerwehr, Voltairestr. 2, 10179, Berlin, Deutschland
- Ärztliche Leitung, Rettungsdienst im Land Berlin, Berlin, Deutschland
- Fakultät für Gesundheit, Universität Witten Herdecke, Witten, Deutschland
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16
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Sever MS, Ortiz A, Maggiore U, Bac-García E, Vanholder R. Mass Disasters and Burnout in Nephrology Personnel: From Earthquakes and Hurricanes to COVID-19 Pandemic. Clin J Am Soc Nephrol 2021; 16:829-837. [PMID: 33414153 PMCID: PMC8259469 DOI: 10.2215/cjn.08400520] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Mass disasters result in extensive health problems and make health care delivery problematic, as has been the case during the COVID-19 pandemic. Although COVID-19 was initially considered a pulmonary problem, it soon became clear that various other organs were involved. Thus, many care providers, including kidney health personnel, were overwhelmed or developed burnout. This review aims to describe the spectrum of burnout in mass disasters and suggests solutions specifically for nephrology personnel by extending previous experience to the COVID-19 pandemic. Burnout (a psychologic response to work-related stress) is already a frequent part of routine nephrology practice and, not surprisingly, is even more common during mass disasters due to increased workload and specific conditions, in addition to individual factors. Avoiding burnout is essential to prevent psychologic and somatic health problems in personnel as well as malpractice, understaffing, and inadequate health care delivery, all of which increase the health care burden of disasters. Burnout may be prevented by predisaster organizational measures, which include developing an overarching plan and optimizing health care infrastructure, and ad hoc disaster-specific measures that encompass both organizational and individual measures. Organizational measures include increasing safety, decreasing workload and fear of malpractice, optimizing medical staffing and material supplies, motivating personnel, providing mental health support, and enabling flexibility in working circumstances. Individual measures include training on coping with stress and problematic conditions, minimizing the stigma of emotional distress, and maintaining physical health. If these measures fall short, asking for external help is mandatory to avoid an inefficient disaster health care response. Minimizing burnout by applying these measures will improve health care provision, thus saving as many lives as possible.
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Affiliation(s)
- Mehmet Sukru Sever
- Department of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Alberto Ortiz
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
| | - Umberto Maggiore
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy,UO Nefrologia, Azienda-Ospedaliero Universitaria di Parma, Parma, Italy
| | - Enrique Bac-García
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain,Department of Psychiatry, Universidad Autonoma de Madrid, Madrid, Spain
| | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium,European Kidney Health Alliance, Brussels, Belgium
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17
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Vanholder R, Sükrü Sever M, Lameire N. Kidney problems in disaster situations. Nephrol Ther 2021; 17S:S27-S36. [PMID: 33910695 DOI: 10.1016/j.nephro.2020.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 02/12/2020] [Indexed: 11/30/2022]
Abstract
Mass disasters, particularly earthquakes, cause many medical problems, including kidney problems, but an organized approach to cope with them was initiated only at the end of previous century, subsequent to the Armenian Spitak earthquake in 1988. Originally, interventions were focused on acute kidney injury (AKI) following crush injury and rhabdomyolysis in victims who had been trapped under the debris of collapsed buildings. However, similar problems were also registered in the context of other catastrophic events, especially man-made disasters like wars and torture. Other kidney-related problems, such as the preservation of treatment continuity in chronic kidney disease (CKD), especially in maintenance dialysis patients, deserved attention as well. Specific therapeutic principles apply to disaster-related kidney problems and these may differ from usual day-to-day clinical practice. Those approaches have been formulated in global and specific country-related guidelines and recommendations. It is clear that a well-conceived and organized management of kidney diseases in disasters benefits outcomes. Furthermore, it may be useful if the model and philosophy that were applied over the last three decades could be adapted by broadening the scope of disasters leading to intervention. Actions should be guided and coordinated by a panel of experts steering ad hoc interventions, rather than applying the "old" static model where a single coordinating center instructs and uses volunteers listed long before a potential event occurs.
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Affiliation(s)
- Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, 10, Corneel Heymanslaan, B9000 Gent, Belgium.
| | - Mehmet Sükrü Sever
- Department of Nephrology, Istanbul School of Medicine, Istanbul University, Millet Caddesi, 34093 Istanbul, Turkey
| | - Norbert Lameire
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, 10, Corneel Heymanslaan, B9000 Gent, Belgium
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18
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Parks RM, Anderson GB, Nethery RC, Navas-Acien A, Dominici F, Kioumourtzoglou MA. Tropical cyclone exposure is associated with increased hospitalization rates in older adults. Nat Commun 2021; 12:1545. [PMID: 33750775 PMCID: PMC7943804 DOI: 10.1038/s41467-021-21777-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/27/2021] [Indexed: 11/26/2022] Open
Abstract
Hurricanes and other tropical cyclones have devastating effects on society. Previous case studies have quantified their impact on some health outcomes for particular tropical cyclones, but a comprehensive assessment over longer periods is currently missing. Here, we used data on 70 million Medicare hospitalizations and tropical cyclone exposures over 16 years (1999-2014). We formulated a conditional quasi-Poisson model to examine how tropical cyclone exposure (days greater than Beaufort scale gale-force wind speed; ≥34 knots) affect hospitalizations for 13 mutually-exclusive, clinically-meaningful causes. We found that tropical cyclone exposure was associated with average increases in hospitalizations from several causes over the week following exposure, including respiratory diseases (14.2%; 95% confidence interval [CI]: 10.9-17.9%); infectious and parasitic diseases (4.3%; 95%CI: 1.2-8.1%); and injuries (8.7%; 95%CI: 6.0-11.8%). Average decadal tropical cyclone exposure in all impacted counties would be associated with an estimated 16,772 (95%CI: 8,265-25,278) additional hospitalizations. Our findings demonstrate the need for targeted preparedness strategies for hospital personnel before, during, and after tropical cyclones.
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Affiliation(s)
- Robbie M Parks
- The Earth Institute, Columbia University, New York, NY, USA.
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - G Brooke Anderson
- Department of Environmental & Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Rachel C Nethery
- Department of Biostatistics, T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Francesca Dominici
- Department of Biostatistics, T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
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19
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Bell SA, Klasa K, Iwashyna TJ, Norton EC, Davis MA. Long-term healthcare provider availability following large-scale hurricanes: A difference-in-differences study. PLoS One 2020; 15:e0242823. [PMID: 33232383 PMCID: PMC7685502 DOI: 10.1371/journal.pone.0242823] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 11/10/2020] [Indexed: 11/19/2022] Open
Abstract
Background Hurricanes Katrina and Sandy were two of the most significant disasters of the 21st century that critically impacted communities and the health of their residents. Despite the assumption that disasters affect access to healthcare, to our knowledge prior studies have not rigorously examined availability of healthcare providers following disasters. Objective The objective of this study was to examine availability of healthcare providers following large-scale hurricanes. Methods Using historical data on healthcare providers from the National Plan and Provider Enumeration System and county-level population characteristics, we conducted a quasi-experimental study to examine the effect of large-scale hurricanes on healthcare provider availability in the short-term and long-term. We separately examined availability of primary care physicians, medical specialists, surgeons, and nurse practitioners. A difference-in-differences analysis was used to control for time variant factors comparing county-level health care provider availability in affected and unaffected counties the year before Hurricanes Katrina and Sandy, to five years after each storm. Results Counties affected by Hurricane Katrina compared to unaffected locales experienced a decrease of 3.59 primary care physicians per 10,000 population (95% CI: -6.5, -0.7), medical specialists (decrease of 5.9 providers per 10,000 (95% CI: -11.3, -0.5)), and surgeons (decrease of 2.1 (95% CI: -3.8, -0.37)). However, availability of nurse practitioners did not change appreciably. Counties affected by Hurricane Sandy exhibited less pronounced changes. Changes in availability of primary care physicians, nurse practitioners, medical specialists, and surgeons were not statistically significant. Conclusion Large-scale hurricanes appear to affect availability of healthcare providers for up to several years following impact of the storm. Effects vary depending on the characteristics of the community. Primary care physicians and medical specialists availability was the most impacted, potentially having long-term implications for population health in the context of disaster recovery.
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Affiliation(s)
- Sue Anne Bell
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, United States of America
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States of America
- * E-mail:
| | - Katarzyna Klasa
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
| | - Theodore J. Iwashyna
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- University of Michigan Institute for Social Research, Ann Arbor, Michigan, United States of America
| | - Edward C. Norton
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
| | - Matthew A. Davis
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, United States of America
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
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20
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Abstract
Supplemental Digital Content is available in the text. To provide contemporary estimates of the burdens (costs and mortality) associated with acute inpatient Medicare beneficiary admissions for sepsis.
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21
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Abstract
Advances in digital health technologies have revolutionised home medical care. Yet many home medical devices (HMEDs, which includes devices referred to as 'life support equipment') rely upon a stable and resilient electricity supply. For users of HMEDs, interruptions to electricity supply can compromise treatment, well-being or survival. This paper addresses a challenge critical to the continued innovation in digital health technologies: the reliable supply of electricity. We bridge the current gap between electricity networks and digital health technologies through a novel method for the remote detection of the phase (that is, which part of the network that each house is connected to), in order to eliminate avoidable interruptions to supply for HMED users. We present an unsupervised phase identification algorithm capable of remote phase detection at scale, and without transformer data. This method translates data insights into actionable energy provision for HMED users and other vulnerable customers, enables more accurate management and planning, and improves electricity reliability which is critical for HMED users and the continued advances in digital health technologies.
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Lameire N, Sever MS, Van Biesen W, Vanholder R. Role of the International and National Renal Organizations in Natural Disasters: Strategies for Renal Rescue. Semin Nephrol 2020; 40:393-407. [DOI: 10.1016/j.semnephrol.2020.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Lukowsky LR, Dobalian A, Goldfarb DS, Kalantar-Zadeh K, Der-Martirosian C. Access to Care for VA Dialysis Patients During Superstorm Sandy. J Prim Care Community Health 2020; 10:2150132719863599. [PMID: 31347445 PMCID: PMC6661787 DOI: 10.1177/2150132719863599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: This study examines the use of dialysis services by end-stage renal disease (ESRD) patients following the Superstorm Sandy-related, months-long closure of the New York campus of the US Department of Veterans Affairs (VA) New York Harbor VA Healthcare System (NYHHS, Manhattan VAMC). Methods: Outpatient visits, dialysis care, emergency department visits, and hospitalizations at VA and non-VA facilities for 47 Manhattan VAMC ESRD patients were examined 12 months pre- and post-Sandy using VA administrative and clinical data. Results: The Brooklyn campus of NYHHS, which is within ten miles of Manhattan VAMC, experienced the largest increase in the number of dialysis encounters after the closure. Dialysis encounters for VA patients also increased at non-VA facilities, rising on average, to 106 per month. For the James J Peters Bronx VAMC, the number of total dialysis encounters for Manhattan VAMC patients fluctuated between 39 and 43 per month, dropping to less than 30 after the Manhattan VAMC dialysis unit reopened. Conclusion: Manhattan VAMC ESRD patients used nearby alternate VA sites and non-VA clinics for their care during the closure of the Manhattan VAMC dialysis unit. The VA electronic health records played an important role in ensuring continuity of care for patients who exclusively used VAMC facilities post-Sandy because patient information was immediately accessible at other VA facilities. The events related to Superstorm Sandy highlight the need for dialysis providers to have a comprehensive disaster plan, including nearby alternate care sites that can increase service capacity when a dialysis facility is closed because of a disaster.
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Affiliation(s)
- Lilia R Lukowsky
- 1 Veterans Emergency Management Evaluation Center (VEMEC), US Department of Veterans Affairs, North Hills, CA, USA
| | - Aram Dobalian
- 1 Veterans Emergency Management Evaluation Center (VEMEC), US Department of Veterans Affairs, North Hills, CA, USA.,2 University of Memphis School of Public Health, Memphis, TN, USA
| | - David S Goldfarb
- 3 New York Harbor VA Healthcare System (NYHHS), New York, NY, USA.,4 NYU Langone Health, New York, NY, USA
| | | | - Claudia Der-Martirosian
- 1 Veterans Emergency Management Evaluation Center (VEMEC), US Department of Veterans Affairs, North Hills, CA, USA
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Smith RS, Zucker RJ, Frasso R. Natural Disasters in the Americas, Dialysis Patients, and Implications for Emergency Planning: A Systematic Review. Prev Chronic Dis 2020; 17:E42. [PMID: 32530396 PMCID: PMC7316419 DOI: 10.5888/pcd17.190430] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction Natural hazards are elements of the physical environment caused by forces extraneous to human intervention and may be harmful to human beings. Natural hazards, such as weather events, can lead to natural disasters, which are serious societal disruptions that can disrupt dialysis provision, a life-threatening event for dialysis-dependent people. The adverse outcomes associated with missed dialysis sessions are likely exacerbated in island settings, where health care resources and emergency procedures are limited. The effect of natural disasters on dialysis patients living in geographically vulnerable areas such as the Cayman Islands is largely understudied. To inform predisaster interventions, we systematically reviewed studies examining the effects of disasters on dialysis patients and discussed the implications for emergency preparedness in the Cayman Islands. Methods Two reviewers independently screened 434 titles and abstracts from PubMed, Scopus, CINAHL, and Cochrane Library. We included studies if they were original research articles published in English from 2009 to 2019 and conducted in the Americas. Results Our search yielded 15 relevant articles, which we included in the final analysis. Results showed that disasters have both direct and indirect effects on dialysis patients. Lack of electricity, clean water, and transportation, and closure of dialysis centers can disrupt dialysis care, lead to missed dialysis sessions, and increase the number of hospitalizations and use of the emergency department. Additionally, disasters can exacerbate depression and lead to posttraumatic stress disorder among dialysis patients. Conclusion To our knowledge, this systematic review is the first study that presents a synthesis of the scientific literature on the effects of disasters on dialysis populations. The indirect and direct effects of disasters on dialysis patients highlight the need for predisaster interventions at the patient and health care system levels. Particularly, educating patients about an emergency renal diet and offering early dialysis can help to mitigate the negative effects of disasters.
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Affiliation(s)
- Rashida S Smith
- College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Robert J Zucker
- College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Rosemary Frasso
- College of Population Health, Thomas Jefferson University, 901 Walnut St, 10th Fl, Philadelphia, PA 19107.
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Quast T, Andel R, Sadhu AR. Long-term Effects of Disasters on Seniors With Diabetes: Evidence From Hurricanes Katrina and Rita. Diabetes Care 2019; 42:2090-2097. [PMID: 31548250 PMCID: PMC6804607 DOI: 10.2337/dc19-0567] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 08/21/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To estimate the long-run mortality effects of Hurricanes Katrina and Rita on seniors with diabetes. RESEARCH DESIGN AND METHODS We performed a retrospective cohort analysis of Medicare enrollment and claims data covering four states and ∼10 years. Affected individuals were identified by whether they lived in a county that suffered a high impact and were stratified by whether they moved to a different county following the storms. Propensity scores matched affected and comparison subjects based on demographic and socioeconomic characteristics and the presence of chronic conditions. Our sample consisted of 170,328 matched affected subjects. RESULTS The affected subjects had a nearly 40% higher all-cause mortality risk in the 1st month after the storms, but the difference fell to <6% by the end of the full observation period. The mortality risks of heart disease and nephritis also exhibited the largest differences immediately following the storms. Among the affected subjects, the all-cause mortality risk was higher for those who moved to a different county, with an especially large difference among those who moved to an affected county. CONCLUSIONS The propensity matching procedure resulted in the comparison and affected groups having similar observable characteristics. However, we only examined the extreme outcome of mortality, our definition of affected was somewhat crude, and our sample did not include individuals enrolled in Medicare Advantage. Our findings highlight the importance of the immediate response to disasters, yet also demonstrate the long-lasting impact disasters can have.
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Affiliation(s)
- Troy Quast
- College of Public Health, University of South Florida, Tampa, FL
| | - Ross Andel
- College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, and Department of Neurology, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Archana R Sadhu
- Weill Cornell Medical College, Texas A&M Health Science Center, and Houston Methodist, Houston, Texas
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Limaye VS, Max W, Constible J, Knowlton K. Estimating the Health-Related Costs of 10 Climate-Sensitive U.S. Events During 2012. GEOHEALTH 2019; 3:245-265. [PMID: 32159045 PMCID: PMC7007172 DOI: 10.1029/2019gh000202] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/30/2019] [Accepted: 07/25/2019] [Indexed: 05/14/2023]
Abstract
Climate change threatens human health, but there remains a lack of evidence on the economic toll of climate-sensitive public health impacts. We characterize human mortality and morbidity costs associated with 10 climate-sensitive case study events spanning 11 US states in 2012: wildfires in Colorado and Washington, ozone air pollution in Nevada, extreme heat in Wisconsin, infectious disease outbreaks of tick-borne Lyme disease in Michigan and mosquito-borne West Nile virus in Texas, extreme weather in Ohio, impacts of Hurricane Sandy in New Jersey and New York, allergenic oak pollen in North Carolina, and harmful algal blooms on the Florida coast. Applying a consistent economic valuation approach to published studies and state estimates, we estimate total health-related costs from 917 deaths, 20,568 hospitalizations, and 17,857 emergency department visits of $10.0 billion in 2018 dollars, with a sensitivity range of $2.7-24.6 billion. Our estimates indicate that the financial burden of deaths, hospitalizations, emergency department visits, and associated medical care is a key dimension of the overall economic impact of climate-sensitive events. We found that mortality costs (i.e., the value of a statistical life) of $8.4 billion exceeded morbidity costs and lost wages ($1.6 billion combined). By better characterizing health damages in economic terms, this work helps to shed light on the burden climate-sensitive events already place on U.S. public health each year. In doing so, we provide a conceptual framework for broader estimation of climate-sensitive health-related costs. The high health-related costs associated with climate-sensitive events highlight the importance of actions to mitigate climate change and adapt to its unavoidable impacts.
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Affiliation(s)
| | - Wendy Max
- Institute for Health & AgingUniversity of CaliforniaSan FranciscoCAUSA
| | | | - Kim Knowlton
- Natural Resources Defense CouncilNew YorkNYUSA
- Mailman School of Public HealthColumbia UniversityNew YorkNYUSA
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Dempsey TM, Lapinsky SC, Melnychuk E, Lapinsky SE, Reed MJ, Niven AS. Special Populations: Disaster Care Considerations in Chronically Ill, Pregnant, and Morbidly Obese Patients. Crit Care Clin 2019; 35:677-695. [PMID: 31445613 DOI: 10.1016/j.ccc.2019.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Special populations, which include the morbidly obese and patients with chronic, complex medical conditions that require long-term health care services and infrastructure, are at increased risk for morbidity and mortality when these services are disrupted during a disaster. Past experiences have identified significant challenges in restoring necessary care services to these patients following major environmental events. This article describes the impact of disasters on special populations, provides a framework for future disaster preparation and planning, and identifies areas in need of further research. Gravid patients, who are often overlooked in disaster planning and preparation, are also discussed.
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Affiliation(s)
- Timothy M Dempsey
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA. https://twitter.com/tdemps3
| | - Stephanie C Lapinsky
- Division of Critical Care Medicine, University of Toronto, 600 University Avenue, #18-214, Toronto, Ontario M5G1X5, Canada
| | - Eric Melnychuk
- Department of Critical Care Medicine, Geisinger Medical Center, 100 North Academy Avenue, Danville, PA 17821-2037, USA
| | - Stephen E Lapinsky
- Division of Critical Care Medicine, University of Toronto, 600 University Avenue, #18-214, Toronto, Ontario M5G1X5, Canada
| | - Mary Jane Reed
- Department of Critical Care Medicine, Geisinger Medical Center, 100 North Academy Avenue, Danville, PA 17821-2037, USA. https://twitter.com/mj17820
| | - Alexander S Niven
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA. https://twitter.com/niven_alex
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Abstract
Disasters occur regularly, and frequently large numbers of patients treated with maintenance dialysis or with the recent onset of acute kidney injury are put at risk owing to the lack of access to dialysis care precipitating also a kidney failure disaster. The absence of necessary dialysis treatments can result in excessive emergency department visits, hospitalizations, morbidity, or an early death. Those with kidney failure are often evaluated in disaster medical locations or hospitals without nephrologists in attendance. Here we offer guidance for medical personnel evaluating such patients so that dialysis-dependent individuals can be properly assessed and managed with the need for urgent dialysis recognized. A disaster dialysis triage system is proposed. (Disaster Med Public Health Preparedness. 2019;13:782-790).
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Abstract
BACKGROUND South Africa faced repeated episodes of temporary power shutdowns, or load shedding, in 2014/2015. The effect of load shedding on children's health is unknown. METHODS We determined periods of load shedding using Twitter, Facebook, and data from the City of Cape Town. We obtained the number of unscheduled hospital admissions between June 2014 and May 2015 from Red Cross Children's Hospital, Cape Town, and weather data from the South African Weather Service. We used quasi-Poisson regression models to explore the relationship between number of hospital admissions and load shedding, adjusted for season, weather, and past admissions. Based on assumptions about the causal process leading to hospital admissions, we estimated the average treatment effect, that is, the difference in expected number of admissions per day had there been load shedding each day or on any of the preceding 2 days compared with if there had not been any load shedding. RESULTS We found a 10% increase (95% confidence interval: 4%, 15%) in hospital admissions for days where load shedding was experienced on the same day, or no more than 2 days prior, compared with when there was no load shedding in the past 2 days. The increase was more pronounced during weekdays (12% [7%, 18%] vs. 1% [-9%, 11%]), and for specific diagnoses (e.g., respiratory system: 14% [2%, 26%]). The average treatment effect was estimated as 6.50 (5.12, 7.87) highlighting that about 6 additional admissions a day could be attributed to load shedding. CONCLUSIONS The association we measured is consistent with our hypothesis that failures of the power infrastructure increase risk to children's health. See video abstract at, http://links.lww.com/EDE/B409.
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Burger J, Gochfeld M, Lacy C. Ethnic differences in risk: experiences, medical needs, and access to care after hurricane Sandy in new jersey. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2019; 82:128-141. [PMID: 30722754 PMCID: PMC6419501 DOI: 10.1080/15287394.2019.1568329] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This survey investigation assessed an economically challenged and largely minority population regarding concerns, evacuation status, medical needs and access to care during, and after, Hurricane Sandy by ethnicity status for patients using New Jersey's Federally Qualified Health Centers (FQHC). Data obtained contribute to understanding risk from disasters, and improving environmental justice for vulnerable populations following disasters. FQHCs provide medical and dental services for 5% of New Jersey 's population; 95% of those served are uninsured, underinsured, or live below the poverty level. Economically vulnerable individuals are more at risk and were disproportionately harmed by Sandy. There were ethnic differences in days evacuated, days without power and heat, self-rating of personal/family impact, center use, need and access, and interruptions of care and medications. Hispanics and Blacks reported needing centers significantly more than White population. Primary medical conditions were diabetes, asthma, hypertension, and arrhythmia and heart disease, which did not vary ethnically. Understanding medical needs and concerns of vulnerable populations may help policymakers and practitioners prepare and respond promptly to disasters, reducing risk, and building resiliency for the medical care system.
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Affiliation(s)
- Joanna Burger
- Division of Life Sciences, Rutgers University, Piscataway, New Jersey, USA
- Environmental and Occupational Health Science Institute, Rutgers University, Piscataway, New Jersey
| | - Michael Gochfeld
- Environmental and Occupational Health Science Institute, Rutgers University, Piscataway, New Jersey
- Robert Wood Johnson Medical School, Rutgers University, Piscataway, USA
| | - Clifton Lacy
- Robert Wood Johnson Medical School, Rutgers University, Piscataway, USA
- Center for Disaster Preparedness and Emergency Response, and School of Communication and Information, Rutgers University, New Brunswick, New Jersey, USA
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Emergency Department Visits by and Hospitalizations of Senior Diabetics in the Three Years Following Hurricanes Katrina and Rita. ACTA ACUST UNITED AC 2019; 3:151-160. [PMID: 31681907 DOI: 10.1007/s41885-019-0039-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
While prior studies have investigated health care utilization immediately following disasters, few have examined utilization beyond that period. We use individual-level U.S. Medicare claims data for three years prior to (2002-2004) and after (2006-2008) Hurricanes Katrina and Rita to investigate whether senior diabetics affected by the storms had a greater number of emergency department visits and days hospitalized in the three years following the storms. An event study was conducted using regression analysis that controlled for all fixed individual characteristics. While the 2006 and 2007 rates of increase in utilization were relatively similar across the control group and the two affected groups, in 2008 the affected groups exhibited substantially greater increases in both emergency department visits and days hospitalized. The differences correspond to an additional 380,907 days hospitalized and 21,583 emergency department visits in 2008. The results indicate that, in addition to short term effects previously estimated, disasters may have longer term effects on utilization of healthcare services. These potential effects suggest that improved post-disaster care may significantly reduce the healthcare costs of disasters.
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Ruskin J, Rasul R, Schneider S, Bevilacqua K, Taioli E, Schwartz RM. Lack of access to medical care during Hurricane Sandy and mental health symptoms. Prev Med Rep 2018; 10:363-369. [PMID: 29868393 PMCID: PMC5984240 DOI: 10.1016/j.pmedr.2018.04.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/26/2018] [Accepted: 04/21/2018] [Indexed: 11/17/2022] Open
Abstract
Destruction caused by natural disasters compromises medical providers' and hospitals' abilities to administer care. Hurricane Sandy was particularly devastating, resulting in massive disruptions of medical care in the region. This study aimed to determine whether a lack of access to medical care during Hurricane Sandy was associated with posttraumatic stress disorder (PTSD) symptoms and other mental health/substance abuse outcomes. A secondary aim was to examine whether having a chronic illness moderates those associations. Self-reported medical access and mental health symptomatology were obtained from New York City and Long Island residents (n = 1669) following Hurricane Sandy under the Leaders in Gathering Hope Together project (10/23/2013–2/25/2015) and Project Restoration (6/5/2014–8/9/2016). Multivariable logistic regressions were utilized to determine the relationship between lack of access to medical care and mental health outcomes. Of the 1669 participants, 994 (59.57%) were female, 866 (51.89%) were white, and the mean age was 46.22 (SD = 19.2) years old. Those without access to medical care had significantly higher odds of showing symptoms of PTSD (AOR = 2.71, CI = [1.77–4.16]), as well as depression (AOR = 1.94, CI = [1.29–2.92]) and anxiety (AOR = 1.61, CI = [1.08–2.39]) compared to those with access. Lack of access to care was associated with a 2.12 point increase in perceived stress scale score (SE = 0.63). The interaction between having a chronic illness and lack of access to medical care was not significantly associated with any outcomes. The findings emphasize the importance of making medical care more accessible to patients, both chronically and acutely ill, during natural disasters to benefit their physical as well as their mental health. Individuals without access to medical care had asignificantly higher odds of showing symptoms of mental health difficulties. Chronic illness did not moderate the relationship between a lack of access to care and mental health outcomes. Access to medical care during natural disasters may benefit the mental health of survivors with and without chronic illness.</span>
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Affiliation(s)
- Julia Ruskin
- Department of Occupational Medicine Epidemiology and Prevention, Northwell Health, Great Neck, NY, United States
- Feinstein Institute for Medical Research, Manhasset, NY, United States
- Joint Center for Trauma, Disaster Health and Resilience at Mount Sinai, Stony Brook University, and Northwell Health, United States
| | - Rehana Rasul
- Department of Occupational Medicine Epidemiology and Prevention, Northwell Health, Great Neck, NY, United States
- Feinstein Institute for Medical Research, Manhasset, NY, United States
- Joint Center for Trauma, Disaster Health and Resilience at Mount Sinai, Stony Brook University, and Northwell Health, United States
- Biostatistics Unit, Feinstein Institute for Medical Research
- Department of Occupational Medicine Epidemiology and Prevention, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Samantha Schneider
- Department of Occupational Medicine Epidemiology and Prevention, Northwell Health, Great Neck, NY, United States
- Feinstein Institute for Medical Research, Manhasset, NY, United States
- Joint Center for Trauma, Disaster Health and Resilience at Mount Sinai, Stony Brook University, and Northwell Health, United States
| | - Kristin Bevilacqua
- Department of Occupational Medicine Epidemiology and Prevention, Northwell Health, Great Neck, NY, United States
- Feinstein Institute for Medical Research, Manhasset, NY, United States
- Joint Center for Trauma, Disaster Health and Resilience at Mount Sinai, Stony Brook University, and Northwell Health, United States
| | - Emanuela Taioli
- Joint Center for Trauma, Disaster Health and Resilience at Mount Sinai, Stony Brook University, and Northwell Health, United States
- Department of Population Health Science and Policy and Institute of Translational Epidemiology, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Rebecca M. Schwartz
- Department of Occupational Medicine Epidemiology and Prevention, Northwell Health, Great Neck, NY, United States
- Feinstein Institute for Medical Research, Manhasset, NY, United States
- Joint Center for Trauma, Disaster Health and Resilience at Mount Sinai, Stony Brook University, and Northwell Health, United States
- Biostatistics Unit, Feinstein Institute for Medical Research
- Department of Occupational Medicine Epidemiology and Prevention, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Population Health Science and Policy and Institute of Translational Epidemiology, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Corresponding author at: Department of Occupational Medicine, Epidemiology and Prevention (OMEP), Northwell Health Physician Partners, Hofstra Northwell School of Medicine, 175 Community Drive 2nd floor, Great Neck, NY 11021, United States.
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Lessons From an Extreme Hurricane Season. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2017.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Risk of mortality during and after the 2011 Great East Japan Earthquake and Tsunami among older coastal residents. Sci Rep 2017; 7:16591. [PMID: 29185489 PMCID: PMC5707380 DOI: 10.1038/s41598-017-16636-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 11/14/2017] [Indexed: 11/16/2022] Open
Abstract
The Japan Gerontological Evaluation Study is a nationwide cohort study of individuals aged 65 years and older established in July 2010. Seven months later, one of the study field sites was directly in the line of the 2011 Great East Japan Earthquake and Tsunami. Despite the 1-hour warning interval between the earthquake and tsunami, many coastal residents lost their lives. We analyzed the risk of all-cause mortality on the day of the disaster as well as in the 38-month interval after the disaster. Among 860 participants, 33 (3.8%) died directly because of the tsunami and an additional 95 people died during the 38-month follow-up period. Individuals with depressive symptoms had elevated risk of mortality on the day of the disaster (odds ratio = 3.90 [95% CI: 1.13, 13.47]). More socially connected people also suffered increased risk of mortality, although these estimates were not statistically significant. In contrast, after the disaster, frequent social interactions reverted back to predicting improved survival (hazard ratio = 0.46 (95% CI: 0.26, 0.82)). Depressive symptoms and stronger social connectedness were associated with increased risk of mortality on the day of the disaster. After the disaster, social interactions were linked to improved survival.
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Stryckman B, Walsh L, Carr BG, Hupert N, Lurie N. Impact of Superstorm Sandy on Medicare Patients' Utilization of Hospitals and Emergency Departments. West J Emerg Med 2017; 18:1035-1041. [PMID: 29085534 PMCID: PMC5654871 DOI: 10.5811/westjem.2017.7.34730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/28/2017] [Accepted: 07/05/2017] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION National health security requires that healthcare facilities be prepared to provide rapid, effective emergency and trauma care to all patients affected by a catastrophic event. We sought to quantify changes in healthcare utilization patterns for an at-risk Medicare population before, during, and after Superstorm Sandy's 2012 landfall in New Jersey (NJ). METHODS This study is a retrospective cohort study of Medicare beneficiaries impacted by Superstorm Sandy. We compared hospital emergency department (ED) and healthcare facility inpatient utilization in the weeks before and after Superstorm Sandy landfall using a 20% random sample of Medicare fee-for-service beneficiaries continuously enrolled in 2011 and 2012 (N=224,116). Outcome measures were pre-storm discharges (or transfers), average length of stay, service intensity weight, and post-storm ED visits resulting in either discharge or hospital admission. RESULTS In the pre-storm week, hospital transfers from skilled nursing facilities (SNF) increased by 39% and inpatient discharges had a 0.3 day decreased mean length of stay compared to the prior year. In the post-storm week, ED visits increased by 14% statewide; of these additional "surge" patients, 20% were admitted to the hospital. The increase in ED demand was more than double the statewide average in the most highly impacted coastal regions (35% versus 14%). CONCLUSION Superstorm Sandy impacted both pre- and post-storm patient movement in New Jersey; post-landfall ED surge was associated with overall storm impact, which was greatest in coastal counties. A significant increase in the number and severity of pre-storm transfer patients, in particular from SNF, as well as in post-storm ED visits and inpatient admissions, draws attention to the importance of collaborative regional approaches to healthcare in large-scale events.
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Affiliation(s)
| | - Lauren Walsh
- U.S. Department of Health and Human Services, Washington, D.C
| | - Brendan G Carr
- U.S. Department of Health and Human Services, Washington, D.C.,Thomas Jefferson University, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Nathaniel Hupert
- U.S. Department of Health and Human Services, Washington, D.C.,Weill Cornell Medical College, Department of Healthcare Policy and Research, Department of Medicine, New York, New York
| | - Nicole Lurie
- U.S. Department of Health and Human Services, Washington, D.C
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Geographic Distribution of Disaster-Specific Emergency Department Use After Hurricane Sandy in New York City. Disaster Med Public Health Prep 2016; 10:351-61. [PMID: 26857616 PMCID: PMC7112993 DOI: 10.1017/dmp.2015.190] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective We aimed to characterize the geographic distribution of post-Hurricane Sandy emergency department use in administrative flood evacuation zones of New York City. Methods Using emergency claims data, we identified significant deviations in emergency department use after Hurricane Sandy. Using time-series analysis, we analyzed the frequency of visits for specific conditions and comorbidities to identify medically vulnerable populations who developed acute postdisaster medical needs. Results We found statistically significant decreases in overall post-Sandy emergency department use in New York City but increased utilization in the most vulnerable evacuation zone. In addition to dialysis- and ventilator-dependent patients, we identified that patients who were elderly or homeless or who had diabetes, dementia, cardiac conditions, limitations in mobility, or drug dependence were more likely to visit emergency departments after Hurricane Sandy. Furthermore, patients were more likely to develop drug-resistant infections, require isolation, and present for hypothermia, environmental exposures, or administrative reasons. Conclusions Our study identified high-risk populations who developed acute medical and social needs in specific geographic areas after Hurricane Sandy. Our findings can inform coherent and targeted responses to disasters. Early identification of medically vulnerable populations can help to map “hot spots” requiring additional medical and social attention and prioritize resources for areas most impacted by disasters. (Disaster Med Public Health Preparedness. 2016;10:351–361)
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Effect of Hurricane Sandy on Long Island Emergency Departments Visits. Disaster Med Public Health Prep 2016; 10:344-50. [PMID: 26833178 DOI: 10.1017/dmp.2015.189] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to examine the effect of Hurricane Sandy on Long Island mental health emergency department (ED) visits and to determine whether these visits varied according to patient demographics or geographic area and intensity of the impact. METHODS Individual-level de-identified data were extracted from the Statewide Planning and Research Cooperative System from New York State ED visits from October 1 to December 2012 for residents of Nassau and Suffolk counties in Long Island. The dates of the ED visits were grouped into 4 periods: (1) pre-Sandy, October 1-28; (2) during Sandy, October 29; (3) post-Sandy I, October 30 to November 1; and (4) post-Sandy II, November 2-30. RESULTS A total of 126,337 ED visits were recorded among 23 EDs. A significant drop in volume was observed on October 29; 399 more ED visits for physical health diagnoses were identified in the post-Sandy I period than in the pre-Sandy period. "Diseases of the respiratory system" was the only diagnosis group that showed a positive trend in the post-Sandy I period compared with the pre-Sandy period (increase of 4%). No significant changes in mental health visits were observed after Sandy landfall. CONCLUSIONS This analysis suggests that the critical temporal window during which ED resources should be increased is in the immediate aftermath of a hurricane. (Disaster Med Public Health Preparedness. 2016;10:344-350).
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Lee DC, Gupta VK, Carr BG, Malik S, Ferguson B, Wall SP, Smith SW, Goldfrank LR. Acute post-disaster medical needs of patients with diabetes: emergency department use in New York City by diabetic adults after Hurricane Sandy. BMJ Open Diabetes Res Care 2016; 4:e000248. [PMID: 27547418 PMCID: PMC4964212 DOI: 10.1136/bmjdrc-2016-000248] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 06/13/2016] [Accepted: 07/01/2016] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To evaluate the acute impact of disasters on diabetic patients, we performed a geospatial analysis of emergency department (ED) use by New York City diabetic adults in the week after Hurricane Sandy. RESEARCH DESIGN AND METHODS Using an all-payer claims database, we retrospectively analyzed the demographics, insurance status, and medical comorbidities of post-disaster ED patients with diabetes who lived in the most geographically vulnerable areas. We compared the patterns of ED use among diabetic adults in the first week after Hurricane Sandy's landfall to utilization before the disaster in 2012. RESULTS In the highest level evacuation zone in New York City, postdisaster increases in ED visits for a primary or secondary diagnosis of diabetes were attributable to a significantly higher proportion of Medicare patients. Emergency visits for a primary diagnosis of diabetes had an increased frequency of certain comorbidities, including hypertension, recent procedure, and chronic skin ulcers. Patients with a history of diabetes visited EDs in increased numbers after Hurricane Sandy for a primary diagnosis of myocardial infarction, prescription refills, drug dependence, dialysis, among other conditions. CONCLUSIONS We found that diabetic adults aged 65 years and older are especially at risk for requiring postdisaster emergency care compared to other vulnerable populations. Our findings also suggest that there is a need to support diabetic adults particularly in the week after a disaster by ensuring access to medications, aftercare for patients who had a recent procedure, and optimize their cardiovascular health to reduce the risk of heart attacks.
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Affiliation(s)
- David C Lee
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York, USA
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Vibha K Gupta
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York, USA
| | - Brendan G Carr
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Health & Human Services, Emergency Care Coordination Center, Office of the Assistant Secretary for Preparedness & Response, Washington, DC, USA
| | - Sidrah Malik
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York, USA
| | - Brandy Ferguson
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York, USA
| | - Stephen P Wall
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York, USA
| | - Silas W Smith
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York, USA
| | - Lewis R Goldfrank
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York, USA
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Study Design and Results of a Population-Based Study on Perceived Stress Following Hurricane Sandy. Disaster Med Public Health Prep 2015; 10:325-32. [PMID: 27113715 DOI: 10.1017/dmp.2015.157] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Hurricane Sandy was one of the deadliest storms in US history, with at least 162 deaths and numerous injuries. This research aimed to quantify the impact of Hurricane Sandy on the New York metropolitan area. METHODS The project included 601 volunteers aged at least 18 years who were recruited in Nassau, Suffolk, Queens, and Richmond counties and Staten Island between 2013 and 2014 through close partnerships with coalition community leaders. Participants completed a self-administered questionnaire on demographics and behavioral factors and a 35-point check off list on hurricane exposure. Perceived stress was assessed by using the 10-item Perceived Stress Scale (PSS). RESULTS Participants had a mean stress score of 15.6 (SD=7.3; vs general population mean of 13.0), with 30.14% of the sample categorized as "high stress" (mean≥20). In the multivariable regression analysis, age was significantly negatively associated with PSS score. A reported history of mental health issues, Hispanic ethnicity, and overall exposure to Hurricane Sandy were statistically significantly associated with PSS score in a positive direction. CONCLUSIONS Perceived stress was high in areas affected by Hurricane Sandy and was significantly associated with individual hurricane exposure. This study is a first step toward defining what segments of the population are more vulnerable and informing intervention and emergency preparedness efforts. (Disaster Med Public Health Preparedness. 2015;10:325-332).
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Gray NA, Wolley M, Liew A, Nakayama M. Natural disasters and dialysis care in the Asia-Pacific. Nephrology (Carlton) 2015; 20:873-80. [DOI: 10.1111/nep.12522] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Nicholas A Gray
- Department of Renal Medicine; Nambour General Hospital; Nambour Queensland Australia
- The University of Queensland; Sunshine Coast Clinical School; Nambour General Hospital; Nambour Queensland Australia
| | - Martin Wolley
- Department of Renal Medicine; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - Adrian Liew
- Department of Renal Medicine; Tan Tock Seng Hospital; Singapore
| | - Masaaki Nakayama
- Department of Nephrology and Hypertension; Fukushima Medical University School of Medicine; Fukushima Japan
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Hurricane Sandy: Impact on Emergency Department and Hospital Utilization by Older Adults in Lower Manhattan, New York (USA). Prehosp Disaster Med 2015; 30:496-502. [PMID: 26369433 DOI: 10.1017/s1049023x15005087] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND On October 29th, 2012, Hurricane Sandy caused a storm surge interrupting electricity with disruption to Manhattan's (New York, USA) health care infrastructure. Beth Israel Medical Center (BIMC) was the only fully functioning major hospital in lower Manhattan during and after Hurricane Sandy. The impact on emergency department (ED) and hospital use by geriatric patients in lower Manhattan was studied. METHODS The trends of ED visits and hospitalizations in the immediate post-Sandy phase (IPS) during the actual blackout (October 29 through November 4, 2012), and the extended post-Sandy phase (EPS), when neighboring hospitals were still incapacitated (November 5, 2012 through February 10, 2013), were analyzed with baseline. The analysis was broken down by age groups (18-64, 65-79, and 80+ years old) and included the reasons for ED visits and admissions. RESULTS During the IPS, there was a significant increase in geriatric visits (from 11% to 16.5% in the 65-79 age group, and from 6.5% to 13% in the 80+ age group) as well as in hospitalizations (from 22.7% to 25.2% in the 65-79 age group, and from 17.6% to 33.8% in the 80+ age group). However, these proportions returned to baseline during the EPS. The proportions of the categories "dialysis," "respiratory device," "social," and "syncope" in geriatric patients in ED visits were significantly higher than younger patients. The increases of the categories "medication," "dialysis," "respiratory device," and "social" represented two-thirds of absolute increase in both ED visits and admissions for the 65-79 age group, and half of the absolute increase in ED visits for the 80+ age group. The categories "social" and "respiratory device" peaked one day after the disaster, "dialysis" peaked two days after, and "medication" peaked three days after in ED visit analysis. CONCLUSIONS There was a disproportionate increase in ED visits and hospitalizations in the geriatric population compared with the younger population during the IPS. The primary factor of the disproportionate impact on the geriatric population appears to be from indirect effects of the hurricane, mainly due to the subsequent power outages, such as "dialysis," "respiratory device," and "social." Further investigation by chart review may provide more insights to better aid with future disaster preparedness.
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Murakami N, Siktel HB, Lucido D, Winchester JF, Harbord NB. Disaster Preparedness and Awareness of Patients on Hemodialysis after Hurricane Sandy. Clin J Am Soc Nephrol 2015; 10:1389-96. [PMID: 26220814 PMCID: PMC4527030 DOI: 10.2215/cjn.10181014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 04/20/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients with ESRD on dialysis live in a complex sociomedical situation and are dependent on technology and infrastructure, such as transportation, electricity, and water, to sustain their lives. Interruptions of this infrastructure by natural disasters can result in devastating outcomes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Between November of 2013 and April of 2014, a cross-sectional survey was conducted of patients who received maintenance hemodialysis before and after the landfall of Hurricane Sandy on October 29, 2012 in lower Manhattan, New York. The primary outcome was the number of missed dialysis sessions after the storm. Dialysis-specific and general disaster preparedness were assessed using checklists prepared by the National Kidney Foundation and US Homeland Security, respectively. RESULTS In total, 598 patients were approached, and 357 (59.7%) patients completed the survey. Participants were 60.2% men and 30.0% black, with a median age of 60 years old; 94 (26.3%) participants missed dialysis (median of two sessions [quartile 1 to quartile 3 =1-3]), and 236 (66.1%) participants received dialysis at nonregular dialysis unit(s): 209 (58.5%) at affiliated dialysis unit(s) and 27 (7.6%) at emergency rooms. The percentages of participants who carried their insurance information and detailed medication list were 75.9% and 44.3%, respectively. Enhancement of the dialysis emergency packet after the hurricane was associated with a significantly higher cache of medical records at home at follow-up survey (P<0.001, Fisher's exact test). Multivariate Poisson regression analysis showed that dialysis-specific preparedness (incidence rate ratio, 0.91; 95% confidence interval, 0.87 to 0.98), other racial ethnicity (incidence rate ratio, 0.34; 95% confidence interval, 0.20 to 0.57), dialysis treatment in affiliated units (incidence rate ratio, 0.69; 95% confidence interval, 0.51 to 0.94), and older age (incidence rate ratio, 0.98; 95% confidence interval, 0.97 to 0.99) were associated with a significantly lower incidence rate ratio of missed dialysis. CONCLUSIONS There is still room to improve the preparedness for natural disasters of patients with ESRD. Provider- or facility-oriented enhancement of awareness of the disease and preparedness should be a priority.
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Affiliation(s)
- Naoka Murakami
- Division of Nephrology and Hypertension, Department of Medicine and
| | - Hira Babu Siktel
- Division of Nephrology and Hypertension, Department of Medicine and
| | - David Lucido
- Office of Graduate Medical Education, Mount Sinai Beth Israel, New York, New York
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Affiliation(s)
- Michael Davis
- Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jeffrey B Kopp
- Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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Lurie N, Finne K, Worrall C, Jauregui M, Thaweethai T, Margolis G, Kelman J. Early Dialysis and Adverse Outcomes After Hurricane Sandy. Am J Kidney Dis 2015; 66:507-12. [PMID: 26120039 DOI: 10.1053/j.ajkd.2015.04.050] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 04/29/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Hemodialysis patients have historically experienced diminished access to care and increased adverse outcomes after natural disasters. Although "early dialysis" in advance of a storm is promoted as a best practice, evidence for its effectiveness as a protective measure is lacking. Building on prior work, we examined the relationship between the receipt of dialysis ahead of schedule before the storm (also known as early dialysis) and adverse outcomes of patients with end-stage renal disease in the areas most affected by Hurricane Sandy. STUDY DESIGN Retrospective cohort analysis, using claims data from the Centers for Medicare & Medicaid Services Datalink Project. SETTING & PARTICIPANTS Patients receiving long-term hemodialysis in New York City and the state of New Jersey, the areas most affected by Hurricane Sandy. FACTOR Receipt of early dialysis compared to their usual treatment pattern in the week prior to the storm. OUTCOMES Emergency department (ED) visits, hospitalizations, and 30-day mortality following the storm. RESULTS Of 13,836 study patients, 8,256 (60%) received early dialysis. In unadjusted logistic regression models, patients who received early dialysis were found to have lower odds of ED visits (OR, 0.75; 95% CI, 0.63-0.89; P=0.001) and hospitalizations (OR, 0.77; 95% CI, 0.65-0.92; P=0.004) in the week of the storm and similar odds of 30-day mortality (OR, 0.80; 95% CI, 0.58-1.09; P=0.2). In adjusted multivariable logistic regression models, receipt of early dialysis was associated with lower odds of ED visits (OR, 0.80; 95% CI, 0.67-0.96; P=0.01) and hospitalizations (OR, 0.79; 95% CI, 0.66-0.94; P=0.01) in the week of the storm and 30-day mortality (OR, 0.72; 95% CI, 0.52-0.997; P=0.048). LIMITATIONS Inability to determine which patients were offered early dialysis and declined and whether important unmeasured patient characteristics are associated with receipt of early dialysis. CONCLUSIONS Patients who received early dialysis had significantly lower odds of having an ED visit and hospitalization in the week of the storm and of dying within 30 days.
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Affiliation(s)
- Nicole Lurie
- Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, Washington, DC.
| | - Kristen Finne
- Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, Washington, DC
| | - Chris Worrall
- Centers for Medicare & Medicaid Services, US Department of Health and Human Services, Washington, DC
| | | | | | - Gregg Margolis
- Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, Washington, DC
| | - Jeffrey Kelman
- Centers for Medicare & Medicaid Services, US Department of Health and Human Services, Washington, DC
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