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Salas RN, Burke LG, Phelan J, Wellenius GA, Orav EJ, Jha AK. Impact of extreme weather events on healthcare utilization and mortality in the United States. Nat Med 2024; 30:1118-1126. [PMID: 38424213 DOI: 10.1038/s41591-024-02833-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024]
Abstract
Climate change is intensifying extreme weather events. Yet a systematic analysis of post-disaster healthcare utilization and outcomes for severe weather and climate disasters, as tracked by the US government, is lacking. Following exposure to 42 US billion-dollar weather disasters (severe storm, flood, flood/severe storm, tropical cyclone and winter storm) between 2011 and 2016, we used a difference-in-differences (DID) approach to quantify changes in the rates of emergency department (ED) visits, nonelective hospitalizations and mortality between fee-for-service Medicare beneficiaries in affected compared to matched control counties in post-disaster weeks 1, 1-2 and 3-6. Overall, disasters were associated with higher rates of ED utilization in affected counties in post-disaster week 1 (DID of 1.22% (95% CI, 0.20% to 2.25%; P < 0.020)) through week 2. Nonelective hospitalizations were unchanged. Mortality was higher in affected counties in week 1 (DID of 1.40% (95% CI, 0.08% to 2.74%; P = 0.037)) and persisted for 6 weeks. Counties with the greatest loss and damage experienced greater increases in ED and mortality rates compared to all affected counties. Thus, billion-dollar weather disasters are associated with excess ED visits and mortality in Medicare beneficiaries. Tracking these outcomes is important for adaptation that protects patients and communities, health system resilience and policy.
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Affiliation(s)
- Renee N Salas
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Harvard Global Health Institute, Cambridge, MA, USA.
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Laura G Burke
- Harvard Medical School, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, MA, USA
| | - Jessica Phelan
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Gregory A Wellenius
- Boston University School of Public Health, Center for Climate and Health, Boston, MA, USA
| | - E John Orav
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ashish K Jha
- Brown University School of Public Health, Providence, RI, USA
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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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Huang W, Gao Y, Xu R, Yang Z, Yu P, Ye T, Ritchie EA, Li S, Guo Y. Health Effects of Cyclones: A Systematic Review and Meta-Analysis of Epidemiological Studies. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:86001. [PMID: 37639476 PMCID: PMC10461789 DOI: 10.1289/ehp12158] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND More intense cyclones are expected in the future as a result of climate change. A comprehensive review is urgently needed to summarize and update the evidence on the health effects of cyclones. OBJECTIVES We aimed to provide a systematic review with meta-analysis of current evidence on the risks of all reported health outcomes related to cyclones and to identify research gaps and make recommendations for further research. METHODS We systematically searched five electronic databases (MEDLINE, Embase, PubMed, Scopus, and Web of Science) for relevant studies in English published before 21 December 2022. Following the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines, we developed inclusion criteria, screened the literature, and included epidemiological studies with a quantitative risk assessment of any mortality or morbidity-related outcomes associated with cyclone exposures. We extracted key data and assessed study quality for these studies and applied meta-analyses to quantify the overall effect estimate and the heterogeneity of comparable studies. RESULTS In total, 71 studies from eight countries (the United States, China, India, Japan, the Philippines, South Korea, Australia, Brazil), mostly the United States, were included in the review. These studies investigated the all-cause and cause-specific mortality, as well as morbidity related to injury, cardiovascular diseases (CVDs), respiratory diseases, infectious diseases, mental disorders, adverse birth outcomes, cancer, diabetes, and other outcomes (e.g., suicide rates, gender-based violence). Studies mostly included only one high-amplitude cyclone (cyclones with a Saffir-Simpson category of 4 or 5, i.e., Hurricanes Katrina or Sandy) and focused on mental disorders morbidity and all-cause mortality and hospitalizations. Consistently elevated risks of overall mental health morbidity, post-traumatic stress disorder (PTSD), as well as all-cause mortality or hospitalizations, were found to be associated with cyclones. However, the results for other outcomes were generally mixed or limited. A statistically significant overall relative risk of 1.09 [95% confidence interval (CI): 1.04, 1.13], 1.18 (95% CI: 1.12, 1.25), 1.15 (95% CI: 1.13, 1.18), 1.26 (95% CI: 1.05, 1.50) was observed for all-cause mortality, all-cause hospitalizations, respiratory disease, and chronic obstructive pulmonary disease hospitalizations, respectively, after cyclone exposures, whereas no statistically significant risks were identified for diabetes mortality, heart disease mortality, and preterm birth. High between-study heterogeneity was observed. CONCLUSIONS There is generally consistent evidence supporting the notion that high-amplitude cyclones could significantly increase risks of mental disorders, especially for PTSD, as well as mortality and hospitalizations, but the evidence for other health outcomes, such as chronic diseases (e.g., CVDs, cancer, diabetes), and adverse birth outcomes remains limited or inconsistent. More studies with rigorous exposure assessment, of larger spatial and temporal scales, and using advanced modeling strategy are warranted in the future, especially for those small cyclone-prone countries or regions with low and middle incomes. https://doi.org/10.1289/EHP12158.
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Affiliation(s)
- Wenzhong Huang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yuan Gao
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rongbin Xu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zhengyu Yang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Pei Yu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tingting Ye
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Elizabeth A. Ritchie
- School of Earth Atmosphere and Environment, Monash University, Melbourne, Victoria, Australia
- Department of Civil Engineering, Monash University, Melbourne, Victoria, Australia
| | - Shanshan Li
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Sever L, Pehlivan G, Canpolat N, Saygılı S, Ağbaş A, Demirgan E, Oh J, Levtchenko E, Ivanov DD, Shroff R. Management of pediatric dialysis and kidney transplant patients after natural or man-made disasters. Pediatr Nephrol 2023; 38:315-325. [PMID: 36194369 PMCID: PMC9529603 DOI: 10.1007/s00467-022-05734-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/02/2022] [Accepted: 09/02/2022] [Indexed: 01/10/2023]
Abstract
Pediatric patients on kidney replacement therapy (KRT) are among the most vulnerable during large-scale disasters, either natural or man-made. Hemodialysis (HD) treatments may be impossible because of structural damage and/or shortage of medical supplies, clean water, electricity, and healthcare professionals. Lack of peritoneal dialysis (PD) solutions and increased risk of infectious/non-infectious complications may make PD therapy challenging. Non-availability of immunosuppressants and increased risk of infections may result in graft loss and deaths of kidney transplant recipients. Measures to mitigate these risks must be considered before, during, and after the disaster including training of staff and patients/caregivers to cope with medical and logistic problems. Soon after a disaster, if the possibility of performing HD or PD is uncertain, patients should be directed to other centers, or the duration and/or number of HD sessions or the PD prescription adapted. In kidney transplant recipients, switching among immunosuppressants should be considered in case of non-availability of the medications. Post-disaster interventions target treating neglected physical and mental problems and also improving social challenges. All problems experienced by pediatric KRT patients living in the affected area are applicable to displaced patients who may also face extra risks during their travel and also at their destination. The need for additional local, national, and international help and support of non-governmental organizations must be anticipated and sought in a timely manner.
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Affiliation(s)
- Lale Sever
- Department of Pediatric Nephrology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Gülseren Pehlivan
- Department of Pediatric Nephrology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nur Canpolat
- Department of Pediatric Nephrology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Seha Saygılı
- Department of Pediatric Nephrology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ayşe Ağbaş
- Department of Pediatric Nephrology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ebru Demirgan
- Department of Pediatric Nephrology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Jun Oh
- Department of Pediatric Nephrology, Medical Center University Hamburg/Eppendorf, Hamburg, Germany
| | | | - Dymtro D. Ivanov
- Department of Nephrology and Renal Replacement Therapy, Shupyk National Health Care University, Kiev, Ukraine
| | - Rukshana Shroff
- UCL Great Ormond Street Hospital and Institute of Child Health, Renal Unit, London, UK
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Kshirsagar AV, Zeitler EM, Weaver A, Franceschini N, Engel LS. Environmental Exposures and Kidney Disease. KIDNEY360 2022; 3:2174-2182. [PMID: 36591345 PMCID: PMC9802544 DOI: 10.34067/kid.0007962021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/04/2022] [Indexed: 12/31/2022]
Abstract
Accumulating evidence underscores the large role played by the environment in the health of communities and individuals. We review the currently known contribution of environmental exposures and pollutants on kidney disease and its associated morbidity. We review air pollutants, such as particulate matter; water pollutants, such as trace elements, per- and polyfluoroalkyl substances, and pesticides; and extreme weather events and natural disasters. We also discuss gaps in the evidence that presently relies heavily on observational studies and animal models, and propose using recently developed analytic methods to help bridge the gaps. With the expected increase in the intensity and frequency of many environmental exposures in the decades to come, an improved understanding of their potential effect on kidney disease is crucial to mitigate potential morbidity and mortality.
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Affiliation(s)
- Abhijit V. Kshirsagar
- UNC Kidney Center and Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, North Carolina
| | - Evan M. Zeitler
- UNC Kidney Center and Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, North Carolina
| | - Anne Weaver
- Center for Public Health and Environmental Assessment, Office of Research and Development, United States Environmental Protection Agency, Chapel Hill, North Carolina
| | - Nora Franceschini
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Lawrence S. Engel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
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Andrade EL, Cordova A, Schagen CRV, Jula M, Rodriguez-Diaz CE, Rivera MI, Santos-Burgoa C. The impact of Hurricane Maria on individuals living with non-communicable disease in Puerto Rico: the experience of 10 communities. BMC Public Health 2022; 22:2083. [PMCID: PMC9664670 DOI: 10.1186/s12889-022-14552-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/04/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Coinciding with the rising non-communicable disease (NCD) prevalence worldwide is the increasing frequency and severity of natural hazards. Protecting populations with NCDs against natural hazards is ever more pressing given their increased risk of morbidity and mortality in disaster contexts. This investigation examined Hurricane Maria’s impacts across ten lower SES municipalities in Puerto Rico with varying community characteristics and hurricane impacts to understand experiences of supporting individuals with NCD management in the six-month period following the hurricane.
Methods
We conducted 40 qualitative interviews with mayors, first responders, faith leaders, community leaders, and municipal employees from 10 municipalities in Puerto Rico. Using QSR NVivo software, we deductively and inductively coded interview transcripts and undertook thematic analysis to characterize community-level hurricane impact and consequences for NCD management, and to identify convergent and divergent themes.
Results
Damages to infrastructure, including healthcare facilities and roadways, complicated the provision of timely health care for NCDs, patient transport, and pharmaceutical/medical supply chain continuity. Lengthy power outages at both healthcare facilities and private residences were barriers to healthcare service delivery, use of medical equipment, and storage of prescription medications with refrigeration, and led to a widespread mental health crisis. Cascading failures such as fuel shortages further compounded these challenges. The consequences of these impacts included the reported exacerbation of health conditions and loss of life among NCD patients.
Conclusions
Study findings identify contributors to morbidity and mortality among individuals with NCDs following Hurricane Maria. With the growing frequency of catastrophic disasters from natural hazards, the experiences of communities that endured these impacts offer important lessons regarding policies and practices to better support community disaster resilience and address the evolving preparedness needs of NCD patients.
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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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Tofighi M, Asgary A, Merchant AA, Shafiee MA, Najafabadi MM, Nadri N, Aarabi M, Heffernan J, Wu J. Modelling COVID-19 transmission in a hemodialysis centre using simulation generated contacts matrices. PLoS One 2021; 16:e0259970. [PMID: 34797862 PMCID: PMC8604317 DOI: 10.1371/journal.pone.0259970] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 11/01/2021] [Indexed: 01/12/2023] Open
Abstract
The COVID-19 pandemic has been particularly threatening to patients with end-stage kidney disease (ESKD) on intermittent hemodialysis and their care providers. Hemodialysis patients who receive life-sustaining medical therapy in healthcare settings, face unique challenges as they need to be at a dialysis unit three or more times a week, where they are confined to specific settings and tended to by dialysis nurses and staff with physical interaction and in close proximity. Despite the importance and critical situation of the dialysis units, modelling studies of the SARS-CoV-2 spread in these settings are very limited. In this paper, we have used a combination of discrete event and agent-based simulation models, to study the operations of a typical large dialysis unit and generate contact matrices to examine outbreak scenarios. We present the details of the contact matrix generation process and demonstrate how the simulation calculates a micro-scale contact matrix comprising the number and duration of contacts at a micro-scale time step. We have used the contacts matrix in an agent-based model to predict disease transmission under different scenarios. The results show that micro-simulation can be used to estimate contact matrices, which can be used effectively for disease modelling in dialysis and similar settings.
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Affiliation(s)
- Mohammadali Tofighi
- ADERSIM (Advanced Disaster, Emergency, and Rapid Response Simulation), York University, Toronto, Ontario, Canada
| | - Ali Asgary
- ADERSIM (Advanced Disaster, Emergency, and Rapid Response Simulation), York University, Toronto, Ontario, Canada
| | | | | | - Mahdi M. Najafabadi
- ADERSIM (Advanced Disaster, Emergency, and Rapid Response Simulation), York University, Toronto, Ontario, Canada
| | - Nazanin Nadri
- ADERSIM (Advanced Disaster, Emergency, and Rapid Response Simulation), York University, Toronto, Ontario, Canada
| | - Mehdi Aarabi
- University Health Network (UHN), Toronto, Ontario, Canada
| | - Jane Heffernan
- Modelling Infection and Immunity Lab, York University, Toronto, Ontario, Canada
| | - Jianhong Wu
- LIAM (Laboratory for Industrial and Applied Mathematics), York University, Toronto, Ontario, Canada
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