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Nethery RC, Katz-Christy N, Kioumourtzoglou MA, Parks RM, Schumacher A, Anderson GB. Integrated causal-predictive machine learning models for tropical cyclone epidemiology. Biostatistics 2023; 24:449-464. [PMID: 34962265 PMCID: PMC10102905 DOI: 10.1093/biostatistics/kxab047] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 11/04/2021] [Accepted: 11/24/2021] [Indexed: 11/13/2022] Open
Abstract
Strategic preparedness reduces the adverse health impacts of hurricanes and tropical storms, referred to collectively as tropical cyclones (TCs), but its protective impact could be enhanced by a more comprehensive and rigorous characterization of TC epidemiology. To generate the insights and tools necessary for high-precision TC preparedness, we introduce a machine learning approach that standardizes estimation of historic TC health impacts, discovers common patterns and sources of heterogeneity in those health impacts, and enables identification of communities at highest health risk for future TCs. The model integrates (i) a causal inference component to quantify the immediate health impacts of recent historic TCs at high spatial resolution and (ii) a predictive component that captures how TC meteorological features and socioeconomic/demographic characteristics of impacted communities are associated with health impacts. We apply it to a rich data platform containing detailed historic TC exposure information and records of all-cause mortality and cardiovascular- and respiratory-related hospitalization among Medicare recipients. We report a high degree of heterogeneity in the acute health impacts of historic TCs, both within and across TCs, and, on average, substantial TC-attributable increases in respiratory hospitalizations. TC-sustained windspeeds are found to be the primary driver of mortality and respiratory risks.
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Affiliation(s)
- Rachel C Nethery
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 655 Huntington Ave, Boston, MA, USA
| | - Nina Katz-Christy
- Department of Statistics, Harvard University, 1 Oxford St, Cambridge, MA, USA
| | - Marianthi-Anna Kioumourtzoglou
- Department of Environmental Health Sciences, Columbia Mailman School of Public Health, 722 W. 168th Street, New York City, NY, USA
| | - Robbie M Parks
- Department of Environmental Health Sciences, Columbia Mailman School of Public Health, 722 W. 168th Street, New York City, NY, USA
| | - Andrea Schumacher
- Cooperative Institute for Research in the Atmosphere, Colorado State University, 3925A West Laporte Ave, Fort Collins, CO, USA
| | - G Brooke Anderson
- Department of Environmental & Radiological Health Sciences, Colorado State University, 122A Environmental Health Building, Fort Collins, CO, USA
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Locke SH, Gargano LM, Alper HE, Brite J. Long-Term Lower Respiratory Symptoms among World Trade Center Health Registry Enrollees Following Hurricane Sandy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13738. [PMID: 36360618 PMCID: PMC9654591 DOI: 10.3390/ijerph192113738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
Several studies showed an association between lower respiratory tract symptoms (LRS) and exposure to the 9/11 terrorist attack. However, few studies have examined the long-term impact of natural disasters on those with prior respiratory distress. The present study aims to assess the impact of Hurricane Sandy on persistent LRS among people exposed to the World Trade Center (WTC) terrorist attack. The analytic sample consisted of WTC Health Registry enrollees who completed survey waves 1, 3, and 4 and the Hurricane Sandy Survey and did not report LRS before the WTC terrorist attack. The log binomial was used to assess the association between the impact of Hurricane Sandy and persistent LRS. Of 3277 enrollees, 1111 (33.9%) reported persistent LRS post-Sandy. Participants of older age, males, lower household income, current smokers, and those with previous asthma were more likely to report persistent LRS. In separate adjusted models, multiple Sandy-related inhalation exposures (relative risk (RR): 1.2, 95% CI: 1.06-1.37), Sandy-related PTSD (RR: 1.27, 95% CI: 1.15-1.4), and Sandy LRS (RR: 1.64, 95% CI: 1.48-1.81) were associated with persistent LRS post-Sandy. Our findings suggest that respiratory protection is important for everyone performing reconstruction and clean-up work after a natural disaster, particularly among those with previous respiratory exposures.
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Affiliation(s)
- Sean H. Locke
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA
| | - Lisa M. Gargano
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA
| | - Howard E. Alper
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA
| | - Jennifer Brite
- Department of Health & Human Performance, York College of City University of New York (CUNY), New York, NY 11451, USA
- CUNY Institute for Demographic Research, City University of New York (CUNY), New York, NY 11451, USA
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Assessing the Feasibility and Effectiveness of a Linkage Into Mental Health Care Program for Adults Affected by Hurricane Sandy. Disaster Med Public Health Prep 2022; 17:e238. [PMID: 36062582 PMCID: PMC9905213 DOI: 10.1017/dmp.2022.176] [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 Research indicates that greater exposure to Hurricane Sandy is associated with increased mental health difficulties. This study examined whether Project Restoration, a program that linked adults into mental health care (L2C), was effective in reducing post-Sandy mental health difficulties as compared to a cohort of adults matched on mental health difficulties that were not linked into post-Sandy mental health care. METHODS Project Restoration participants (n = 52) with elevated self-reported mental health difficulties had the option to enroll into L2C. Project LIGHT (n = 63) used similar methodologies but did not have a L2C component and served as the matched control group. RESULTS Multivariable modeling showed significant decreases in all mental health difficulties except for depression in the Project Restoration group, whereas there were no significant decreases in LIGHT. The decrease in anxiety from baseline to follow-up was significantly greater for Project Restoration as compared to LIGHT. CONCLUSION Findings confirm the powerful impact community outreach and treatment have on reducing mental health difficulties after a disaster.
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Projecting the Impacts of a Changing Climate: Tropical Cyclones and Flooding. Curr Environ Health Rep 2022; 9:244-262. [PMID: 35403997 DOI: 10.1007/s40572-022-00340-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW There is clear evidence that the earth's climate is changing, largely from anthropogenic causes. Flooding and tropical cyclones have clear impacts on human health in the United States at present, and projections of their health impacts in the future will help inform climate policy, yet to date there have been few quantitative climate health impact projections. RECENT FINDINGS Despite a wealth of studies characterizing health impacts of floods and tropical cyclones, many are better suited for qualitative, rather than quantitative, projections of climate change health impacts. However, a growing number have features that will facilitate their use in quantitative projections, features we highlight here. Further, while it can be difficult to project how exposures to flood and tropical cyclone hazards will change in the future, climate science continues to advance in its capabilities to capture changes in these exposures, including capturing regional variation. Developments in climate epidemiology and climate science are opening new possibilities in projecting the health impacts of floods and tropical cyclones under a changing climate.
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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: 13] [Impact Index Per Article: 4.3] [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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Using NYC 311 Call Center Data to Assess Short- and Long-Term Needs Following Hurricane Sandy. Disaster Med Public Health Prep 2021; 16:1447-1451. [PMID: 34016206 DOI: 10.1017/dmp.2021.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Hurricane Sandy made landfall across New York City (NYC) in October 2012, but the long-term consequences of the storm are still not fully understood. We analyzed NYC data to quantify the extent of Hurricane Sandy-related concerns over time. METHODS Data on NYC 311 Call Center inquiries were downloaded from the NYC Open Data website (October 29, 2012 to May 26, 2020) to provide information about Sandy-related calls using the keywords "Hurricane" and "Sandy". RESULTS In the first 2 wk after Hurricane Sandy, 15.6% of 311 calls were related to the storm. From 2012 to 2020, the volume of inquiries decreased from 87,209 to 25. The majority of calls in 2012 (49,181; 56%) was requesting general Hurricane Sandy information, and in 2020 assistance with property restoration (20; 79%). CONCLUSIONS The long-term consequences of Hurricane Sandy in NYC persist into 2020, almost 8 y after the initial event. The needs of Hurricane Sandy victims have changed over time from requiring general information regarding closures, property destruction and immediate disaster relief to aid with legal, financial, and mental health consequences. Disaster response policy-makers must understand the changing needs of NYC residents to provide resources and prepare for future disasters.
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Yan M, Wilson A, Dominici F, Wang Y, Al-Hamdan M, Crosson W, Schumacher A, Guikema S, Magzamen S, Peel JL, Peng RD, Anderson GB. Tropical Cyclone Exposures and Risks of Emergency Medicare Hospital Admission for Cardiorespiratory Diseases in 175 Urban United States Counties, 1999-2010. Epidemiology 2021; 32:315-326. [PMID: 33591048 PMCID: PMC8887827 DOI: 10.1097/ede.0000000000001337] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Although injuries experienced during hurricanes and other tropical cyclones have been relatively well-characterized through traditional surveillance, less is known about tropical cyclones' impacts on noninjury morbidity, which can be triggered through pathways that include psychosocial stress or interruption in medical treatment. METHODS We investigated daily emergency Medicare hospitalizations (1999-2010) in 180 US counties, drawing on an existing cohort of high-population counties. We classified counties as exposed to tropical cyclones when storm-associated peak sustained winds were ≥21 m/s at the county center; secondary analyses considered other wind thresholds and hazards. We matched storm-exposed days to unexposed days by county and seasonality. We estimated change in tropical cyclone-associated hospitalizations over a storm period from 2 days before to 7 days after the storm's closest approach, compared to unexposed days, using generalized linear mixed-effect models. RESULTS For 1999-2010, 175 study counties had at least one tropical cyclone exposure. Cardiovascular hospitalizations decreased on the storm day, then increased following the storm, while respiratory hospitalizations were elevated throughout the storm period. Over the 10-day storm period, cardiovascular hospitalizations increased 3% (95% confidence interval = 2%, 5%) and respiratory hospitalizations increased 16% (95% confidence interval = 13%, 20%) compared to matched unexposed periods. Relative risks varied across tropical cyclone exposures, with strongest association for the most restrictive wind-based exposure metric. CONCLUSIONS In this study, tropical cyclone exposures were associated with a short-term increase in cardiorespiratory hospitalization risk among the elderly, based on a multi-year/multi-site investigation of US Medicare beneficiaries ≥65 years.
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Affiliation(s)
- Meilin Yan
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
- Beijing Innovation Center for Engineering Science and Advanced Technology and State Key Joint Laboratory of Environmental Simulation and Pollution Control, Peking University, Beijing, China
| | - Ander Wilson
- Department of Statistics, Colorado State University, Fort Collins, Colorado, USA
| | - Francesca Dominici
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Yun Wang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Mohammad Al-Hamdan
- Universities Space Research Association, National Aeronautics and Space Administration
| | - William Crosson
- Universities Space Research Association, National Aeronautics and Space Administration
| | - Andrea Schumacher
- Cooperative Institute for Research in the Atmosphere, Colorado State University, Fort Collins, Colorado, USA
| | - Seth Guikema
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Sheryl Magzamen
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Jennifer L. Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Roger D. Peng
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - G. Brooke Anderson
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
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Eyes of a Hurricane: The Effect of Hurricane Harvey on Ophthalmology Consultations at Houston's County Hospital. Disaster Med Public Health Prep 2021; 17:e13. [PMID: 33818371 DOI: 10.1017/dmp.2020.470] [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: 02/02/2023]
Abstract
OBJECTIVE This study aimed to characterize ophthalmology consultations ordered after Hurricane Harvey compared to consultations ordered during the same time period of the prior year. METHODS A retrospective chart review was performed at an urban, level 1 trauma center of a county hospital. All patients were included who received an electronic health record, documented ophthalmology consultation order between September 2017 and October 2017 (the time period immediately following Hurricane Harvey) or September 2016 and October 2016. Patient demographic risk factors were collected. Patient ICD10 clinical diagnoses were categorized as extraocular, intraocular, infectious, physiological, or other, and then subcategorized as trauma or non-trauma-related. A geographical heat map was generated to compare the changes in diagnosis volume by zip code to the magnitude of rainfall in the county. RESULTS Following Hurricane Harvey, ophthalmology consultation volume decreased, number of infectious ophthalmology diagnoses increased (P < 0.001), percentage of patients on immunosuppression increased (P < 0.001), and the number of private insurance payers increased while the number of county-funded insurance payers decreased (P = 0.003). CONCLUSIONS The risk of infectious eye diagnosis was double the risk of traumatic eye diagnosis from Hurricane Harvey flooding. During public disaster planning, different ophthalmological medical resources and responses should be considered for flooding versus high-wind events.
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Waddell SL, Jayaweera DT, Mirsaeidi M, Beier JC, Kumar N. Perspectives on the Health Effects of Hurricanes: A Review and Challenges. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2756. [PMID: 33803162 PMCID: PMC7967478 DOI: 10.3390/ijerph18052756] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 01/14/2023]
Abstract
Hurricanes are devastating natural disasters which dramatically modify the physical landscape and alter the socio-physical and biochemical characteristics of the environment, thus exposing the affected communities to new environmental stressors, which persist for weeks to months after the hurricane. This paper has three aims. First, it conceptualizes potential direct and indirect health effects of hurricanes and provides an overview of factors that exacerbate the health effects of hurricanes. Second, it summarizes the literature on the health impact of hurricanes. Finally, it examines the time lag between the hurricane (landfall) and the occurrence of diseases. Two major findings emerge from this paper. Hurricanes are shown to cause and exacerbate multiple diseases, and most adverse health impacts peak within six months following hurricanes. However, chronic diseases, including cardiovascular disease and mental disorders, continue to occur for years following the hurricane impact.
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Affiliation(s)
| | | | - Mehdi Mirsaeidi
- Division of Pulmonary, Allergy, Critical Care, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
| | - John C. Beier
- Division of Environmental Health Sciences, Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
| | - Naresh Kumar
- Division of Environmental Health, Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
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Konkel L. Tropical Cyclone Exposures and Health: A New Data Set to Assess Associations over Time. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:124001. [PMID: 33290096 PMCID: PMC7728360 DOI: 10.1289/ehp8653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/20/2020] [Indexed: 06/12/2023]
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Effects of Hurricanes on Emergency Department Utilization: An Analysis Across 7 US Storms. Disaster Med Public Health Prep 2020; 15:762-769. [PMID: 33023692 DOI: 10.1017/dmp.2020.281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Emergency departments (EDs) are critical sources of care after natural disasters such as hurricanes. Understanding the impact on ED utilization by subpopulation and proximity to the hurricane's path can inform emergency preparedness planning. This study examines changes in ED utilization for residents of 344 counties after the occurrence of 7 US hurricanes between 2005 and 2016. METHODS This retrospective observational study used ED data from the Healthcare Cost and Utilization Project State Inpatient Databases and State Emergency Department Databases. ED utilization rates for weeks during and after hurricanes were compared with pre-hurricane rates, stratified by the proximity of the patient county to the hurricane path, age, and disease category. RESULTS The overall population rate of weekly ED visits changed little post-hurricane, but rates by disease categories and age demonstrated varying results. Utilization rates for respiratory disorders exhibited the largest post-hurricane increase, particularly 2-3 weeks following the hurricane. The change in population rates by disease categories and age tended to be larger for people residing in counties closer to the hurricane path. CONCLUSIONS Changes in ED utilization following hurricanes depend on disease categories, age, and proximity to the hurricane path. Emergency managers could incorporate these factors into their planning processes.
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Anderson GB, Ferreri J, Al-Hamdan M, Crosson W, Schumacher A, Guikema S, Quiring S, Eddelbuettel D, Yan M, Peng RD. Assessing United States County-Level Exposure for Research on Tropical Cyclones and Human Health. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:107009. [PMID: 33112191 PMCID: PMC7592507 DOI: 10.1289/ehp6976] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 05/02/2023]
Abstract
BACKGROUND Tropical cyclone epidemiology can be advanced through exposure assessment methods that are comprehensive and consistent across space and time, as these facilitate multiyear, multistorm studies. Further, an understanding of patterns in and between exposure metrics that are based on specific hazards of the storm can help in designing tropical cyclone epidemiological research. OBJECTIVES a) Provide an open-source data set for tropical cyclone exposure assessment for epidemiological research; and b) investigate patterns and agreement between county-level assessments of tropical cyclone exposure based on different storm hazards. METHODS We created an open-source data set with data at the county level on exposure to four tropical cyclone hazards: peak sustained wind, rainfall, flooding, and tornadoes. The data cover all eastern U.S. counties for all land-falling or near-land Atlantic basin storms, covering 1996-2011 for all metrics and up to 1988-2018 for specific metrics. We validated measurements against other data sources and investigated patterns and agreement among binary exposure classifications based on these metrics, as well as compared them to use of distance from the storm's track, which has been used as a proxy for exposure in some epidemiological studies. RESULTS Our open-source data set was typically consistent with data from other sources, and we present and discuss areas of disagreement and other caveats. Over the study period and area, tropical cyclones typically brought different hazards to different counties. Therefore, when comparing exposure assessment between different hazard-specific metrics, agreement was usually low, as it also was when comparing exposure assessment based on a distance-based proxy measurement and any of the hazard-specific metrics. DISCUSSION Our results provide a multihazard data set that can be leveraged for epidemiological research on tropical cyclones, as well as insights that can inform the design and analysis for tropical cyclone epidemiological research. https://doi.org/10.1289/EHP6976.
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Affiliation(s)
- G. Brooke Anderson
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Joshua Ferreri
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
- School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Mohammad Al-Hamdan
- Universities Space Research Association, NASA Marshall Space Flight Center, Huntsville, Alabama, USA
| | - William Crosson
- Universities Space Research Association, NASA Marshall Space Flight Center, Huntsville, Alabama, USA
| | - Andrea Schumacher
- Cooperative Institute for Research in the Atmosphere, Colorado State University, Fort Collins, Colorado, USA
| | - Seth Guikema
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Steven Quiring
- Department of Geography, Ohio State University, Columbus, Ohio, USA
| | - Dirk Eddelbuettel
- Department of Statistics, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
| | - Meilin Yan
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
- Beijing Innovation Center for Engineering Science and Advanced Technology and State Key Joint Laboratory of Environmental Simulation and Pollution Control, Peking University, Beijing, China
| | - Roger D. Peng
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Sun S, Weinberger KR, Yan M, Brooke Anderson G, Wellenius GA. Tropical cyclones and risk of preterm birth: A retrospective analysis of 20 million births across 378 US counties. ENVIRONMENT INTERNATIONAL 2020; 140:105825. [PMID: 32485474 DOI: 10.1016/j.envint.2020.105825] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/25/2020] [Accepted: 05/19/2020] [Indexed: 05/02/2023]
Abstract
BACKGROUND The public health impacts of tropical cyclones (TCs) are expected to increase due to the continued growth of coastal populations and the increasing severity of these events. However, the impact of TCs on pregnant women, a vulnerable population, remains largely unknown. We aimed to estimate the association between prenatal exposure to TCs and risk of preterm birth in the eastern United States (US) and to assess whether the association varies by individual- and area-level characteristics. METHODS We included data on 19,529,748 spontaneous singleton births from 1989 to 2002 across 378 US counties. In each county, we classified days as exposed to a TC when TC-associated peak sustained winds at the county's population-weighted center were >17.2 m/s (gale-force winds or greater). We defined preterm birth as births delivered prior to 37 completed weeks of gestation. We used distributed lag log-linear mixed-effects models to estimate the relative risk (RR) and absolute risk difference (ARD) for TC exposure by comparing preterm births occurring in TC-periods (from 2 days before to 30 days after the TC's closest approach to the county's population center) to matched non-TC periods. We conducted secondary analyses using other wind thresholds (12 m/s and 22 m/s) and other exposure metrics: county distance to storm track (30 km, 60 km, and 100 km) and cumulative rainfall within the county (75 mm, 100 mm, and 125 mm). RESULTS During the study period, there were 1,981,797 (10.1%) preterm births and 58 TCs that affected at least one US county on which we had birth data. The risk of preterm birth was positively associated with TC exposure defined as peak sustained wind speed >17.2 m/s (gale-force winds or greater) [RR: 1.01 (95% CI: 0.99, 1.03); ARD: 9 (95% CI: -7, 25) per 10,000 pregnancies], distance to storm track <60 km [RR: 1.02 (95% CI: 1.01, 1.04); ARD: 23 (95% CI: 9, 38) per 10,000 pregnancies], and cumulative rainfall >100 mm [RR: 1.04 (95% CI: 1.02, 1.06); ARD: 36 (95% CI: 16, 56) per 10,000 pregnancies]. Results were comparable when considering other wind, distance, or rain thresholds. The association was more pronounced among early preterm births and mothers living in more socially vulnerable counties but did not vary across strata of other hypothesized risk factors. CONCLUSIONS Maternal exposure to TC was associated with a higher risk of preterm birth. Our findings provide initial evidence that severe storms may trigger preterm birth.
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Affiliation(s)
- Shengzhi Sun
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States; Department of Epidemiology and Center for Environmental Health and Technology, Brown University School of Public Health, Providence, RI, United States.
| | - Kate R Weinberger
- Department of Epidemiology and Center for Environmental Health and Technology, Brown University School of Public Health, Providence, RI, United States; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meilin Yan
- Beijing Innovation Center for Engineering Science and Advanced Technology and State Key Joint Laboratory of Environmental Simulation and Pollution Control, College of Environmental Sciences and Engineering, Peking University, Beijing, China; Department of Environmental & Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States
| | - G Brooke Anderson
- Department of Environmental & Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States
| | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States; Department of Epidemiology and Center for Environmental Health and Technology, Brown University School of Public Health, Providence, RI, United States
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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: 37] [Impact Index Per Article: 7.4] [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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The effect of a terrorist attack on emergency department inflow: an observation study using difference-in-differences methodology. Scand J Trauma Resusc Emerg Med 2019; 27:57. [PMID: 31126312 PMCID: PMC6534874 DOI: 10.1186/s13049-019-0634-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/17/2019] [Indexed: 11/10/2022] Open
Abstract
Study objective The objective of this study was to investigate how the terrorist attack in Stockholm, Sweden affected patient inflow to the general emergency departments (EDs) in close proximity of the attack. The study analyzed if, and to what extent, the attack impacted ED inflow during the following days and weeks. Methods In a retrospective observational study, anonymized aggregated data on ED arrivals (inflow of patients) to all seven of the EDs in the Stockholm County was analyzed using the Difference-in-Differences (DiD) estimator. The control groups were the affected hospitals in the years prior to the terrorist attack. The number of ED visits was retrieved from the Stockholm County Council administrative database. Results The study shows a statistically significant reduction in overall ED inflow of 7–9% following the attack. The effect was strongest initially after the attack, and ED inflow regained normal levels within approximately three weeks’ time, without any significant rebound effect. The effect on ED inflow also decreased with distance from ground zero, and was not significant further away than 10 km. Conclusion The results showed that ED inflow was significantly decreased in the weeks immediately following the Stockholm terrorist attack. The reasons for this cannot be fully explained in this observational study. However, the results suggest that some patients actively choose when, where and if they should go to the ED.
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Bevilacqua K, Schneider S, Rasul R, Taioli E, Schwartz RM. Engagement in linkage to mental health care program in the Rockaways after Hurricane Sandy. JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 47:743-756. [PMID: 30597560 PMCID: PMC6590356 DOI: 10.1002/jcop.22150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/15/2018] [Accepted: 12/11/2018] [Indexed: 06/09/2023]
Abstract
The Rockaways area of New York City was especially devastated by Hurricane Sandy. This study examined participant characteristics associated with acceptance of a linkage to and attendance at appointments for mental health difficulties (MHD). Participants (N = 1,011) completed questionnaires to assess mental health symptoms. Participants who met screening criteria (n = 442) were offered linkage to care. Individuals who had a higher mental health symptom burden (MHSB; i.e., those who screened in on more than one criteria vs. only one criterion) had 2.68 greater odds of accepting services (95% confidence interval [1.68, 4.26]). MHSB was not associated with attending a first appointment (p = 0.80). Female gender and Hispanic ethnicity were also associated with acceptance of linkage to care, though not attendance. Reducing stigma around MHD associated with natural disasters and increasing knowledge about the mental health care system could promote help-seeking behavior among survivors.
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Affiliation(s)
- Kristin Bevilacqua
- Department of Occupational MedicineEpidemiology and Prevention, Northwell Health
- Joint Center for Disaster HealthTrauma and Resilience
| | - Samantha Schneider
- Department of Occupational MedicineEpidemiology and Prevention, Northwell Health
- Joint Center for Disaster HealthTrauma and Resilience
| | - Rehana Rasul
- Department of Occupational MedicineEpidemiology and Prevention, Northwell Health
- Joint Center for Disaster HealthTrauma and Resilience
- Department of BiostatisticsNorthwell Health
| | - Emanuela Taioli
- Joint Center for Disaster HealthTrauma and Resilience
- Institute of Translational Epidemiology, Department of Population Health Science and PolicyThe Icahn School of Medicine at Mount Sinai
| | - Rebecca M. Schwartz
- Department of Occupational MedicineEpidemiology and Prevention, Northwell Health
- Joint Center for Disaster HealthTrauma and Resilience
- Institute of Translational Epidemiology, Department of Population Health Science and PolicyThe Icahn School of Medicine at Mount Sinai
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
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Lukowsky LR, Der-Martirosian C, Dobalian A. Seeking Information from the VA During Natural Disasters. Hosp Top 2018; 96:114-122. [PMID: 30588867 DOI: 10.1080/00185868.2018.1521251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of this study is to identify factors influencing patient preferences for communication from the US Department of Veterans Affairs (VA) during natural disasters. The 37-question, probability-based survey collected data from 2,264 VA users living in the Northeast US logistic regression analyses were conducted for top four modalities, and age was identified as the most important predictor of communication preferences. The findings suggest that the use of multiple modalities, such as telephone, television, radio, text, and email is necessary to successfully disseminate information and effectively reach all VA patients in the event of large-scale emergencies.
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Affiliation(s)
- Lilia R Lukowsky
- a US Department of Veterans Affairs , Veterans Emergency Management Evaluation Center (VEMEC) , North Hills , California , USA
| | - Claudia Der-Martirosian
- a US Department of Veterans Affairs , Veterans Emergency Management Evaluation Center (VEMEC) , North Hills , California , USA
| | - Aram Dobalian
- a US Department of Veterans Affairs , Veterans Emergency Management Evaluation Center (VEMEC) , North Hills , California , USA.,b Division of Health Systems Management and Policy , University of Memphis School of Public Health , Memphis , Tennessee , USA
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19
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Park SH, Cha WC, Kim G, Lee TR, Hwang SY, Shin TG, Sim MS, Jo IJ. Effect of typhoons on the Korean national emergency medical service system. Clin Exp Emerg Med 2018; 5:272-277. [PMID: 30571906 PMCID: PMC6301860 DOI: 10.15441/ceem.17.255] [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: 07/14/2017] [Accepted: 10/12/2017] [Indexed: 11/23/2022] Open
Abstract
Objective While the effect of typhoons on emergency medicine has been evaluated, data are scarce on their effects on the emergency medical service (EMS). This study evaluated the effect of typhoons on EMS patients and performance. Methods The study period was January 2010 to December 2012. Meteorological data regarding typhoons were provided by the Korean Meteorological Administration. EMS data were retrieved from the EMS database of the national emergency management agency. The database includes ambulance run sheets, which contain clinical and operational data. In this case-crossover study, the cases and controls were EMS calls on the day of typhoon warnings and calls one week prior to the typhoon warnings, respectively. Results During the study period, 11 typhoons affected Korea. A total of 14,521 cases were selected for analysis. Overall, there were no obvious differences between the case and control groups. However, there were statistically significant differences in age, place, and time requests. There were fewer patients between 0 and 15 years of age (P=0.01) and more unconscious patients (P=0.01) in the case group. The EMS operational performance, as measured by the times elapsed between call to start, call to field, and call to hospital did not differ significantly. There was also no significant difference in the time from hospital arrival between the cases (28.67, standard deviation 16.37) and controls (28.97, standard deviation 28.91) (P=0.39). Conclusion Typhoons did not significantly affect the EMS system in this study. Further study is necessary to understand the reasons for this finding.
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Affiliation(s)
- Soo Hyun Park
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Korea
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Korea
| | - Giwoon Kim
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Tae Rim Lee
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Korea
| | - Min Seob Sim
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Korea
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Korea
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Pines JM. Freestanding emergency department visits and disasters: The case of Hurricane Harvey. Am J Emerg Med 2018; 36:1513-1515. [DOI: 10.1016/j.ajem.2018.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 01/03/2018] [Indexed: 11/28/2022] Open
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Bell SA, Abir M, Choi H, Cooke C, Iwashyna T. All-Cause Hospital Admissions Among Older Adults After a Natural Disaster. Ann Emerg Med 2018; 71:746-754.e2. [PMID: 28789804 PMCID: PMC7075393 DOI: 10.1016/j.annemergmed.2017.06.042] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 06/23/2017] [Accepted: 06/28/2017] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE We characterize hospital admissions among older adults for any cause in the 30 days after a significant natural disaster in the United States. The main outcome was all-cause hospital admissions in the 30 days after natural disaster. Separate analyses were conducted to examine all-cause hospital admissions excluding the 72 hours after the disaster, ICU admissions, all-cause inhospital mortality, and admissions by state. METHODS A self-controlled case series analysis using the 2011 Medicare Provider and Analysis Review was conducted to examine exposure to natural disaster by elderly adults located in zip codes affected by tornadoes during the 2011 southeastern superstorm. Spatial data of tornado events were obtained from the National Oceanic and Atmospheric Administration's Severe Report database, and zip code data were obtained from the US Census Bureau. RESULTS All-cause hospital admissions increased by 4% for older adults in the 30 days after the April 27, 2011, tornadoes (incidence rate ratio 1.04; 95% confidence interval 1.01 to 1.07). When the first 3 days after the disaster that may have been attributed to immediate injuries were excluded, hospitalizations for any cause also remained higher than when compared with the other 11 months of the year (incidence rate ratio 1.04; 95% confidence interval 1.01 to 1.07). There was no increase in ICU admissions or inhospital mortality associated with the natural disaster. When data were examined by individual states, Alabama, which had the highest number of persons affected, had a 9% increase in both hospitalizations and ICU admissions. CONCLUSION When all time-invariant characteristics were controlled for, this natural disaster was associated with a significant increase in all-cause hospitalizations. This analysis quantifies acute care use after disasters through examining all-cause hospitalizations and represents an important contribution to building models of resilience-the ability to recover from a disaster-and hospital surge capacity.
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Affiliation(s)
- Sue Anne Bell
- National Clinician Scholars Program, Institute for Health Care Policy and Innovation and School of Nursing, University of Michigan, Ann Arbor, MI.
| | - Mahshid Abir
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI
| | - HwaJung Choi
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Colin Cooke
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Theodore Iwashyna
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
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Mining co-occurrence and sequence patterns from cancer diagnoses in New York State. PLoS One 2018; 13:e0194407. [PMID: 29698405 PMCID: PMC5919533 DOI: 10.1371/journal.pone.0194407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 02/19/2018] [Indexed: 11/19/2022] Open
Abstract
The goal of this study is to discover disease co-occurrence and sequence patterns from large scale cancer diagnosis histories in New York State. In particular, we want to identify disparities among different patient groups. Our study will provide essential knowledge for clinical researchers to further investigate comorbidities and disease progression for improving the management of multiple diseases. We used inpatient discharge and outpatient visit records from the New York State Statewide Planning and Research Cooperative System (SPARCS) from 2011-2015. We grouped each patient’s visit history to generate diagnosis sequences for seven most popular cancer types. We performed frequent disease co-occurrence mining using the Apriori algorithm, and frequent disease sequence patterns discovery using the cSPADE algorithm. Different types of cancer demonstrated distinct patterns. Disparities of both disease co-occurrence and sequence patterns were observed from patients within different age groups. There were also considerable disparities in disease co-occurrence patterns with respect to different claim types (i.e., inpatient, outpatient, emergency department and ambulatory surgery). Disparities regarding genders were mostly found where the cancer types were gender specific. Supports of most patterns were usually higher for males than for females. Compared with secondary diagnosis codes, primary diagnosis codes can convey more stable results. Two disease sequences consisting of the same diagnoses but in different orders were usually with different supports. Our results suggest that the methods adopted can generate potentially interesting and clinically meaningful disease co-occurrence and sequence patterns, and identify disparities among various patient groups. These patterns could imply comorbidities and disease progressions.
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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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Lower Respiratory Symptoms Associated With Environmental and Reconstruction Exposures After Hurricane Sandy. Disaster Med Public Health Prep 2018; 12:697-702. [PMID: 29352822 DOI: 10.1017/dmp.2017.140] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In a population with prior exposure to the World Trade Center (WTC) disaster, this study sought to determine the relationship between Hurricane Sandy-related inhalation exposures and post-Sandy lower respiratory symptoms (LRS). METHODS Participants included 3835 WTC Health Registry enrollees who completed Wave 3 (2011-2012) and Hurricane Sandy (2013) surveys. The Sandy-related inhalational exposures examined were: (1) reconstruction exposure; (2) mold or damp environment exposure; and (3) other respiratory irritants exposure. LRS were defined as wheezing, persistent cough, or shortness of breath reported on ≥1 of the 30 days preceding survey completion. Associations between LRS and Sandy exposures, controlling for socio-demographic factors, post-traumatic stress disorder, and previously reported LRS and asthma were examined using multiple logistic regression. RESULTS Over one-third of participants (34.4%) reported post-Sandy LRS. Each of the individual exposures was also independently associated with post-Sandy LRS, each having approximately twice the odds of having post-Sandy LRS. We found a dose-response relationship between the number of types of Sandy-related exposures reported and post-Sandy LRS. CONCLUSIONS This study provides evidence that post-hurricane clean-up and reconstruction exposures can increase the risk for LRS. Public health interventions should emphasize the importance of safe remediation practices and recommend use of personal protective equipment. (Disaster Med Public Health Preparedness. 2018;12:697-702).
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Toner ES, McGinty M, Schoch-Spana M, Rose DA, Watson M, Echols E, Carbone EG. A Community Checklist for Health Sector Resilience Informed by Hurricane Sandy. Health Secur 2017; 15:53-69. [PMID: 28192055 DOI: 10.1089/hs.2016.0079] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This is a checklist of actions for healthcare, public health, nongovernmental organizations, and private entities to use to strengthen the resilience of their community's health sector to disasters. It is informed by the experience of Hurricane Sandy in New York and New Jersey and analyzed in the context of findings from other recent natural disasters in the United States. The health sector is defined very broadly, including-in addition to hospitals, emergency medical services (EMS), and public health agencies-healthcare providers, outpatient clinics, long-term care facilities, home health providers, behavioral health providers, and correctional health services. It also includes community-based organizations that support these entities and represent patients. We define health sector resilience very broadly, including all factors that preserve public health and healthcare delivery under extreme stress and contribute to the rapid restoration of normal or improved health sector functioning after a disaster. We present the key findings organized into 8 themes. We then describe a conceptual map of health sector resilience that ties these themes together. Lastly, we provide a series of recommended actions for improving health sector resilience at the local level. The recommended actions emphasize those items that individuals who experienced Hurricane Sandy deemed to be most important. The recommendations are presented as a checklist that can be used by a variety of interested parties who have some role to play in disaster preparedness, response, and recovery in their own communities. Following a general checklist are supplemental checklists that apply to specific parts of the larger health sector.
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Schwartz RM, Gillezeau CN, Liu B, Lieberman-Cribbin W, Taioli E. Longitudinal Impact of Hurricane Sandy Exposure on Mental Health Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14090957. [PMID: 28837111 PMCID: PMC5615494 DOI: 10.3390/ijerph14090957] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 08/21/2017] [Accepted: 08/22/2017] [Indexed: 02/08/2023]
Abstract
Hurricane Sandy hit the eastern coast of the United States in October 2012, causing billions of dollars in damage and acute physical and mental health problems. The long-term mental health consequences of the storm and their predictors have not been studied. New York City and Long Island residents completed questionnaires regarding their initial Hurricane Sandy exposure and mental health symptoms at baseline and 1 year later (N = 130). There were statistically significant decreases in anxiety scores (mean difference = -0.33, p < 0.01) and post-traumatic stress disorder (PTSD) scores (mean difference = -1.98, p = 0.001) between baseline and follow-up. Experiencing a combination of personal and property damage was positively associated with long-term PTSD symptoms (ORadj 1.2, 95% CI [1.1-1.4]) but not with anxiety or depression. Having anxiety, depression, or PTSD at baseline was a significant predictor of persistent anxiety (ORadj 2.8 95% CI [1.1-6.8], depression (ORadj 7.4 95% CI [2.3-24.1) and PTSD (ORadj 4.1 95% CI [1.1-14.6]) at follow-up. Exposure to Hurricane Sandy has an impact on PTSD symptoms that persists over time. Given the likelihood of more frequent and intense hurricanes due to climate change, future hurricane recovery efforts must consider the long-term effects of hurricane exposure on mental health, especially on PTSD, when providing appropriate assistance and treatment.
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Affiliation(s)
- Rebecca M Schwartz
- Department of Occupational Medicine, Epidemiology and Prevention, Hofstra Northwell Health School of Medicine, Great Neck, NY 11021, USA.
| | - Christina N Gillezeau
- Department of Population Health Science and Policy and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Bian Liu
- Department of Population Health Science and Policy and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Wil Lieberman-Cribbin
- Department of Population Health Science and Policy and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Emanuela Taioli
- Department of Population Health Science and Policy and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
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