Using Medicare data to identify individuals who are electricity dependent to improve disaster preparedness and response

The necessity to improve disaster preparedness among patients with amyotrophic lateral sclerosis and their families

Disaster preparation is an important issue for patients with amyotrophic lateral sclerosis (ALS). However, to the best of our knowledge, no studies have investigated disaster preparedness among patients with ALS. In this study, we aimed to investigate disaster preparation in patients with ALS and their caregivers, including their families, in Japan. We conducted a nationwide webinar in September 2022 titled "ALS Café" and distributed a self-report questionnaire to participants with questions about awareness of disaster preparedness, social countermeasures, stockpiles, and electricity demand. Forty-eight patients with ALS (27 male; average age 60.0 ± 9.3 years) and 23 caregivers (8 male; 55.7 ± 9.9 years) responded. The median revised ALS Functional Rating Scale score was 30.5, and 25% of the patients with ALS were on a ventilator. More than 70% of the respondents answered that they were not prepared for disasters, increasing to 89% in patients not using ventilators. In the event of their phones being down, 86% of the respondents had no plans for alternative means of communication. <30% of the respondents, including ventilator users, had secured human resources for transportation. Twenty-five percent of the respondents did not stockpile food and beverages, and 12% of the ventilator users had no government-recommended ventilator preparation equipment. Thus, although patients with ALS and their families with ventilators have a high awareness of disaster preparedness, their awareness remains insufficient. Furthermore, patients with ALS and their families without ventilators have a low awareness of disaster preparedness. Therefore, better education regarding disaster preparedness is necessary for these groups.

Spatiotemporal distribution of power outages with climate events and social vulnerability in the USA

Power outages threaten public health. While outages will likely increase with climate change, an aging electrical grid, and increased energy demand, little is known about their frequency and distribution within states. Here, we characterize 2018-2020 outages, finding an average of 520 million customer-hours total without power annually across 2447 US counties (73.7% of the US population). 17,484 8+ hour outages (a medically-relevant duration with potential health consequences) and 231,174 1+ hour outages took place, with greatest prevalence in Northeastern, Southern, and Appalachian counties. Arkansas, Louisiana, and Michigan counties experience a dual burden of frequent 8+ hour outages and high social vulnerability and prevalence of electricity-dependent durable medical equipment use. 62.1% of 8+ hour outages co-occur with extreme weather/climate events, particularly heavy precipitation, anomalous heat, and tropical cyclones. Results could support future large-scale epidemiology studies, inform equitable disaster preparedness and response, and prioritize geographic areas for resource allocation and interventions.

The independent and synergistic impacts of power outages and floods on hospital admissions for multiple diseases

Highly destructive disasters such as floods and power outages (PO) are becoming more commonplace in the U.S. Few studies examine the effects of floods and PO on health, and no studies examine the synergistic effects of PO and floods, which are increasingly co-occurring events. We examined the independent and synergistic impacts of PO and floods on cardiovascular diseases, chronic respiratory diseases, respiratory infections, and food-/water-borne diseases (FWBD) in New York State (NYS) from 2002 to 2018. We obtained hospitalization data from the NYS discharge database, PO data from the NYS Department of Public Service, and floods events from NOAA. Distributed lag nonlinear models were used to evaluate the PO/floods-health association while controlling for time-varying confounders. We identified significant increased health risks associated with both the independent effects from PO and floods, and their synergistic effects. Generally, the Rate Ratios (RRs) for the co-occurrence of PO and floods were the highest, followed by PO alone, and then floods alone, especially when PO coverage is >75th percentile of its distribution (1.72% PO coverage). For PO and floods combined, immediate effects (lag 0) were observed for chronic respiratory diseases (RR:1.58, 95%CI: 1.24, 2.00) and FWBD (RR:3.02, 95%CI: 1.60, 5.69), but delayed effects were found for cardiovascular diseases (lag 3, RR:1.13, 95%CI: 1.03, 1.24) and respiratory infections (lag 6, RR:1.85, 95%CI: 1.35, 2.53). The risk association was slightly stronger among females, whites, older adults, and uninsured people but not statistically significant. Improving power system resiliency could be a very effective way to alleviate the burden on hospitals during co-occurring floods. We conclude that PO and floods have independently and jointly led to increased hospitalization for multiple diseases, and more research is needed to confirm our findings.

Energy, Data, and Decision-Making: a Scoping Review-the 3D Commission

Access to energy is an important social determinant of health, and expanding the availability of affordable, clean energy is one of the Sustainable Development Goals. It has been argued that climate mitigation policies can, if well-designed in response to contextual factors, also achieve environmental, economic, and social progress, but otherwise pose risks to economic inequity generally and health inequity specifically. Decisions around such policies are hampered by data gaps, particularly in low- and middle-income countries (LMICs) and among vulnerable populations in high-income countries (HICs). The rise of "big data" offers the potential to address some of these gaps. This scoping review sought to explore the literature linking energy, big data, health, and decision-making.Literature searches in PubMed, Embase, and Web of Science were conducted. English language articles up to April 1, 2020, were included. Pre-agreed study characteristics including geographic location, data collected, and study design were extracted and presented descriptively, and a qualitative thematic analysis was performed on the articles using NVivo.Thirty-nine articles fulfilled eligibility criteria. These included a combination of review articles and research articles using primary or secondary data sources. The articles described health and economic effects of a wide range of energy types and uses, and attempted to model effects of a range of technological and policy innovations, in a variety of geographic contexts. Key themes identified in our analysis included the link between energy consumption and economic development, the role of inequality in understanding and predicting harms and benefits associated with energy production and use, the lack of available data on LMICs in general, and on the local contexts within them in particular. Examples of using "big data," and areas in which the articles themselves described challenges with data limitations, were identified.The findings of this scoping review demonstrate the challenges decision-makers face in achieving energy efficiency gains and reducing emissions, while avoiding the exacerbation of existing inequities. Understanding how to maximize gains in energy efficiency and uptake of new technologies requires a deeper understanding of how work and life is shaped by socioeconomic inequalities between and within countries. This is particularly the case for LMICs and in local contexts where few data are currently available, and for whom existing evidence may not be directly applicable. Big data approaches may offer some value in tracking the uptake of new approaches, provide greater data granularity, and help compensate for evidence gaps in low resource settings.

[Knowledge gained from a 31-h power outage in Berlin Köpenick-medical problems and challenges]

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.

Trends from 2008 to 2018 in Electricity-dependent Durable Medical Equipment Rentals and Sociodemographic Disparities

BACKGROUND

Duration and number of power outages have increased over time, partly fueled by climate change, putting users of electricity-dependent durable medical equipment (hereafter, "durable medical equipment") at particular risk of adverse health outcomes. Given health disparities in the United States, we assessed trends in durable medical equipment rental prevalence and individual- and area-level sociodemographic inequalities.

METHODS

Using Kaiser Permanente South California electronic health record data, we identified durable medical equipment renters. We calculated annual prevalence of equipment rental and fit hierarchical generalized linear models with ZIP code random intercepts, stratified by rental of breast pumps or other equipment.

RESULTS

243,559 KPSC members rented durable medical equipment between 2008 and 2018. Rental prevalence increased over time across age, sex, racial-ethnic, and Medicaid categories, most by >100%. In adjusted analyses, Medicaid use was associated with increased prevalence and 108 (95% confidence interval [CI] = 99, 117) additional days of equipment rental during the study period. ZIP code-level sociodemographics were associated with increased prevalence of equipment rentals, for example, a 1 SD increase in percent unemployed and

CONCLUSIONS

We observed some socioeconomic disparities among a growing electricity-dependent population. Our findings are consistent with the hypothesis that reliable electricity access is increasingly required to meet the health needs of medically disadvantaged groups. See video abstract at http://links.lww.com/EDE/B793.

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Key Words

• durable medical equipment
• electronic health records
• socioeconomic factors
• vulnerable populations
• medicaid

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MESH Headings

• Durable Medical Equipment
• Electricity
• Ethnicity
• Humans
• Medicaid
• Racial Groups
• United States/epidemiology

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Grants

• K99 DA051534 NIDA NIH HHS
• P30 ES009089 NIEHS NIH HHS
• R00 ES027023 NIEHS NIH HHS

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Affiliation(s)

Joan A. Casey Columbia University Mailman School of Public Health, New York, NY
Marriele Mango Clean Energy Group, Montpelier, VT
Seth Mullendore Clean Energy Group, Montpelier, VT
Mathew V. Kiang Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA
Diana Hernández Columbia University Mailman School of Public Health, New York, NY
Bonnie H. Li Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
Kris Li Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
Theresa M. Im Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
Sara Y. Tartof Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA

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Health Care Needs in the Aftermath of Hurricane Maria in Puerto Rico: A Perspective from Federal Medical Shelter Manatí

INTRODUCTION

On September 20, 2017, Hurricane Maria, a Category 4 hurricane, swept across Puerto Rico (PR), wreaking devastation to PR's power, water, and health care infrastructure. To address the imminent humanitarian crisis, the US government mobilized Federal Medical Shelters (FMS) to serve the needs of hurricane victims. This study's objective was to provide a description of the patients seeking emergency care at FMS and the changes in their needs over time.

METHODS

This retrospective, cross-sectional study included all patients presenting to the FMS Manatí from October 6, two weeks after Hurricane Maria's landfall, to November 2, 2017. Categories were created to catalogue the nature of new acute medical issues by patients presenting to the Shelter. Descriptive, graphical analyses were performed to assess changes to presenting complaints over time, and by age groups defined as infant (age ≤1 years), child (1 year < age ≤10 years), adolescent (10 years < age ≤ 25 years), and adult (age > 25 years).

RESULTS

Over the 30-day period, 5,268 patients were seen in the FMS seeking medical care (average 188.1 patients per day), spending less than five hours in the facility. The distribution of patients' age was bimodal: the first peak at one year and the second at age 50. The most common patient complaint was infection (38.8%), then musculoskeletal (MSK) complaints (11.8%) and management of chronic medical conditions (11.8%). The proportion of patients presenting with chronic disease complaints declined over the course of the period of observation (21.4% on Day 4 to 8.0% on Day 30) while the proportion of patients presenting with infection increased (31.0% on Day 4 to 48.6% on Day 30). Infection complaints were highest in all age groups, but most in infxants (80.2%), while MSK and chronic disease complaints were highest in adults (14.9% and 14.9%, respectively).

CONCLUSION

Infection treatment and chronic disease management were important medical needs facing patients seeking care at FMS Manatí after Hurricane Maria. These findings suggest that basic needs related to sanitation and shelter remained important weeks after the hurricane, and a focus on access to medications, infection control, and injury prevention/management after a disaster needs to be prioritized during disaster response.

Sepsis Among Medicare Beneficiaries: 1. The Burdens of Sepsis, 2012-2018

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.

Power Outage Preparedness and Concern among Vulnerable New York City Residents

Power outages can impact health, and certain populations may be more at risk. Personal preparedness may reduce impacts, but information on power outage preparedness and risk perception among vulnerable populations is limited. We examined power outage preparedness and concern among New York City residents, including vulnerable populations defined as older adults (≥ 65 years), and respondents with household members who require assistance with daily activities or depend on electric medical devices. A random sample telephone survey was conducted during November-December 2016. Preparedness was defined as having a three-day supply of drinking water, non-perishable food, and a working flashlight. Among all respondents (n = 887), 58% were prepared and 46% expressed concern about health. Respondents with electric-dependent household members (9% of all respondents) tended to have higher preparedness (70 vs. 56% of respondents without electric-dependent household members). Among this group, only 40% reported being registered with a utility company to receive early notification of outages. While the subgroup sample was small, respondents with registered electric-dependent household members had lower preparedness than those with non-registered users (59 vs. 76%). Respondents with household members who needed assistance had comparable levels of preparedness to respondents without someone who needed assistance (59 vs. 57%). Older adults had greater preparedness than younger adults (65 vs. 56%). Health concerns were greater among all vulnerable groups than the general population. Levels of preparedness varied among vulnerable respondents, and awareness of power outage notification programs was low. Our findings highlight the need to increase awareness and preparedness among at-risk people.

Improving Disaster Resilience Among Older Adults: Insights from Public Health Departments and Aging-in-Place Efforts

This study uses interview data collected from public health departments and aging-in-place efforts-specifically, from coordinators of age-friendly communities and village executive directors-to explore how current aging-in-place efforts can be harnessed to strengthen the disaster resilience of older adults and which existing programs or new collaborations among public health departments and these organizations show promise for improving disaster resilience for older populations. Interviews with stakeholders revealed that most age-friendly communities and senior villages did not place a high priority on promoting disaster preparedness. While most public health departments conducted or took the lead on disaster preparedness and resilience activities, they were not necessarily tailored to older adults. Aligning and extending public health departments' current preparedness activities to include aging-in-place efforts and greater tailoring of existing preparedness activities to the needs of older adults could significantly improve their disaster preparedness and resilience. For jurisdictions that do not have an existing aging-in-place effort, public health departments can help initiate those efforts and work to incorporate preparedness activities at the outset of newly developing aging-in-place efforts.

Who's at Risk When the Power Goes Out? The At-home Electricity-Dependent Population in the United States, 2012

OBJECTIVES

Natural and man-made disasters can result in power outages that can affect certain vulnerable populations dependent on electrically powered durable medical equipment. This study estimated the size and prevalence of that electricity-dependent population residing at home in the United States.

METHODS

We used the Truven Health MarketScan 2012 database to estimate the number of employer-sponsored privately insured enrollees by geography, age group, and sex who resided at home and were dependent upon electrically powered durable medical equipment to sustain life. We estimated nationally representative prevalence and used US Census population estimates to extrapolate the national population and produce maps visualizing prevalence and distribution of electricity-dependent populations residing at home.

RESULTS

As of 2012, among the 175 million persons covered by employer-sponsored private insurance, the estimated number of electricity-dependent persons residing at home was 366 619 (95% confidence interval: 365 700-367 537), with a national prevalence of 218.2 per 100 000 covered lives (95% confidence interval: 217.7-218.8). Prevalence varied significantly by age group (χ = 264 289 95, P < .0001) and region (χ = 12 286 30, P < .0001), with highest prevalence in those 65 years of age or older and in the South and the West. Across all insurance types in the United States, approximately 685 000 electricity-dependent persons resided at home.

CONCLUSIONS

These results may assist public health jurisdictions addressing unique needs and necessary resources for this particularly vulnerable population. Results can verify and enhance the development of functional needs registries, which are needed to help first responders target efforts to those most vulnerable during disasters affecting the power supply.

How Do Communities Use a Participatory Public Health Approach to Build Resilience? The Los Angeles County Community Disaster Resilience Project

Community resilience is a key concept in the National Health Security Strategy that emphasizes development of multi-sector partnerships and equity through community engagement. Here, we describe the advancement of CR principles through community participatory methods in the Los Angeles County Community Disaster Resilience (LACCDR) initiative. LACCDR, an initiative led by the Los Angeles County Department of Public Health with academic partners, randomized 16 community coalitions to implement either an Enhanced Standard Preparedness or Community Resilience approach over 24 months. Facilitated by a public health nurse or community educator, coalitions comprised government agencies, community-focused organizations and community members. We used thematic analysis of data from focus groups (n = 5) and interviews (n = 6 coalition members; n = 16 facilitators) to compare coalitions’ strategies for operationalizing community resilience levers of change (engagement, partnership, self-sufficiency, education). We find that strategies that included bidirectional learning helped coalitions understand and adopt resilience principles. Strategies that operationalized community resilience levers in mutually reinforcing ways (e.g., disseminating information while strengthening partnerships) also secured commitment to resilience principles. We review additional challenges and successes in achieving cross-sector collaboration and engaging at-risk groups in the resilience versus preparedness coalitions. The LACCDR example can inform strategies for uptake and implementation of community resilience and uptake of the resilience concept and methods.

Factors Related to Evacuation Intentions of Power-Dependent Home Care Patients in Japan

This study investigated factors affecting disaster preparedness and evacuation intentions among home-care patients dependent on electrical power for life support. Health professionals interviewed 53 home-care patients using the Kanazawa and Kochi Disaster Preparedness Checklist. About half of the participants requiring continuous artificial ventilation or aspiration indicated that they would not or could not evacuate following a disaster-even though their lives could be at risk. The availability of emergency medical equipment for use during a power outage was positively associated with the desire to evacuate. Our results indicate the need for improved systems to assist power-dependent home-care patients.

Early Dialysis and Adverse Outcomes After Hurricane Sandy

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.

Variables associated with effects on morbidity in older adults following disasters

INTRODUCTION

Older adults are vulnerable to disproportionately higher morbidity following disasters. Reasons for this vulnerability are multifaceted and vary by disaster type as well as patient comorbidities. Efforts to mitigate this increased morbidity require identification of at-risk older adults who can be targeted for intervention.

METHODS

A PubMed search was performed using the search terms "geriatric, disaster" and "morbidity, disaster" to identify published articles that reported variables associated with increased morbidity of older adults during and after disasters. A review of article titles and abstracts was then conducted to identify those articles that contained evidence-based variables that render older adults vulnerable to poor health outcomes during disasters.

RESULTS

A total of 233 studies was initially identified. After applying exclusion criteria, nine studies were chosen for the comprehensive review. Based on the synthesis of the literature, factors were identified that were repeatedly associated with morbidity and mortality among older adults during and shortly after disasters.

CONCLUSION

Older adults, especially those with multiple co-morbidities, are at risk of increased morbidity after disasters and catastrophic events. Factors such as the need for prescription medications, low social support, visual and hearing impairment, impaired mobility, and poor economic status are associated with an increased risk of morbidity.