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Adult Mortality Five Years after a Natural Disaster.

ABSTRACT: Exposure to extreme events has been hypothesized to affect subsequent mortality because of mortality selection and scarring effects of the event itself. We examine survival at and in the five years after the 2004 Indian Ocean earthquake and tsunami for a population-representative sample of residents of Aceh, Indonesia who were differentially exposed to the disaster. For this population, the dynamics of selection and scarring are a complex function of the degree of tsunami impact in the community, the nature of individual exposures, age at exposure, and gender. Among individuals from tsunami-affected communities we find evidence for positive mortality selection among older individuals, with stronger effects for males than for females, and that this selection dominates any scarring impact of stressful exposures that elevate mortality. Among individuals from other communities, where mortality selection does not play a role, there is evidence of scarring with property loss associated with elevated mortality risks in the five years after the disaster among adults age 50 or older at the time of the disaster.

SUBMITTER: Ho JY

PROVIDER: S-EPMC5929150 | biostudies-literature | 2017 Sep

REPOSITORIES: biostudies-literature

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Adult Mortality Five Years after a Natural Disaster.

Ho Jessica Y JY Frankenberg Elizabeth E Sumantri Cecep C Thomas Duncan D

Population and development review 20170628 3

Exposure to extreme events has been hypothesized to affect subsequent mortality because of mortality selection and scarring effects of the event itself. We examine survival at and in the five years after the 2004 Indian Ocean earthquake and tsunami for a population-representative sample of residents of Aceh, Indonesia who were differentially exposed to the disaster. For this population, the dynamics of selection and scarring are a complex function of the degree of tsunami impact in the community ...[more]

PMID: 29731526

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Project description:ObjectivesTo develop a transparent and reproducible measure for hospitals that can indicate when deaths in hospital or within 30 days of discharge are high relative to other hospitals, given the characteristics of the patients in that hospital, and to investigate those factors that have the greatest effect in changing the rank of a hospital, whether interactions exist between those factors, and the stability of the measure over time.DesignRetrospective cross sectional study of admissions to English hospitals.SettingHospital episode statistics for England from 1 April 2005 to 30 September 2010, with linked mortality data from the Office for National Statistics.Participants36.5 million completed hospital admissions in 146 general and 72 specialist trusts.Main outcome measuresDeaths within hospital or within 30 days of discharge from hospital.ResultsThe predictors that were used in the final model comprised admission diagnosis, age, sex, type of admission, and comorbidity. The percentage of people admitted who died in hospital or within 30 days of discharge was 4.2% for males and 4.5% for females. Emergency admissions comprised 75% of all admissions and 5.5% died, in contrast to 0.8% who died after an elective admission. The percentage who died with a Charlson comorbidity score of 0 was 2% in contrast with 15% who died with a score greater than 5. Given these variables, the relative standardised mortality rates of the hospitals were not noticeably changed by adjusting for the area level deprivation and number of previous emergency visits to hospital. There was little evidence that including interaction terms changed the relative values by any great amount. Using these predictors the summary hospital mortality index (SHMI) was derived. For 2007/8 the model had a C statistic of 0.911 and accounted for 81% of the variability of between hospital mortality. A random effects funnel plot was used to identify outlying hospitals. The outliers from the SHMI over the period 2005-10 have previously been identified using other mortality indicators.ConclusionThe SHMI is a relatively simple tool that can be used in conjunction with other information to identify hospitals that may need further investigation.

Dataset Information

Adult Mortality Five Years after a Natural Disaster.

Publications

Adult Mortality Five Years after a Natural Disaster.

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