Dataset Information

Long-term Effects of Disasters on Seniors With Diabetes: Evidence From Hurricanes Katrina and Rita.

ABSTRACT: OBJECTIVE:To estimate the long-run mortality effects of Hurricanes Katrina and Rita on seniors with diabetes. RESEARCH DESIGN AND METHODS:We performed a retrospective cohort analysis of Medicare enrollment and claims data covering four states and ?10 years. Affected individuals were identified by whether they lived in a county that suffered a high impact and were stratified by whether they moved to a different county following the storms. Propensity scores matched affected and comparison subjects based on demographic and socioeconomic characteristics and the presence of chronic conditions. Our sample consisted of 170,328 matched affected subjects. RESULTS:The affected subjects had a nearly 40% higher all-cause mortality risk in the 1st month after the storms, but the difference fell to <6% by the end of the full observation period. The mortality risks of heart disease and nephritis also exhibited the largest differences immediately following the storms. Among the affected subjects, the all-cause mortality risk was higher for those who moved to a different county, with an especially large difference among those who moved to an affected county. CONCLUSIONS:The propensity matching procedure resulted in the comparison and affected groups having similar observable characteristics. However, we only examined the extreme outcome of mortality, our definition of affected was somewhat crude, and our sample did not include individuals enrolled in Medicare Advantage. Our findings highlight the importance of the immediate response to disasters, yet also demonstrate the long-lasting impact disasters can have.

SUBMITTER: Quast T

PROVIDER: S-EPMC6804607 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Long-term Effects of Disasters on Seniors With Diabetes: Evidence From Hurricanes Katrina and Rita.

Quast Troy T Andel Ross R Sadhu Archana R AR

Diabetes care 20190923 11

<h4>Objective</h4>To estimate the long-run mortality effects of Hurricanes Katrina and Rita on seniors with diabetes.<h4>Research design and methods</h4>We performed a retrospective cohort analysis of Medicare enrollment and claims data covering four states and ∼10 years. Affected individuals were identified by whether they lived in a county that suffered a high impact and were stratified by whether they moved to a different county following the storms. Propensity scores matched affected and com ...[more]

PMID: 31548250

Similar Datasets

Project description:BackgroundHurricanes Katrina and Sandy were two of the most significant disasters of the 21st century that critically impacted communities and the health of their residents. Despite the assumption that disasters affect access to healthcare, to our knowledge prior studies have not rigorously examined availability of healthcare providers following disasters.ObjectiveThe objective of this study was to examine availability of healthcare providers following large-scale hurricanes.MethodsUsing historical data on healthcare providers from the National Plan and Provider Enumeration System and county-level population characteristics, we conducted a quasi-experimental study to examine the effect of large-scale hurricanes on healthcare provider availability in the short-term and long-term. We separately examined availability of primary care physicians, medical specialists, surgeons, and nurse practitioners. A difference-in-differences analysis was used to control for time variant factors comparing county-level health care provider availability in affected and unaffected counties the year before Hurricanes Katrina and Sandy, to five years after each storm.ResultsCounties affected by Hurricane Katrina compared to unaffected locales experienced a decrease of 3.59 primary care physicians per 10,000 population (95% CI: -6.5, -0.7), medical specialists (decrease of 5.9 providers per 10,000 (95% CI: -11.3, -0.5)), and surgeons (decrease of 2.1 (95% CI: -3.8, -0.37)). However, availability of nurse practitioners did not change appreciably. Counties affected by Hurricane Sandy exhibited less pronounced changes. Changes in availability of primary care physicians, nurse practitioners, medical specialists, and surgeons were not statistically significant.ConclusionLarge-scale hurricanes appear to affect availability of healthcare providers for up to several years following impact of the storm. Effects vary depending on the characteristics of the community. Primary care physicians and medical specialists availability was the most impacted, potentially having long-term implications for population health in the context of disaster recovery.

Project description:BackgroundAlthough studies have shown associations between neighbourhood quality and chronic disease outcomes, such associations are potentially confounded by the selection of different types of people into different neighbourhood environments. We sought to identify the causal effects of neighbourhood deprivation on type 2 diabetes risk, by comparing refugees in Sweden who were actively dispersed by government policy to low-deprivation, moderate-deprivation, or high-deprivation neighbourhoods.MethodsIn this quasi-experimental study, we analysed national register data for refugees who arrived in Sweden aged 25-50 years, at a time when the government policy involved quasi-random dispersal of refugees to neighbourhoods with different levels of poverty and unemployment, schooling, and social welfare participation. Individuals in our sample were assigned to a neighbourhood categorised as high deprivation (≥1 SD above the mean), moderate deprivation (within 1 SD of the mean), or low deprivation (≥1 SD below the mean). The primary outcome was new diagnosis of type 2 diabetes between Jan 1, 2002, and Dec 31, 2010. We used multivariate logistic and linear regressions to assess the effects of neighbourhood deprivation on diabetes risk, controlling for potential confounders affecting neighbourhood assignment and assessing effects of cumulative exposure to different neighbourhood conditions.FindingsWe included data for 61 386 refugees who arrived in Sweden during 1987-91 and who were assigned to one of 4833 neighbourhoods. Being assigned to an area deemed high deprivation versus low deprivation was associated with an increased risk of diabetes (odds ratio [OR] 1·22, 95% CI 1·07-1·38; p=0·001). In analyses that included fixed effects for assigned municipality, the increased diabetes risk was estimated to be 0·85 percentage points (95% CI -0·030 to 1·728; p=0·058). Neighbourhood effects grew over time such that 5 years of additional exposure to high-deprivation versus low-deprivation neighbourhoods was associated with a 9% increase in diabetes risk.InterpretationThis study makes use of a pre-existing governmental natural experiment to show that neighbourhood deprivation increased the risk of diabetes in refugees in Sweden. This finding has heightened importance in the context of the current refugee crisis in Europe.FundingUS National Heart, Lung, and Blood Institute, US National Center for Advancing Translational Sciences, US National Institute on Minority Health and Health Disparities, Swedish Research Council.

Dataset Information

Long-term Effects of Disasters on Seniors With Diabetes: Evidence From Hurricanes Katrina and Rita.

Publications

Long-term Effects of Disasters on Seniors With Diabetes: Evidence From Hurricanes Katrina and Rita.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets