Miller School of Medicine, Department of Neurological Surgery, University of Miami, Miami, FL 33136, USA.
Miller School of Medicine, Department of Obstetrics and Gynecology, University of Miami, Miami, FL 33136, USA.
Int J Environ Res Public Health. 2021 Mar 2;18(5):2442. doi: 10.3390/ijerph18052442.
Extreme weather events (EWE) are expected to increase as climate change intensifies, leaving coastal regions exposed to higher risks. South Florida has the highest HIV infection rate in the United States, and disruptions in clinic utilization due to extreme weather conditions could affect adherence to treatment and increase community transmission. The objective of this study was to identify the association between EWE and HIV-clinic attendance rates at a large academic medical system serving the Miami-Dade communities. The following methods were utilized: (1) Extreme heat index (EHI) and extreme precipitation (EP) were identified using daily observations from 1990-2019 that were collected at the Miami International Airport weather station located 3.6 miles from the studied HIV clinics. Data on hurricanes, coastal storms and flooding were collected from the National Oceanic and Atmospheric Administration Storms Database (NOAA) for Miami-Dade County. (2) An all-HIV clinic registry identified scheduled daily visits during the study period (hurricane seasons from 2017-2019). (3) Daily weather data were linked to the all-HIV clinic registry, where patients' 'no-show' status was the variable of interest. (4) A time-stratified, case crossover model was used to estimate the relative risk of no-show on days with a high heat index, precipitation, and/or an extreme natural event. A total of 26,444 scheduled visits were analyzed during the 383-day study period. A steady increase in the relative risk of 'no-show' was observed in successive categories, with a 14% increase observed on days when the heat index was extreme compared to days with a relatively low EHI, 13% on days with EP compared to days with no EP, and 10% higher on days with a reported extreme weather event compared to days without such incident. This study represents a novel approach to improving local understanding of the impacts of EWE on the HIV-population's utilization of healthcare, particularly when the frequency and intensity of EWE is expected to increase and disproportionately affect vulnerable populations. More studies are needed to understand the impact of EWE on routine outpatient settings.
随着气候变化的加剧，极端天气事件预计会增加，使沿海地区面临更高的风险。南佛罗里达州是美国 HIV 感染率最高的地区，由于极端天气条件导致的诊所就诊率中断，可能会影响治疗的依从性，并增加社区传播的风险。本研究的目的是确定在为迈阿密戴德社区服务的大型学术医疗系统中，极端天气事件与 HIV 诊所就诊率之间的关联。采用以下方法：（1）利用位于距研究 HIV 诊所 3.6 英里的迈阿密国际机场气象站 1990-2019 年的每日观测资料，确定极端高温指数（EHI）和极端降水（EP）。从迈阿密戴德县国家海洋和大气管理局风暴数据库（NOAA）收集有关飓风、沿海风暴和洪水的数据。（2）所有 HIV 诊所登记册确定了研究期间（2017-2019 年的飓风季节）的每日预约。（3）将每日天气数据与所有 HIV 诊所登记册相关联，其中患者的“未露面”状态是感兴趣的变量。（4）采用时间分层病例交叉模型来估计高温指数高、降水和/或极端自然事件发生日“未露面”的相对风险。在 383 天的研究期间分析了 26444 次预约。在连续的类别中观察到“未露面”的相对风险稳步增加，与相对较低的 EHI 相比，高温指数极端时的“未露面”风险增加 14%，与无降水相比，降水时的“未露面”风险增加 13%，与无极端天气事件相比，有报告的极端天气事件发生时的“未露面”风险增加 10%。本研究代表了一种改进对极端天气事件对 HIV 人群利用医疗保健影响的本地理解的新方法，特别是当极端天气事件的频率和强度预计会增加且不成比例地影响弱势人群时。需要开展更多研究以了解极端天气事件对常规门诊环境的影响。
