飓风后老年人慢性病住院情况：一项自身对照病例系列分析。
Hospitalizations for chronic conditions following hurricanes among older adults: A self-controlled case series analysis.
机构信息
University of Michigan School of Nursing, Ann Arbor, Michigan, USA.
University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
出版信息
J Am Geriatr Soc. 2022 Jun;70(6):1695-1703. doi: 10.1111/jgs.17702. Epub 2022 Feb 16.
BACKGROUND/PURPOSE: Extreme events such as hurricanes adversely impact healthcare systems and the communities they serve. The degree to which hurricanes affect healthcare use among high need groups such as older adults with chronic conditions has not been well examined, nor has the impact of hurricane severity on health outcomes. We characterized hospitalizations among older adults by chronic condition after eight large-scale hurricanes in the United States.
METHODS
Using a combination of administrative healthcare data and the Federal Emergency Management Agency's Disaster Declaration database we conducted a self-controlled case series analysis. We identified Medicare beneficiaries who were exposed to one of eight hurricanes and compared hospitalizations in the 30-days after a hurricane to hospitalizations in the rest of the calendar year of the hurricane. We examined hospitalizations (1) in total, (2) separately for diabetes, congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) admissions, and (3) by hurricane damage category.
RESULTS
Among all older adults exposed, hospitalizations in the 30-day period after each disaster increased for all three chronic conditions; diabetes (incidence rate ratio [IRR] = 1.06, 95% confidence interval [CI] 1.03, 1.10), COPD (IRR = 1.06, 95% CI 1.04, 1.08), and CHF (IRR = 1.19, 95% CI 1.17, 1.21. In the 30-to-60-day period hospitalizations also increased for each chronic condition; diabetes (IRR = 1.06, 95% CI 1.03, 1.10), COPD (IRR = 1.12, 95% CI 1.10, 1.15), and CHF (IRR = 1.32, 95% CI 1.30, 1.34). Substantial differences in hospitalizations were observed according to individual hurricane and by the chronic disease examined.
CONCLUSION
Exposure to hurricanes is associated with an increase in hospitalizations for chronic conditions across all hurricane damage categories. As disasters are expected to increase in strength and frequency, our results underscore the need for response strategies and health policy planning for healthcare systems designed to address the health needs of older Americans with chronic conditions.
背景/目的：飓风等极端事件对医疗保健系统及其服务的社区产生了不利影响。飓风对老年人等高需求群体的医疗保健使用的影响程度，以及飓风严重程度对健康结果的影响，尚未得到充分研究。我们在美国八次大规模飓风中描述了患有慢性病的老年人的住院情况。
方法
使用行政医疗保健数据和联邦紧急事务管理局（Federal Emergency Management Agency）的灾害声明数据库的组合，我们进行了自我对照病例系列分析。我们确定了暴露于八次飓风中的一次的 Medicare 受益人，并将飓风后 30 天的住院情况与飓风当年的剩余时间的住院情况进行了比较。我们检查了（1）总体住院情况，（2）糖尿病、充血性心力衰竭（congestive heart failure，CHF）和慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）入院情况的单独住院情况，以及（3）按飓风破坏类别分类的住院情况。
结果
在所有暴露于飓风的老年人中，每种慢性病的 30 天住院人数都有所增加；糖尿病（发病率比 [incidence rate ratio，IRR] = 1.06，95%置信区间 [confidence interval，CI] 1.03，1.10），COPD（IRR = 1.06，95% CI 1.04，1.08），和 CHF（IRR = 1.19，95% CI 1.17，1.21）。在 30 至 60 天期间，每种慢性病的住院人数也有所增加；糖尿病（IRR = 1.06，95% CI 1.03，1.10），COPD（IRR = 1.12，95% CI 1.10，1.15），和 CHF（IRR = 1.32，95% CI 1.30，1.34）。根据个别飓风和所检查的慢性病，住院情况存在显著差异。
结论
暴露于飓风与所有飓风破坏类别中慢性病住院人数的增加有关。随着灾害的强度和频率预计将增加，我们的结果强调了为旨在满足患有慢性病的美国老年人的健康需求的医疗保健系统制定应对策略和卫生政策规划的必要性。
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