Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island.
Providence Veterans Affairs Medical Center, Providence, Rhode Island.
JAMA Health Forum. 2022 Aug 5;3(8):e222534. doi: 10.1001/jamahealthforum.2022.2534.
On September 20, 2017, one of the most destructive hurricanes in US history made landfall in Puerto Rico. Anecdotal reports suggest that many persons with kidney failure left Puerto Rico after Hurricane Maria; however, empirical estimates of migration and health outcomes for this population are scarce.
To assess the changes in migration and mortality among patients with kidney failure in need of dialysis treatment in Puerto Rico after Hurricane Maria.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used an interrupted time-series design of 6-month mortality rates and migration of 11 652 patients who received hemodialysis or peritoneal dialysis care in Puerto Rico before Hurricane Maria (before October 1, 2017) and/or during and after Hurricane Maria (on/after October 1, 2017). Data analyses were performed from February 12, 2019, to June 16, 2022..
Number of unique persons dialyzed in Puerto Rico per quarter; receipt of dialysis treatment outside Puerto Rico per quarter; and 6-month mortality rate per person-quarter for all persons undergoing dialysis.
Hurricane Maria.
The entire study sample comprised 11 652 unique persons (mean [SD] age, 59 [14.7] years; 7157 [61.6%] men and 4465 [38.4%] women; 10 675 [91.9%] Hispanic individuals). There were 9022 patients with kidney failure and dialysis treatment before and 5397 patients after Hurricane Maria. Before the hurricane, the mean quarterly number of unique persons dialyzed in Puerto Rico was 2834 per quarter (95% CI, 2771-2897); afterwards it dropped to 261 (95% CI, -348 to -175; relative change, 9.2%). The percentage of persons who had 1 or more dialysis sessions outside of Puerto Rico in the next quarter following a previous dialysis in Puerto Rico was 7.1% before Hurricane Maria (95% CI, 4.8 to 9.3). There was a significant increase of 5.8 percentage points immediately after the hurricane (95% CI, 2.7 to 9.0). The 6-month mortality rate per person-quarter was 0.08 (95% CI, 0.08 to 0.09), and there was a nonsignificant increase in level of mortality rates and a nonsignificant decreasing trend in mortality rates.
The findings of this cross-sectional study suggest there was a significant increase in the number of people receiving dialysis outside of Puerto Rico after Hurricane Maria. However, no significant differences in mortality rates before and after the hurricane were found, which may reflect disaster emergency preparedness among dialysis facilities and the population with kidney failure, as well as efforts from other stakeholders.
2017 年 9 月 20 日，美国历史上破坏力最大的飓风之一在波多黎各登陆。有传闻称，飓风玛丽亚过后，许多肾衰竭患者离开波多黎各；然而，关于这一人群的移民和健康结果的实证估计却很少。
评估玛丽亚飓风过后波多黎各需要透析治疗的肾衰竭患者的移民和死亡率变化。
设计、设置和参与者：这项横断面研究采用了 6 个月死亡率和 11652 名在玛丽亚飓风前（2017 年 10 月 1 日之前）和/或在玛丽亚飓风期间和之后（2017 年 10 月 1 日及之后）在波多黎各接受血液透析或腹膜透析治疗的患者的移民和死亡率的中断时间序列设计。数据分析于 2019 年 2 月 12 日至 2022 年 6 月 16 日进行。
每季度在波多黎各接受透析治疗的独特人数；每季度在波多黎各以外接受透析治疗的人数；所有接受透析治疗的患者每季度的 6 个月死亡率。
玛丽亚飓风。
整个研究样本包括 11652 名独特的患者（平均[标准差]年龄为 59[14.7]岁；7157[61.6%]为男性，4465[38.4%]为女性；10675[91.9%]为西班牙裔个体）。有 9022 名患者在飓风前有肾脏衰竭和透析治疗，5397 名患者在飓风后有。在飓风前，每季度在波多黎各接受透析治疗的独特患者人数平均为 2834 人/季度（95%CI，2771-2897）；飓风后下降至 261 人（95%CI，-348 至-175；相对变化，9.2%）。在波多黎各接受透析治疗后，下一个季度有 1 次或更多透析治疗的患者百分比为 7.1%（95%CI，4.8%至 9.3%）。飓风后立即增加了 5.8 个百分点（95%CI，2.7%至 9.0%）。每季度的 6 个月死亡率为 0.08（95%CI，0.08 至 0.09），死亡率水平无显著变化，死亡率呈下降趋势。
这项横断面研究的结果表明，飓风玛丽亚过后，在波多黎各以外接受透析治疗的人数显著增加。然而，在飓风前后未发现死亡率有显著差异，这可能反映了透析机构和肾衰竭人群的灾害应急准备情况，以及其他利益相关者的努力。
