All-Cause Hospitalizations after Large-Scale Hurricanes among Older Adults: A Self-Controlled Case Series Study

Abstract

Introduction: Understanding the drivers of health care utilization patterns following disasters can better support health planning. This study characterized all-cause hospitalizations among older Americans after eight large-scale hurricanes. Study Objective: The objective of this study was to characterize all-cause hospitalizations for any cause among older Americans in the 30 days after eight large-scale hurricanes. Methods: A self-controlled case series study among Medicare beneficiaries (age 65+) exposed to one of eight hurricanes was conducted. The predicted probability of sociodemographic factors associated with hospitalization using logit models was estimated. Results: Hurricane Sandy (2012) had the highest post-hurricane admission rate, a 23% increase (incidence rate ratio [IRR] = 1.23; 95% CI, 1.22-1.24), while Hurricane Irene in 2011 had only a 10% increase (IRR = 1.10; 95% CI, 1.09-1.11). Higher likelihood of hospitalization occurring after hurricanes included being 85 or older (36.8% probability of hospitalization; 95% CI, 34.7-39.0) and being dually eligible for Medicare and Medicaid (62.8%; 95% CI, 60.7-64.9). Conclusion: Planning to address the surge in hospitalization for a longer time period after hurricanes and interventions targeted to support aging Americans are needed.

Health Effects of Cyclones: A Systematic Review and Meta-Analysis of Epidemiological Studies

“…The excess risk for all-cause hospitalization associated with cyclone exposures was estimated by five studies from the United States. 9 , 56 , 63 – 65 Four of these studies observed an increased risk of all-cause hospitalization for up to 3 months after a high-amplitude hurricane (e.g., Hurricanes Katrina, Sandy, or Wilma). 9 , 56 , 63 , 65 A case-crossover study on eight large-scale hurricanes reported an elevated risk ranging from 15% to 37% for all-cause hospitalization among the population years of age in the 1-month period following cyclone exposures.…”

“… 9 , 56 , 63 – 65 Four of these studies observed an increased risk of all-cause hospitalization for up to 3 months after a high-amplitude hurricane (e.g., Hurricanes Katrina, Sandy, or Wilma). 9 , 56 , 63 , 65 A case-crossover study on eight large-scale hurricanes reported an elevated risk ranging from 15% to 37% for all-cause hospitalization among the population years of age in the 1-month period following cyclone exposures. 63 However, another time-series study on Hurricane Sandy showed no change in inpatient use inside the storm zone but did show a statistically significant reduction outside the storm zone over the 1-y post-cyclone period.…”

“… 9 , 56 , 63 , 65 A case-crossover study on eight large-scale hurricanes reported an elevated risk ranging from 15% to 37% for all-cause hospitalization among the population years of age in the 1-month period following cyclone exposures. 63 However, another time-series study on Hurricane Sandy showed no change in inpatient use inside the storm zone but did show a statistically significant reduction outside the storm zone over the 1-y post-cyclone period. 64 The meta-analysis of 10 estimates from three studies suggest a meta- (95% CI: 1.12, 1.25) for being hospitalized after cyclone exposures ( Figure 3 ).…”

“… 64 The meta-analysis of 10 estimates from three studies suggest a meta- (95% CI: 1.12, 1.25) for being hospitalized after cyclone exposures ( Figure 3 ). 63 – 65 The meta-RR was generally robust to the sensitivity analysis by excluding each estimate in turn (Table S6). High between-study heterogeneity ( , ), as well as statistically insignificant asymmetry (Figure S3a; for Egger’s regression ), were observed.…”

The threaten of typhoons to the health of residents in inland areas: a study on the vulnerability of residents to death risk during typhoon “Lekima”

“…Consistently, the older adults (≥ 65) were more vulnerable than the young group during the typhoon. Bell found the sizeable increase in older inpatients during eight separate hurricanes of American [ 44 ]. Weinberder referred that the increase in the proportion of emergency department visits due to cardiovascular disease, respiratory disease and kidney disease among the older adults (≥ 65) was associated with Hurricane Sandy [ 14 ].…”