Tropical Cyclone Exposures and Risks of Emergency Medicare Hospital Admission for Cardiorespiratory Diseases in 175 Urban United States Counties, 1999-2010.
Tropical Cyclone Exposures and Risks of Emergency Medicare Hospital Admission for Cardiorespiratory Diseases in 175 Urban United States Counties, 1999-2010.
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1999-2010 年美国 175 个城市县的热带气旋暴露和心肺疾病紧急医疗住院风险。
DOI：
10.1097/ede.0000000000001337
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发表时间：
2021-05-01
期刊：
影响因子：
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通讯作者：
Anderson GB
中科院分区：
文献类型：
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作者：
Yan M;Wilson A;Dominici F;Wang Y;Al-Hamdan M;Crosson W;Schumacher A;Guikema S;Magzamen S;Peel JL;Peng RD;Anderson GB
虽然在飓风和其他热带气旋期间经历的伤害通过传统监测得到了相对较好的特征，但对热带气旋对非伤害发病率的影响知之甚少，非伤害发病率可通过心理社会压力或医疗中断等途径触发。我们调查了美国180个县的每日紧急医疗保险住院情况(1999-2010)，利用了现有的高人口县队列。当风暴相关的最大持续风速在县中心为≥21m/S时，我们将县归类为热带气旋影响县；二级分析考虑了其他风速阈值和危害。我们按县和季节将暴风暴发日与未暴发日进行了匹配。我们使用广义线性混合效应模型，与未接触热带气旋的天数相比，估计了风暴前2天至风暴最接近后7天期间热带气旋相关住院人数的变化。在1999-2010年间，175个研究县至少接触过一次热带气旋。心血管住院在风暴日减少，然后在风暴之后增加，而呼吸系统住院在整个风暴期间上升。在10天的暴风期间，与非暴露期相比，心血管住院增加了3%(95%可信区间：2%，5%)，呼吸系统住院增加了16%(95%可信区间：13%，20%)。不同热带气旋暴露的相对风险各不相同，与限制最严格的基于风的暴露指标的相关性最强。在这项研究中，根据对美国联邦医疗保险受益人≥65年的多年/多地点调查，暴露于热带气旋与老年人心肺疾病住院风险的短期增加有关。
While injuries experienced during hurricanes and other tropical cyclones have been relatively well- characterized through traditional surveillance, less is known about tropical cyclones’ impacts on non-injury morbidity, which can be triggered through pathways that include psychosocial stress or interruption in medical treatment. We investigated daily emergency Medicare hospitalizations (1999–2010) in 180 United States counties, drawing on an existing cohort of high-population counties. We classified counties as exposed to tropical cyclones when storm-associated peak sustained winds were ≥ 21 m/s at the county center; secondary analyses considered other wind thresholds and hazards. We matched storm-exposed days to unexposed days by county and seasonality. We estimated change in tropical cyclone-associated hospitalizations over a storm period from 2 days before to 7 days after the storm’s closest approach, compared to unexposed days, using generalized linear mixed-effect models. For 1999–2010, 175 study counties had at least one tropical cyclone exposure. Cardiovascular hospitalizations decreased on the storm day, then increased following the storm, while respiratory hospitalizations were elevated throughout the storm period. Over the 10-day storm period, cardiovascular hospitalizations increased 3% (95% confidence interval [CI]: 2%, 5%) and respiratory hospitalizations increased 16% (95% CI: 13%, 20%) compared to matched unexposed periods. Relative risks varied across tropical cyclone exposures, with strongest association for the most restrictive wind-based exposure metric. In this study, tropical cyclone exposures were associated with a short-term increase in cardiorespiratory hospitalization risk among the elderly, based on a multi-year/multi-site investigation of US Medicare beneficiaries ≥ 65 years.