Changes in Migration and Mortality Among Patients With Kidney Failure in Puerto Rico After Hurricane Maria.
Changes in Migration and Mortality Among Patients With Kidney Failure in Puerto Rico After Hurricane Maria.
复制标题
DOI：
10.1001/jamahealthforum.2022.2534
复制
发表时间：
2022-08-05
期刊：
影响因子：
--
通讯作者：
中科院分区：
文献类型：
--
作者：
Did migration and mortality change among people with kidney failure after Hurricane Maria in Puerto Rico? In this cross-sectional study of 11 652 patients with kidney failure who were receiving dialysis care in Puerto Rico, Hurricane Maria was associated with a significant increase in the number receiving dialysis outside of the island and a decline in those receiving dialysis in Puerto Rico. There was no evidence of increased mortality among patients in need of dialysis after Hurricane Maria. These findings suggest that emergency preparedness strategies enabled the availability of dialysis and continuity of care for patients in need of dialysis after this extreme weather event. 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. 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. This cross-sectional study of patients with kidney failure in Puerto Rico examines dialysis care, migration, and mortality rates before, during, and after Hurricane Maria.
