Association Between Exposure to Hurricane Irma and Mortality and Hospitalization in Florida Nursing Home Residents.
Association Between Exposure to Hurricane Irma and Mortality and Hospitalization in Florida Nursing Home Residents.
复制标题
DOI：
10.1001/jamanetworkopen.2020.19460
复制
发表时间：
2020-10-01
影响因子：
13.8
通讯作者：
Hyer K
中科院分区：
文献类型：
--
作者：
Dosa DM;Skarha J;Peterson LJ;Jester DJ;Sakib N;Ogarek J;Thomas KS;Andel R;Hyer K
与对照组相比，在飓风过后的30天和90天内，暴露在飓风中与养老院居民住院和死亡的风险增加有关吗？在这项队列研究中，61 564名暴露于飓风Irma的养老院居民和61 813名未暴露于飓风Irma的对照组居民，首次住院和死亡的几率在30天和90天显著增加。与短期护理相比，长期护理与更大的死亡风险相关。研究结果表明，在灾难情况下，为养老院居民优先考虑加强应急准备是有必要的。在遭受飓风或covid - 19大流行等灾难后，养老院居民患病和死亡的风险更高。先前的研究表明，与灾害有关的养老院居民死亡率经常被低估。有必要更好地了解灾害对养老院居民的影响，并根据病人的特点区分脆弱性。评估与2017年9月10日在佛罗里达州Cudjoe Key登陆的四级飓风Irma暴露相关的死亡率和发病率，在养老院的短期住宿（<90天居住）和长期住宿（≥90天居住）居民中。对佛罗里达州养老院居民的队列研究，将2017年9月暴露于飓风伊尔玛的居民与2015年日历年同期居住在同一疗养院的对照组居民进行比较。数据分析时间为2019年8月28日至2020年7月22日。经历过飓风“厄玛”的居民被认为受到了影响；那些没有暴露的人被认为没有暴露。结果变量包括风暴后短期和长期的30天和90天死亡率和首次住院。截至2017年9月7日，共有61 564名居住在佛罗里达州640家养老院的居民被确认。2015年对61 813名居民进行了比较队列评估。两个队列中大多数是女性（2015年，68%；2017年，67%），大多数是白人（2015年，79%；2017年，78%），每组中约有40%的居民年龄在85岁以上。与2015年的对照组相比，30天的养老院死亡人数增加了262人，90天的养老院死亡人数增加了433人。接触者（与未接触者）首次住院的几率在风暴后的前30天内为1.09 (95% CI, 1.05-1.13)，在90天内为1.05 (95% CI, 1.02-1.08)；30天死亡率为1.12 (95% CI, 1.05-1.18)， 90天死亡率为1.07 （95% CI, 1.03-1.11）。在长期居住的居民中，暴露于飓风Irma的人的死亡率是未暴露者的1.18倍（95% CI, 1.08-1.29），住院率是30天后未暴露者的1.11倍（95% CI, 1.04-1.18）。本研究结果显示，疗养院居民面对灾害后果的风险相当大。这些风险可能被州和联邦机构低估了。长期居住的居民，即那些在养老院居住90天或更长时间的人，可能最容易受到飓风灾害的影响。本队列研究评估暴露于飓风Irma与佛罗里达州养老院短期和长期居民30天和90天死亡率和发病率之间的关系。
Was exposure to Hurricane Irma associated with an increased risk of hospitalization and mortality among nursing home residents in the 30 and 90 days after the storm compared with a control group? In this cohort study of 61 564 nursing home residents exposed to Hurricane Irma and a control group of 61 813 nonexposed residents, the odds of a first hospitalization and mortality increased significantly at 30 and 90 days for those exposed. A long nursing home stay was associated with a greater risk for mortality compared with a short stay. Findings suggest that prioritizing heightened emergency preparedness in disaster situations for nursing home residents is warranted. Nursing home residents are at heightened risk for morbidity and mortality following an exposure to a disaster such as a hurricane or the COVID19 pandemic. Previous research has shown that nursing home resident mortality related to disasters is frequently underreported. There is a need to better understand the consequences of disasters on nursing home residents and to differentiate vulnerability based on patient characteristics. To evaluate mortality and morbidity associated with exposure to Hurricane Irma, a Category 4 storm that made landfall on September 10, 2017, in Cudjoe Key, Florida, among short-stay (<90-day residence) and long-stay (≥90-day residence) residents of nursing homes. Cohort study of Florida nursing home residents comparing residents exposed to Hurricane Irma in September 2017 to a control group of residents residing at the same nursing homes over the same time period in calendar year 2015. Data were analyzed from August 28, 2019, to July 22, 2020. Residents who experienced Hurricane Irma were considered exposed; those who did not were considered unexposed. Outcome variables included 30-day and 90-day mortality and first hospitalizations after the storm in both the short term and the long term. A total of 61 564 residents who were present in 640 Florida nursing home facilities on September 7, 2017, were identified. A comparison cohort of 61 813 residents was evaluated in 2015. Both cohorts were mostly female (2015, 68%; 2017, 67%), mostly White (2015, 79%; 2017, 78%), and approximately 40% of the residents in each group were over the age of 85 years. Compared with the control group in 2015, an additional 262 more nursing home deaths were identified at 30 days and 433 more deaths at 90 days. The odds of a first hospitalization for those exposed (vs nonexposed) were 1.09 (95% CI, 1.05-1.13) within the first 30 days after the storm and 1.05 (95% CI, 1.02-1.08) at 90 days; the odds of mortality were 1.12 (95% CI, 1.05-1.18) at 30 days and 1.07 (95% CI, 1.03-1.11) at 90 days. Among long-stay residents, the odds of mortality for those exposed to Hurricane Irma were 1.18 (95% CI, 1.08-1.29) times those unexposed and the odds of hospitalization were 1.11 (95% CI, 1.04-1.18) times those unexposed in the post 30-day period. The findings of this study suggest that nursing home residents are at considerable risk to the consequences of disasters. These risks may be underreported by state and federal agencies. Long-stay residents, those who have resided in a nursing home for 90 days or more, may be most vulnerable to the consequences of hurricane disasters. This cohort study assess the association between exposure to Hurricane Irma and 30- and 90-day mortality and morbidity among short- and long-term residents of nursing homes in Florida.
登录
查看更多内容
影响因子：
12.7
作者：
Laditka, Sarah B.;Laditka, James N.;Richter, Jane V. E.
通讯作者：
Richter, Jane V. E.
DOI：
10.1034/j.1601-5215.2002.51017.x
发表时间：
2003-01-01
影响因子：
6.3
作者：
Hirdes, JP;Frijters, DH;Teare, GF
通讯作者：
Teare, GF
影响因子：
8.3
作者：
Conti, S;Meli, P;Perini, L
通讯作者：
Perini, L
DOI：
10.1016/j.jamda.2013.03.009
发表时间：
2013-10-01
影响因子：
7.6
作者：
Temkin-Greener, Helena;Zheng, Nan Tracy;Mukamel, Dana B.
通讯作者：
Mukamel, Dana B.
DOI：
10.1177/1533317512454709
发表时间：
2012-09
期刊：
American journal of Alzheimer's disease and other dementias
影响因子：
--
作者：
Brown LM;Dosa DM;Thomas K;Hyer K;Feng Z;Mor V
通讯作者：
Mor V