Acute post-disaster medical needs of patients with diabetes: emergency department use in New York City by diabetic adults after Hurricane Sandy.
Acute post-disaster medical needs of patients with diabetes: emergency department use in New York City by diabetic adults after Hurricane Sandy.
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DOI：
10.1136/bmjdrc-2016-000248
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发表时间：
2016
影响因子：
4.1
通讯作者：
Goldfrank LR
中科院分区：
文献类型：
--
作者：
Lee DC;Gupta VK;Carr BG;Malik S;Ferguson B;Wall SP;Smith SW;Goldfrank LR
为了评估灾害对糖尿病患者的急性影响，我们对飓风桑迪后一周内纽约市糖尿病成人急诊科（ED）使用情况进行了地理空间分析。使用全付款人索赔数据库，我们回顾性分析了居住在地理上最脆弱地区的灾后ED糖尿病患者的人口统计学、保险状况和医疗合并症。我们比较了2012年飓风桑迪登陆后第一周糖尿病成人的ED使用模式和灾难前的使用模式。在纽约市最高级别的疏散区，灾后因原发性或继发性诊断为糖尿病的急诊科就诊人数的增加可归因于医疗保险患者比例的显著提高。初步诊断为糖尿病的急诊就诊出现某些合并症的频率增加，包括高血压、近期手术和慢性皮肤溃疡。飓风“桑迪”过后，有糖尿病病史的患者因心肌梗死、处方补药、药物依赖、透析等初步诊断到急诊科就诊的人数增加。我们发现，与其他弱势群体相比，65岁及以上的糖尿病成年人尤其需要灾后紧急护理。我们的研究结果还表明，有必要支持糖尿病成年人，特别是在灾难发生后的一周内，确保获得药物治疗，为最近接受过手术的患者提供善后护理，并优化他们的心血管健康，以降低心脏病发作的风险。
To evaluate the acute impact of disasters on diabetic patients, we performed a geospatial analysis of emergency department (ED) use by New York City diabetic adults in the week after Hurricane Sandy. Using an all-payer claims database, we retrospectively analyzed the demographics, insurance status, and medical comorbidities of post-disaster ED patients with diabetes who lived in the most geographically vulnerable areas. We compared the patterns of ED use among diabetic adults in the first week after Hurricane Sandy's landfall to utilization before the disaster in 2012. In the highest level evacuation zone in New York City, postdisaster increases in ED visits for a primary or secondary diagnosis of diabetes were attributable to a significantly higher proportion of Medicare patients. Emergency visits for a primary diagnosis of diabetes had an increased frequency of certain comorbidities, including hypertension, recent procedure, and chronic skin ulcers. Patients with a history of diabetes visited EDs in increased numbers after Hurricane Sandy for a primary diagnosis of myocardial infarction, prescription refills, drug dependence, dialysis, among other conditions. We found that diabetic adults aged 65 years and older are especially at risk for requiring postdisaster emergency care compared to other vulnerable populations. Our findings also suggest that there is a need to support diabetic adults particularly in the week after a disaster by ensuring access to medications, aftercare for patients who had a recent procedure, and optimize their cardiovascular health to reduce the risk of heart attacks.