The Long-Run Impacts of Natural Disasters on Mortality and Disease Burden Among US Elderly and Disabled Adults

其他项目信息-项目摘要/摘要 自然灾害对美国老年人死亡率和疾病负担的长期影响 残障成年人 近几十年来，自然灾害的频率和严重性都有所增加，预计这一趋势还会加剧。 在气候变化下。这些灾难对个人健康和福祉构成的风险在 患有与年龄相关的残疾或慢性病的老年人，如患有阿尔茨海默病或 痴呆症。关于备灾和应对灾害的公共政策在避免或 减少灾害对健康的影响，提高个人健康复原力。这些产品的优化设计 政策的关键在于准确地量化灾害带来的短期和长期健康风险。 确定最脆弱的人群，并了解推动和 调解结果。然而，关于这些重要的维度，仍有许多未知之处。该项目将使用 1992年以来所有老年人(65岁以上)和长期残疾受益人的个人行政医疗保险数据- 2017年估计飓风等一系列自然灾害的短期和长期影响， 龙卷风和洪水--关于老年人的健康、医疗保健使用和与健康相关的支出。这个 研究将从各种数据中汇编一个全面的、空间上详细的美国自然灾害数据库 消息来源。联邦医疗保险数据提供了9位数字的居住邮政编码，使研究人员能够准确地确定 比以前的研究更准确地定位受害者。该项目将跟踪生活在受灾地区的个人 灾难发生前的区域，无论他们搬到哪里，都将使用未受影响的老年人作为对照组 以确定在没有活动的情况下结果将如何演变。该项目还将使用新的 基于个人健康特征来识别易受伤害的亚群的机器学习方法(例如， 先前存在的慢性病)、人口特征(例如年龄、种族、性别)以及当地经济和公共卫生 情况(例如，人均收入、肥胖率、社区参与全国洪灾 保险计划的社区评级系统)。该项目还将评估几项连续性护理 可减缓或加剧灾后死亡率和疾病影响，包括损害的机制 卫生保健设施，失去与医生的联系，以及健康计划网络限制。这一分析将 适用于所有受益者和被认为特别是 容易受到连续性护理中断的影响，如患有多种既往慢性病的成年人。最后， 项目将估计某些特征(例如，医疗保健可获得性、地方政府 支出和健康行为)可以解释灾民在灾后重新安置到的地区 健康结果。

OTHER PROJECT INFORMATION – Project Summary/Abstract The Long-run Impacts of Natural Disasters on Mortality and Disease Burden among US Elderly and Disabled Adults Natural disasters have increased in frequency and severity in recent decades, a trend projected to intensify under climate change. The risks these disasters pose to individual health and well-being are heightened among older adults with age-related disabilities or chronic illness, such as those living with Alzheimer’s disease or dementia. Public policies regarding disaster preparedness and response serve an important role in avoiding or reducing the health impacts of disasters and improving individual health resiliency. The optimal design of these policies depends crucially on quantifying the short- and long-run health risks imposed by disasters, precisely identifying the most vulnerable populations, and understanding the underlying mechanisms that drive and mediate outcomes. However, much remains unknown about these important dimensions. This project will use individual-level administrative Medicare data on all elderly (65+) and long-term disabled beneficiaries from 1992– 2017 to estimate the short- and long-run effects of a broad range of natural disasters – such as hurricanes, tornadoes, and floods – on health, health care use, and health-related expenditures among the elderly. The study will compile a comprehensive and spatially detailed database of US natural disasters from a variety of data sources. The Medicare data provide the 9-digit ZIP code of residence, allowing researchers to pinpoint the location of victims more precisely than prior research. The project will track individuals living in disaster-affected areas before the disaster regardless of where they move, and a control group of unaffected elderly will be used to establish how outcomes would have evolved in the absence of the event. The project will also use a new machine learning approach to identify vulnerable subpopulations based on individual health characteristics (e.g., pre-existing chronic conditions), demographic traits (e.g., age, race, sex), and local economic and public health circumstances (e.g., per capita income, prevalence of obesity, community participation in the National Flood Insurance Program's Community Rating System). The project will also assess several continuity-of-care mechanisms that could moderate or exacerbate post-disaster mortality and disease impacts, including damage to health care facilities, loss of access to one’s physician, and health plan network restrictions. This analysis will be performed for the whole population of beneficiaries and for subpopulations thought to be particularly vulnerable to continuity-of-care disruptions, like adults with multiple pre-existing chronic conditions. Finally, the project will estimate the extent to which certain characteristics (e.g., health care availability, local government expenditure, and healthy behaviors) in areas where victims relocate to following a disaster can explain their health outcomes.