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

其他项目信息-项目概要/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 残疾成年人 近几十年来，自然灾害的频率和严重程度都有所增加，预计这一趋势还会加剧 在气候变化下。这些灾害对个人健康和福祉构成的风险在以下人群中加剧： 患有与年龄有关的残疾或慢性疾病的老年人，如阿尔茨海默病患者， 痴呆关于备灾和救灾的公共政策在避免或 减少灾害对健康的影响，提高个人的健康复原力。这些的最佳设计 政策的制定关键取决于量化灾害造成的短期和长期健康风险， 确定最脆弱的人群，并了解驱动和 中介结果。然而，对这些重要方面仍有许多未知之处。This project will use 1992年至2000年期间所有老年人（65岁以上）和长期残疾受益人的个人层面行政医疗保险数据 2017年估计各种自然灾害的短期和长期影响-如飓风， 龙卷风和洪水-对老年人健康、保健使用和与健康有关的支出的影响。的 这项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 源医疗保险数据提供了居住地的9位邮政编码，使研究人员能够确定 受害者的位置比之前的研究更精确。该项目将跟踪生活在受灾地区的个人， 无论他们搬到哪里，都将使用灾难前的地区，并将使用未受影响的老年人作为对照组 以确定在没有该事件的情况下结果会如何演变。该项目还将使用新的 基于个人健康特征识别脆弱亚群的机器学习方法（例如， 预先存在的慢性病），人口统计学特征（例如，年龄、种族、性别），以及当地经济和公共卫生 环境（例如，人均收入，肥胖率，社区参与国家洪水 保险计划的社区评级系统）。该项目还将评估几个连续性护理 可能减轻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，失去访问自己的医生，和健康计划网络的限制。该分析将 对所有受益人和被认为特别需要的亚群体进行 易受连续护理中断的影响，如患有多种预先存在的慢性疾病的成年人。最后 项目将估计某些特征（例如，卫生保健的可获得性，地方政府 支出和健康行为）可以解释他们在灾难发生后重新安置的地区的健康状况。 健康成果。

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.