Assessing Health Effects and Risk Factors after Hurricane Sandy in NYS

描述(申请人提供)：气候变化将导致更极端的天气事件，如热浪和飓风，这被发现与增加的死亡率和发病率有关。然而，在我们对飓风等极端天气事件的影响的了解方面仍然存在重大差距，包括缺乏对其直接和长期健康影响、尽管精神健康的其他健康后果、个人和社区脆弱性以及修正因素的研究。此外，人们对应对和恢复战略对健康的影响知之甚少。拟议的研究将通过评估飓风桑迪在纽约州(NYS)的后果对多种健康结果和风险因素的短期和长期影响来填补这些空白。该项目将通过评估死亡率和多种相关发病率，包括精神健康、损伤、呼吸系统疾病、心血管疾病、一氧化碳中毒、传染病、水/食源性疾病和透析(目标1)，处理RFA-TP13-001优先恢复研究区域B下描述的所有四个优先领域。我们将进一步评估低社会经济地位(SES)、环境因素、社区特征和社会脆弱性是否改变了沙地健康协会(目标2)。此外，我们的研究将评估不同疏散或流离失所战略对健康的影响，以及飓风桑迪造成的医疗服务中断的影响(目标3)。还将评估透析患者护理模式的改变和患者转移的后果。最后，我们将确定可改变的危险因素、有效的家居清洁策略和监测，以减轻健康负担。通过使用纽约的多个数据集，包括入院、急诊科就诊、诊所就诊和处方账单数据，以及社区调查，我们将招募所有潜在的精神健康和其他病例。计划在学校教职员工和漏油家庭居民中进行的两项调查将收集有关心理健康、桑迪期间的活动模式和家庭清洁的详细信息。在回顾队列研究中，采用非条件Logistic回归分析比较受灾地区(在7个受影响的县被归类为疏散区)和对照地区(同一县和类似的SES未受沙尘暴影响)的各项健康结果。趋势分析还将用于使用时间序列分析方法ARIMA比较桑迪前后的效果。所有结果将在桑迪飓风前、桑迪飓风后3个月和1年内的三个时间窗口内进行比较。拟议的研究很重要，因为它不仅将描述飓风桑迪过后使用不同的疏散或恢复战略的多种健康后果的影响，而且还将确定脆弱性和可修改的因素，这将直接有助于应急准备和应对。强大的州-县-社区伙伴关系，独特的访问纽约多个大型数据集的权限，以及经验丰富的多学科研究团队将确保该项目是可行和可持续的。

DESCRIPTION (provided by applicant): Climate change will lead to more extreme weather events such as heatwaves and hurricanes, which were found to be associated with increased mortality and morbidity. However, significant gaps remain in our understanding of the impacts from extreme weather event like hurricanes, including the paucity of research on its immediate and long-term health effects, other health outcomes despite mental health, individual and community vulnerabilities, and modified factors. Furthermore, little is known about the health impacts of response and recovery strategies. The proposed study will fill these gaps by evaluating the short- and long- term effects on multiple health outcomes and risk factors in the aftermath of Hurricane Sandy in New York State (NYS). This project will address all four priority areas described under Priority Recovery Research Area B of the RFA-TP13-001 by assessing mortality and multiple relevant morbidity including mental health, injury, respiratory, cardiovascular diseases, CO poisoning, infectious diseases, water-/food-borne diseases, and dialysis (Aim 1). We will further evaluate whether low socio-economic status (SES), environmental factors, community characteristics, and social vulnerability modified the Sandy-health association (Aim 2). Moreover, our study will assess the health effects of different evacuation or displacement strategies and impacts of health care access disruption by Hurricane Sandy (Aim 3). Care pattern change in dialysis patients and consequence of patient transfer will also be evaluated. Finally, we will determine the modifiable risk factors, effective home cleaning strategy and surveillance to reduce health burden. By using multiple NYS datasets, including hospital admission, emergency department visit, clinic visit and prescription billing data, and community surveys, we will recruit all potential mental health and other cases. The two surveys planned among school staff and residents with oil spill homes will collect detailed information on mental health, activity patterns during Sandy, and home cleaning. Each health outcome will be compared between the affected areas (categorized as evacuation zones in the 7 impacted counties) and the control areas (unaffected by Sandy in the same county and similar SES) using unconditional logistic regression analysis in a retrospective cohort study. Trend analysis will also be used to compare pre- and post-Sandy effects using ARIMA, a time-series analysis method. All outcomes will be compared within three time windows, pre-Sandy, 3 months and 1-year after Hurricane Sandy. The proposed study is important as it will not only characterize the impacts of multiple health outcomes after Hurricane Sandy and using different evacuation or recovery strategies, but also identify vulnerabilities and modifiable factors, which will directly contribute to emergency preparedness and responses. The strong state-county-community partnership, unique access to multiple large NYS datasets, and the experienced multidisciplinary research team will assure that the project is feasible and sustainable.