Assessing Health Effects and Risk Factors after Hurricane Sandy in NYS

描述（由申请人提供）：气候变化将导致更多的极端天气事件，如热浪和飓风，这被发现与死亡率和发病率增加有关。然而，在我们对飓风等极端天气事件影响的理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的研究，其他健康结果，尽管心理健康，个人和社区脆弱性以及修改因素。此外，人们对应对和恢复战略的健康影响知之甚少。拟议中的研究将通过评估纽约州（NYS）飓风桑迪过后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。本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、心血管疾病、CO中毒、传染病、水/食源性疾病和透析（目标1），解决RFA-TP 13 -001优先恢复研究领域B中描述的所有四个优先领域。我们将进一步评估是否低社会经济地位（SES），环境因素，社区特征和社会脆弱性修改了桑迪健康协会（目标2）。此外，我们的研究将评估不同的疏散或流离失所战略的健康影响，以及飓风桑迪（目标3）造成的医疗服务中断的影响。还将评价透析患者的护理模式变化和患者转移的后果。最后，我们将确定可改变的风险因素，有效的家居清洁策略和监测，以减少健康负担。通过使用多个纽约州数据集，包括入院、急诊、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心理健康和其他病例。这两项调查计划在学校工作人员和有石油泄漏家园的居民中进行，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。在一项回顾性队列研究中，将使用非条件logistic回归分析比较受影响地区（在7个受影响县中被归类为疏散区）和对照地区（在同一县中未受桑迪影响且SES相似）的每项健康结局。趋势分析也将用于比较前和后桑迪的影响，使用ARIMA，时间序列分析方法。所有结果将在三个时间窗口内进行比较，即桑迪前、飓风桑迪后3个月和1年。拟议的研究很重要，因为它不仅将描述飓风桑迪后多种健康后果的影响，并使用不同的疏散或恢复战略，而且还将确定脆弱性和可改变的因素，这将直接有助于应急准备和反应。强大的州-县-社区合作伙伴关系，对多个大型NYS数据集的独特访问，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.