The Long-Run Impact of Hurricane Katrina on Mortality, Morbidity and Health Care Cost Among the Elderly

 描述（由申请人提供）：近几十年来，受自然灾害影响的人数和自然灾害造成的损失有所增加。气候变化有可能加剧这一趋势。老年人受灾害影响的比例可能更大，阿尔茨海默病和老年痴呆症患者的风险更大。然而，关于灾害对成人健康和保健费用的影响，仍有许多未知之处。例如，以前没有任何研究衡量过灾害对医疗保健利用或支出的影响，这是灾害成本的一个潜在重要组成部分。此外，现有的研究，绝大多数依赖于调查，已受到限制的低频数据，非随机损耗，小或非代表性的样本，回忆错误，并缺乏一个控制组。克服这些局限性很重要，因为旨在减少健康风险和在自然灾害后提供有效援助的公共政策和方案，关键取决于了解短期和长期健康风险的动态，并确定弱势群体。我们建议估计短期和长期的影响，卡特里娜飓风对健康，医疗保健利用率和老年人的支出。我们的研究通过利用1992-2011年老年人（65岁以上）近宇宙的个人层面行政医疗保险数据的力量克服了上述局限性。重要的是，我们可以识别飓风前居住在新奥尔良的个人，跟踪他们，无论他们搬到哪里，观察灾难前后的详细健康史（包括医疗保健费用和使用），并建立一个未受影响的老年人对照组，大大提高了我们估计的可靠性。我们的样本的完整性将使我们能够看到 在科普严重干扰的能力有限的潜在脆弱亚群中，例如患有阿尔茨海默病和相关痴呆症的老年人，这是老龄化研究的一个重要新问题，也是NIA的一个高度优先领域。除了估计对这些亚组的健康影响外，我们还将研究这些和其他精神和身体健康状况的发病和进展。该项目有两个具体目标：（1）全面估计卡特里娜飓风对老年人的长期死亡率、发病率、卫生保健利用率和医疗支出的影响;（2）确定卡特里娜飓风对健康、死亡率和卫生保健支出的短期和长期影响背后的主要分组和机制。实现这些目标有助于为改善健康的对策提供信息。

 DESCRIPTION (provided by applicant): The number of people affected by natural disasters and the damages that natural disasters cause have increased over recent decades. Climate change threatens to exacerbate this trend. The elderly are likely to be disproportionately affected by disasters, with even greater risk for those with Alzheimer's disease and senile dementia. However, much remains unknown about disasters' effects on adult health and health care costs. For example, no previous study has measured the impact of disasters on health care utilization or expenditures, a potentially important component of the cost of disasters. In addition, existing studies, which overwhelmingly rely on surveys, have been limited by low-frequency data, non-random attrition, small or non-representative samples, errors in recall, and lack of a control group. Overcoming these limitations is important, as public policies and programs aimed at reducing health risks and providing effective assistance following natural disasters depend crucially on understanding the dynamics of the short- and long-run health risks and identifying vulnerable populations. We propose to estimate the short- and long-run effects of Hurricane Katrina on health, health care utilization, and expenditures among the elderly. Our study overcomes the abovementioned limitations by harnessing the power of individual-level administrative Medicare data on the near-universe of elderly (65+) from 1992-2011. Importantly, we can identify individuals living in New Orleans prior to the hurricane, track them regardless of where they move, observe detailed health histories (including health care costs and utilization) before and after the disaster, and construct a control group of unaffected elderly, greatly improving the reliability of our estimates. The completeness of our sample will allow us to look at impacts in potentially vulnerable subpopulations with limited ability to cope with severe disruptions, such as elderly with Alzheimer's disease and related dementias, an important emerging issue for aging research and a high-priority area for NIA. In addition to estimating the health impacts on these subgroups, we will examine the onset and progression of these and other mental and physical health conditions. The project has two Specific Aims: (1) produce comprehensive estimates of the long-run mortality, morbidity, health care utilization, and medical spending impacts of Hurricane Katrina on the elderly and (2) identify the main sub-groups and mechanisms behind the short- and long-run impact of Hurricane Katrina on health, mortality, and health care spending. Achieving these aims can help inform health-improving policy responses.