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

 描述(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。气候变化可能会加剧这一趋势。老年人可能受到灾难的影响不成比例，阿尔茨海默病和老年痴呆症患者的风险更大。然而，灾难对成人健康和医疗保健成本的影响仍有许多未知之处。例如，以前没有任何研究衡量灾害对卫生保健利用或支出的影响，这可能是灾害成本的重要组成部分。此外，现有的研究绝大多数依赖于调查，受到低频率数据、非随机自然减员、小样本或不具代表性的样本、回忆错误以及缺乏对照组的限制。克服这些限制是重要的，因为旨在降低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至关重要地取决于了解短期和长期健康风险的动态并确定弱势群体。我们建议估计卡特里娜飓风对老年人的健康、医疗保健利用和支出的短期和长期影响。我们的研究克服了上述限制，利用了1992-2011年近宇宙老年人(65岁以上)的个人管理医疗保险数据的力量。重要的是，我们可以识别飓风前居住在新奥尔良的个人，无论他们搬到哪里，都可以跟踪他们，观察灾难前后的详细健康历史(包括医疗保健费用和使用率)，并建立一个未受影响的老年人对照组，极大地提高了我们估计的可靠性。我们样本的完整性将使我们能够查看 对应对严重干扰能力有限的潜在脆弱亚群的影响，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。除了评估对这些亚群的健康影响外，我们还将研究这些疾病以及其他心理和身体健康状况的发生和发展。该项目有两个具体目标：(1)对卡特里娜飓风对老年人的长期死亡率、发病率、医疗保健利用和医疗支出影响进行全面估计，以及(2)确定卡特里娜飓风对健康、死亡率和医疗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政策反应提供信息。

 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.