Exposure to hurricanes significantly increases risk of death among patients on dialysis
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Patients on dialysis are at a significantly heightened risk of death for 30 days after being exposed to a hurricane, according to data published in the Journal of the American Society of Nephrology.
However, the risk gradually declines following the hurricane.
“Patients who require maintenance dialysis are particularly vulnerable to extreme weather events. Prior studies have shown higher mortality among dialysis-dependent patients when exposed to heat waves and wildfire smoke. Failed power, water and transportation systems, patient displacement and hospital surges can impede dialysis access,” Matthew F. Blum, MD, from the department of medicine at the Johns Hopkins University School of Medicine in Maryland, and colleagues wrote. They added, “To determine the potential impact of severe weather events on death in the dialysis population, we estimated the association between time-varying, county-level hurricane exposure and 30-day mortality among patients receiving in-center and home dialysis in the United States.”
In a retrospective cohort analysis, researchers evaluated data for 187,388 patients who initiated maintenance dialysis treatment between Jan. 1, 1997, and Dec. 31, 2017. All patients received treatment in one of 108 hurricane-afflicted counties in the eastern half of the United States. Data were derived from the U.S. Renal Data System, the CMS, the United Network for Organ Sharing and the End-Stage Renal Disease Networks.
Researchers identified counties afflicted by hurricanes if at least one tropical cyclone event occurred with peak local wind speeds greater than or equal to 64 knots.
Using time-varying Cox proportional hazards models, researchers determined the risk of a patient’s death after the hurricane. Mortality served as the primary outcome of the study.
In 529,339 person-years of follow-up on dialysis, there were 27 hurricanes and 105,398 deaths. A total of 29,849 patients were exposed to at least one hurricane, and compared with those who were not exposed, they had slightly lower socioeconomic indicators, including lower educational attainment, larger proportion below the poverty level and lower median monthly housing costs. Overall, hurricane exposure correlated with a 13% higher risk of death after adjusting for demographic and socioeconomic factors.
“Our findings suggest that dialysis-dependent patients are vulnerable during hurricanes and highlight the need to safeguard this population, especially given the predicted increased hurricane intensity with climate change,” Blum said in a press release. “Anything that disrupts someone’s ability to obtain dialysis — including extreme weather — can put them at risk of death. There are groups, such as the Kidney Community Emergency Response Coalition, that seek to prepare for these events.”
Reference:
Study reveals risk of death after hurricanes for people on dialysis. https://medicalxpress.com/news/2022-07-reveals-death-hurricanes-people-dialysis.html. Published July 14, 2022. Accessed July 14, 2022.
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