Due to climate change, billion-dollar disasters are becoming increasingly common. According to the National Oceanic and Atmospheric Administration (NOAA), from 2011 to 2016, a total of 42 disasters caused at least one billion U.S. dollars (USD) in damage. In reviewing these events, researchers found a knowledge gap regarding the impact experienced by elderly Americans, specifically those receiving Medicare.
Among those most affected after large disasters are fee-for-service (FFS) Medicare recipients. However, their mortality rates and utilization of healthcare services are not tracked by NOAA beyond immediate deaths related to the event. Additionally, healthcare utilization has not been well documented among FFS Medicare recipients by any agency for disasters besides tropical storms and long-term disasters such as wildfires and drought.
A study conducted by Salas et al., “Impact of extreme weather events on healthcare utilization and mortality in the United States,” published in Nature Medicine addresses this gap in knowledge by analyzing short-term one billion USD weather events that took place between 2011 and 2016. The researchers recorded emergency department visits, nonelective hospitalizations, and mortality by FFS Medicare beneficiaries in 4,884 U.S. counties that experienced floods, severe storms, tropical cyclones, or winter storms.
The findings revealed that one week after the disaster, emergency department visits increased by 1.09% in the chosen counties. Since there is a growing number of FFS Medicare recipients in the nation, this suggests an average excess of 268 emergency department visits per average-sized short-term disaster. The largest number of excess visits was projected to be directly after a tropical cyclone, with 1,165 additional visits. Mortality rates increased by 1.15% one week after a short-term event, compared to pre-disaster rates, potentially resulting in 20 excess deaths in the FFS Medicare population.
When the 2–6-week period after a one billion USD short-term disaster was analyzed, it was found that emergency department visits grew 1.34% in the first two weeks. Unexpectedly, non-elective hospitalizations decreased in affected counties compared to control counties in the six weeks after a disaster, especially if the event in question was a flood. The authors of the study concluded that while more research had to be done on this phenomenon, the cause was likely a lack of transportation to the hospital after an event, as well as a change in operations at hospitals due to damage from the storm.
The researchers conclude that the long-term data they collected could better guide disaster recovery policy and practice. They believe that metrics such as mortality should be modified to include these longer-term results and that their overall results could provide a framework for the U.S. and other countries to track healthcare utilization after a disaster.
By Sarah Ortega