Hurricanes and Mortality among Patients Receiving Dialysis

Area of Science:

• Nephrology
• Public Health
• Environmental Medicine

Background:

• Severe weather events like hurricanes can disrupt essential services, posing life-threatening risks to patients requiring maintenance dialysis.
• Disruptions to power, water, and transportation systems during hurricanes can critically impact patient care and survival.

Purpose of the Study:

• To investigate the hypothesis that mortality risk is elevated for patients on maintenance dialysis in the 30 days subsequent to a hurricane.
• To quantify the association between hurricane exposure and mortality in a large cohort of dialysis patients.

Main Methods:

• Utilized data from the United States Renal Data System, following patients on maintenance dialysis initiated between 1997 and 2017 in hurricane-prone counties.
• Defined hurricane exposure based on tropical cyclone events with peak local wind speeds of at least 64 knots.
• Employed time-varying Cox proportional hazards models to estimate the risk of death post-hurricane, adjusting for covariates.

Main Results:

• The study included 187,388 patients, with 29,849 exposed to at least one hurricane over 529,339 person-years.
• Hurricane exposure was significantly associated with increased mortality (hazard ratio, 1.13; 95% CI, 1.05–1.22), even after adjusting for demographic, socioeconomic factors, and seasonality.
• A total of 105,398 deaths were recorded during the study period.

Conclusions:

• Patients undergoing maintenance dialysis face a heightened mortality risk in the 30-day period following a hurricane.
• These findings underscore the vulnerability of dialysis patients to extreme weather events and the need for preparedness strategies.