Impact of extreme weather events on healthcare utilization and mortality in the United States

doi:10.1038/s41591-024-02833-x

. 2024 Apr;30(4):1118-1126.

doi: 10.1038/s41591-024-02833-x. Epub 2024 Feb 29.

Impact of extreme weather events on healthcare utilization and mortality in the United States

Renee N Salas ^{1

2

3

4}, Laura G Burke ^{5

6

7}, Jessica Phelan ⁶, Gregory A Wellenius ⁸, E John Orav ⁶, Ashish K Jha ⁹

Affiliations

¹ Massachusetts General Hospital, Department of Emergency Medicine, Boston, MA, USA. rnsalas@mgh.harvard.edu.
² Harvard Medical School, Boston, MA, USA. rnsalas@mgh.harvard.edu.
³ Harvard Global Health Institute, Cambridge, MA, USA. rnsalas@mgh.harvard.edu.
⁴ Harvard T.H. Chan School of Public Health, Boston, MA, USA. rnsalas@mgh.harvard.edu.
⁵ Harvard Medical School, Boston, MA, USA.
⁶ Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁷ Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, MA, USA.
⁸ Boston University School of Public Health, Center for Climate and Health, Boston, MA, USA.
⁹ Brown University School of Public Health, Providence, RI, USA.

PMID: 38424213
DOI: 10.1038/s41591-024-02833-x

Impact of extreme weather events on healthcare utilization and mortality in the United States

Renee N Salas et al. Nat Med. 2024 Apr.

. 2024 Apr;30(4):1118-1126.

doi: 10.1038/s41591-024-02833-x. Epub 2024 Feb 29.

Authors

Renee N Salas ^{1

2

3

4}, Laura G Burke ^{5

6

7}, Jessica Phelan ⁶, Gregory A Wellenius ⁸, E John Orav ⁶, Ashish K Jha ⁹

Affiliations

¹ Massachusetts General Hospital, Department of Emergency Medicine, Boston, MA, USA. rnsalas@mgh.harvard.edu.
² Harvard Medical School, Boston, MA, USA. rnsalas@mgh.harvard.edu.
³ Harvard Global Health Institute, Cambridge, MA, USA. rnsalas@mgh.harvard.edu.
⁴ Harvard T.H. Chan School of Public Health, Boston, MA, USA. rnsalas@mgh.harvard.edu.
⁵ Harvard Medical School, Boston, MA, USA.
⁶ Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁷ Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, MA, USA.
⁸ Boston University School of Public Health, Center for Climate and Health, Boston, MA, USA.
⁹ Brown University School of Public Health, Providence, RI, USA.

PMID: 38424213
DOI: 10.1038/s41591-024-02833-x

Abstract

Climate change is intensifying extreme weather events. Yet a systematic analysis of post-disaster healthcare utilization and outcomes for severe weather and climate disasters, as tracked by the US government, is lacking. Following exposure to 42 US billion-dollar weather disasters (severe storm, flood, flood/severe storm, tropical cyclone and winter storm) between 2011 and 2016, we used a difference-in-differences (DID) approach to quantify changes in the rates of emergency department (ED) visits, nonelective hospitalizations and mortality between fee-for-service Medicare beneficiaries in affected compared to matched control counties in post-disaster weeks 1, 1-2 and 3-6. Overall, disasters were associated with higher rates of ED utilization in affected counties in post-disaster week 1 (DID of 1.22% (95% CI, 0.20% to 2.25%; P < 0.020)) through week 2. Nonelective hospitalizations were unchanged. Mortality was higher in affected counties in week 1 (DID of 1.40% (95% CI, 0.08% to 2.74%; P = 0.037)) and persisted for 6 weeks. Counties with the greatest loss and damage experienced greater increases in ED and mortality rates compared to all affected counties. Thus, billion-dollar weather disasters are associated with excess ED visits and mortality in Medicare beneficiaries. Tracking these outcomes is important for adaptation that protects patients and communities, health system resilience and policy.

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References

1. Arias, P. A. et al. Technical summary. In Climate Change 2021: The Physical Science Basis. Contribution of Working Group I to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change (eds Masson-Delmotte, V. et al.) 33–144 (Cambridge University Press, 2021).
1. Kossin, J. P., Knapp, K. R., Olander, T. L. & Velden, C. S. Global increase in major tropical cyclone exceedance probability over the past four decades. Proc. Natl Acad. Sci. USA 117, 11975–11980 (2020). - DOI - PubMed - PMC
1. Prein, A. F. Thunderstorm straight line winds intensify with climate change. Nat. Clim. Chang. 13, 1353–1359 (2023). - DOI
1. Smith, A. B. & Katz, R. W. US billion-dollar weather and climate disasters: data sources, trends, accuracy and biases. Nat. Hazards 67, 387–410 (2013). - DOI
1. Smith, A. B. & Matthews, J. L. Quantifying uncertainty and variable sensitivity within the US billion-dollar weather and climate disaster cost estimates. Nat. Hazards 77, 1829–1851 (2015). - DOI

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[1] Arias, P. A. et al. Technical summary. In Climate Change 2021: The Physical Science Basis. Contribution of Working Group I to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change (eds Masson-Delmotte, V. et al.) 33–144 (Cambridge University Press, 2021).

[2] Arias, P. A. et al. Technical summary. In Climate Change 2021: The Physical Science Basis. Contribution of Working Group I to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change (eds Masson-Delmotte, V. et al.) 33–144 (Cambridge University Press, 2021).

[3] Kossin, J. P., Knapp, K. R., Olander, T. L. & Velden, C. S. Global increase in major tropical cyclone exceedance probability over the past four decades. Proc. Natl Acad. Sci. USA 117, 11975–11980 (2020). - DOI - PubMed - PMC

[4] Kossin, J. P., Knapp, K. R., Olander, T. L. & Velden, C. S. Global increase in major tropical cyclone exceedance probability over the past four decades. Proc. Natl Acad. Sci. USA 117, 11975–11980 (2020). - DOI - PubMed - PMC

[5] Prein, A. F. Thunderstorm straight line winds intensify with climate change. Nat. Clim. Chang. 13, 1353–1359 (2023). - DOI

[6] Prein, A. F. Thunderstorm straight line winds intensify with climate change. Nat. Clim. Chang. 13, 1353–1359 (2023). - DOI

[7] Smith, A. B. & Katz, R. W. US billion-dollar weather and climate disasters: data sources, trends, accuracy and biases. Nat. Hazards 67, 387–410 (2013). - DOI

[8] Smith, A. B. & Katz, R. W. US billion-dollar weather and climate disasters: data sources, trends, accuracy and biases. Nat. Hazards 67, 387–410 (2013). - DOI

[9] Smith, A. B. & Matthews, J. L. Quantifying uncertainty and variable sensitivity within the US billion-dollar weather and climate disaster cost estimates. Nat. Hazards 77, 1829–1851 (2015). - DOI

[10] Smith, A. B. & Matthews, J. L. Quantifying uncertainty and variable sensitivity within the US billion-dollar weather and climate disaster cost estimates. Nat. Hazards 77, 1829–1851 (2015). - DOI

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Impact of extreme weather events on healthcare utilization and mortality in the United States

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Impact of extreme weather events on healthcare utilization and mortality in the United States

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