Dialysis Care and Death Following Hurricane Sandy

• DOI: 10.1053/j.ajkd.2014.07.005
• Publication Date: 2014-08-22T07:32:45Z
• Authors: Jeffrey Kelman; Kristen Finne; Alina Bogdanov; Chris Worrall; Gregg Margolis; Kristin Rising; Thomas E. MaCurdy; Nicole Lurie
• Keywords: Male; New Jersey; Cyclonic Storms; Middle Aged; Medicare; United States; Patient Care Management; 3. Good health; Cohort Studies; Disasters; Hospitalization; Insurance Claim Review; 03 medical and health sciences; 0302 clinical medicine; Renal Dialysis; Humans; Kidney Failure, Chronic; Female; New York City; Emergency Service, Hospital; Retrospective Studies

Hurricane Sandy affected access to critical health care infrastructure. Patients with end-stage renal disease (ESRD) historically have experienced problems accessing care and adverse outcomes during disasters.Retrospective cohort study with 2 comparison groups.Using Centers for Medicare & Medicaid Services claims data, we assessed the frequency of early dialysis, emergency department (ED) visits, hospitalizations, and 30-day mortality for patients with ESRD in Sandy-affected areas (study group) and 2 comparison groups: (1) patients with ESRD living in states unaffected by Sandy during the same period and (2) patients with ESRD living in the Sandy-affected region a year prior to the hurricane (October 1, 2011, through October 30, 2011).Regional variation in dialysis care patterns and mortality for patients with ESRD in New York City and the State of New Jersey.Frequency of early dialysis, ED visits, hospitalizations, and 30-day mortality.Of 13,264 study patients, 59% received early dialysis in 70% of the New York City and New Jersey dialysis facilities. The ED visit rate was 4.1% for the study group compared with 2.6% and 1.7%, respectively, for comparison groups 1 and 2 (both P<0.001). The hospitalization rate for the study group also was significantly higher than that in either comparison group (4.5% vs 3.2% and 3.8%, respectively; P<0.001 and P<0.003). 23% of study group patients who visited the ED received dialysis in the ED compared with 9.3% and 6.3% in comparison groups 1 and 2, respectively (both P<0.001). The 30-day mortality rate for the study group was slightly higher than that for either comparison group (1.83% vs 1.47% and 1.60%, respectively; P<0.001 and P=0.1).Lack of facility level damage and disaster-induced power outage severity data.Nearly half the study group patients received early dialysis prior to Sandy's landfall. Poststorm increases in ED visits, hospitalizations, and 30-day mortality were found in the study group, but not in the comparison groups.