Dialysis care and death following Hurricane Sandy

Abstract

Background: 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.

Study design: Retrospective cohort study with 2 comparison groups.

Setting & participants: 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).

Factor: Regional variation in dialysis care patterns and mortality for patients with ESRD in New York City and the State of New Jersey.

Measurements: Frequency of early dialysis, ED visits, hospitalizations, and 30-day mortality.

Results: 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).

Limitations: Lack of facility level damage and disaster-induced power outage severity data.

Conclusions: 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.

Keywords: Dialysis; Hurricane Sandy; Kidney Community Emergency Response (KCER) Program; disaster planning; emergency preparedness; end-stage renal disease (ESRD); natural disaster; vulnerable population.