Abstract
Extreme weather events (EWE) are expected to increase as climate change intensifies, leaving coastal regions exposed to higher risks. South Florida has the highest HIV infection rate in the United States, and disruptions in clinic utilization due to extreme weather conditions could affect adherence to treatment and increase community transmission. The objective of this study was to identify the association between EWE and HIV-clinic attendance rates at a large academic medical system serving the Miami-Dade communities. The following methods were utilized: (1) Extreme heat index (EHI) and extreme precipitation (EP) were identified using daily observations from 1990–2019 that were collected at the Miami International Airport weather station located 3.6 miles from the studied HIV clinics. Data on hurricanes, coastal storms and flooding were collected from the National Oceanic and Atmospheric Administration Storms Database (NOAA) for Miami-Dade County. (2) An all-HIV clinic registry identified scheduled daily visits during the study period (hurricane seasons from 2017–2019). (3) Daily weather data were linked to the all-HIV clinic registry, where patients’ ‘no-show’ status was the variable of interest. (4) A time-stratified, case crossover model was used to estimate the relative risk of no-show on days with a high heat index, precipitation, and/or an extreme natural event. A total of 26,444 scheduled visits were analyzed during the 383-day study period. A steady increase in the relative risk of ‘no-show’ was observed in successive categories, with a 14% increase observed on days when the heat index was extreme compared to days with a relatively low EHI, 13% on days with EP compared to days with no EP, and 10% higher on days with a reported extreme weather event compared to days without such incident. This study represents a novel approach to improving local understanding of the impacts of EWE on the HIV-population’s utilization of healthcare, particularly when the frequency and intensity of EWE is expected to increase and disproportionately affect vulnerable populations. More studies are needed to understand the impact of EWE on routine outpatient settings.
Highlights
A steady increase in the relative risk of ‘no-show’ was observed in successive categories, with a 14% increase observed on days when the heat index was extreme compared to days with a relatively low extreme heat index (EHI), 13% on days with extreme precipitation (EP) compared to days with no EP, and 10% higher on days with a reported extreme weather event compared to days without such incident
Based on 30 years of data, the extreme weather events (EWE) values were as follows: the EHI values corresponding to any value above the 90th percentile was 100.83 ◦ F (Appendix A–Figure A1A,B); the Extreme Precipitation amounts corresponding to any value above the 90th percentile was
The sum of the number of extreme precipitation days was equivalent to 2132 scheduled visits to an HIV clinic (Figure 3B)
Summary
Science predicts an increase of 1.5 ◦ C will lead to devastating extreme weather events (EWE), such as heavy rainfall or a high heat index [1]. EWEs are becoming more frequent and more intense [2], with coastal areas like Miami, Florida being vulnerable [3]. The State of Florida (the warmest state in the United States (U.S.)) [4] is surrounded by water and had a documented annual mean temperature increase from. 69.8 ◦ F in 1895 to 71.2 ◦ F in 2015—an increase of 1.4 ◦ F over 120 years. Individual regions within a state may experience changes that differ from the mean. Miami has experienced a steady increase in its annual average temperature, from 75.1 ◦ F in 1950 to
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
