Maintaining Quality of Care among Dialysis Patients in Affected Areas after Typhoon Morakot.

Chia-Ming Chang,Tzu-Ching Sung,Jung-Der Wang,Yi-Ting Huang,Yi-Fang Tu,Hsin-I Shih,Tzu-Yuan Stessa Chao

doi:10.3390/ijerph18147400

Abstract

Natural disasters have negative health impacts on patients who need dialysis in affected areas. Severely affected areas are usually rural, with limited basic infrastructure and a population without optimal dialysis-specific care after a disaster. A population-based longitudinal case–cohort study enrolled 715,244 adults from the National Health Insurance Registry who lived in areas affected by a major natural disaster, Typhoon Morakot, in 2009. The observation period was from 2008 to 2011. A total of 13,268 patients (1.85%) had a history of end-stage renal disease (ESRD). Of the ESRD patients, 1264 patients (9.5%) received regular dialysis. Only eight patients missed dialysis sessions in the first month after the disaster. Compared to the moderately affected areas, the incidences of acute cerebrovascular and cardiovascular diseases were higher in patients in severely affected areas. Male dialysis patients aged 45–75 years had a higher mortality rate than that of the general population. Among the affected adults receiving regular dialysis, patients with diabetes (adjusted hazard ratio (aHR): 1.58, 95% confidence interval (CI): 1.20–2.08) or a history of cerebrovascular disease (aHR: 1.58, 95% CI: 1.12–2.21), chronic obstructive pulmonary disease (COPD) or asthma (aHR: 1.99, 95% CI: 1.24–3.17) in moderately affected areas had significantly elevated mortality rates. Additionally, among dialysis patients living in severely affected areas, those with a history of cerebrovascular disease (aHR: 4.52 95% CI: 2.28–8.79) had an elevated mortality rate. Early evacuation plans and high-quality, accessible care for cardiovascular and cerebrovascular diseases are essential to support affected populations before and after disasters to improve dialysis patients’ health outcomes.

Highlights

Climate-associated heavy precipitation events and floods have increased in recent decades [1,2]
Patients on regular dialysis in the severely affected area were older (62.69 (13.27) vs. 62.37 (12.45) years), consisted of a higher proportion of individuals living in rural areas (61% vs. 23%), and included a higher proportion of individuals with multiple underlying diseases
The results of this study suggested that adults on regular dialysis in affected areas were at increased risk for hospitalization due to infection and injury, but not due to acute pulmonary edema, acute ischemic heart diseases, acute cerebrovascular diseases, or Peripheral arterial occlusive diseases (PAOD)

Summary

Introduction

Climate-associated heavy precipitation events and floods have increased in recent decades [1,2]. Variable rainfall patterns have increased the frequency and intensity of flooding, which has had substantial impacts on human health and heightened the risk of health effects in those with chronic comorbidities, communicable diseases, and stress [3,4,5]. Heavy floods and associated mudslides can cause substantial damage to basic infrastructure (electrical utilities, backup generators, and structural damage) and lead to.

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