Methodological Challenges and Contributions in Disaster Epidemiology

Abstract

Considering the very unusual and extreme situations under which a disaster and the corresponding adverse health responses occur, it is challenging to provide a unified methodological framework for disaster epidemiology. In this commentary, we identify targets of estimation and common challenges in estimating the quantities of interest. In some cases, we discuss methodological contributions and future work regarding the design and analysis of epidemiologic studies of disasters. To ground our points, we refer to some of the papers published in this issue. Although disasters occur in a wide variety of settings and circumstances, it is possible to identify several methodological challenges and commonalities in the epidemiologic studies of disasters published in this issue. These provide a platform for developing statistical methods to assess short- and long-term adverse health effects of disasters and to predict consequences of future disasters. Disasters have been defined as acute, collectively experienced traumatic events, with a sudden onset. They can be natural (e.g., hurricanes, floods, earthquakes) or man-made (e.g., plane crashes, industrial accidents, terrorist attacks, suicide bombings). By definition, disasters are rare events that, with respect to timing and form, are somewhat unpredictable. This uncertainty poses obvious methodological challenges, because it is exceedingly difficult to have systems in place to adequately track either exposures or health outcomes before, during, and after significant disasters. Therefore, study design and statistical methods to estimate the health impact of a disaster can deviate substantially from those commonly used in more traditional epidemiologic studies.