Peritraumatic Stress From a Disaster Increases Risk for Onset of Chronic Diseases Among Older Adults

Background and Objectives Our understanding of the impact of disaster exposure on the physical health of older adults is largely based on hospital admissions for acute illnesses in the weeks following a disaster. Studies of longer-term outcomes have centered primarily on mental health. Missing have been studies examining whether exposure to disaster increases the risk for the onset of chronic diseases. We examined the extent to which 2 indicators of disaster exposure (geographic exposure and peritraumatic stress) were associated with new onset of cardiovascular disease, diabetes, arthritis, and lung disease to improve our understanding of the long-term physical health consequences of disaster exposure. Research Design and Methods We linked self-reported data collected prior to and following Hurricane Sandy from a longitudinal panel study with Medicare data to assess time to new onset of chronic diseases in the 4 years after the hurricane. Results We found that older adults who reported high levels of peritraumatic stress from Hurricane Sandy had more than twice the risk of experiencing a new diagnosis of lung disease, diabetes, and arthritis in the 4 years after the hurricane compared to older adults who did not experience high levels of peritraumatic stress. Geographic proximity to the hurricane was not associated with these outcomes. Analyses controlled for known risk factors for the onset of chronic diseases, including demographic, psychosocial, and health risks. Discussion and Implications Findings reveal that physical health effects of disaster-related peritraumatic stress extend beyond the weeks and months after a disaster and include new onset of chronic diseases that are associated with loss of functioning and early mortality.

Health Disparities and Climate Change: The Intersection of Three Disaster Events on Vulnerable Communities in Houston, Texas

Although evidence suggests that successive climate disasters are on the rise, few studies have documented the disproportionate impacts on communities of color. Through the unique lens of successive disaster events (Hurricane Harvey and Winter Storm Uri) coupled with the COVID-19 pandemic, we assessed disaster exposure in minority communities in Harris County, Texas. A mixed methods approach employing qualitative and quantitative designs was used to examine the relationships between successive disasters (and the role of climate change), population geography, race, and health disparities-related outcomes. This study identified four communities in the greater Houston area with predominantly non-Hispanic African American residents. We used data chronicling the local community and environment to build base maps and conducted spatial analyses using Geographic Information System (GIS) mapping. We complemented these data with focus groups to assess participants’ experiences in disaster planning and recovery, as well as community resilience. Thematic analysis was used to identify key patterns. Across all four communities, we observed significant Hurricane Harvey flooding and significantly greater exposure to 10 of the 11 COVID-19 risk factors examined, compared to the rest of the county. Spatial analyses reveal higher disease burden, greater social vulnerability, and significantly higher community-level risk factors for both pandemics and disaster events in the four communities, compared to all other communities in Harris County. Two themes emerged from thematic data analysis: (1) Prior disaster exposure prepared minority populations in Harris County to better handle subsequent disaster suggesting enhanced disaster resilience, and (2) social connectedness was key to disaster resiliency. Long-standing disparities make people of color at greater risk for social vulnerability. Addressing climate change offers the potential to alleviate these health disparities.

Weather-Related Disaster in a Diverse Cohort of Aging Adults

As climate change contributes to increasing frequency and intensity of weather-related disasters, it is critical to define characteristics that increase risk of poor health outcomes during and after events. Given the aging of the United States (US) population and over-representation of older adults in disaster-prone areas, disaster-related impacts on older adults present a growing public health challenge. We linked data from the REGARDS study, a cohort of 30,107 Black and White adults (mean age 65 years at baseline, 2003-2007), with community data from the National Establishment Time Series database and longitudinal weather-related disaster data from the Spatial Hazard Events and Losses Database for the US. We calculated disaster exposure for each year for the county in which the respondents lived from 2003 – 2015: 84% of county-years showed at least some impacts, including 16% of counties experiencing medium impacts ($10- $50 property damage per capita or 2 fatalities) and 12% severe (greater than $50 per capital or 3 fatalities); this mirrors that of the continental US (77% some impact, 15% medium, 13% severe). REGARDS participants exposed to moderate or severe disasters were more likely to be Black and low socioeconomic status compared to those who were not exposed. For community characteristics, higher disaster exposure was associated with a greater density of resources including ambulatory care, food stores, social services, and destinations for daily living. Our approach showcases how disaster preparedness systems need better data about specific individual-and community-level factors that increase risk among older adults to better serve communities.

Impact of Hurricane Sandy on Hospital Admissions 2 Years Later

Disaster exposure is often followed by acute illness and injuries requiring hospital admission in the weeks after the disaster. It is not known whether disaster exposure is associated with hospitalization in the years after the disaster. We examined the extent to which disaster exposure is associated with hospitalization two years after Hurricane Sandy. The analyses fill a gap in our understanding of long-term physical health consequences of disaster exposure by identifying older adults at greatest risk for hospitalization two years after disaster exposure. Older adults (n=909) who participated in a longitudinal panel study provided data before and after Hurricane Sandy. These data were linked with Medicare inpatient files to assess the impact of Hurricane Sandy on hospital admissions after the post-hurricane interview. Those who reported experiencing a lot of fear and distress in the midst of Hurricane Sandy were at an increased risk of being hospitalized in the second or third years after the hurricane [Hazard Ratio=1.81 (1.15 – 2.85)]. Findings held after controlling for pre-hurricane demographics, social risks, chronic conditions, and decline in physical functioning after the hurricane. These findings are the first to show that disaster exposure increases risk for hospital admissions two years after a disaster, and that older adults’ appraisal of their emotional distress during the disaster has prognostic significance that is not explained by known risks for hospital admissions. The findings suggest that interventions during the storm and after the storm, may reduce long-term health consequences of disaster exposure among older adults.

Sex-specific associations between type 2 diabetes incidence and exposure to dioxin and dioxin-like pollutants: a meta-analysis

The relationship between persistent organic pollutants (POPs), including dioxins and dioxin-like polychlorinated biphenyls (DL-PCBs), and diabetes incidence in adults has been extensively studied. However, significant variability exists in the reported associations both between and within studies. Emerging data from rodent studies suggest that dioxin exposure disrupts glucose homeostasis in a sex-specific manner. Thus, we performed a meta-analysis of relevant epidemiological studies to investigate whether there are sex-specific associations between dioxin or DL-PCB exposure and type 2 diabetes incidence. Articles were organized into the following subcategories: data stratified by sex (16%), unstratified data (56%), and data from only 1 sex (16% male, 12% female). We also considered whether exposure occurred either abruptly at high levels through a contamination event (“disaster exposure”) or chronically at background levels (“non-disaster exposure”). Only 8 studies compared associations between dioxin/DL-PCB exposure and diabetes risk in males versus females within the same population. When all sex-stratified or single sex studies were considered in the meta-analysis, the summary odds ratio (OR) for increased diabetes risk was similar between females and males (1.78 and 1.95, respectively) when comparing exposed to reference populations, suggesting that this relationship is not sex-specific. However, when we considered disaster-exposed populations separately, the association differed substantially between sexes, with females showing a much higher OR than males (2.86 and 1.59, respectively). Moreover, the association between dioxin/DL-PCB exposure and diabetes was stronger for females than males in disaster-exposed populations. In contrast, both sexes had significantly increased ORs in non-disaster exposure populations and the OR for females was lower than males (1.40 and 2.02, respectively). Our review emphasizes the importance of considering sex differences, as well as the mode of pollutant exposure, when exploring the relationship between pollutant exposure and diabetes in epidemiological studies.

Ready When the Big One Comes? Natural Disasters and Mass Support for Preparedness Investment

Societies can address collective threats such as natural disasters or pandemics by investing in preparedness (ex ante) or by offering compensation after an adverse event has occurred (ex post). What explains which of these options voters prefer? We study how personal exposure and policy knowledge affect mass support for long-term disaster preparedness, a type of long-term investment meant to cope with an increasingly destructive and frequent class of events. We first assess whether support for preparedness reflects personal affectedness and find that neither subjective nor geo-coded measures of disaster exposure predict policy preferences. Second, we explore whether this finding can be explained by misperceptions about the features of the available policy options. We find that revealing the damage reductions associated with preparedness systematically reduces opposition to long-term investment. These results suggest that opposition to preparing for collective threats may depend more on informational deficiencies than on personal experience with realized risks.

The pandemic is not occurring in a vacuum: The impact of COVID-19 and other disasters on workforce mental health in Australia

Objective: Prior to COVID-19, many Australians experienced extreme bushfires, droughts and floods. A history of experiencing these events might be a risk factor for increased psychological distress during COVID-19. This study aimed to provide insight into the mental health of Australian workers during the initial COVID-19 outbreak, with an additional focus on whether previous disaster exposure and impact from that disaster is a risk factor for increased psychological distress. Methods: A snowball recruitment strategy was used. Participants (n = 596) completed an online survey, which included the Depression Anxiety Stress Scales 21, and questions related to mental health and disaster exposure. Results: Overall, 19.2%, 13.4% and 16.8% of participants were experiencing moderate to extremely severe depression, anxiety and stress symptoms respectively. Multiple regression found that higher depression, anxiety and stress symptoms were associated with a pre-existing mental health diagnosis; only higher stress symptoms were associated with having experienced a disaster, with impact, in addition to COVID-19. Conclusions: People who have experienced impact from an additional disaster might need additional support to protect their mental health during COVID-19. A focus on the cumulative mental health impacts of multiple disasters, and the implications for organisational communities where recovery work is undertaken, such as schools and workplaces, is needed.