ABSTRACT
Weather-related disasters are increasing in frequency and severity, leaving survivors to cope with ensuing mental, financial, and physical hardships. This adversity can exacerbate existing morbidities, trigger new ones, and increase the risk of mortality-features that are also characteristic of advanced age-inviting the hypothesis that extreme weather events may accelerate aging. To test this idea, we examined the impact of Hurricane Maria and its aftermath on immune cell gene expression in large, age-matched, cross-sectional samples from free-ranging rhesus macaques (Macaca mulatta) living on an isolated island. A cross section of macaques was sampled 1 to 4 y before (n = 435) and 1 y after (n = 108) the hurricane. Hurricane Maria was significantly associated with differential expression of 4% of immune-cell-expressed genes, and these effects were correlated with age-associated alterations in gene expression. We further found that individuals exposed to the hurricane had a gene expression profile that was, on average, 1.96 y older than individuals that were not-roughly equivalent to an increase in 7 to 8 y of a human life. Living through an intense hurricane and its aftermath was associated with expression of key immune genes, dysregulated proteostasis networks, and greater expression of inflammatory immune cell-specific marker genes. Together, our findings illuminate potential mechanisms through which the adversity unleashed by extreme weather and potentially other natural disasters might become biologically embedded, accelerate age-related molecular immune phenotypes, and ultimately contribute to earlier onset of disease and death.
Subject(s)
Aging/immunology , Macaca/immunology , Survivors/psychology , Age Factors , Animals , Cross-Sectional Studies , Cyclonic Storms , Disasters , Natural Disasters/mortality , Risk FactorsABSTRACT
Objectives. To determine the number and causes of excess deaths in Puerto Rico after Hurricane Maria made landfall on September 20, 2017. Methods. We obtained monthly vital statistics data on all deaths from January 2008 through October 2017. We conducted a time-series analysis to estimate excess mortality in September and October 2017 overall and by age, sex, and cause of death. Results. We estimated a total of 1205 excess deaths (95% confidence interval [CI] = 707, 1702). Excess deaths were slightly higher among men than women (632 and 579 deaths, respectively) and found only among people aged 60 years or older (1038 deaths). Most excess deaths occurred from heart disease (253 deaths), "other" causes (204 deaths), diabetes (195 deaths), Alzheimer's disease (122 deaths), and septicemia (81 deaths). Conclusions. The number of excess deaths was similar to recent government estimates. However, this study is the first to identify the causes of death that were exacerbated by the disaster. Public Health Implications. An accurate estimation of the top causes of excess mortality can help authorities plan resource allocation for the island's recovery and for the prevention of deaths in future disasters.
Subject(s)
Cyclonic Storms/mortality , Natural Disasters/mortality , Vital Statistics , Adult , Age Factors , Aged , Cause of Death , Female , Humans , Male , Middle Aged , Puerto RicoSubject(s)
Computer Simulation , Cyclonic Storms/statistics & numerical data , Floods/statistics & numerical data , Forecasting , Global Warming/statistics & numerical data , Rain , Atmosphere/chemistry , Cyclonic Storms/mortality , Floods/mortality , Floods/prevention & control , Hot Temperature , Humans , India , Japan , Natural Disasters/mortality , Natural Disasters/prevention & control , United Kingdom , United States , Volatilization , Water/analysisSubject(s)
Climate Change/statistics & numerical data , Disaster Planning , Natural Disasters , Risk Assessment , Altitude , Climate Change/economics , Climate Change/mortality , Cyclonic Storms , Droughts/mortality , Droughts/statistics & numerical data , Dust/analysis , Environmental Monitoring , Floods/prevention & control , Floods/statistics & numerical data , Hot Temperature/adverse effects , Humans , Natural Disasters/economics , Natural Disasters/mortality , Natural Disasters/prevention & control , Soot/adverse effects , Soot/analysis , Water Supply , Wildfires/economics , Wildfires/mortality , Wildfires/statistics & numerical dataABSTRACT
BACKGROUND/PURPOSE: People with different age distributions and extrication times might have distinct injury characteristics and outcomes in earthquakes. METHODS: A retrospective study was conducted to analyze the casualties in the 2016 Taiwan earthquake using data from the incident registry system and the field disaster operation system. The study subjects were assigned to 4 groups by age: preschool (<5 years), school (5-17 years), adult (18-64 years), and elderly (>64 years). Classification and regression tree analysis and receiver-operating characteristic curves were utilized to examine several factors, including extrication time, age group, floor height, and structural damage, for earthquake-related mortality. A two-sided p value less than 0.05 was considered statistically significant. RESULTS: A total of 238 enrollees were assigned to the preschool (n = 18, 7.6%), school (n = 45, 18.9%), adult (n = 169, 71.0%), or elderly (n = 6, 2.5%) groups. Among the parameters, the extrication time exhibited the strongest association with mortality. Regarding the association between the extrication time and mortality hazard in multivariate models, we found significant odds ratios (ORs) at the extrication time cutoffs of 12, 24 and 72 h (OR = 42.61, 95% confidence interval [CI]: 13.92-130.37; OR = 37.58, 95% CI: 14.77-95.60; OR = 95.16, 95% CI: 23.02-393.48, respectively, all p < 0.001). The optimal extrication time cutoff for mortality was 12 h in the preschool group and 24 h in the school and adult groups. CONCLUSION: Extrication time is strongly associated with earthquake-related mortality. These findings may facilitate strategic approaches for patients entrapped in damaged buildings and can contribute to future training for field search and rescues after earthquakes.
Subject(s)
Earthquakes/mortality , Natural Disasters/mortality , Rescue Work/statistics & numerical data , Time Factors , Adolescent , Adult , Aged , Child , Child, Preschool , Humans , Male , Middle Aged , ROC Curve , Registries , Regression Analysis , Retrospective Studies , Taiwan/epidemiology , Young AdultABSTRACT
BACKGROUND: Natural disasters are believed to be associated with cardiovascular disease. This study aimed to explore the changes in mortality due to ischemic heart disease (IHD) and their associations with natural disasters at the global level. METHODS: Country-specific data on the impact of natural disasters, rates of mortality due to IHD and years of life lost (YLL) and socioeconomic variables were obtained for 193 countries for the period from 1990 to 2017. An ecological trend study was conducted to estimate the changes in the IHD mortality and YLL rates and their associations with natural disasters (occurrence, casualties and total damage). Correlation analyses and multivariate linear regression were used. RESULTS: Significant changes were found in the IHD mortality and YLL rates and the occurrence of disasters between the two equal periods (1990 to 2003 and 2004 to 2017) (p<0.001). The bivariate Pearson correlation test revealed that the trend in the occurrence of natural disasters was positively correlated with trends in the IHD mortality and YLL rates among females and all individuals (p<0.05) and was marginally correlated among males. Multiple linear regression revealed an independent association between the occurrence of natural disasters and the IHD mortality rate among males, females and all individuals (standardized coefficients = 0.163, 0.357 and 0.241, p<0.05), and similar associations were found for the YLL rate (standardized coefficients = 0.194, 0.233 and 0.189, p<0.05). CONCLUSIONS: Our study demonstrated significant changes in the IHD mortality and YLL rates at the global level and their independent associations with natural disasters. Both males and females were vulnerable to natural disasters. These results provide evidence that can be used to support policy making and resource allocation when responding to disasters and developing strategies to reduce the burden of IHD.
Subject(s)
Myocardial Ischemia/mortality , Ecology , Female , Humans , Male , Natural Disasters/mortality , Risk FactorsABSTRACT
Natural disturbances are an important driver of population dynamics. Because it is difficult to observe wildlife during these events, our understanding of the strategies that species use to survive these disturbances is limited. On October 10, 2018, Hurricane Michael made landfall on Florida's northwest coast. Using satellite and acoustic telemetry, we documented movements of 6 individual turtles: one loggerhead sea turtle, one Kemp's ridley sea turtle, three green sea turtles and one diamondback terrapin, in a coastal bay located less than 30 km from hurricane landfall. Post-storm survival was confirmed for all but the Kemp's ridley; the final condition of that individual remains unknown. No obvious movements were observed for the remaining turtles however the loggerhead used a larger home range in the week after the storm. This study highlights the resiliency of turtles in response to extreme weather conditions. However, long-term impacts to these species from habitat changes post-hurricane are unknown.
Subject(s)
Behavior, Animal/physiology , Natural Disasters/mortality , Turtles/physiology , Animal Distribution/physiology , Animals , Animals, Wild , Cyclonic Storms/statistics & numerical data , Ecosystem , Florida , Gulf of Mexico , Movement/physiologyABSTRACT
PURPOSE: Although the wind, rain, and flooding of Hurricane Maria in Puerto Rico abated shortly after its landfall on September 20, 2017, the disruption of the electrical, communications, transportation, and medical infrastructure of the island was unprecedented in scope and caused lasting harm for many months afterward. A compilation of recommendations from radiation oncologists who were in Puerto Rico during the disaster, and from a panel of American Society for Radiation Oncology (ASTRO) cancer experts was created. METHODS AND MATERIALS: Radiation oncologists throughout Puerto Rico collaborated and improvised to continue treating patients in the immediate aftermath of the storm and as routine clinical operations were restored gradually. Empirical lessons from the experience of radiation therapy administration in this profoundly altered context of limited resources, impaired communication, and inadequate transportation were organized into a recommended template, applicable to any radiation oncology practice. ASTRO disease-site experts provided evidence-guidelines for mitigating the impact of a 2- to 3-week interruption in radiation therapy. RESULTS: Practical measures to mitigate the medical impact of a disaster are summarized within the framework of "Prepare, Communicate, Operate, Compensate." Specific measures include the development of an emergency operations plan tailored to specific circumstances, prospective coordination with other radiation oncology clinics before a disaster, ongoing communications with emergency management organizations, and routine practice of alternate methods to disseminate information among providers and patients. CONCLUSIONS: These recommendations serve as a starting point to assist any radiation oncology practice in becoming more resiliently prepared for a local or regional disruption from any cause. Disease-site experts provide evidence-based guidelines on how to mitigate the impact of a 2- to 3-week interruption in radiation therapy for lung, head and neck, uterine cervix, breast, and prostate cancers through altered fractionation or dose escalation.
Subject(s)
Cyclonic Storms/mortality , Natural Disasters/mortality , Radiation Oncology/standards , Humans , Puerto RicoABSTRACT
BACKGROUND: Hurricane Maria struck Puerto Rico on Sept 20, 2017, devastating the island. Controversy surrounded the official death toll, fuelled by estimates of excess mortality from academics and investigative journalists. We analysed all-cause excess mortality following the storm. METHODS: We did a time-series analysis in Puerto Rico from September, 2017, to February, 2018. Mortality data were from the Puerto Rico Vital Statistics System. We developed two counterfactual scenarios to establish the population at risk. In the first scenario, the island's population was assumed to track the most recent census estimates. In the second scenario, we accounted for the large-scale population displacement. Expected mortality was projected for each scenario through over-dispersed log-linear regression from July, 2010, to August, 2017, taking into account changing distributions of age, sex, and municipal socioeconomic development, as well as both long-term and seasonal trends in mortality. Excess mortality was calculated as the difference between observed and expected deaths. FINDINGS: Between September, 2017, and February, 2018, we estimated that 1191 excess deaths (95% CI 836-1544) occurred under the census scenario. Under the preferred displacement scenario, we estimated that 2975 excess deaths (95% CI 2658-3290) occurred during the same observation period. The ratio of observed to expected mortality was highest for individuals living in municipalities with the lowest socioeconomic development (1·43, 95% CI 1·39-1·46), and for men aged 65 years or older (1·33, 95% CI 1·30-1·37). Excess risk persisted in these groups throughout the observation period. INTERPRETATION: Analysis of all-cause mortality with vital registration data allows for unbiased estimation of the impact of disasters associated with natural hazards and is useful for public health surveillance. It does not depend on certified cause of death, the basis for the official death toll in Puerto Rico. Although all sectors of Puerto Rican society were affected, recovery varied by municipal socioeconomic development and age groups. This finding calls for equitable disaster preparedness and response to protect vulnerable populations in disasters. FUNDING: Forensic Science Bureau, Department of Public Safety, and Milken Institute School of Public Health of The George Washington University (Washington, DC, USA).
Subject(s)
Cause of Death , Cyclonic Storms/mortality , Natural Disasters/mortality , Age Factors , Humans , Puerto Rico , Sex FactorsABSTRACT
OBJECTIVES: As an emerging country with the fourth largest population in the world, Indonesia's purchasing power has strengthened, leading to socioeconomic changes that affect its healthcare system. Additionally, there is a surge of healthcare utilisation after the implementation of a new national insurance scheme, particularly within emergency departments. Similar to other low- to middle-income countries, Indonesia has not prioritised the progress of emergency medicine despite existing evidence that suggests that the early intervention of many acute conditions lowers the rates of morbidity and mortality. This article will review the past and current state of emergency medicine in Indonesia. METHODS: The information gathered through PubMed, Ovid, and private and government institution databases, using the search term 'Indonesia', 'Emergency Medicine', 'Emergency Medical Services', and 'Disaster Medicine'. Additionally, we interviewed physicians who are involved in the development of emergency medicine in Indonesia. RESULTS: Indonesia's emergency medicine can be broken down into three sections: pre-hospital, hospital and the development of emergency medicine as a specialty. At the pre-hospital setting, disaster medicine and emergency medical service have not been established well enough to meet the demands of the population. For hospitals, there are two types of emergency departments - academic versus non-academic. Currently, there is no accredited emergency medicine residency programme despite the recognition of the specialty. CONCLUSION: The development of emergency medicine in Indonesia is in its infancy and will require rapid improvement to meet its country's demand. Academic, private and government sectors need to collaborate to promote and invest in emergency medicine.
Subject(s)
Emergency Medicine/standards , Quality of Health Care/standards , Civil Defense/methods , Civil Defense/standards , Developing Countries/statistics & numerical data , Emergency Medicine/methods , Emergency Service, Hospital/organization & administration , Emergency Service, Hospital/standards , Humans , Indonesia , Natural Disasters/mortality , Quality of Health Care/statistics & numerical dataABSTRACT
OBJECTIVES: To examine associations between access to medical care, geological data, and infant and child mortality in the area of North-Eastern Japan that was impacted by the Great East Japan Earthquake and Tsunami (GEJET) in 2011. DESIGN: A population-based ecological study using publicly available data. SETTING: Twenty secondary medical areas (SMAs) in the disaster-affected zones in the north-eastern prefectures of Japan (Iwate, Fukushima and Miyagi). PARTICIPANTS: Children younger than 10 years who died in the 20 SMAs between 2008 and 2014 (n=1 748). Primary and secondary outcome measures: Multiple regression analysis for infant and child mortality rate. The mean values were applied for infant and child mortality rates and other factors before GEJET (2008-2010) and after GEJET (2012-2014). RESULTS: Between 2008 and 2014, the most common cause of death among children younger than 10 years was accidents. The mortality rate per 100 000 persons was 39.1±41.2 before 2011, 226.7±43.4 in 2011 and 31.4±39.1 after 2011. Regression analysis revealed that the mortality rate was positively associated with low age in each period, while the coastal zone was negatively associated with fewer disaster base hospitals in 2011. By contrast, the number of obstetrics and gynaecology centres (ß=-189.9, p=0.02) and public health nurses (ß=-1.7, p=0.01) was negatively associated with mortality rate per person in 2011. CONCLUSIONS: In 2011, the mortality rate among children younger than 10 years was 6.4 times higher than that before and after 2011. Residence in a coastal zone was significantly associated with higher child mortality rates.