title: Dialysis care and death following Hurricane Sandy.
abstract: BACKGROUND
  Hurricane Sandy affected access to critical health care infrastructure. Patients with end-stage renal disease (ESRD) historically have experienced problems accessing care and adverse outcomes during disasters.
  
  
  METHODS
  Retrospective cohort study with 2 comparison groups.
  
  
  METHODS
  Using Centers for Medicare & Medicaid Services claims data, we assessed the frequency of early dialysis, emergency department (ED) visits, hospitalizations, and 30-day mortality for patients with ESRD in Sandy-affected areas (study group) and 2 comparison groups: (1) patients with ESRD living in states unaffected by Sandy during the same period and (2) patients with ESRD living in the Sandy-affected region a year prior to the hurricane (October 1, 2011, through October 30, 2011).
  
  
  METHODS
  Regional variation in dialysis care patterns and mortality for patients with ESRD in New York City and the State of New Jersey.
  
  
  METHODS
  Frequency of early dialysis, ED visits, hospitalizations, and 30-day mortality.
  
  
  RESULTS
  Of 13,264 study patients, 59% received early dialysis in 70% of the New York City and New Jersey dialysis facilities. The ED visit rate was 4.1% for the study group compared with 2.6% and 1.7%, respectively, for comparison groups 1 and 2 (both P<0.001). The hospitalization rate for the study group also was significantly higher than that in either comparison group (4.5% vs 3.2% and 3.8%, respectively; P<0.001 and P<0.003). 23% of study group patients who visited the ED received dialysis in the ED compared with 9.3% and 6.3% in comparison groups 1 and 2, respectively (both P<0.001). The 30-day mortality rate for the study group was slightly higher than that for either comparison group (1.83% vs 1.47% and 1.60%, respectively; P<0.001 and P=0.1).
  
  
  CONCLUSIONS
  Lack of facility level damage and disaster-induced power outage severity data.
  
  
  CONCLUSIONS
  Nearly half the study group patients received early dialysis prior to Sandy's landfall. Poststorm increases in ED visits, hospitalizations, and 30-day mortality were found in the study group, but not in the comparison groups.
authors.affiliation: Centers for Medicare & Medicaid Services, US Department of Health and Human Services, Washington, DC.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Kelman
authors.affiliation: Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, Washington, DC.
authors.forename: Kristen
authors.initials: K
authors.lastname: Finne
authors.affiliation: Acumen, LLC, Burlingame, CA.
authors.forename: Alina
authors.initials: A
authors.lastname: Bogdanov
authors.affiliation: Centers for Medicare & Medicaid Services, US Department of Health and Human Services, Washington, DC.
authors.forename: Chris
authors.initials: C
authors.lastname: Worrall
authors.affiliation: Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, Washington, DC.
authors.forename: Gregg
authors.initials: G
authors.lastname: Margolis
authors.affiliation: Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Kristin
authors.initials: K
authors.lastname: Rising
authors.affiliation: Acumen, LLC, Burlingame, CA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: MaCurdy
authors.affiliation: Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, Washington, DC. Electronic address: nicole.lurie@hhs.gov.
authors.forename: Nicole
authors.initials: N
authors.lastname: Lurie
mesh_terms: D015331:Cohort Studies; D055867:Cyclonic Storms; D004190:Disasters; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D009515:New Jersey / Q000453:epidemiology; D009519:New York City / Q000453:epidemiology; D010346:Patient Care Management / Q000379:methods / Q000458:organization & administration; D006435:Renal Dialysis / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States
keywords: Dialysis; Hurricane Sandy; Kidney Community Emergency Response (KCER) Program; disaster planning; emergency preparedness; end-stage renal disease (ESRD); natural disaster; vulnerable population