title: Associations between community-level disaster exposure and individual-level changes in disability and risk of death for older Americans.
abstract: Disasters occur frequently in the United States (US) and their impact on acute morbidity, mortality and short-term increased health needs has been well described. However, barring mental health, little is known about the medium or longer-term health impacts of disasters. This study sought to determine if there is an association between community-level disaster exposure and individual-level changes in disability and/or the risk of death for older Americans. Using the US Federal Emergency Management Agency's database of disaster declarations, 602 disasters occurred between August 1998 and December 2010 and were characterized by their presence, intensity, duration and type. Repeated measurements of a disability score (based on activities of daily living) and dates of death were observed between January 2000 and November 2010 for 18,102 American individuals aged 50-89 years, who were participating in the national longitudinal Health and Retirement Study. Longitudinal (disability) and time-to-event (death) data were modelled simultaneously using a 'joint modelling' approach. There was no evidence of an association between community-level disaster exposure and individual-level changes in disability or the risk of death. Our results suggest that future research should focus on individual-level disaster exposures, moderate to severe disaster events, or higher-risk groups of individuals.
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Victorian Centre for Biostatistics (ViCBiostat), Melbourne, Australia. Electronic address: sam.brilleman@monash.edu.
authors.forename: Samuel L
authors.initials: SL
authors.lastname: Brilleman
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Victorian Centre for Biostatistics (ViCBiostat), Melbourne, Australia.
authors.forename: Rory
authors.initials: R
authors.lastname: Wolfe
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Victorian Centre for Biostatistics (ViCBiostat), Melbourne, Australia; Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Australia.
authors.forename: Margarita
authors.initials: M
authors.lastname: Moreno-Betancur
authors.affiliation: Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; Center for Clinical Management Research, Veterans Affairs Ann Arbor Health System, Ann Arbor, MI, USA.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Sales
authors.affiliation: Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; Center for Clinical Management Research, Veterans Affairs Ann Arbor Health System, Ann Arbor, MI, USA; Institute for Social Research, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Langa
authors.affiliation: Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Yun
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Daugherty Biddison
authors.affiliation: R Adams Cowley Shock Trauma Center, University of Maryland Medical School, Baltimore, MD, USA.
authors.forename: Lewis
authors.initials: L
authors.lastname: Rubinson
authors.affiliation: Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; Center for Clinical Management Research, Veterans Affairs Ann Arbor Health System, Ann Arbor, MI, USA.
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Iwashyna
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003256:Community Participation / Q000379:methods* / Q000706:statistics & numerical data; D006233:Persons with Disabilities / Q000523:psychology* / Q000706:statistics & numerical data; D004189:Disaster Planning / Q000458:organization & administration / Q000706:statistics & numerical data / Q000639:trends*; D004190:Disasters; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality; D044469:Racial Groups / Q000706:statistics & numerical data; D014481:United States
keywords: Death; Disability; Disaster; Health and Retirement Study; Joint model; Shared parameter model; Survival