Impact of Extreme Weather on Healthcare Utilization by People with HIV in Metropolitan Miami
Open Access
- 2 March 2021
- journal article
- research article
- Published by MDPI AG in International Journal of Environmental Research and Public Health
- Vol. 18 (5), 2442
- https://doi.org/10.3390/ijerph18052442
Abstract
Extreme weather events (EWE) are expected to increase as climate change intensifies, leaving coastal regions exposed to higher risks. South Florida has the highest HIV infection rate in the United States, and disruptions in clinic utilization due to extreme weather conditions could affect adherence to treatment and increase community transmission. The objective of this study was to identify the association between EWE and HIV-clinic attendance rates at a large academic medical system serving the Miami-Dade communities. The following methods were utilized: (1) Extreme heat index (EHI) and extreme precipitation (EP) were identified using daily observations from 1990–2019 that were collected at the Miami International Airport weather station located 3.6 miles from the studied HIV clinics. Data on hurricanes, coastal storms and flooding were collected from the National Oceanic and Atmospheric Administration Storms Database (NOAA) for Miami-Dade County. (2) An all-HIV clinic registry identified scheduled daily visits during the study period (hurricane seasons from 2017–2019). (3) Daily weather data were linked to the all-HIV clinic registry, where patients’ ‘no-show’ status was the variable of interest. (4) A time-stratified, case crossover model was used to estimate the relative risk of no-show on days with a high heat index, precipitation, and/or an extreme natural event. A total of 26,444 scheduled visits were analyzed during the 383-day study period. A steady increase in the relative risk of ‘no-show’ was observed in successive categories, with a 14% increase observed on days when the heat index was extreme compared to days with a relatively low EHI, 13% on days with EP compared to days with no EP, and 10% higher on days with a reported extreme weather event compared to days without such incident. This study represents a novel approach to improving local understanding of the impacts of EWE on the HIV-population’s utilization of healthcare, particularly when the frequency and intensity of EWE is expected to increase and disproportionately affect vulnerable populations. More studies are needed to understand the impact of EWE on routine outpatient settings.This publication has 6 references indexed in Scilit:
- Assessment of extreme heat and hospitalizations to inform early warning systemsProceedings of the National Academy of Sciences of the United States of America, 2019
- Characteristics of Climate Change and Extreme Weather from 1951 to 2011 in ChinaInternational Journal of Environmental Research and Public Health, 2018
- Our Warming Planet: Is the HIV-1-Infected Population in the Crosshairs.2016
- The Seasonal Nature of Extreme Hydrological Events in the Northeastern United StatesJournal of Hydrometeorology, 2015
- Spatial variation in hyperthermia emergency department visits among those with employer-based insurance in the United States – a case-crossover analysisEnvironmental Health, 2015
- Conditional Poisson models: a flexible alternative to conditional logistic case cross-over analysisBMC Medical Research Methodology, 2014