Single-Day Inclement Weather Events is an Adherence Barrier for Treatment among Hemodialysis Patients in Urban Northeastern Cities

摘要

Accessing essential health care services is a challenge during inclement weather disturbances that disproportionately impacts medically fragile populations such as end-stage renal disease (ESRD) patients who receive outpatient dialysis. Epidemiologic evidence regarding this relationship is needed to inform adaptation strategies. The overall goal of this study is to investigate the association between inclement weather conditions such as precipitation, snowfall, snow depth, and wind on missed hemodialysis appointments in selected United States (US) northeastern cities: Boston, MA (BOS); New York City, NY (NYC), and Philadelphia, PA (PHL) from 2010 to 2012. We extracted total daily total precipitation, total snowfall, total snow depth, fastest 2-minute wind speed (WSF2), and fastest 5-second wind speed (WSF5) from national weather databases. The relationship between the occurrence of inclement weather events and missed appointments was investigated using marginal logistic regression to determine population-level effects for each location. Inclement snowfall days exhibited consistent increased odds for missed appointments in BOS (Odds Ratios (OR) 4.63 and 95% confidence interval (CI) 2.30-9.31), NYC (OR=1.66; CI: 1.08-2.55), and PHL (OR=1.70; CI: 1.30-2.22). Inclement rainfall days also exhibited a significant impact on HD patients in PHL (OR 1.81; CI: 1.37-2.40); and during inclement snow depth days in NYC and PHL. BOS and PHL demonstrated significant associations during sustained windy days (WSF2). Our results showed that inclement weather conditions have impact on missed appointments among hemodialysis patients. There is need to maintain uninterrupted critical health care and access to medically fragile communities in local climate resilience strategies. As such, weather forecasting has utility for predicting rates of location-specific missed appointments. Coordination between dialysis centers and health providers can enhance medical care preparedness and delivery.