Flooding and emergency department visits: Effect modification by the CDC/ATSDR Social Vulnerability Index

Ramesh, Balaji; Jagger, Meredith A.; Zaitchik, Benjamin F.; Kolivras, Korine N.; Swarup, Samarth; Deanes, Lauren; Hallisey, Elaine; Sharpe, J. Danielle; Gohlke, Julia M.

doi:10.1016/j.ijdrr.2022.102986

Cited by 20 publications

(7 citation statements)

References 31 publications

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“…Beyond findings related to specific vulnerable groups, a more general measure of social vulnerability, the Centers for Disease Control and Prevention Agency for Toxic Substances and Disease Registry's SVI was also correlated with moderate to poor agreement in exposure assessment among the three evaluated data sources. SVI scores have been associated with climate and environmental disaster-related health outcomes like heat-related illness and mortality, wildfires and vulnerability to climate extremes, and tropical storms (49,(72)(73)(74)(75)(76) further highlighting the importance of accurate assessment of exposures to climate extremes in these populations at increased risk.…”

Section: Discussionmentioning

confidence: 99%

Agreement in extreme precipitation exposure assessment is modified by race and social vulnerability

Aune

Zaitchik²,

Curriero³

et al. 2023

Front. Epidemiol.

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Epidemiologic investigations of extreme precipitation events (EPEs) often rely on observations from the nearest weather station to represent individuals' exposures, and due to structural factors that determine the siting of weather stations, levels of measurement error and misclassification bias may differ by race, class, and other measures of social vulnerability. Gridded climate datasets provide higher spatial resolution that may improve measurement error and misclassification bias. However, similarities in the ability to identify EPEs among these types of datasets have not been explored. In this study, we characterize the overall and temporal patterns of agreement among three commonly used meteorological data sources in their identification of EPEs in all census tracts and counties in the conterminous United States over the 1991–2020 U.S. Climate Normals period and evaluate the association between sociodemographic characteristics with agreement in EPE identification. Daily precipitation measurements from weather stations in the Global Historical Climatology Network (GHCN) and gridded precipitation estimates from the Parameter-elevation Relationships on Independent Slopes Model (PRISM) and the North American Land Data Assimilation System (NLDAS) were compared in their ability to identify EPEs defined as the top 1% of precipitation events or daily precipitation >1 inch. Agreement among these datasets is fair to moderate from 1991 to 2020. There are spatial and temporal differences in the levels of agreement between ground stations and gridded climate datasets in their detection of EPEs in the United States from 1991 to 2020. Spatial variation in agreement is most strongly related to a location's proximity to the nearest ground station, with areas furthest from a ground station demonstrating the lowest levels of agreement. These areas have lower socioeconomic status, a higher proportion of Native American population, and higher social vulnerability index scores. The addition of ground stations in these areas may increase agreement, and future studies intending to use these or similar data sources should be aware of the limitations, biases, and potential for differential misclassification of exposure to EPEs. Most importantly, vulnerable populations should be engaged to determine their priorities for enhanced surveillance of climate-based threats so that community-identified needs are met by any future improvements in data quality.

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Section: Discussionmentioning

confidence: 99%

Agreement in extreme precipitation exposure assessment is modified by race and social vulnerability

Aune

Zaitchik²,

Curriero³

et al. 2023

Front. Epidemiol.

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“…SVI is a tool developed by the Centers for Disease Control and Prevention (CDC) to measure the extent of social vulnerability within a county or census tract[15]. An increasing number of studies have employed the SVI index as a proxy for SDOH [16, 17]. The SVI score is a composite measure combining and normalizing the scores of four different themes derived from percentile ranking U.S. census data of different variables at the corresponding geographic level – census tract or county.…”

Section: Methodsmentioning

confidence: 99%

Section: Social Determinants Of Health Variablesmentioning

confidence: 99%

Identifying Racial Disparities in Clozapine Prescriptions Among Schizophrenia Patients using Data from Electronic Health Records

Barry

Jarskog

Xia

et al. 2022

Preprint

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Objective This study sought to assess the demographic factors that alter the likelihood of being prescribed clozapine. The primary hypothesis is that African American patients are less likely to be prescribed Clozapine than White and other racial groups. Additionally, this study aims to expand on earlier studies of clozapine by examining how multiple variables, especially social determinants of health, gender, rurality, and care patterns affect the rates at which clozapine is prescribed. Methods This observational study examines the racial disparities and other factors associated with receiving a clozapine prescription for patients with a schizophrenia diagnosis using structured data in the Electronic Health Records (EHR) from a multi-facility health system from 10/1/2015 - 11/30/2021. Bivariate analysis, multiple logistic regression, and sensitivity analysis tests were performed to determine which factors differed significantly between the group of patients who were prescribed clozapine and those who were not. Results Results showed that being white and having a higher socioeconomic income was associated with an increased clozapine prescription rate, while gender, rurality, age at first diagnosis, and ethnicity did not influence prescription likelihood. Increased treatment length was also associated with a greater likelihood of being prescribed clozapine. Conclusion African American patients are over-diagnosed with schizophrenia and under-prescribed clozapine compared to Caucasians after controlling for the variables associated with demographics, social determinants of health, and care access patterns. Future research is needed to understand and disentangle the biological, clinical, administrative, and societal causes behind the disparity in clozapine treatment.

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“…Such communities also grapple with limited resources, leading to challenges in risk communication and self-mitigation [15]. Postdisaster, they experience increased rates of emergency department visits [4,16], along with heightened risks of posttraumatic stress and healthcare inaccessibility [17]. Notably, the relationship between well-being loss and SVI was quantified in the context of earthquakes by Markhvida et al [18].…”

Section: Introductionmentioning

confidence: 99%

Impact of Power Outages Depends on Who Loses It: Equity-Informed Grid Resilience Planning

Tutay,

Kutanoglu,

Hasenbein

2023

Preprint

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This research presents a novel approach for enhancing power grid resilience with a focus on social equity in light of increasing natural disasters. Utilizing a two-stage stochastic optimization model for flood mitigation investments, we optimize substation hardening and power flow decisions to minimize the weighted combination of expected load shed and expected equity metric. Our method uniquely approximates community power outages stemming from transmission grid disruptions, sidestepping the complexities of the distribution grid, and it incorporates two equity metrics (affected population and duration of loss) to address the uneven postdisaster well-being loss across communities. Our approach's novelty lies in integrating this equity-informed resilience model with realistic flood scenario generation and utilizing a large-scale synthetic but a realistic power grid of Texas. The findings highlight the importance of the composite objective function in altering power flow decisions to prioritize electricity provision and save communities in disadvantaged areas even without investing in substation hardening. The results also quantify the equity and load shed benefits of substation hardening as a function of the investment budget with a parameterized analysis. With an attention to equity, power outages increase in nonvulnerable communities — a trade-off made to mitigate well-being loss in the most vulnerable areas. We further explore a justice model inspired by the government's Justice40 initiative but find it less effective than our equity-informed models at preventing well-being loss. Our research, enriched by a comprehensive sensitivity analysis, offers valuable insights for policymakers, grid operators, and utilities aiming for a more resilient and equitable power grid.

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Flooding and emergency department visits: Effect modification by the CDC/ATSDR Social Vulnerability Index

Cited by 20 publications

References 31 publications

Agreement in extreme precipitation exposure assessment is modified by race and social vulnerability

Agreement in extreme precipitation exposure assessment is modified by race and social vulnerability

Identifying Racial Disparities in Clozapine Prescriptions Among Schizophrenia Patients using Data from Electronic Health Records

Impact of Power Outages Depends on Who Loses It: Equity-Informed Grid Resilience Planning

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