Power Outage: An Ignored Risk Factor for COPD Exacerbations

Wangjian Zhang; Scott C Sheridan; Guthrie S Birkhead; Daniel P Croft; Jerald A Brotzge; John G Justino; Neil A Stuart; Zhicheng Du; Xiaobo X Romeiko; Bo Ye; Guanghui Dong; Yuantao Hao; Shao Lin

doi:10.1016/j.chest.2020.05.555

Power Outage: An Ignored Risk Factor for COPD Exacerbations

Chest. 2020 Dec;158(6):2346-2357. doi: 10.1016/j.chest.2020.05.555. Epub 2020 Jun 2.

Authors

Wangjian Zhang¹, Scott C Sheridan², Guthrie S Birkhead³, Daniel P Croft⁴, Jerald A Brotzge⁵, John G Justino⁶, Neil A Stuart⁷, Zhicheng Du⁸, Xiaobo X Romeiko¹, Bo Ye³, Guanghui Dong⁹, Yuantao Hao⁸, Shao Lin¹⁰

Affiliations

¹ Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, NY.
² Department of Geography, Kent State University, Kent, OH.
³ Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY.
⁴ Department of Medicine, University of Rochester Medical Center, Rochester, NY.
⁵ New York State Mesonet, College of Arts and Sciences, State University of New York, Albany, NY.
⁶ Center for Global Health, University at Albany, State University of New York, Rensselaer, NY.
⁷ National Weather Service, Albany, NY.
⁸ Department of Medical Statistics and Epidemiology, University at Albany, State University of New York, Rensselaer, NY.
⁹ Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, China.
¹⁰ Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, NY; Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY. Electronic address: slin@albany.edu.

Abstract

Background: COPD is the third leading cause of death in the United States, with 16 million Americans currently experiencing difficulty with breathing. Power outages could be life-threatening for those relying on electricity. However, significant gaps remain in understanding the potential impact of power outages on COPD exacerbations.

Research question: The goal of this study was to determine how power outages affect COPD exacerbations.

Study design and methods: Using distributed lag nonlinear models controlling for time-varying confounders, the hospitalization rate during a power outage was compared vs non-outage periods to determine the rate ratio (RR) for COPD and its subtypes at each of 0 to 6 lag days in New York State from 2001 to 2013. Stratified analyses were conducted according to sociodemographic characteristics, season, and clinical severity; changes were investigated in numerous critical medical indicators, including length of stay, hospital cost, the number of comorbidities, and therapeutic procedures between the two periods.

Results: The RR of COPD hospitalization following power outages ranged from 1.03 to 1.39 across lag days. The risk was strongest at lag₀ and lag₁ days and lasted significantly for 7 days. Associations were stronger for the subgroup with acute bronchitis (RR, 1.08-1.69) than for cases of acute exacerbation (RR, 1.03-1.40). Compared with non-outage periods, the outage period was observed to be $4.67 thousand greater in hospital cost and 1.38 greater in the number of comorbidities per case. The average cost (or number of comorbidities) was elevated in all groups stratified according to cost (or number of comorbidities). In contrast, changes in the average length of stay (-0.43 day) and the average number of therapeutic procedures (-0.09) were subtle.

Interpretation: Power outages were associated with a significantly elevated rate of COPD hospitalization, as well as greater costs and number of comorbidities. The average cost and number of comorbidities were elevated in all clinical severity groups.

Keywords: COPD; medical indicator; power outage; sociodemographic.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Acute Disease
Bronchitis* / economics
Bronchitis* / epidemiology
Bronchitis* / therapy
Comorbidity
Disease Progression
Electric Power Supplies* / standards
Electric Power Supplies* / statistics & numerical data
Female
Health Status Indicators
Hospital Costs / trends*
Hospitalization* / economics
Hospitalization* / statistics & numerical data
Humans
Male
Middle Aged
Pulmonary Disease, Chronic Obstructive* / economics
Pulmonary Disease, Chronic Obstructive* / epidemiology
Pulmonary Disease, Chronic Obstructive* / physiopathology
Pulmonary Disease, Chronic Obstructive* / therapy
Risk Assessment
Risk Factors
Severity of Illness Index
Symptom Flare Up
United States / epidemiology

Grants and funding

R15 ES028000/ES/NIEHS NIH HHS/United States