Dr. Daniel Samano Studies Impacts of Extreme Weather on Healthcare Utilization by People with HIV in Miami

As climate change intensifies, extreme weather events, such as heavy rainfall or a high heat index, are expected to increase. Regions most at risk are those near the coast, such as South Florida—a location that also has the highest HIV infection rate in the nation.

A new study led by Daniel Samano, M.D., M.P.H., sr. clinical research coordinator at the University of Miami Miller School’s Departments of Neurological Surgery and Neuro Critical Care, examined how extreme weather events could lead to disruptions in HIV-clinic utilization. The study—the first of its kind and published online in March in the International Journal of Environmental Research and Public Health—demonstrated an association between extreme weather events, specifically heat index and precipitation, with healthcare utilization of people who live with HIV in Miami. The findings highlight the population’s challenges of attending important appointments and adherence to care. 

“Climate and health are a multidisciplinary area that needs much research and funding,” said Dr. Samano, who is an alumnus of the Master of Public Health program at the Miller School’s Department of Public Health Sciences. “We are all vulnerable to climate change, but the level of vulnerability is greater in different population sub-groups. Our research examines a novel methodology that can be replicated by geographic locations and/or population sub-groups accessing healthcare. We aim to help decision-makers understand how weather influences the population they serve in order to plan the delivery of healthcare services accordingly.”

To conduct the study, co-authors utilized extreme heat index and extreme precipitation observations collected by the Miami International Airport weather station—located 3.5 miles from HIV clinics—from 1990 to 2019. They also utilized data on hurricanes, coastal storms, and flooding from the National Oceanic and Atmospheric Administration Storms Database for Miami-Dade County. An HIV-clinic registry also facilitated to identify scheduled daily visits during hurricane seasons from 2017 to 2019.  

During the 383-day study period, a total of 26,444 scheduled visits were analyzed. Co-authors found a steady increase in patients not attending their appointments, with a 14 percent increase in non-attendance observed on days when the heat index was extreme compared to days with a low index. On days when there was a rise in precipitation compared to days without, there was a 13 percent increase. Additionally, there was a 10 percent higher chance of non-attendance on days with reported extreme weather events—also compared to days without such events.   

Co-authors note that the study represents a novel approach to improving local understanding of the impacts of extreme weather events on the utilization of healthcare among people who live with HIV—especially when the frequency and intensities of the events are expected to increase and disproportionately affect vulnerable populations.  

They also note that more studies are needed to identify the influence of climate on health, as well as to identify solutions to provide care for the HIV-population that can help mitigate climate-related effects on their treatment. 

“The study started with anecdotal observations, which we tested on a small scale with two small clinics,” said study senior author, Lunthita M. Duthely, Ed.D., research assistant professor at the Miller School’s Department of Obstetrics, Gynecology and Reproductive Sciences. “With encouragement from Dr. James Schultz, a disaster expert in the Department of Public Health and experts at the National Oceanic and Atmospheric Administration, we expanded the data set and applied a more rigorous statistical and methodological approach, which was guided by a climate and health expert with the Centers for Disease Control and Prevention. This was really a team science approach to bringing different data sets together for a better understanding of the problem.”

Written by Amanda Torres
Published on March 24, 2021