Healthcare Access in the Aftermath: A Longitudinal Analysis of Disaster Impact on US Communities.

Research on climate-related disasters and healthcare infrastructure has largely focused on short-term, localized impacts. This study examined the long-term association between climate-related disasters and healthcare facilities across 3108 contiguous United States counties from 2000 to 2014. Utilizing databases like the National Establishment Time Series and the Spatial Hazards and Events Losses Database, we classified county-level infrastructure changes ("never had", "lost", "gained", and "always had") and disaster severity (minor, moderate, severe), respectively. Autoregressive linear models were used to estimate the total number of moderate and severe disasters (2000-2013) associated with the change in the number of healthcare establishments in 2014, after adjusting for healthcare establishments, total population, and poverty in 2000. Results demonstrate that an increase in one moderate disaster was significantly associated with increased hospital infrastructure (Count, 0.14; 95% CI, 0.03-0.25), while severe disasters were significantly associated with a decrease (Count, -0.31; 95% CI, -0.47--0.14). Similar but stronger associations were observed for ambulatory care (Moderate: Count, 2.52; 95% CI 0.91-4.12 and Severe: Count, -5.99; 95% CI, -8.53--3.64, respectively). No significant associations were found among pharmacies. These findings highlight the varying impacts of climate-related disasters on healthcare accessibility. Future initiatives should prioritize strengthening existing infrastructure and enhance disaster recovery strategies.