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Hemodialysis Clinics in Flood Zones: A Case Study of Hurricane Harvey

Published online by Cambridge University Press:  01 February 2021

Rebecca Kaiser
University of Dayton, Dayton, OhioUSA
Ibraheem M. Karaye
Program in Epidemiology, University of Delaware, Newark, DelawareUSA
Temitope Olokunlade
Department of Environmental Health, Texas A&M University, College Station, TexasUSA
Tracy Anne Hammond
Professor, Texas A&M University Department of Computer Science and Engineering, College Station, TexasUSA
Daniel W. Goldberg
Assistant Professor, Texas A&M University Department of Geography, College Station, TexasUSA
Jennifer A. Horney*
Program in Epidemiology, University of Delaware, Newark, DelawareUSA
Correspondence: Jennifer A. Horney, PhD, MPH, CPH, Professor and Founding Director, Department of Epidemiology, University of Delaware College of Health Sciences, 100 Discovery Blvd, Room 731, Newark, Delaware19713USA, E-mail:



Hurricane Harvey (2017) forced the closure of hemodialysis centers across Harris County, Texas (USA) disrupting the provision of dialysis services. This study aims to estimate the percentage of hemodialysis clinics flooded after Harvey, to identify the proportion of such clinics located in high-risk flood zones, and to assess the sensitivity of the Federal Emergency Management Agency (FEMA) Flood Insurance Rate Maps (FIRMs) for estimation of flood risk.


Data on 124 hemodialysis clinics in Harris County were extracted from and geocoded using ArcGIS Online. The FIRMs were overlaid to identify the flood zone designation of each hemodialysis clinic.


Twenty-one percent (26 of 124) of hemodialysis clinics in Harris County flooded after Harvey. Of the flooded clinics, 57.7% were in a high-risk flood zone, 30.8% were within 1km of a high-risk flood zone, and 11.5% were not in or near a high-risk flood zone. The FIRMs had a sensitivity of 58%, misidentifying 42% (11 of 26) of the clinics flooded.


Hurricanes are associated with severe disruptions of medical services, including hemodialysis. With one-quarter of Harris County in the 100-year floodplain, projected increases in the frequency and severity of disasters, and inadequate updates of flood zone designation maps, the implementation of new regulations that address the development of hemodialysis facilities in high-risk flood areas should be considered.

Original Research
© The Author(s), 2021. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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