Time to recovery in diabetes and comorbidities following Hurricane Katrina

Impact of disasters, including pandemics, on cardiometabolic outcomes across the life-course: a systematic review

BACKGROUND

Disasters are events that disrupt the daily functioning of a community or society, and may increase long-term risk of adverse cardiometabolic outcomes, including cardiovascular disease, obesity and diabetes. The objective of this study was to conduct a systematic review to determine the impact of disasters, including pandemics, on cardiometabolic outcomes across the life-course.

DESIGN

A systematic search was conducted in May 2020 using two electronic databases, EMBASE and Medline. All studies were screened in duplicate at title and abstract, and full-text level. Studies were eligible for inclusion if they assessed the association between a population-level or community disaster and cardiometabolic outcomes ≥1 month following the disaster. There were no restrictions on age, year of publication, country or population. Data were extracted on study characteristics, exposure (eg, type of disaster, region, year), cardiometabolic outcomes and measures of effect. Study quality was evaluated using the Joanna Briggs Institute critical appraisal tools.

RESULTS

A total of 58 studies were included, with 24 studies reporting the effects of exposure to disaster during pregnancy/childhood and 34 studies reporting the effects of exposure during adulthood. Studies included exposure to natural (n=35; 60%) and human-made (n=23; 40%) disasters, with only three (5%) of these studies evaluating previous pandemics. Most studies reported increased cardiometabolic risk, including increased cardiovascular disease incidence or mortality, diabetes and obesity, but not all. Few studies evaluated the biological mechanisms or high-risk subgroups that may be at a greater risk of negative health outcomes following disasters.

CONCLUSIONS

The findings from this study suggest that the burden of disasters extend beyond the known direct harm, and attention is needed on the detrimental indirect long-term effects on cardiometabolic health. Given the current COVID-19 pandemic, these findings may inform public health prevention strategies to mitigate the impact of future cardiometabolic risk.

PROSPERO REGISTRATION NUMBER

CRD42020186074.

Perspectives on the Health Effects of Hurricanes: A Review and Challenges

Hurricanes are devastating natural disasters which dramatically modify the physical landscape and alter the socio-physical and biochemical characteristics of the environment, thus exposing the affected communities to new environmental stressors, which persist for weeks to months after the hurricane. This paper has three aims. First, it conceptualizes potential direct and indirect health effects of hurricanes and provides an overview of factors that exacerbate the health effects of hurricanes. Second, it summarizes the literature on the health impact of hurricanes. Finally, it examines the time lag between the hurricane (landfall) and the occurrence of diseases. Two major findings emerge from this paper. Hurricanes are shown to cause and exacerbate multiple diseases, and most adverse health impacts peak within six months following hurricanes. However, chronic diseases, including cardiovascular disease and mental disorders, continue to occur for years following the hurricane impact.

Long-term Effects of Disasters on Seniors With Diabetes: Evidence From Hurricanes Katrina and Rita

OBJECTIVE

To estimate the long-run mortality effects of Hurricanes Katrina and Rita on seniors with diabetes.

RESEARCH DESIGN AND METHODS

We performed a retrospective cohort analysis of Medicare enrollment and claims data covering four states and ∼10 years. Affected individuals were identified by whether they lived in a county that suffered a high impact and were stratified by whether they moved to a different county following the storms. Propensity scores matched affected and comparison subjects based on demographic and socioeconomic characteristics and the presence of chronic conditions. Our sample consisted of 170,328 matched affected subjects.

RESULTS

The affected subjects had a nearly 40% higher all-cause mortality risk in the 1st month after the storms, but the difference fell to <6% by the end of the full observation period. The mortality risks of heart disease and nephritis also exhibited the largest differences immediately following the storms. Among the affected subjects, the all-cause mortality risk was higher for those who moved to a different county, with an especially large difference among those who moved to an affected county.

CONCLUSIONS

The propensity matching procedure resulted in the comparison and affected groups having similar observable characteristics. However, we only examined the extreme outcome of mortality, our definition of affected was somewhat crude, and our sample did not include individuals enrolled in Medicare Advantage. Our findings highlight the importance of the immediate response to disasters, yet also demonstrate the long-lasting impact disasters can have.

Long-term Effects of Disasters on Health Care Utilization: Hurricane Katrina and Older Individuals with Diabetes

OBJECTIVE

While the short-term effects of disasters on health care utilization are well documented, less is known regarding potential longer-term effects. This study investigates the effects of Hurricane Katrina on the health care utilization of older individuals with diabetes.

METHODS

We examined Medicare claims and enrollment data for the 2002-2004 and 2006-2008 time periods for older individuals with diabetes. Our quasi-experimental design analyzed utilization across 2 treated and 3 control groups. We compared the proportion of individuals who received a screen related to diabetes before and after Katrina in the treated groups to the proportions in the control groups. Our regression analysis employs individual and year fixed effects to control for factors specific to a given individual or to a given year.

RESULTS

We found that utilization rates in the 2002-2004 period exhibited roughly parallel trends for the treated and control groups, which provides support for our research design. The 2006-2008 utilization rates were generally lower for the treated groups than they were for the control groups. The differences were especially pronounced for older age cohorts.

CONCLUSIONS

Our study suggests that the effects of disasters on health care utilization may persist for years after the event. Recovery efforts may be improved by addressing both short-term and long-term health care interruptions. (Disaster Med Public Health Preparedness. 2019;13:724-731).

Emergency Department Visits by and Hospitalizations of Senior Diabetics in the Three Years Following Hurricanes Katrina and Rita

While prior studies have investigated health care utilization immediately following disasters, few have examined utilization beyond that period. We use individual-level U.S. Medicare claims data for three years prior to (2002-2004) and after (2006-2008) Hurricanes Katrina and Rita to investigate whether senior diabetics affected by the storms had a greater number of emergency department visits and days hospitalized in the three years following the storms. An event study was conducted using regression analysis that controlled for all fixed individual characteristics. While the 2006 and 2007 rates of increase in utilization were relatively similar across the control group and the two affected groups, in 2008 the affected groups exhibited substantially greater increases in both emergency department visits and days hospitalized. The differences correspond to an additional 380,907 days hospitalized and 21,583 emergency department visits in 2008. The results indicate that, in addition to short term effects previously estimated, disasters may have longer term effects on utilization of healthcare services. These potential effects suggest that improved post-disaster care may significantly reduce the healthcare costs of disasters.

A modified Community Assessment for Public Health Emergency Response (CASPER) four months after Hurricane Sandy

This study sought to assess access to utilities, basic needs, financial burden, and perceived safety among households in the Rockaway Peninsula of New York City, United States, four months after Hurricane Sandy struck in 2012. A modified cluster survey design was used to select households for inclusion in the study. Survey content was created using the Community Assessment for Public Health Emergency Response (CASPER) toolkit, gathering relevant data on access to food and water, basic utilities, financial burden, household demographics, and safety. Four months after Sandy, electricity and heat had been restored to all households. However, around one-third of them still had difficulty in obtaining food, and about one-half believed that their neighborhood was unsafe. One-quarter had problems in acquiring prescription medications, and approximately one-half reported anxiety. While basic utilities were almost entirely restored, there were ongoing challenges in Rockaway four months after Sandy, relating to financial hardship, food insecurity, healthcare, and psychologic distress.

Public Health Agency Responses and Opportunities to Protect Against Health Impacts of Climate Change Among US Populations with Multiple Vulnerabilities

During the past several decades, unprecedented global changes in climate have given rise to an increase in extreme weather and other climate events and their consequences such as heavy rainfall, hurricanes, flooding, heat waves, wildfires, and air pollution. These climate effects have direct impacts on human health such as premature death, injuries, exacerbation of health conditions, disruption of mental well-being, as well as indirect impacts through food- and water-related infections and illnesses. While all populations are at risk for these adverse health outcomes, some populations are at greater risk because of multiple vulnerabilities resulting from increased exposure to risk-prone areas, increased sensitivity due to underlying health conditions, and limited adaptive capacity primarily because of a lack of economic resources to respond adequately. We discuss current governmental public health responses and their future opportunities to improve resilience of special populations at greatest risk for adverse health outcomes. Vulnerability assessment, adaptation plans, public health emergency response, and public health agency accreditation are all current governmental public health actions. Governmental public health opportunities include integration of these current responses with health equity initiatives and programs in communities.

Evaluating emergency preparedness and impact of a hurricane sandy in pediatric patients with diabetes

Background

Natural disasters have always been associated with significant adverse events including medical and mental health problems. Children with chronic disease such has diabetes have also been believed to be affected to a greater extent by any natural disaster. The purpose of this study was to assess and compare emergency preparedness post-disaster and post-traumatic stress effects of Hurricane Sandy in affected and relatively unaffected populations.

Methods

The study was conducted between February and July 2013. A total of 142 families caring for children with Type 1 Diabetes Mellitus (T1DM) who attended clinics were recruited from hospitals in Bronx, NY (control) and in NJ (affected) by Hurricane Sandy. Subjects were recruited to participate in a survey 3–6 months after the hurricane. Data on demographics, glycemic control and insulin regimens were collected. Families were surveyed for socio-economic status (SES), using Hollingshead questionnaire, general and diabetes preparedness and the Hurricane Related Traumatic Experiences (HURTE) questionnaire was used to evaluate for symptoms of post-traumatic stress.

Results

Ninety-five percent of families reported to be generally well to moderately prepared for the hurricane and 83 % reported to be very well prepared with regards to their child’s diabetes during the disaster. There was no difference between the sites for preparedness for the disaster, age or gender. There was a trend toward significance (p < 0.06) in New Jersey subjects as to a greater psychological impact from the hurricane. Poor glycemic control was significantly associated with lower SES (p < 0.008). Most importantly, SES was unrelated to preparedness for diabetes management during the hurricane.

Conclusions

Despite low SES, families were generally well to moderately prepared for hurricane. In children with diabetes, interventional studies should be designed and implemented so that glycemic control remains unaffected, following any major disaster.

Acute post-disaster medical needs of patients with diabetes: emergency department use in New York City by diabetic adults after Hurricane Sandy

OBJECTIVE

To evaluate the acute impact of disasters on diabetic patients, we performed a geospatial analysis of emergency department (ED) use by New York City diabetic adults in the week after Hurricane Sandy.

RESEARCH DESIGN AND METHODS

Using an all-payer claims database, we retrospectively analyzed the demographics, insurance status, and medical comorbidities of post-disaster ED patients with diabetes who lived in the most geographically vulnerable areas. We compared the patterns of ED use among diabetic adults in the first week after Hurricane Sandy's landfall to utilization before the disaster in 2012.

RESULTS

In the highest level evacuation zone in New York City, postdisaster increases in ED visits for a primary or secondary diagnosis of diabetes were attributable to a significantly higher proportion of Medicare patients. Emergency visits for a primary diagnosis of diabetes had an increased frequency of certain comorbidities, including hypertension, recent procedure, and chronic skin ulcers. Patients with a history of diabetes visited EDs in increased numbers after Hurricane Sandy for a primary diagnosis of myocardial infarction, prescription refills, drug dependence, dialysis, among other conditions.

CONCLUSIONS

We found that diabetic adults aged 65 years and older are especially at risk for requiring postdisaster emergency care compared to other vulnerable populations. Our findings also suggest that there is a need to support diabetic adults particularly in the week after a disaster by ensuring access to medications, aftercare for patients who had a recent procedure, and optimize their cardiovascular health to reduce the risk of heart attacks.

Diabetes Care Provided to Children Displaced by Hurricane Katrina

OBJECTIVE

Although previous studies have examined the impact of Hurricane Katrina on adults with diabetes, less is known about the effects on children with diabetes and on those displaced by the storm. We analyzed individual-level enrollment and utilization data of children with diabetes who were displaced from Louisiana and were enrolled in the Texas Medicaid Hurricane Katrina emergency waiver (TexKat).

METHODS

We compared the utilization and outcomes of children displaced from Louisiana with those of children who lived in areas less affected by Hurricane Katrina. Data from both before and after the storm were used to calculate difference-in-difference estimates of the effects of displacement on the children. We analyzed 4 diabetes management procedures (glycated hemoglobin [HbA1C] tests, eye exams, microalbumin tests, and thyroid tests) and a complication from poor diabetes management (diabetic ketoacidosis).

RESULTS

Children enrolled in the waiver generally did not experience a decrease in care relative to the control group while the waiver program was in effect. After the waiver ended, however, we observed a drop in care and an increase in complications relative to the control group.

CONCLUSIONS

Although the waiver appeared to have been largely successful immediately following Katrina, future waivers may be improved by ensuring that enrollees continue to receive care after the waivers expire.

Emergency and disaster preparedness for chronically ill patients: a review of recommendations

Recent disasters, especially those in developed countries, have highlighted the importance of disaster preparedness measures for chronic diseases. A number of surviving patients experienced the exacerbation of a chronic illness, such as hypertension, diabetes, cancer, and chronic respiratory diseases, due to disaster-related stress, interruption of care, or both; for some patients, these exacerbations resulted in death. Here, we review reports from recent disasters in developed countries and summarize the recommendations for disaster preparedness of chronically ill patients. A considerable number of recommendations based on the lessons learned from recent disasters have been developed, and they provide practical and essential steps to prevent treatment interruption during and after a disaster. To improve preparedness efforts, we suggest that health care providers should be aware of the following three suggestions: 1) recommendations should be evidence-based; 2) recommendations should contain consistent messages; and 3) recommendations should be feasible.

Disaster research: a nursing opportunity

Nurses working or living near a community disaster have the opportunity to study health-related consequences to disaster or disaster recovery. In such a situation, the researchers need to deal with the conceptual and methodological issues unique to postdisaster research and know what resources are available to guide them, even if they have no specialized training or previous experience in disaster research. The purpose of this article is to review issues and challenges associated with conducting postdisaster research and encourage nurses to seek resources and seize opportunities to conduct research should the situation arise. Current disaster studies and the authors' personal experiences conducting maternal-child research in post-Katrina New Orleans (2005-2013) provide real-life examples of how health professionals and nurses faced the challenges of doing postdisaster research. After catastrophic events, nurses need to step forward to conduct disaster research that informs and improves future disaster planning and healthcare responses.