Annals of Emergency Medicine
Volume 51, Issue 4, 2008, Pages 426-432

Burden of Disease and Health Status Among Hurricane Katrina-Displaced Persons in Shelters: A Population-Based Cluster Sample (Article)

Greenough P.G.* , Lappi M.D. , Hsu E.B. , Fink S. , Hsieh Y.-H. , Vu A. , Heaton C. , Kirsch T.D.
  • a Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States, Harvard Humanitarian Initiative, Harvard University, Boston, MA, United States
  • b Harvard Humanitarian Initiative, Harvard University, Boston, MA, United States
  • c Department of Emergency Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, United States, Center for Emergency Preparedness and Response, Johns Hopkins University, Baltimore, MD, United States
  • d Harvard Humanitarian Initiative, Harvard University, Boston, MA, United States
  • e Department of Emergency Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, United States, Center for Emergency Preparedness and Response, Johns Hopkins University, Baltimore, MD, United States
  • f Department of Emergency Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, United States, Center for Refugee and Disaster Response, Johns Hopkins University, Baltimore, MD, United States
  • g Harvard Humanitarian Initiative, Harvard University, Boston, MA, United States
  • h Department of Emergency Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, United States, Center for Refugee and Disaster Response, Johns Hopkins University, Baltimore, MD, United States

Abstract

Study objective: Anecdotal evidence suggests that the population displaced to shelters from Hurricane Katrina had a significant burden of disease, socioeconomic vulnerability, and marginalized health care access. For agencies charged with providing health care to at-risk displaced populations, knowing the prevalence of acute and chronic disease is critical to direct resources and prevent morbidity and mortality. Methods: We performed a 2-stage 18-cluster sample survey of 499 evacuees residing in American Red Cross shelters in Louisiana 2 weeks after landfall of Hurricane Katrina. In stage 1, shelters with a population of more than 100 individuals were randomly selected, with probability proportional to size sampling. In stage 2, 30 adult heads of household were randomly chosen within shelters by using a shelter log or a map of the shelter where no log existed. Survey questions focused on demographics, socioeconomic indicators, acute and chronic burden of disease, and health care access. Results: Two thirds of the sampled population was single, widowed, or divorced; the majority was female (57.6%) and black (76.4%). Socioeconomic indicators of under- and unemployment (52.9%), dependency on benefits or assistance (38.5%), lack of home ownership (66.2%), and lack of health insurance (47.0%) suggested vulnerability. One third lacked a health provider. Among those who arrived at shelters with a chronic disease (55.6%), 48.4% lacked medication. Hypertension, hypercholesterolemia, diabetes, pulmonary disease, and psychiatric illness were the most common chronic conditions. Risk factors for lacking medications included male sex (odds ratio [OR] 1.58; 95% confidence interval [CI] 0.96 to 2.59) and lacking health insurance (OR 2.25; 95% CI 1.21 to 4.20). More than one third (34.5%) arrived at the shelter with symptoms warranting immediate medical intervention, including dehydration (12.0%), dyspnea (11.5%), injury (9.4%), and chest pain (9.7%). Risk factors associated with presenting to shelters with acute symptoms included concurrent chronic disease with medication (OR 2.60; 95% CI 1.98 to 3.43), concurrent disease and lacking medication (OR 2.22; 95% CI 1.36 to 3.63), and lacking health insurance (OR 1.83; 95% CI 1.10 to 3.02). Conclusion: A population-based understanding of vulnerability, health access, and chronic and acute disease among the displaced will guide disaster health providers in preparation and response. © 2008 American College of Emergency Physicians.

Author Keywords

[No Keywords available]

Index Keywords

unemployment hypercholesterolemia health insurance human sex difference injury diabetes mellitus priority journal health status hypertension housing Logistic Models morbidity chronic disease hurricane mental disease United States cluster analysis Humans Louisiana male female Socioeconomic Factors Risk Factors socioeconomics Incidence Article major clinical study adult dehydration health care access lung disease dyspnea Natural Disasters Health Services Accessibility thorax pain high risk patient mortality health care need
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-40949115448&doi=10.1016%2fj.annemergmed.2007.04.004&partnerID=40&md5=4dbec03fe801400d7738ed7d14366bdd
DOI: 10.1016/j.annemergmed.2007.04.004
ISSN: 01960644
Cited by: 60
Original Language: English