Impact of a natural disaster on diabetes: exacerbation of disparities and long-term consequences

Abstract

Objective: To examine the impact of Hurricane Katrina on the health of individuals with diabetes.

Research design and methods: This was an observational study in 1,795 adults with an A1C measurement 6 months before and 6-16 months after Hurricane Katrina in three health care systems: private (Tulane University Hospital and Clinic [TUHC]), state (Medical Center of Louisiana at New Orleans [MCLNO]), and Veterans Affairs (VA). Glycemic control (A1C), blood pressure, and lipids before the hurricane were compared with the patients' first measurement thereafter. The CORE Diabetes Model was used to project life expectancy and health economic impact.

Results: Mean predisaster A1C levels differed between MCLNO and VA patients (mean 7.7 vs. 7.3%, P < 0.001) and increased significantly among MCLNO patients to 8.3% (P < 0.001) but not among VA and TUHC patients. Mean systolic blood pressure increased in all three systems (130-137.6 mmHg for TUHC and 130.7-143.7 for VA, P < 0.001; 132-136 for MCLNO, P = 0.008). Mean LDL cholesterol increased in the VA (97.1-104.3 mg/dl) and TUHC patients (103.4-115.5; P < 0.001). Hurricane Katrina increased modeled direct, indirect, and total health care costs and also reduced life expectancy as well as quality-adjusted life expectancy, with the economic impact being quite substantial because of the large population size affected. We estimate a lifetime cost of USD $504 million for the adult population affected, with the largest economic impact seen among MCLNO patients.

Conclusions: A major disaster had a significant effect on diabetes management and exacerbated existing disparities. These effects may have a lasting impact on both health and economic implications.

Figure 1

Model of relationship between change in A1C and time in patients in three different health systems in New Orleans, before and after Hurricane Katrina.

Figure 2

Model of relationship between change in systolic blood pressure (SBP) and time in patients in three different health systems in New Orleans, before and after Hurricane Katrina.

Figure 3

Model of relationship between change in diastolic blood pressure (DBP) and time in patients in three different health systems in New Orleans, before and after Hurricane Katrina.