ArticlePDF Available

Chronic Disease and Related Conditions at Emergency Treatment Facilities in the New Orleans Area After Hurricane Katrina

Authors:
Andrea J Sharma at Centers for Disease Control and Prevention
Andrea J Sharma
Edward C Weiss
Edward C Weiss
Edward C Weiss
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Stacy L Young
Stacy L Young
Stacy L Young
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Kevin Stephens
Kevin Stephens
Kevin Stephens
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Show all 9 authorsHide
Download full-text PDF
Read full-text
Download citation

Abstract

Disaster preparations usually focus on preventing injury and infectious disease. However, people with chronic disease and related conditions (CDRCs), including obstetric/gynecological conditions, may be vulnerable to disruptions caused by disasters. We used surveillance data collected after Hurricane Katrina to characterize the burden of visits for CDRCs at emergency treatment facilities (eg, hospitals, disaster medical assistance teams, military aid stations). In 6 parishes in and around New Orleans, health care providers at 29 emergency treatment facilities completed a standardized questionnaire for injury and illness surveillance from September 8 through October 22, 2005. Of 21,673 health care visits, 58.0% were for illness (24.3% CDRCs, 75.7% non-CDRCs), 29.1% for injury, 7.2% for medication refills, and 5.7% for routine or follow-up care. The proportion of visits for CDRCs increased with age. Among men presenting with CDRCs, the most common illnesses were cardiovascular disease (36.8%), chronic lower-respiratory disease (12.3%), and diabetes/glucose abnormalities (7.7%). Among women presenting with CDRCs, the most common were cardiovascular disease (29.2%), obstetric/gynecological conditions (18.2%), and chronic lower-respiratory disease (12.0%). Subsequent hospitalization occurred among 28.7% of people presenting with CDRCs versus 10.9% of those with non-CDRCs and 3.8% of those with injury. Our data illustrate the importance of including CDRCs as a part of emergency response planning.
Content uploaded by Susanne Straif-Bourgeois
Author content
All content in this area was uploaded by Susanne Straif-Bourgeois on Nov 23, 2022
Content may be subject to copyright.
Chronic Disease and Related Conditions at
Emergency Treatment Facilities in the New Orleans
Area After Hurricane Katrina
Andrea J. Sharma, PhD, MPH, Edward C. Weiss, MD, MPH, Stacy L. Young, MPH,
Kevin Stephens, MD, JD, Raoult Ratard, MD, MPH,
Susanne Straif-Bourgeois, PhD, MPH, Theresa M. Sokol, MPH,
Peter Vranken, DPh, and Carol H. Rubin, DVM
ABSTRACT
Background: Disaster preparations usually focus on preventing injury and infectious disease. However,
people with chronic disease and related conditions (CDRCs), including obstetric/gynecological condi-
tions, may be vulnerable to disruptions caused by disasters.
Methods: We used surveillance data collected after Hurricane Katrina to characterize the burden of visits
for CDRCs at emergency treatment facilities (eg, hospitals, disaster medical assistance teams, military
aid stations). In 6 parishes in and around New Orleans, health care providers at 29 emergency
treatment facilities completed a standardized questionnaire for injury and illness surveillance from
September 8 through October 22, 2005.
Results: Of 21,673 health care visits, 58.0% were for illness (24.3% CDRCs, 75.7% non-CDRCs), 29.1%
for injury, 7.2% for medication refills, and 5.7% for routine or follow-up care. The proportion of visits
for CDRCs increased with age. Among men presenting with CDRCs, the most common illnesses were
cardiovascular disease (36.8%), chronic lower-respiratory disease (12.3%), and diabetes/glucose
abnormalities (7.7%). Among women presenting with CDRCs, the most common were cardiovascular
disease (29.2%), obstetric/gynecological conditions (18.2%), and chronic lower-respiratory disease
(12.0%). Subsequent hospitalization occurred among 28.7% of people presenting with CDRCs versus
10.9% of those with non-CDRCs and 3.8% of those with injury.
Conclusions: Our data illustrate the importance of including CDRCs as a part of emergency response
planning. (Disaster Med Public Health Preparedness. 2008;2:27–32)
Key Words: surveillance, chronic disease, disasters, Louisiana, obstetrics
On August 29, 2005, Hurricane Katrina made
landfall along the Gulf Coast of the United
States as a category 3 storm (winds 111–130
mph), resulting in widespread flooding of areas in and
around New Orleans. Disaster response traditionally
focuses on preventing injury and infectious disease.
1
However, among populations with a large burden of
chronic disease, management of chronic disease and
related conditions is essential to prevent severe ex-
acerbations or complications.
2,3
After Hurricane Kat-
rina, a limited-needs assessment conducted in evac-
uation centers demonstrated that the majority of
non–injury-related health care visits were for medi-
cation refills, oral health problems, or chronic disease
conditions.
4
Another survey reported that 41% of
evacuees had a history of at least 1 chronic disease.
5
There are almost no published data on the burden of
chronic conditions at emergency treatment facilities.
In response to Hurricane Katrina, the Centers for
Disease Control and Prevention (CDC) and the Lou-
isiana Department of Health and Hospitals imple-
mented active surveillance to monitor for injuries and
illnesses at functioning emergency treatment facilities
(eg, hospitals, disaster medical assistance teams, mil-
itary aid stations) in and around New Orleans.
6,7
The
objectives of the present analysis were to determine
the prevalence of visits for chronic disease and related
conditions (CDRCs) from September 8 to October
22, 2005, at emergency treatment facilities serving
the area, and to characterize the distribution of spe-
cific CDRCs by age and sex.
METHODS
On September 8, 2005, the Louisiana Department of
Health and Hospitals and the CDC established an
active surveillance system for injury and illness that
captured information from visits to functioning emer-
RESEARCH
Disaster Medicine and Public Health Preparedness 27
https://doi.org/10.1097/DMP.0b013e31816452f0 Published online by Cambridge University Press
gency treatment facilities (eg, hospitals, disaster medical as-
sistance teams, military aid stations) providing acute care in
6 parishes (Jefferson, Orleans, Plaquemines, St Bernard, St
Charles, and St Tammany) in and around New Orleans.
6,7
Data were collected prospectively as facilities opened and
joined the surveillance system. Retrospective data were col-
lected from hospital facilities when available. This report
focuses on data collected from the 8 hospital and 21 nonhos-
pital facilities participating in the surveillance system from
September 8 to October 22, 2005.
Health care providers were instructed to complete a stan-
dardized 1-page case-report form for every patient visit to an
emergency treatment facility. The form was developed by the
CDC for use in clinical, posthurricane settings. Data were
collected on patient demographics and reason for visit (ie,
injury, illness, both illness and injury, medication refill, or
routine care or follow-up). Data also were collected on symp-
toms, mechanism of injury, primary clinical impressions (for
illness), preexisting conditions, and disposition (ie, hospital-
ized, discharged, left without treatment, left against medical
advice, transferred, expired, unknown) among visits for in-
jury and illness. For the purpose of this analysis, patients with
both illness and injury (n ⫽299) were combined with those
who had only illness (n ⫽15,069) into 1 illness category.
When data collection by health care providers was not prac-
tical, epidemiologists were assigned to abstract the medical
record.
To characterize CDRCs, health care providers were in-
structed to select 1 primary clinical impression for the most
severe complaint or condition from a checklist that included
the following categories: cardiovascular disease; cerebrovas-
cular diseases; hyperglycemia, hypoglycemia, or diabetes mel-
litus; renal failure; and chronic lower respiratory disease. The
list included 13 other conditions that we considered non-
CDRC (eg, dehydration, heat-related illness, infectious dis-
eases, mental health–related conditions) and an “other” cat-
egory with space to record a clinical impression. To capture
CDRC data in the write-in fields, the following 7 additional
categories were created: dental; obstetric/gynecological
(women only); chronic gastrointestinal; chronic pain; hema-
tology/oncology; arthritis; and other chronic conditions. A
medical epidemiologist (E.C.W.) categorized subjects as hav-
ing a CDRC if they had a clinical impression consistent with
symptoms, acute events, or complications of a chronic con-
dition. In cases in which more than 1 clinical impression was
noted, a person was categorized as having a CDRC if 1
clinical impression was consistent with a CDRC.
Of the 26,230 visits recorded from September 8 to October
22, 2005, a total of 2200 (8.4%) were excluded because of
REASON FOR VISITDISPOSITION
Total number
of visits
n=21,673*
Illness
n=12,567
(58.0%)
Injury
n=6,308
(29.1%)
Medication Refill
n=1,557
(7.2%)
Follow-Up Visit
n=1,241
(5.7%)
CDRCs
n=3,054
(24.3%)
Disposition Data
Available
n=2,862
(93.7%)
Hospitalized
n=822
(28.7%)
Non-CDRCs
n=9,513
(75.7%)
Disposition Data
Available
n=8,859
(93.1%)
Hospitalized
n=966
(10.9%)
Disposition Data
Available
N=5,633
(89.3%)
Hospitalized
n=216
(3.8%)
*4,557 visits excluded from the analysis due to reason for visit was immunization (n=3) or unknown (n=358), or missing data on the following: primary clinical
impression (n=1510), mechanism of injury (n=329), or age and/or sex (n=2357).
CDRC = Chronic disease and related conditions.
FIGURE 1
Distribution of visits to emergency treatment facilities, by reason for visit and disposition, in New
Orleans area September 8 –October 22, 2005
Chronic Disease After Hurricane Katrina
28 Disaster Medicine and Public Health Preparedness VOL. 2/NO. 1
https://doi.org/10.1097/DMP.0b013e31816452f0 Published online by Cambridge University Press
missing data regarding reason for visit (n ⫽358, 1.4%),
reason for visit was immunization (n ⫽3), or if the reason for
visit was known, data was missing on primary clinical im-
pression (n ⫽1510, 5.8%) or mechanism of injury (n ⫽329,
1.3%). An additional 2357 (9.0%) visits were excluded be-
cause of missing data about age or sex. A total of 21,673 visits
were included in the analysis.
We describe the proportion of visits to emergency treatment
facilities by reason for visit and the distribution of CDRCs by
age group and sex. The distributions of CDRCs among men
and women were reported separately to account for an addi-
tional primary clinical impression (obstetric/gynecological)
among women. Disposition data were collected for 17,354 of
the 18,875 visits for injury or illness. In a subanalysis, we
describe the proportion of visits in which the disposition was
hospitalization. All of the data analyses were performed using
SAS software, version 9.0 (SAS Institute, Cary, NC).
RESULTS
Of the 21,673 visits, 58.0% presented for illness, 29.1% for
injuries, 7.2% for medication refills, and 5.7% for routine or
follow-up care (Fig. 1). Among visits for illness (n ⫽12,567),
75.7% were for non-CDRC illnesses (eg, dehydration, heat-
related illness, infectious disease, mental health) and 24.3%
were for CDRCs. The proportion of visits for illness due to
CDRCs increased with age, from 12.3% among patients ages
0 to 19 years to 40.9% among those ages 80 years or older
(Fig. 2).
Among the 3054 patients presenting with a CDRC, the most
common CDRCs were cardiovascular disease (32.8%), ob-
stetric/gynecological conditions (18.2%), and chronic lower
respiratory disease (12.1%; Table 1). Among the 1435 men
presenting with a CDRC, the most common CDRCs were
cardiovascular disease (36.8%); chronic lower respiratory dis-
ease (12.3%); and hypoglycemia, hyperglycemia, or diabetes
mellitus (7.7%; Table 2). The proportion of men presenting
with cardiovascular disease increased with age from 14.0%
among those ages 0 to 19 years to 54.9% among those ages 80
years or older. Chronic lower respiratory disease was the most
common CDRC among men ages 0 to 19 years (54.7%) and
the second-most common CDRC among men in all age
groups 40 years or older (8.8%). Dental problems were the
most common CDRC among men ages 20 to 39 years
(20.2%).
Among the 1619 women presenting with a CDRC, the most
common CDRCs were cardiovascular disease (29.2%), ob-
stetric/gynecological conditions (18.2%), and chronic lower
respiratory disease (12.0%; Table 3). The proportion present-
ing for cardiovascular disease increased with age from 5.7%
among women ages 0 to 19 years to 46.2% among women
ages 80 years or older. Obstetric/gynecological conditions
were the most common CDRCs among women ages 0 to 19
years (33.6%) and 20 to 39 years (48.0%). Chronic lower
respiratory conditions were the second-most common CDRC
among women in all age groups (12.0%), affecting the great-
est proportion among women ages 0 to 19 years (28.7%).
Overall, hyperglycemia, hypoglycemia, or diabetes mellitus
was the fourth-most common CDRC category among women
(6.1%).
Among the 17,354 visits for which data on disposition were
available (Fig. 1), hospitalization was the disposition for
28.7% of people presenting with CDRCs compared with
10.9% with non-CDRC illness and 3.8% with injuries. Al-
though the proportion of visits for which the disposition was
hospitalization varied by sex and increased with age across all
reasons for visit (Fig. 3), within each age group hospitaliza-
tion was more common for visits for CDRCs than for visits
for either non-CDRCs or injuries.
12.3% 18.4% 24.9%
37.1% 40.9%
87.7% 81.6% 75.1%
62.9% 59.1%
0%
50%
100%
0-19 20-39 40-59 60-79 ≥80
Age Group (years)
non-CDRC
CDRC
FIGURE 2
Among visits for illness, the proportion with primary
clinical impressions related to chronic disease or
related conditions (CDRCs) or non-CDRCs by age group
TABLE 1
Total Number of People Presenting With Chronic
Disease and Related Conditions at Emergency
Treatment Facilities in New Orleans Area After
Hurricane Katrina, September 8 –October 22, 2005
Chronic Disease and Related Conditions
nⴝ3054
No. %
Cardiovascular disease 1001 32.8
Cerebrovascular disease 149 4.9
Hyper-/hypoglycemia, diabetes 209 6.8
Renal failure 77 2.5
Chronic lower respiratory disease 371 12.1
Dental problems 172 5.6
Obstetric/gynecological conditions 294 18.2*
Chronic gastrointestinal conditions 201 6.6
Chronic pain syndromes 132 4.3
Hematology, oncology 131 4.3
Arthritis 103 3.4
Other chronic conditions 214 7.0
*Percentage based on only the female population, n ⫽1619.
Chronic Disease After Hurricane Katrina
Disaster Medicine and Public Health Preparedness 29
https://doi.org/10.1097/DMP.0b013e31816452f0 Published online by Cambridge University Press
DISCUSSION
Hurricane Katrina created substantive public health and
medical challenges, especially in southern Louisiana, where
the subsequent flooding of New Orleans imposed cata-
strophic public health conditions. Several large hospitals
were rendered inoperable. Nearly all of the smaller treatment
facilities and pharmacies were shut down, leaving people
with chronic medical conditions without access to their usual
sources of medical care and medications.
8
In this article, we
have described the relevance of CDRCs in medical response.
After Hurricane Katrina, CDRCs accounted for a significant
proportion of visits to emergency treatment facilities in and
around New Orleans for illness, particularly among people
ages 60 years or older. The burden was magnified by the high
rate of hospitalization among those presenting with CDRCs.
Cardiovascular disease, chronic lower respiratory disease, ob-
stetric/gynecological conditions, and hyperglycemia, hypo-
glycemia, or diabetes were the most common CDRCs. Al-
though not as common, cerebrovascular disease and renal
failure often require immediate interventions with medica-
tion or dialysis to prevent further morbidity or mortality.
Disaster preparations usually focus on preventing injury and
infectious disease. Disaster preparedness also includes plan-
ning for the needs of people who are vulnerable to the stresses
and disruptions caused by the disaster. This includes people
with either recognized or unrecognized chronic medical con-
ditions. Preparations for controlling chronic diseases and
adverse pregnancy outcomes following a disaster can be
guided to some degree by the predisaster disease burden, by
an awareness of the immediate CDRC needs for specialty
TABLE 2
Number of Men Presenting at Emergency Treatment Facilities for Chronic Disease and Related Conditions After
Hurricane Katrina, by Age Group, in New Orleans Area September 8 –October 22, 2005
Chronic Disease and Related Conditions
0–19 y 20–39 y 40–59 y 60–79 y 80ⴙy Total
No. % No. % No. % No. % No. % No. %
Cardiovascular disease 12 14.0 59 22.4 209 36.0 181 47.3 67 54.9 528 36.8
Cerebrovascular disease 0 0 7 2.7 32 5.5 28 7.3 6 4.9 73 5.1
Hyper-/hypoglycemia, diabetes 2 2.3 18 6.8 57 9.8 25 6.5 8 6.6 110 7.7
Renal failure 0 0 5 1.9 23 4.0 15 3.9 8 6.6 51 3.6
Chronic lower respiratory disease 47 54.7 33 12.6 47 8.1 41 10.1 8 6.6 176 12.3
Dental problems 4 4.7 53 20.2 39 6.7 9 2.4 1 0.8 106 7.4
Chronic gastrointestinal conditions 11 12.8 20 7.6 43 7.4 25 6.5 8 6.6 107 7.5
Chronic pain syndromes 4 4.7 17 6.5 22 3.8 3 0.8 1 0.8 47 3.3
Hematology, oncology 2 2.3 22 8.4 25 4.3 18 4.7 7 5.7 74 5.2
Arthritis 0 0 7 2.7 38 6.5 17 4.4 0 0 62 4.3
Other chronic conditions 4 4.7 22 8.4 46 7.9 21 5.5 8 6.6 101 7.0
Total 86 100.0 263 100.0 581 100.0 383 100.0 122 100.0 1435 100.0
TABLE 3
Number of Women Presenting at Emergency Treatment Facilities for Chronic Disease and Related Conditions After
Hurricane Katrina, by Age Group, in New Orleans Area September 8 –October 22, 2005
Chronic Disease and Related Conditions
0–19 y 20–39 y 40–59 y 60–79 y 80ⴙy Total
No. % No. % No. % No. % No. % No. %
Cardiovascular disease 7 5.7 36 8.8 160 30.9 191 47.8 79 46.2 473 29.2
Cerebrovascular disease 0 0 4 1.0 22 4.3 34 8.5 16 9.4 76 4.7
Hyper-/hypoglycemia, diabetes 5 4.1 10 2.5 44 8.5 34 8.5 6 3.5 99 6.1
Renal failure 0 0 3 0.7 7 1.4 13 3.3 3 1.8 26 1.6
Chronic lower respiratory disease 35 28.7 43 10.5 64 12.4 35 8.8 18 10.5 195 12.0
Dental problems 5 4.1 30 7.4 26 5.0 4 1.0 1 0.6 66 4.1
Obstetric/gynecological conditions 41 33.6 196 48.0 44 8.5 5 1.3 8 4.7 294 18.2
Chronic gastrointestinal conditions 12 9.8 17 4.2 30 5.8 22 5.5 13 7.6 94 5.8
Chronic pain syndromes 5 4.1 30 7.4 43 8.3 7 1.8 0 0 85 5.3
Hematology, oncology 5 4.1 15 3.7 14 2.7 18 4.5 5 2.9 57 3.5
Arthritis 0 0 2 0.5 22 4.3 12 3.0 5 2.9 41 2.5
Other chronic conditions 7 5.7 22 5.4 42 8.1 25 6.3 17 9.9 113 7.0
Total 122 100.0 408 100.0 518 100.0 400 100.0 171 100.0 1619 100.0
Chronic Disease After Hurricane Katrina
30 Disaster Medicine and Public Health Preparedness VOL. 2/NO. 1
https://doi.org/10.1097/DMP.0b013e31816452f0 Published online by Cambridge University Press
care and medications, and by the capacity of the health care
delivery system in the area.
3
Whether previously diagnosed or
not, chronic illnesses can be exacerbated by disaster condi-
tions (eg, lack of food or water, extreme heat or cold, physical
and mental stress).
9–12
Therefore, active surveillance of
CDRCs following a disaster can help tailor disaster response
efforts. For example, data could be used to direct essential
resources—such as health care providers, medications, or
equipment—to potential shortage areas.
13
Without appropri-
ate care following a disaster, patients with chronic stable
conditions, such as cardiovascular disease, diabetes, or dialy-
sis-dependent renal failure, may experience severe exacerba-
tions or complications such as heart attack, diabetic ketoac-
idosis, or even death.
To improve surveillance for chronic disease following a di-
saster, a questionnaire that limits the potential for misclassi-
fication is needed. Since Hurricane Katrina, surveillance
questionnaires have been updated to distinguish between
exacerbations of chronic illness and presentation for stable
chronic conditions, as well as presentation for pregnancy
complications versus gynecological conditions not related to
pregnancy.
13
Ideally, the questionnaire would be added to the
forms already used by disaster medical assistance teams, and
could be integrated into the medical record with ease.
The findings in this article are subject to several limitations.
First, the surveillance system was not specifically designed to
detect CDRCs. Substantial ambiguity occurred in the symp-
toms and diagnoses reported, resulting in probable misclassi-
fication; however, an effort was made to classify CDRCs
conservatively. Second, our estimates of CDRCs may be low
because we did not include mental health disorders, medica-
tion refills, or follow-up care visits. Mental health was not
included as a chronic condition because the category descrip-
tion did not differentiate chronic mental health conditions
from acute disorders related to the disaster. Similarly, the
underlying medical condition of those requiring medication
refills or follow-up care was not ascertained; therefore, the
proportion of visits for CDRCs remains unknown. Third,
owing to the mass evacuation of the New Orleans area, the
loss of health care infrastructure, and the lack of baseline
data, determining the absolute burden of CDRCs on the
health care system was not possible and generalizability to
future disasters is limited. Fourth, prospective data collection
began on September 8. Thus, there is little information on
the distribution of visits in the first week after the hurricane.
Finally, the proportion of obstetric/gynecological visits result-
ing from complications of pregnancy is not known; however,
write-in data suggest that at least 25% of visits were preg-
nancy related.
Despite these limitations, this report contains important in-
formation about medical needs following a disaster. Because
of the substantial burden of CDRCs, these findings highlight
the importance of emergency response plans and improved
active surveillance to address chronic diseases, especially
among older adults, and to protect the health of pregnant
women. Rapid initiation of surveillance following a disaster is
0%
10%
20%
30%
40%
50%
60%
70%
sCRDCsCRDC-noN
y
rujn
Is
CRD
C
sCRDC-noN
y
r
u
jn
I
Reason for Visit
0-19 y
20-39 y
40-59 y
60-79 y
≥80 y
N
EMOWN
E
M
FIGURE 3
Proportion of visits for which disposition was hospitalization by sex, age, and
reason for visit
Chronic Disease After Hurricane Katrina
Disaster Medicine and Public Health Preparedness 31
https://doi.org/10.1097/DMP.0b013e31816452f0 Published online by Cambridge University Press
crucial to accurately characterize the burden of disease and
direct the appropriate essential resource needs to emergency
treatment facilities in the area. The findings underscore a
need for including chronic disease care and prevention of
complications in predisaster planning and postdisaster sur-
veillance.
About the Authors
Drs Sharma, Weiss, and Vranken are with the Epidemic Intelligence Service,
Office of Workforce and Career Development, CDC; Ms Young and Dr Rubin
are with the Division of Environmental Hazards and Health Effects, National
Center for Environmental Health, CDC; Dr Stephens is with the City of New
Orleans Health Department; and Drs Ratard and Straif-Bourgeois and Ms Sokol
are with the Office of Public Health, Louisiana Department of Health and
Hospitals.
Address correspondence and reprint requests to Andrea J. Sharma, Centers for
Disease Control and Prevention, Mailstop K-26, 4770 Buford Hwy, Atlanta,
GA 30341-3724 (e-mail: ajsharma@cdc.gov).
Received for publication August 17, 2007; accepted December 5, 2007.
Authors’ Disclosure
The findings in this report are based, in part, on contributions by the many
men and women who provided emergency treatment services throughout the
greater New Orleans area during the disaster response, the Greater New
Orleans Public Health Response Team, and the National Center for
Chronic Disease Prevention and Health Promotion, CDC. The findings and
conclusions in this report are those of the authors and do not necessarily
represent the views of the CDC.
ISSN: 1935-7893 © 2008 by the American Medical Association and Lip-
pincott Williams & Wilkins.
DOI: 10.1097/DMP.0b013e31816452f0
REFERENCES
1. Noji EK, ed. The Public Health Consequences of Disasters. New York:
Oxford University Press; 1997.
2. Mokdad AH, Mensah GA, Posner SF et al. When chronic conditions
become acute: prevention and control of chronic diseases and adverse
health outcomes during natural disasters. Prev Chronic Dis [serial online], vol
2. November 2005. http://www.cdc.gov/Pcd/issues/2005/nov/05_0201.htm.
Accessed January 22, 2008.
3. Ford ES, Mokdad AH, Link MW et al. Chronic disease in health emer-
gencies: in the eye of the hurricane. Prev Chronic Dis [serial online], vol 3.
April 2006;3. http://www.cdc.gov/pcd/issues/2006/apr/05_0235.htm. Ac-
cessed January 22, 2008.
4. Centers for Disease Control and Prevention. Update on CDC’s response
to Hurricane Katrina. US Department of Health and Human Services,
CDC Web site. September 19, 2005. http://www.cdc.gov/od/katrina/09-
19-05.htm. Accessed January 22, 2008.
5. The Washington Post/Kaiser Family Foundation/Harvard University
Survey Project. Survey of Hurricane Katrina Evacuees. Henry J Kaiser
Family Foundation Web site 2005. http://www.kff.org/newsmedia/upload/
7401.pdf. Accessed January 22, 2008.
6. Lopez C, Bergeron T, Ratard R et al. Injury and illness surveillance in
hospitals and acute-care facilities after hurricanes Katrina and Rita—
New Orleans area, Louisiana, September 25-October 15, 2005. MMWR
Morb Mortal Wkly Rep. 2006;55:35–38.
7. Williams W, Guarisco J, Guillot K et al. Surveillance for illness and
injury after hurricane Katrina—New Orleans, Louisiana, September
8-25, 2005. MMWR Morb Mortal Wkly Rep. 2005;54:1018–1021.
8. The Federal Response to Hurricane Katrina: Lessons Learned. The
White House Web site. February 23, 2006. http://www.whitehouse.gov/
reports/katrina-lessons-learned.pdf. Accessed January 22, 2008.
9. Kirizuka K, Nishizaki H, Kohriyama K et al. Influences of the great
Hanshin-Awaji earthquake on glycemic control in diabetic patients.
Diabetes Res Clin Pract. 1997;36:193–196.
10. Kario K, McEwen BS, Pickering TG. Disasters and the heart: a review
of the effects of earthquake-induced stress on cardiovascular disease.
Hypertens Res. 2003;26:355–367.
11. Sengul A, Ozer E, Salman S et al. Lessons learnt from influences of the
Marmara earthquake on glycemic control and quality of life in people
with type 1 diabetes. Endocr J. 2004;51:407–414.
12. Trichopoulos D, Katsouyanni K, Zavitsanos X, Tzonou A, Dalla-Vorgia
P. Psychological stress and fatal heart attack: the Athens (1981) earth-
quake natural experiment. Lancet. 1983;1:441–444.
13. Active public health surveillance in clinical care settings. Centers for
Disease Control and Prevention Web site. July 24, 2006. http://www.
bt.cdc.gov/disasters/hurricanes/asccs.asp. Accessed January 22, 2008.
Chronic Disease After Hurricane Katrina
32 Disaster Medicine and Public Health Preparedness VOL. 2/NO. 1
https://doi.org/10.1097/DMP.0b013e31816452f0 Published online by Cambridge University Press
... Twenty studies focused on hurricanes [56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75], five on extreme winter weather [37][38][39]52,79], four on extreme heat [40][41][42][43], four on floods [46,51,54,55], four on wildfires [36,[76][77][78], three on dust storms [44,45,48], three on typhoons [47,49,50], one on droughts [53] and one involving various types of extreme weather [7]. ...
... Many types of pre-existing disabilities and chronic conditions were included across the studies including some focusing specifically on people with physical disabilities [7, 72,75], chronic obstructive pulmonary disease [41,[43][44][45]48], cardiovascular disease [50], chronic kidney disease [40], end-stage renal disease [49], patients needing hemodialysis [40,56,64], visual impairments [67], multiple sclerosis [36], cognitive impairment [77], various chronic diseases [39,42,46,53,55,57,58,63,65,66,[69][70][71][72], and various types of disabilities [37,38,47,51,52,54,[59][60][61][62]68,73,74,76,79]. ...
... The methodological designs involved 14 surveys [37,39,46,47,55,59,61,63,64,66,68,70,72,77], 13 secondary data analyses of hospital or other administrative databases [7, [40][41][42]44,45,48,50,54,58,65,69,71], nine interview studies [52,53,56,57,60,62,67,76,79], four used mixed methods [36,38,73,75], two involved case studies [49,51], one involved focus groups [74], and one randomized control trial [43]. ...
The impact of climate change related extreme weather events on people with pre-existing disabilities and chronic conditions: a scoping review
Article
Purpose: People with disabilities experience a disproportionate impact of extreme weather events and there is a critical need to better understand the impact that climate change has for them. Most previous reviews focus on the risk of acquiring a new disability or injury after a climate-related event and not the impact on people with pre-existing disabilities or chronic conditions, which is the purpose of this study. Methods: We conducted a scoping review while searching seven international databases that identified 45 studies meeting our inclusion criteria. Results: The studies included in our review involved 2 337 199 participants with pre-existing disabilities and chronic conditions across 13 countries over a 20-year period. The findings demonstrated the follow- ing trends: (1) the impact on physical and mental health; (2) the impact on education and work; (3) barriers to accessing health and community services (i.e., lack of access to services, lack of knowledge about people with disabilities, communication challenges, lack of adequate housing); and (4) coping strategies (i.e., social supports and connecting to resources) and resilience. Conclusions: Our findings highlight the critical need for rehabilitation clinicians and other service providers to explore opportunities to support their clients in preparing for climate-related emergencies.
View
... Accordingly, they are the least prepared to the social, financial and overall health impacts of disasters and emergencies compared to other segments of the community, and their disaster preparedness is disproportionately lower than that of other groups [7,8,9]. Pre-existing health conditions can be exacerbated due to the healthcare delivery disruptions [10,11]. In the post disaster period, structural barriers, damage to health systems and the increased demands on health services can cause further limitation on access to health carefor these people. ...
Scoping review of exploring the roles of primary care providers to increase disaster preparedness of vulnerable populations
Article
Full-text available
  • Jun 2024
Background Primary care providers are well placed to improve disaster preparedness in communities. Their close position to their clients and understanding of theirhealth needs can be utilized to increase disaster preparedeness for vulnerable populations. However, there is still a lack of clarity about their roles and services in this area. The aim of this review was to explore the services provided by primary care providers in the context of disaster preparedness activities for vulnerable populations. Methods Scoping review was performed with PubMed, Scopus and MEDLINE databases. Results A total of 2193 articles were identified from the database screening and 22 full-text articles yielded for the final analysis. After thematic analysis was conducted, six themes were emerged. Conclusion To utilise and maximise theprofessional roles of primary care providers effectively, there is a need to strengthen the expertise and involvement of providers in disaster risk management mechanisms and planning. In addition, there is a need for scientific research to explore the existing capabilities of primary care providers and to facilitate their existing ability to coordinate with disaster management agencies.
View
... Hence, research on the impact of disasters specific to older adults is of rising importance Sands et al., 2022). Along this line of research, previous studies have demonstrated that disaster exposure is strongly associated with post-disaster health problems such as cardiometabolic risks, arthritis, diabetes, dementia, and depression among older adults (Ikeda et al., 2020;Lee et al., 2016;Sharma et al., 2008;Shiba et al., 2019). ...
Longitudinal Associations Between Disaster Damage and Falls/Fear of Falling in Older Adults: 9-Year Follow-Up of Survivors of the 2011 Great East Japan Earthquake and Tsunami
Article
Full-text available
  • Mar 2023
Background and Objectives Fear of falling and falls are common in older adults. However, their associations with natural disaster exposures remain poorly understood. This study aims to examine longitudinal associations between disaster damage with fear of falling/falls among older disaster survivors. Research Design and Methods In this natural experiment study, the baseline survey (4,957 valid responses) took place 7 months before the 2011 Great East Japan Earthquake and Tsunami, and three follow-ups were conducted in 2013, 2016, 2020. Exposures were different types of disaster damage and community social capital. Outcomes were fear of falling and falls (including incident and recurrent falls). We used lagged outcomes in logistic models adjusting for covariates and further examined instrumental activities of daily living (IADL) as a mediator. Results The baseline sample had a mean (SD) age of 74.8 (7.1) years; 56.4% were female. Financial hardship was associated with fear of falling (OR, 1.75; 95% CI [1.33,2.28]) and falls (OR, 1.29; 95% CI [1.05,1.58]), especially recurrent falls (OR, 3.53; 95% CI [1.90,6.57]). Relocation was inversely linked with fear of falling (OR, 0.57; 95% CI [0.34,0.94]). Social cohesion was protectively associated with fear of falling (OR, 0.82; 95% CI [0.71,0.95]) and falls (OR, 0.88; 95% CI [0.78,0.98]) while social participation increased the risk of these issues. IADL partially mediated observed associations between disaster damage and fear of falling/falls. Discussion and Implications Experiences of material damage rather than psychological trauma were associated with falls and fear of falling, and the increased risk of recurrent falls revealed a process of cumulative disadvantage. Findings could inform targeted strategies for protecting older disaster survivors.
View
... [8][9][10] Given the inevitable increased frequency of natural hazards, a primary goal of disaster preparedness is to mitigate the immense public health impact of climate-related natural disasters. 11,12 Disaster-impacted populations have increased incidence of poor health outcomes and indicators, including mortality, [13][14][15] myocardial infarction, [16][17][18][19][20][21] and use of medical care. 22,23 Many disasters require those exposed to relocate temporarily or permanently, impacting health through increased stress, interruptions to usual care, or financial strain. ...
Uneven Growth in Social Capital Organizations After Disasters by Pre-Disaster Conditions in the United States 2000–2014
Article
  • Dec 2022
Introduction Community-level social capital organizations are critical pre-existing resources that can be leveraged in a disaster. Aim The study aimed to test the hypothesis that communities with larger pre-disaster stocks of social capital organizations would maintain pre-disaster levels or experience growth. Methodology An annual panel dataset of counties in the contiguous United States from 2000 to 2014 totaling 46620 county-years, including longitudinal data on disasters and social capital institutions was used to evaluate the effect of disaster on growth of social capital. Results When a county experienced more months of disasters, social capital organizations increased a year later. These findings varied based on the baseline level of social capital organizations. For counties experiencing minor disaster impacts, growth in social capital organizations tends to occur in counties with more social capital organizations in 2000; this effect is a countervailing finding to that of major disasters, and effect sizes are larger. Conclusion Given the growing frequency of smaller-scale disasters and the considerable number of communities that experienced these disasters, the findings suggest that small scale events create the most common and potentially broadest impact opportunity for intervention to lessen disparities in organizational growth.
View
... This review provides an overview of publications that focus on a range of CVD outcomes and their association with hurricanes and other extreme weather events. Particularly, our scoping review summarizes the current literature on the short-term associations between hurricanes and CVD-related hospitalization and CVD-related mortality-evidence that has been described in the aftermath of Hurricanes Katrina, [26][27][28]7,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48]62 Sandy, 14,3,5,[49][50][51] Maria, 65 Irma, 58 Iniki, 57 and Harvey 55 and Typhoon Morakot, 57,58 as well as broadly across multiple hurricanes. 52,60,61,63,64,67,68 Furthermore, the scoping review sheds light on certain vulnerable populations at increased risk of adverse CVD outcomes. ...
Impact of Hurricanes and Associated Extreme Weather Events on Cardiovascular Health: A Scoping Review
Article
Full-text available
  • Nov 2022
Background: The frequency and destructiveness of hurricanes and related extreme weather events (e.g., cyclones, severe storms) have been increasing due to climate change. A growing body of evidence suggests that victims of hurricanes have increased incidence of cardiovascular disease (CVD), likely due to increased stressors around time of the hurricane and in their aftermath. Objectives: The objective was to systematically examine the evidence of the association between hurricanes (and related extreme weather events) and adverse CVD outcomes with the goal of understanding the gaps in the literature. Methods: A comprehensive literature search of population-level and cohort studies focused on CVD outcomes (i.e., myocardial infarction, stroke, and heart failure) related to hurricanes, cyclones, and severe storms was performed in the following databases from inception to December 2021: Ovid MEDLINE, Ovid EMBASE, Web of Science, and The Cochrane Library. Studies retrieved were then screened for eligibility against predefined inclusion/exclusion criteria. Studies were then qualitatively synthesized based on the time frame of the CVD outcomes studied and special populations that were studied. Gaps in the literature were identified based on this synthesis. Results: Of the 1,103 citations identified, 48 met our overall inclusion criteria. We identified articles describing the relationship between CVD and extreme weather, primarily hurricanes, based on data from the United States (42), Taiwan (3), Japan (2), and France (1). Outcomes included CVD and myocardial infarction-related hospitalizations (30 studies) and CVVD-related mortality (7 studies). Most studies used a retrospective study design, including one case-control study, 39 cohort studies, and 4 time-series studies. Discussion: Although we identified a number of papers that reported evaluations of extreme weather events and short-term adverse CVD outcomes, there were important gaps in the literature. These gaps included a) a lack of rigorous long-term evaluation of hurricane exposure, b) lack of investigation of hurricane exposure on vulnerable populations regarding issues related to environmental justice, c) absence of research on the exposure of multiple hurricanes on populations, and d) absence of an exploration of mechanisms leading to worsened CVD outcomes. Future research should attempt to fill these gaps, thus providing an important evidence base for future disaster-related policy. https://doi.org/10.1289/EHP11252.
View
... Out of these categories, data related to the 1999 cyclone are available only in relation to mortality due to drowning and acute trauma, injuries, few of the above-mentioned communicable diseases (cholera and leptospirosis) and psychosocial health, whereas all other aspects have not been investigated. By comparison, there is a substantial mass of data available to look at the health impacts of hurricane Katrina (see, for example, DeSalvo et al., 2007;Sharma et al., 2008;Xiong et al., 2008;Arrieta et al., 2009;Fox et al., 2009;Murray et al., 2009;Rabito et al., 2010). ...
Socio-economic, infrastructural and environmental development and speed of post - disaster recovery in the Kendrapara District of Odisha, India
Thesis
  • Jan 2022
Disasters and development are closely intertwined. This is because development changes can increase or decrease vulnerabilities and capacities in the face of disasters, just like disasters can destroy development efforts or create development opportunities. These links become particularly evident in the post-disaster recovery phase, when rehabilitation and reconstruction can shape future development. Recovery, however, is one of the least studied phases of the disaster risk reduction cycle and the question of which attributes lead to quicker or slower recovery remains uncertain. The Indian state of Odisha is highly prone to tropical cyclones, with the most intense recorded event being the 1999 Odisha Super Cyclonic Storm. Twenty years later, there is still no comprehensive documentation of the losses caused by the cyclone or evaluation of the extent or speed of recovery from the event. This research contributes to enhancing the understanding of how socio-economic, environmental and infrastructural development changes can result in differential post-disaster recovery rates and how different associates of development interact and contribute to speed of recovery in local communities. An innovative mixed methods approach is used (including a systematic review, statistical analysis, remote sensing techniques, focus group discussions and semi-structured interviews) to assess socio-economic, infrastructural and environmental pre-disaster conditions and their relation to speed of recovery. This thesis provides: a comprehensive assessment of documented losses caused by the 1999 Odisha Super Cyclonic Storm; an evaluation of differential recovery over space and time; an assessment of developmental ‘hotspots’ (where recovery exceeded expectation) and ‘coldspots’ (where there was delayed recovery) for the Kendrapara District of Odisha.
View
... 9,[14][15][16] Descriptions of past disasters suggest patients present to healthcare facilities for both acute and chronic medical conditions following a disaster. 12,14,[17][18][19][20][21] These observations may be helpful in anticipating medications required during the initial emergency response. 14,22 Establishing a disaster plan with medication suppliers prior to a disaster event is critical. ...
Disaster Preparedness: Hospital Pharmacy Strategy for Prioritized Inventory Management and Drug Procurement on Vancouver Island
Article
Full-text available
  • Sep 2022
Disaster events can increase demand for medication supplies and interfere with supply chains, leading to compromised care in hospitals. Providing an organized response to an additional surge of disaster-related patients requires pre-planned emergency management procedures. Hospital pharmacists can address this with prioritized drug procurement and inventory management strategies which may improve the availability of key medications for a disaster response. Previous disaster events have provided insight on medications used to treat disaster-related injuries and exacerbations of medical conditions in emergency departments. This article provides a detailed description of Vancouver Island’s hospital pharmacy strategy for the procurement and minimum stock levels of high priority medications in preparation for a disaster.
View
Get ready: disaster preparedness and response for people with chronic illnesses living in hazard-prone Petone, Aotearoa New Zealand
Article
  • Oct 2024
  • Disast Prev Manag
Purpose The purpose of this research is to understand how people living with chronic illness understand their healthcare needs, particularly as they can be disrupted by natural hazards events (e.g. earthquakes, flooding and landslides), which can result in chronic health conditions becoming acute. Research has shown that, because of such disruption, people with chronic illness face the greatest risk of adverse health outcomes during a disaster, placing significant demand on healthcare systems. Design/methodology/approach The research draws on a narrative analysis of in-depth, semi-structured interviews with eight people who have a chronic illness and live in a hazard-prone location, namely Petone, Lower Hutt, Aotearoa New Zealand. Findings Two major narrative themes were identified: “Social Capital”, which included the three subthemes of community, social connection and support and family and friends. Tellers also experienced a strong sense of “Independence”, as demonstrated through seven subthemes that included declaration, defiance, rules, experience, acceptance, responsibility, self-surveillance and self-management. Practical implications Practice output from this research includes the development of fit for purpose emergency management policies and other educational resources to ensure equity, access and choice for people with a chronic illness and their communities. Social implications This research produces in-depth knowledge and insight into the preparedness and response needs of people who live with a chronic illness. This is an under-research area in disaster management in Aotearoa New Zealand. Originality/value Routine medical treatment for people living with chronic illness can be disrupted by natural hazard events (e.g. earthquakes, flooding and landslides), which can result in chronic health conditions becoming acute. Research has shown that, because of such disruption, the chronically ill face the greatest risk of adverse health outcomes during a disaster, placing significant demand on healthcare. This research investigates how people living with chronic illness experience disaster preparedness and response while residing in a hazard-prone location, namely Petone, Lower Hutt, Aotearoa New Zealand. The study argues that it is imperative to acknowledge the experiences of people with chronic illness as they provide specific insights into their needs during a disaster.
View
The Public Health Consequences of Compounding Disasters and Colonialism in Puerto Rico: A Mixed-Methods Investigation
Thesis
Full-text available
  • Jun 2024
In recent decades, the ongoing climate crisis has disproportionately impacted historically marginalized populations globally through environmental hazards and disasters. Understanding the health impacts of multiple disaster exposure has become increasingly critical as disasters associated with climate change and environmental hazards are increasing in frequency, intensity, and duration, and can precede or co-occur with other disasters such as pandemics, oil spills, biological attacks, and other natural and/or human-made disasters. The U.S. territory of Puerto Rico provides a unique opportunity to examine this relationship since it has been plagued by multiple disaster events in the past decade–including a category five hurricane, earthquakes, and the COVID-19 pandemic—and its political relationship with the United States can be considered colonial. Importantly, colonialism could be characterized as a social determinant of health, but it has been scarcely examined as such in epidemiologic literature. This dissertation considers social, occupational, and environmental factors and explores the relationship between multiple disaster exposure, physical, mental, and reproductive health outcomes, and the role of colonialism in modifying this relationship. Aim 1 explored associations between multiple disaster exposure and self-reported physical health, mental health, and health behaviors, and identified effect modifiers, among Puerto Rican participants from the Behavioral Risk Factor Surveillance System from 2017 to 2021. Overall, we found higher levels of poor physical and mental health, substance use, and self-reported perceptions of health in disaster periods compared to pre-disaster levels. Further, sociodemographic characteristics including sex, income, education, and employment status, modified the relationship between exposure and outcome. However, the direction and magnitude of these associations varied by disaster period. Aim 2 explored multiple disaster exposure and pregnancy-related maternal and newborn health outcomes using United States official vital records from 2017 to 2021, focusing on Puerto Rico and using Texas and Florida as comparisons to consider the role of colonialism. Overall, adverse maternal health outcomes (i.e., gestational hypertension, gestational diabetes, and excessive weight gain) were higher among Puerto Rican women in disaster periods compared to pre-disaster levels, and colonialism modified this relationship. Newborn health outcomes (i.e., preterm birth and low birthweight) were not similarly elevated in disaster periods, but this association may be underestimated due to live birth bias. Aim 3 contextualized the results from the first two aims through in-depth interviews with 30 participants in Puerto Rico. We found considerable geographic-level differences in terms of health trajectories and disaster experience, a significant toll on mental and behavioral health, widespread lack of healthcare access, worsening financial conditions over time, complications with prenatal care and worsening reproductive health, a sense of hopelessness about prosperity and quality of life, and participants feeling discouraged from having children. These results helped us identify future research to fill gaps and interpret epidemiology findings. Altogether, the results of this dissertation suggest widespread adverse health impacts from multiple disaster exposure in Puerto Rico and socio-structural inequities due to colonialism, persisting socioeconomic inequity, and governmental mismanagement of pre- and post- disaster conditions. Findings highlight the need for improved disaster preparedness and response, investment in more resilient climate and disaster-ready infrastructure, early disaster interventions to increase access to mental healthcare, and other policies and interventions to address financial inequities, improve quality of life, and reduce the impacts of disasters and colonialism.
View
Responding to concurrent disasters
Chapter
  • Jan 2023
As the frequency and severity of emergencies and disasters has increased over the last several decades, more attention has been focused on the challenges public health agencies and other organizations face when responding to multiple disasters at the same time. The COVID-19 pandemic was declared a public health emergency in January 2020. The declaration was most recently renewed by the U.S. Secretary of the Department of Health and Human Services on January 14, 2022. During that time, public health emergencies have also been declared in response to earthquakes, wildfires, hurricanes, winter storms, and the opioid crisis. More broadly, major disaster declarations have been issued by the President of the United States at the request of Governors or Tribal Chief Executives for 100 other events since January 2020, including flooding, wildfires, hurricanes, and tornados. Public health response to these disasters can limit a public health department's ability to continue to provide essential public health services. Public health emergency or disaster response concurrent with the public health response to the COVID-19 pandemic has placed unsustainable burdens on public health agencies and their staff, particularly in areas like epidemiology, environmental health, and clinical services that are required for concurrent responses to the COVID-19 pandemic and other disasters or emergencies.
View
View
Lessons Learnt from Influences of the Marmara Earthquake on Glycemic Control and Quality of Life in People with Type 1 Diabetes
Article
Full-text available
  • Aug 2004
To examine the short- and long-term influences of the Marmara earthquake, which occurred on August 17, 1999 in Turkey, on glycemic control and quality of life (QOL), HbA1c, insulin requirement and QOL of 88 people with type 1 diabetes living in the quake zone were evaluated one year before (PreE), 3 months after (PostE) and one year after (FE) the earthquake. HbA1c levels and daily insulin requirements increased significantly at PostE (HbA1c from 7.4 +/- 1.3% to 8.5 +/- 1.8%, p<0.05; insulin from 0.58 +/- 0.2 IU/kg/day to 0.77 +/- 0.2 IU/kg/day, p<0.05). Mean total QOL scores at PostE were significantly lower than the scores obtained at PreE (62.7 +/- 17.3 vs 74.2 +/- 13.4, p<0.001). There were no significant differences between HbA1c levels and total QOL scores at PreE and FE. People with type 1 diabetes living in the same house after the earthquake and not having enough food supply were reported to have lower QOL than people moving to another house and having enough food supply after the earthquake (p = 0.014, p<0.0001, respectively). The Marmara Earthquake had a negative impact on the glycemic control and QOL of the subjects with type 1 diabetes for the short term but prequake scores might be achieved after a long period.
View
Chronic Disease in Health Emergencies: In the Eye of the Hurricane
Article
Full-text available
  • May 2006
Inadequately controlled chronic diseases may present a threat to life and well-being during the emergency response to natural disasters. An estimate of the possible numbers of people who may require treatment for chronic diseases should help in planning a response, but such information for local areas is not easily accessible. We explored how a current surveillance system could be used to provide estimates of the potential needs for emergency treatment of chronic diseases in the wake of a natural disaster. We used data from adults aged 18 years or older who participated in the Behavioral Risk Factor Surveillance System (BRFSS) in 2004 to estimate the prevalence and numbers of people with diabetes, heart disease, stroke, hypertension, and current asthma who lived in the New Orleans-Metairie-Kenner, La, metropolitan statistical area. About 9.0% of participants had diabetes, 4.6% had angina or coronary heart disease, 3.0% had had a myocardial infarction, 2.0% had had a stroke, and 6.3% had current asthma. About 25.4% adults had at least one of the above conditions. A surveillance system such as the BRFSS can provide potentially useful baseline information about the numbers of people with chronic diseases and the treatment that they receive; this information can assist the medical and public health community in assessing the needs of people with chronic diseases after disasters and in planning relief efforts.
View
The Public Health Consequences of Disasters
Article
  • Nov 1996
Natural and man-made disasters--earthquakes, floods, volcanic eruptions, industrial crises, and many others--have claimed more than 3 million lives during the past 20 years, adversely affected the lives of at least 800 million people, and caused more than 50 billion dollars in property damages. A major disaster occurs almost daily in some part of the world. Increasing population densities in flood plains, along vulnerable coastal areas, and near dangerous faults in the earth’s crust, as well as the rapid industrialization of developing economies are factors likely to make the threat posed by natural disasters much bigger in the future. Illustrated with examples from recent research in the field, this book summarizes the most pertinent and useful information about the public health impact of natural and man-made disasters. It is divided into four sections dealing with general concerns, geophysical events, weather-related problems, and human-generated disasters. The author starts with a comprehensive discussion of the concepts and role of surveillance and epidemiology, highlighting general environmental health concerns, such as sanitation, water, shelter, and sewage. The other chapters, based on a variety of experiences and literature drawn from both developing and industrialized countries, cover discrete types of natural and technological hazards, addressing their history, origin, nature, observation, and control. Throughout the book the focus is on the level of epidemiologic knowledge on each aspect of natural and man-made disasters. Exposure-, disease-, and health-event surveillance are stressed because of the importance of objective data to disaster epidemiology. In addition, Noji pays particular attention to prevention and control measures, and provides practical recommendations in areas in which the public health practitioner needs more useful information. He advocates stronger epidemiologic awareness as the basis for better understanding and control of disasters. A comprehensive theoretical and practical treatment of the subject, The Public Health Consequences of Disasters is an invaluable tool for epidemiologists, disaster relief specialists, and physicians who treat disaster victims.
View
View
Psychological stress and fatal heart attack: The Athens (1981) earthquake natural experiment
Article
  • Mar 1983
The effects of acute and subacute psychological stress caused by a sudden general disaster on mortality from atherosclerotic heart disease (underlying cause) and cardiac events (proximate cause) were investigated by comparing total and cause-specific mortality during the days after a major earthquake in Athens in 1981 with the mortality during the surrounding month and the corresponding periods of 1980 and 1982. There was an excess of deaths from cardiac and external causes on the days after the major earthquake, but no excess of deaths from cancer and little, if any, excess of deaths from other causes. The excess mortality was more evident when atherosclerotic heart disease was considered as the underlying cause (5, 7, and 8 deaths on the first three days, respectively; background mean deaths per day 2.6; upper 95th centile 5) than when cardiac events in general were considered as the proximate cause (9, 11, and 14 deaths on the first three days, respectively; background mean 7.1, upper 95th centile 12).
View
Influences of The Great Hanshin-Awaji Earthquake on Glycemic Control in Diabetic Patients
Article
  • Jul 1997
  • DIABETES RES CLIN PR
We investigated influences on glycemic control in 177 diabetic patients after The Great Hanshin-Awaji Earthquake which occurred on January 17, 1995. Changes in serum HbA(1c) level were studied according to the worsen rate of dietary and living conditions. A significant temporary increase in the mean value of HbA(1c) level was found after the earthquake (8.34 +/- 2.07% in March, 1995 vs. 7.74 +/- 1.82% in December, 1994, P < 0.01). Ninety nine of them showed more than 0.5% in the rate of increase. Multiple regression analysis was applied to the following factors: inappropriate diet, discontinuation of drug uptake, reduction of exercise, destruction of house, long stay at shelter, sex, age, and pre-earthquake therapy. Among them, inappropriate diet demonstrated the highest partial regression coefficient to raise the mean value of the HbA(1c) level. The increased level of HbA(1c) declined gradually to the pre-earthquake level in September, 1995. This study emphasizes the importance of appropriate diet for diabetic patients during a natural disaster. To fulfil it, medical staff have to educate diabetic patients of their disorders tediously in ordinary time. In addition, it seems quite useful to supply a medical information card and a small medical bag containing essential drugs to each patient.
View
Disasters and the Heart: a Review of the Effects of Earthquake-Induced Stress on Cardiovascular Disease
Article
  • Jun 2003
There is growing evidence that stress contributes to cardiovascular disease. Chronic stress contributes to the atherosclerotic process through increased allostatic load, which is mediated by the neuroendocrine and immune systems (sympathetic nervous system and hypothalamus-pituitary adrenal axis) and related chronic risk factors (insulin resistance syndrome, hypertension, diabetes, and hyperlipidemia). In addition, acute stress can trigger cardiovascular events predominantly through sympathetic nervous activation and potentiation of acute risk factors (blood pressure increase, endothelial cell dysfunction, increased blood viscosity, and platelet and hemostatic activation). Earthquakes provide a good example of naturally occurring acute and chronic stress, and in this review we focus mainly on the effects of the Hanshin-Awaji earthquake on the cardiovascular system. The Hanshin-Awaji earthquake resulted in a 3-fold increase of myocardial infarctions in people living close to the epicenter, particularly in women, with most of the increase occurring in nighttime-onset events. There was also a near doubling in the frequency of strokes. These effects may be mediated by changes in hemostatic factors, as demonstrated by an increase of D-dimer, von Willebrand factor, and tissue-type plasminogen activator (tPA) antigen. Blood pressure also increased after the earthquake, and was prolonged for several weeks in patients with microalbuminuria.
View
Injury and illness surveillance in hospitals and acute-care facilities after hurricanes Katrina and Rita—New Orleans area, Louisiana, September 25-October 15, 2005.
  • Jan 2006
  • 35
  • Lopez