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

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

  • P. Gregg Greenough, MD, MPH

      Affiliations

    • Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA
    • Harvard Humanitarian Initiative, Harvard University, Boston, MA
    • Corresponding Author InformationAddress for reprints: P. Gregg Greenough, MD, MPH, Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, Neville House, Boston, MA 02115; 617-384-5857, fax 617-384-5988
    • ,
  • Michael D. Lappi, DO, PhD

      Affiliations

    • Harvard Humanitarian Initiative, Harvard University, Boston, MA
    • ,
  • Edbert B. Hsu, MD, MPH

      Affiliations

    • Department of Emergency Medicine, Johns Hopkins Medical Institutions, Baltimore, MD
    • Center for Emergency Preparedness and Response, Johns Hopkins University, Baltimore, MD
    • ,
  • Sheri Fink, MD, PhD

      Affiliations

    • Harvard Humanitarian Initiative, Harvard University, Boston, MA
    • ,
  • Yu-Hsiang Hsieh, PhD

      Affiliations

    • Department of Emergency Medicine, Johns Hopkins Medical Institutions, Baltimore, MD
    • Center for Emergency Preparedness and Response, Johns Hopkins University, Baltimore, MD
    • ,
  • Alexander Vu, MD, MPH

      Affiliations

    • Department of Emergency Medicine, Johns Hopkins Medical Institutions, Baltimore, MD
    • Center for Refugee and Disaster Response, Johns Hopkins University, Baltimore, MD.
    • ,
  • Clay Heaton, MPH

      Affiliations

    • Harvard Humanitarian Initiative, Harvard University, Boston, MA
    • ,
  • Thomas D. Kirsch, MD, MPH

      Affiliations

    • Department of Emergency Medicine, Johns Hopkins Medical Institutions, Baltimore, MD
    • Center for Refugee and Disaster Response, Johns Hopkins University, Baltimore, MD.

Received 20 July 2006; received in revised form 7 March 2007; accepted 4 April 2007. published online 22 June 2007.

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.

 

 Supervising editors: Eric K. Noji, MD, MPH; William G. Barsan, MD

 Author contributions: PGG designed the study and developed the sampling frame. PGG, MDL, EBH, SF, and TDK developed the questionnaire. PGG deployed the teams. PGG, MDL, and EBH designed the data analysis. PGG, MDL, EBH, and SF helped write the article. MDL and SF helped coordinate field activity. MDL coordinated data collection. MDL and SF oversaw field management of data. SF trained and coordinated field teams on the questionnaire and sampling frame. Y-HH, AV, and CH conducted cleaning of the data set. Y-HH conducted all statistical analysis and designed graphs, the figure, and tables. AV conducted data entry. CH developed the field database. TDK coordinated Red Cross activity and logistics. PGG takes responsibility for the paper as a whole.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. The American Red Cross provided travel and lodging for study personnel.

 Publication dates: Available online June 20, 2007.

PII: S0196-0644(07)00449-0

doi:10.1016/j.annemergmed.2007.04.004

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

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