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

Abstract

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. Disasters can pose severe immediate challenges to individuals with diabetes, including disrupted access to health care providers, difficulty in obtaining proper nutrition, damaged or lost medications, and challenges in monitoring glucose levels (1). However, the longer-term effects of disasters are less understood. Generally, less attention is paid to effects from disasters as time passes. Further, it is difficult to associate outcomes with disasters significantly later due to challenges in obtaining complete longitudinal data and the occurrence of confounding events. However, there may be significant long-term effects of disasters on those with diabetes. Some individuals may not recover from the initial impact due to the trauma.

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“…These long-term effects include changes in health behaviors, excess hospitalizations, and in some cases, mortality. 1,2 Other studies have examined the impact of diabetes-related hospital admissions after Hurricanes Katrina (2005) and Rita (2005), 3 hypertension among US veterans, 4 and of course, Hurricane Maria (2017) related mortality. 5 Prior studies limited to examining a single disaster suggest that exposure to hurricanes may affect the health of older adults.…”

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“… [7] Even though of different magnitude, suspension of healthcare services is well studied in post-disaster recovery phases: Katrina and Rita hurricanes raised crude mortality rate of 40% in the month following the disaster, and this increment remained after a year (12%) and even after ten years (5.6%). [8] …”

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“…379 Seniors with diabetes who lived in a county highly impacted by Hurricanes Katrina and Rita (N = 170,138), compared to those who did not (N = 170,138), had a nearly 40% higher all-cause mortality risk in the one month following the disasters, which diminished over the subsequent nine years, but was maintained at 5.6% at nine years. 397 > Nephritis-related death was 27% greater at one year post-Katrina in survivors. 397 > Immune system dysregulation can result, leading to increased secondary viral and other infectious disease susceptibility and poorer oral health.…”