Researchers studying the short- and long-term effects of hurricanes Katrina and Rita found that older individuals with diabetes who lived in areas impacted by the storms had a 40% higher risk of mortality in the month following the storms compared to elderly diabetics who lived in unaffected counties, according to a report in Diabetes Care.
“The initial effects of the storms on mortality appear to persist as much as a decade later, although they did dissipate over time,” said study leader Troy Quast, an associate professor of health economics at the University of South Florida College of Public Health in Tampa.
Quast suspects the increased early mortality is related to patients’ difficulties in trying to find health care, keep up with their medications and monitor glucose levels in the aftermath of a major storm. When patients can’t keep their blood sugar under control, complications can ensue, Quast said.
Policy makers tend to focus on the immediate aftermath of the destructive storms, Quast said. “But the effects of these disasters can persist for years,” he added. “There needs to be an appropriate public health response.”
In that vein, “Florida has a program where if an emergency is declared patients can go the pharmacy and get advance refills,” Quast said. The state also has a registry for “individuals who have severe medical needs.”
To take a closer look at how disasters might affect the lives of those with chronic conditions, Quast and his colleagues pored over 10 years of Medicare enrollment and claims data from four states: Louisiana, Mississippi, Texas and Alabama. They used Federal Emergency Management Agency (FEMA) data to categorize counties as affected or not by the hurricanes and the National Death index to keep track of who died since the beginning of the study period.
The researchers focused on 340,656 people aged 65-99 with type 1 or type 2 diabetes who were covered by Medicare between 2004 and 2014. Half lived in affected counties and half in counties that were unaffected.
When the researchers compared the two groups, they found a heightened rate of death among those who lived in affected counties. The risk was highest in the first month after the hurricanes; during that first month, people in the affected counties were 39% more likely to die compared to those in unaffected counties.
By the end of the first year, the risk had dropped somewhat, with those from affected counties about 13% more likely to have died in that period compared to those from unaffected counties. By the end of 10 years, the risk had dropped considerably, but was still there, with patients from affected counties still 10% more likely to have died compared to those from unaffected counties.
The new study shines a light on something that “maybe should be obvious, but isn’t,” said Dr. Erin Kershaw, chief of endocrinology at UPMC in Pittsburgh. “We don’t necessarily think about the long-term impact of disasters on people with chronic diseases.”
People with diabetes “have to control their blood sugar 24/7,” Kershaw said. “The problem isn’t just with patients’ ability to access doctors and medicines, disasters like this completely devastate social connections and the infrastructure that allows us to take care of our health.”
The findings weren’t a surprise to Dr. Lauren Sauer, an assistant professor of emergency medicine at the Johns Hopkins University School of Medicine and director of operations for the Johns Hopkins Office of Critical Event Preparedness and Response.
“I know, anecdotally, that vulnerable populations are more disproportionately impacted in these disasters and people with chronic conditions fall into that category,” Sauer said. “What did surprise me was how high their numbers were, especially knowing that this is probably an underestimation.”
SOURCE: bit.ly/2kTlKlB Diabetes Care, online September 23, 2019.
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