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 people with diabetes.

Methods: An observational study in 1795 Adults with an A1c measurement 6 months before and 6 -16 months after Hurricane Katrina in 3 health care systems: private (TUHC), state (MCLNO), and Veterans Affairs (VA). Glycemic control (A1c), blood pressure (BP), 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 pre-disaster 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 BP increased in all 3 systems (130 to 137.6 mm Hg for TUHC and 130.7 to 143.7 for VA p<0.001; 132 to 136 for MCLNO, p=0.008 ). Mean LDL-cholesterol increased in the VA (97.1 to 104.3 mg/dl) and TUHC patients (103.4 to 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 (QALE), with the economic impact being quite substantial because of the large population size impacted. We estimate a lifetime cost of $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.