Impact of a Natural Disaster on Diabetes
Exacerbation of disparities and long-term consequences
Article Figures & Tables
Figures
- Figure 1
Model of relationship between change in A1C and time in patients in three different health systems in New Orleans, before and after Hurricane Katrina.
- Figure 2
Model of relationship between change in systolic blood pressure (SBP) and time in patients in three different health systems in New Orleans, before and after Hurricane Katrina.
- Figure 3
Model of relationship between change in diastolic blood pressure (DBP) and time in patients in three different health systems in New Orleans, before and after Hurricane Katrina.
Tables
- Table 1
Characteristics of the study population
Total TUHC/private VA MCLNO/public P n 1,795 452 748 595 Age (years) 61.9 ± 11.6 58.6 ± 13.5 66.4 ± 10.5 58.7 ± 9.2 <0.0001 Sex (male) 61.2 44.9 96.9 28.7 <0.0001 Race Caucasian 39.3 44.9 55.1 15.1 <0.0001 African American 56.9 51.3 40.2 82 <0.0001 Other 3.8 3.8 4.7 2.9 <0.0001 -
Data are means ± SD or %.
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- Table 2
Clinical and laboratory parameters among diabetic patients in three health care systems before and after Hurricane Katrina (28 February 2005–27 August 2005 and 1 March 2006–31 December 2006)
n Pre-Katrina mean value Post-Katrina mean value Difference in mean value Patients with increased values* Patients with decreased values† Patients had no changes‡ P for change in mean value A1C (%) TUHC 452 7.5 ± 1.6 7.4 ± 1.8 −0.1 ± 1.4 107 (23.67) 181 (40.04) 164 (36.28) 0.108 VA 748 7.3 ± 1.6 7.4 ± 1.6 0.1 ± 1.4 275 (36.76) 209 (27.94) 264 (35.29) 0.193 MCLNO 584 7.7 ± 1.9 8.1 ± 2.1 0.3 ± 1.8 279 (46.97) 149 (25.08) 166 (27.95) <0.01 Total 1,794 7.5 ± 1.7 7.6 ± 1.9 0.1 ± 1.6 661 (36.85) 539 (30.04) 594 (33.11) <0.01 Systolic blood pressure (mmHg) TUHC 262 130.0 ± 17.7 137.5 ± 21.6 7.5 ± 20.8 145 (55.34) 76 (29.01) 41 (15.65) <0.01 VA 723 130.7 ± 16.6 143.7 ± 18.6 13.0 ± 20.5 505 (69.85) 158 (21.85) 60 (8.30) <0.01 MCLNO 142 132.2 ± 17.7 136.0 ± 19.2 3.8 ± 17.1 84 (59.15) 41 (28.87) 17 (11.97) <0.01 Total 1,127 130.7 ± 17.0 141.2 ± 20.0 10.5 ± 20.4 734 (65.13) 275 (24.40) 118 (10.47) <0.01 Diastolic blood pressure (mmHg) TUHC 262 74.9 ± 11.0 76.3 ± 12.8 1.4 ± 13.7 115 (43.89) 91 (34.73) 56 (21.37) 0.093 VA 723 68.8 ± 12.0 74.2 ± 12.0 5.4 ± 12.8 418 (57.81) 183 (25.31) 122 (16.87) <0.01 MCLNO 142 75.0 ± 10.7 75.5 ± 11.8 0.5 ± 11.6 61 (42.96) 52 (36.62) 29 (20.42) 0.597 Total 1,127 71.0 ± 12.0 74.9 ± 12.2 3.9 ± 13.1 594 (52.71) 326 (28.93) 207 (18.37) <0.01 LDL cholesterol (mg/dl) TUHC 221 103.4 ± 32.6 115.5 ± 39.1 12.1 ± 34.6 141 (63.80) 45 (20.36) 35 (15.84) <0.01 VA 607 97.1 ± 31.9 104.3 ± 36.2 7.2 ± 32.7 317 (52.22) 194 (31.96) 96 (15.82) <0.01 MCLNO 343 107.9 ± 40.2 107.7 ± 41.4 −0.2 ± 39.6 155 (45.19) 142 (41.4) 46 (13.41) 0.948 Total 1,171 101.4 ± 35.0 107.4 ± 38.5 6.0 ± 35.5 613 (52.35) 381 (32.54) 177 (15.12) <0.01 HDL cholesterol (mg/dl) TUHC 228 40.4 ± 13.6 43.5 ± 14.2 3.1 ± 9.5 120 (52.63) 45 (19.74) 63 (27.63) <0.01 VA 543 42.1 ± 10.5 38.0 ± 11.9 −4.1 ± 8.6 91 (16.76) 338 (62.25) 114 (20.99) <0.01 MCLNO 343 47.6 ± 13.6 44.2 ± 14.0 −3.4 ± 8.4 68 (19.83) 190 (55.39) 85 (24.78) <0.01 Total 1,114 43.5 ± 12.5 41.0 ± 13.4 −2.4 ± 9.2 279 (25.04) 573 (51.44) 262 (23.52) <0.01 Triglycerides (mg/dl) TUHC 233 153.2 ± 99.6 158.2 ± 118.0 5.1 ± 111.7 98 (42.06) 101 (43.35) 34 (14.59) 0.491 VA 543 172.8 ± 134.9 161.4 ± 108.2 −11.4 ± 119.9 206 (37.94) 247 (45.49) 90 (16.57) 0.027 MCLNO 344 147.1 ± 104.5 154.6 ± 203.2 7.5 ± 173.9 130 (37.79) 154 (44.77) 60 (17.44) 0.422 Total 1,120 160.8 ± 119.8 158.7 ± 145.7 −2.1 ± 137.5 434 (38.75) 502 (44.82) 184 (16.43) 0.601 -
Data are means ± SD or n (%).
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↵*A1C changes >+0.3, systolic blood pressure changes >+3, diastolic blood pressure changes >+3, LDL cholesterol changes >+5, and HDL cholesterol changes >+3, triglyceride changes >+10.
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↵†A1C changes <−0.3, systolic blood pressure changes <−3, diastolic blood pressure changes <−3, LDL cholesterol changes <−5, and HDL cholesterol changes <−3, triglyceride changes < −10.
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↵‡A1C changes within ±0.3, systolic blood pressure changes within ±3, diastolic blood pressure changes within ±3, LDL cholesterol changes within ±5, and HDL cholesterol changes within ±3, triglyceride changes within ±10.
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- Table 3
CDM estimates of changes in life expectancy and health care costs per patient related to Hurricane Katrina
Effect SD P Extrapolated cost (US$)*† −10% variation (US$) +10% variation (US$) MCLNO (20%) Life expectancy (year) −0.301 0.552 <0.0001 QALE −0.242 0.431 <0.0001 Direct cost 3,502 6,391 <0.0001 62,160,699 55,944,629 68,376,769 Indirect cost 1,741 3,250 <0.0001 30,902,849 27,812,564 33,993,134 Total cost 5,243 8,664 <0.0001 93,063,548 83,757,193 102,369,903 TUHC (75%) Life expectancy (year) −0.078 0.455 <0.0001 QALE −0.07 0.354 <0.0001 Direct cost 1,840 5,354 <0.0001 122,475,392 110,227,853 134,722,931 Indirect cost 430 2,682 <0.0001 28,621,967 25,759,770 31,484,163 Total cost 2,270 6,927 <0.0001 151,097,359 135,987,623 166,207,094 VA (5%) Life expectancy (year) −0.264 0.483 <0.0001 QALE −1.208 0.371 <0.0001 Direct cost 2,683 5,423 <0.0001 178,587,759 160,728,983 196,446,535 Indirect cost 1,224 2,850 <0.0001 81,472,761 73,325,485 89,620,037 Total cost 3,907 7,201 <0.0001 260,060,520 234,054,468 286,066,572 Population cost 504,221,426 453,799,283 554,643,569 -
↵*Adult population (age ≥18 years): 964,677, estimated for greater New Orleans of seven parishes affected by Hurricane Katrina (Orleans Parish, Jefferson Parish, St. Bernard Parish, St. Tammany Parish, Plaquemines Parish, St. Charles Parish, and St. John the Baptist Parish), Louisiana. Source: http://censtats.census.gov/data/LA.
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↵†Prevalence of diabetes in 2006 (Louisiana): 9.2%. Source: http://apps.nccd.cdc.gov/brfss/page.asp?cat=DB&yr=2007&state=LA#DB.
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