Acute post-disaster medical needs of patients with diabetes: emergency department use in New York City by diabetic adults after Hurricane Sandy

Abstract

ObjectiveTo evaluate the acute impact of disasters on diabetic patients, we performed a geospatial analysis of emergency department (ED) use by New York City diabetic adults in the week after Hurricane Sandy.Research design and methodsUsing an all-payer claims database, we retrospectively analyzed the demographics, insurance status, and medical comorbidities of post-disaster ED patients with diabetes who lived in the most geographically vulnerable areas. We compared the patterns of ED use among diabetic adults in the first week after Hurricane Sandy's landfall to utilization before the disaster in 2012.ResultsIn the highest level evacuation zone in New York City, postdisaster increases in ED visits for a primary or secondary diagnosis of diabetes were attributable to a significantly higher proportion of Medicare patients. Emergency visits for a primary diagnosis of diabetes had an increased frequency of certain comorbidities, including hypertension, recent procedure, and chronic skin ulcers. Patients with a history of diabetes visited EDs in increased numbers after Hurricane Sandy for a primary diagnosis of myocardial infarction, prescription refills, drug dependence, dialysis, among other conditions.ConclusionsWe found that diabetic adults aged 65 years and older are especially at risk for requiring postdisaster emergency care compared to other vulnerable populations. Our findings also suggest that there is a need to support diabetic adults particularly in the week after a disaster by ensuring access to medications, aftercare for patients who had a recent procedure, and optimize their cardiovascular health to reduce the risk of heart attacks.

Primary care in disasters: opportunity to address a hidden burden of health care

“…Emerging evidence from academic literature and experience from the field show a consistent pattern of primary health care needs presenting in disasters . This major burden of care is yet to be incorporated into disaster management systems.…”

“…There is now a growing body of epidemiological research on the health consequences of disasters relevant to primary health care which will be encountered in the response and recovery phases, with management of chronic disease being the major burden . Many similar health effects are described, regardless of whether the hazard is flood, earthquake, storm or bushfire.…”

“…Despite the evidence, guidelines for GPs over the response and recovery periods are very limited both in Australia and internationally. This evidence suggests increases in the prevalence and incidence of disease, the deterioration of pre‐existing conditions, and new emergent diagnoses in association with disasters.…”

“…Alongside acute injury, early effects reported include respiratory effects from dust or smoke and dermatological effects from sunburn and animal or insect bites. Significant increases in acute exacerbations of chronic diseases can overwhelm medical facilities, as patients present with diabetes, hypertension, chronic bronchitis, mental health conditions, prescription refills, and drug dependence …”

The Interaction Effects of Meteorological Factors and Air Pollution on the Development of Acute Coronary Syndrome

“…For example, one study showed that 2 weeks following Hurricane Sandy, there was a marked increase in the incidence of myocardial infarction14. Furthermore, another study on Hurricane Sandy also demonstrated that diabetic adults aged 65 years and older were especially at risk for developing acute myocardial infarction the week after that extreme weather event48. The development of ACS in the above-mentioned studies was attributed to the psychological stress of the event and corresponding physiologic derangements49.…”