Geographic Distribution of Disaster-Specific Emergency Department Use After Hurricane Sandy in New York City

Abstract

Objective: We aimed to characterize the geographic distribution of post-Hurricane Sandy emergency department use in administrative flood evacuation zones of New York City. Methods: Using emergency claims data, we identified significant deviations in emergency department use after Hurricane Sandy. Using time-series analysis, we analyzed the frequency of visits for specific conditions and comorbidities to identify medically vulnerable populations who developed acute postdisaster medical needs. Results: We found statistically significant decreases in overall post-Sandy emergency department use in New York City but increased utilization in the most vulnerable evacuation zone. In addition to dialysisand ventilator-dependent patients, we identified that patients who were elderly or homeless or who had diabetes, dementia, cardiac conditions, limitations in mobility, or drug dependence were more likely to visit emergency departments after Hurricane Sandy. Furthermore, patients were more likely to develop drug-resistant infections, require isolation, and present for hypothermia, environmental exposures, or administrative reasons. Conclusions: Our study identified high-risk populations who developed acute medical and social needs in specific geographic areas after Hurricane Sandy. Our findings can inform coherent and targeted responses to disasters. Early identification of medically vulnerable populations can help to map "hot spots" requiring additional medical and social attention and prioritize resources for areas most impacted by disasters. (Disaster Med Public Health Preparedness. 2016;10:351-361)

Emergency Department Visits for Homelessness or Inadequate Housing in New York City before and after Hurricane Sandy

“…3 More surprisingly, however, we also found a statistically significant posthurricane increase in ED visits with a primary or secondary diagnosis code of homelessness. 3 Indeed, homelessness emerged above most medical conditions as having one of the strongest and most persistent increases in ED diagnoses comparing the weeks pre-and post-Sandy's landfall. 3 It is well known that natural disasters can cause people to lose their homes, leading to increases in homelessness.…”

“…3 We found a number of primary medical diagnoses driving this increased ED use, such as renal conditions including dialysis dependence, respiratory conditions including chronic obstructive pulmonary disease and ventilator dependence, and diabetes. 3 More surprisingly, however, we also found a statistically significant posthurricane increase in ED visits with a primary or secondary diagnosis code of homelessness. 3 Indeed, homelessness emerged above most medical conditions as having one of the strongest and most persistent increases in ED diagnoses comparing the weeks pre-and post-Sandy's landfall.…”

“…3 To further identify the geographic changes in the distribution of ED patients with homelessness or inadequate housing diagnoses, we compared the increases in ED utilization with a primary or secondary diagnosis code of homelessness or inadequate housing to a geographic shapefile of post-Hurricane Sandy flood areas mapped by FEMA. These areas were available from the Hurricane Sandy Impact Analysis performed by the FEMA Modeling Task Force.…”

“…3 Indeed, homelessness emerged above most medical conditions as having one of the strongest and most persistent increases in ED diagnoses comparing the weeks pre-and post-Sandy's landfall. 3 It is well known that natural disasters can cause people to lose their homes, leading to increases in homelessness. Thousands of people became newly homeless after Hurricane Sandy, and advocacy groups estimated that 22,000 households remained displaced 1 year later.…”

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

“…study, screening for conditions that demonstrated increased postdisaster use of emergency care, we found that there was also a statistically significant increase in the number of New York City emergency department (ED) patients presenting with a primary or secondary diagnosis of diabetes even in the first week after Hurricane Sandy. 9 These findings require additional investigation as to which characteristics make certain diabetic patients at higher risk for needing acute medical care after a disaster. The goal of this study was to identify salient patient characteristics that increase the likelihood that a diabetic patient will develop acute medical needs after a disaster such as Hurricane Sandy.…”