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

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          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 dialysis- and 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)

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          Most cited references30

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          Mental health effects of Hurricane Sandy: characteristics, potential aftermath, and response.

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            Lessons from Sandy--preparing health systems for future disasters.

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              Burden of disease and health status among Hurricane Katrina-displaced persons in shelters: a population-based cluster sample.

              Anecdotal evidence suggests that the population displaced to shelters from Hurricane Katrina had a significant burden of disease, socioeconomic vulnerability, and marginalized health care access. For agencies charged with providing health care to at-risk displaced populations, knowing the prevalence of acute and chronic disease is critical to direct resources and prevent morbidity and mortality. We performed a 2-stage 18-cluster sample survey of 499 evacuees residing in American Red Cross shelters in Louisiana 2 weeks after landfall of Hurricane Katrina. In stage 1, shelters with a population of more than 100 individuals were randomly selected, with probability proportional to size sampling. In stage 2, 30 adult heads of household were randomly chosen within shelters by using a shelter log or a map of the shelter where no log existed. Survey questions focused on demographics, socioeconomic indicators, acute and chronic burden of disease, and health care access. Two thirds of the sampled population was single, widowed, or divorced; the majority was female (57.6%) and black (76.4%). Socioeconomic indicators of under- and unemployment (52.9%), dependency on benefits or assistance (38.5%), lack of home ownership (66.2%), and lack of health insurance (47.0%) suggested vulnerability. One third lacked a health provider. Among those who arrived at shelters with a chronic disease (55.6%), 48.4% lacked medication. Hypertension, hypercholesterolemia, diabetes, pulmonary disease, and psychiatric illness were the most common chronic conditions. Risk factors for lacking medications included male sex (odds ratio [OR] 1.58; 95% confidence interval [CI] 0.96 to 2.59) and lacking health insurance (OR 2.25; 95% CI 1.21 to 4.20). More than one third (34.5%) arrived at the shelter with symptoms warranting immediate medical intervention, including dehydration (12.0%), dyspnea (11.5%), injury (9.4%), and chest pain (9.7%). Risk factors associated with presenting to shelters with acute symptoms included concurrent chronic disease with medication (OR 2.60; 95% CI 1.98 to 3.43), concurrent disease and lacking medication (OR 2.22; 95% CI 1.36 to 3.63), and lacking health insurance (OR 1.83; 95% CI 1.10 to 3.02). A population-based understanding of vulnerability, health access, and chronic and acute disease among the displaced will guide disaster health providers in preparation and response.
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                Author and article information

                Journal
                Disaster Med Public Health Prep
                Disaster Med Public Health Prep
                DMP
                Disaster Medicine and Public Health Preparedness
                Cambridge University Press (New York, USA )
                1935-7893
                1938-744X
                09 February 2016
                June 2016
                : 10
                : 3 , Superstorm Sandy
                : 351-361
                Affiliations
                [1 ] Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine , New York, New York
                [2 ] Department of Population Health, New York University School of Medicine , New York, New York
                [3 ] Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University , Philadelphia, Pennsylvania
                [4 ]Emergency Care Coordination Center, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC.
                Author notes
                Correspondence and reprint requests to David C. Lee, MD, MS, 462 First Avenue, Room A345, New York, NY 10016 (e-mail: david.lee@ 123456nyumc.org ).
                Article
                S1935789315001901 00190
                10.1017/dmp.2015.190
                7112993
                26857616
                e1206253-4891-4cb2-ae2f-e09155187050
                © Society for Disaster Medicine and Public Health, Inc. 2016

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means subject to acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                Page count
                Figures: 4, Tables: 1, Pages: 11
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                Categories
                Original Research

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