title: Burden of disease and health status among Hurricane Katrina-displaced persons in shelters: a population-based cluster sample.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA. ggreenou@hsph.harvard.edu
authors.forename: P Gregg
authors.initials: PG
authors.lastname: Greenough
authors.forename: Michael D
authors.initials: MD
authors.lastname: Lappi
authors.forename: Edbert B
authors.initials: EB
authors.lastname: Hsu
authors.forename: Sheri
authors.initials: S
authors.lastname: Fink
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Hsieh
authors.forename: Alexander
authors.initials: A
authors.lastname: Vu
authors.forename: Clay
authors.initials: C
authors.lastname: Heaton
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Kirsch
mesh_terms: D000328:Adult; D016000:Cluster Analysis; D004190:Disasters; D005260:Female; D006297:Health Services Accessibility; D006304:Health Status; D006798:Housing; D006801:Humans; D016015:Logistic Models; D008145:Louisiana / Q000453:epidemiology; D008297:Male; D012307:Risk Factors; D012959:Socioeconomic Factors