title: Health of Medicare Advantage plan enrollees at 1 year after Hurricane Katrina.
abstract: OBJECTIVE
  To assess the effects of Hurricane Katrina on mortality, morbidity, disease prevalence, and service utilization during 1 year in a cohort of 20,612 older adults who were living in New Orleans, Louisiana, before the disaster and who were enrolled in a managed care organization (MCO).
  
  
  METHODS
  Observational study comparing mortality, morbidity, and service use for 1 year before and after Hurricane Katrina, augmented by a stratified random sample of 303 enrollees who participated in a telephone survey after Hurricane Katrina.
  
  
  METHODS
  Sources of data for health and service use were MCO claims. Mortality was based on reports to the MCO from the Centers for Medicare & Medicaid Services; morbidity was measured using adjusted clinical groups case-mix methods derived from diagnoses in ambulatory and hospital claims data.
  
  
  RESULTS
  Mortality in the year following Hurricane Katrina was not significantly elevated (4.3% before vs 4.9% after the hurricane). However, overall morbidity increased by 12.6% (P <.001) compared with a 3.4% increase among a national sample of Medicare managed care enrollees. Nonwhite subjects from Orleans Parish experienced a morbidity increase of 15.9% (P <.001). The prevalence of numerous treated medical conditions increased, and emergency department visits and hospitalizations remained significantly elevated during the year.
  
  
  CONCLUSIONS
  The enormous health burden experienced by older individuals and the disruptions in service utilization reveal the long-term effects of Hurricane Katrina on this vulnerable population. Although quick rebuilding of the provider network may have attenuated more severe health outcomes for this managed care population, new policies must be introduced to deal with the health consequences of a major disaster.
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA. lburton@jhsph.edu
authors.forename: Lynda C
authors.initials: LC
authors.lastname: Burton
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Skinner
authors.forename: Lori
authors.initials: L
authors.lastname: Uscher-Pines
authors.forename: Richard
authors.initials: R
authors.lastname: Lieberman
authors.forename: Bruce
authors.initials: B
authors.lastname: Leff
authors.forename: Rebecca
authors.initials: R
authors.lastname: Clark
authors.forename: Qilu
authors.initials: Q
authors.lastname: Yu
authors.forename: Klaus W
authors.initials: KW
authors.lastname: Lemke
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Weiner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D055867:Cyclonic Storms; D004190:Disasters / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D020398:Medicare Part C / Q000706:statistics & numerical data*; D055820:New Orleans / Q000453:epidemiology; D014481:United States / Q000453:epidemiology