Effect of Hurricane Katrina on the incidence of acute coronary syndrome at a primary angioplasty center in New Orleans.
BACKGROUND
In August 2005, New Orleans was hit by Hurricane Katrina, the costliest natural disaster in US history. Previous studies have shown an increase in acute myocardial infarction (AMI) in the immediate hours to weeks after natural disasters. The goals of our study were to detect any long-term increase in the incidence of AMI after Katrina and to investigate any pertinent contributing factors.


METHODS
This was a single-center retrospective cohort observational study. Patients admitted with AMI to Tulane Health Sciences Center hospital in the 2 years before Katrina and in the 2 years after the hospital reopened (5 months after Katrina) were identified from hospital records. The 2 groups (pre- and post-Katrina) were compared for prespecified demographic and clinical data.


RESULTS
In the post-Katrina group, there were 246 admissions for AMI, out of a total census of 11,282 patients (2.18%), as compared with 150 AMI admissions out of a total of 21,229 patients (0.71%) in the pre-Katrina group (P < 0.0001). The post-Katrina group had a significantly higher prevalence of unemployment (P = 0.0003), lack of medical insurance (P < 0.0001), medication noncompliance (P = 0.0001), smoking (P = 0.001), substance abuse (P = 0.03), first-time hospitalization (P < 0.001), local residents rather than visitors affected (P < 0.0001), and people living in temporary housing (P = 0.003).


CONCLUSIONS
The role of chronic stress in the pathogenesis of AMI is poorly understood, especially in the aftermath of natural disasters. Our data suggest that Katrina was associated with prolonged loss of employment and insurance, decreased access to preventive health services, and an increased incidence of AMI. In addition, it appears that chronic stress after a natural disaster can be associated with tobacco abuse and medication and therapeutic noncompliance.


CONCLUSIONS
We found a 3-fold increased incidence of AMI more than 2 years after Hurricane Katrina. Even allowing for the loss of some local hospitals after the disaster, this represents a significant change in overall health of the study population and supports the need for further study into the health effects of chronic stress.
Gautam
Sandeep
S
Tulane University School of Medicine, New Orleans, LA 70112, USA. sgautam@tulane.edu
Menachem
Jonathan
J
Srivastav
Sudesh K
SK
Delafontaine
Patrice
P
Irimpen
Anand
A
D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000523:psychology*; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D055867:Cyclonic Storms; D004190:Disasters; D005260:Female; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000523:psychology*; D055820:New Orleans; D011594:Psychometrics; D012189:Retrospective Studies; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications* / Q000453:epidemiology; D011795:Surveys and Questionnaires