Disaster-related injuries in the period of recovery: the effect of prolonged displacement on risk of injury in older adults.
BACKGROUND
Hurricane Katrina, which struck the Gulf Coast of the United States in August 2005, initially displaced over a million people from their primary place of residence. Displaced older adults subsequently faced challenges, such as new or inferior living conditions, which could increase vulnerability to serious or life-threatening injuries such as hip fracture. The aim of this study was to determine whether Katrina victims who were displaced for a prolonged period of time were more likely to experience injuries than nondisplaced victims.


METHODS
We tracked injury outcomes including fractures, sprains or strains, and lacerations in a cohort of 25,019 older adults (age >or= 65 years) enrolled in a Medicare-Advantage Plan, for 1 year after Katrina. We used medical claims to obtain injury outcomes and analyzed propensity-score adjusted predictors of injury, including displacement status at 12 months.


RESULTS
In our sample, 7,030 (28%) older adults were displaced at 12-month post-Katrina. Displaced victims had 1.53 (95% CI: 1.10-2.13) greater odds of sustaining a hip fracture in the year after the storm and 1.24 (95% CI: 1.07-1.44) greater odds of sustaining other fractures after adjusting for other risk factors. There was no significant association between displacement status at 12 months and sprains or strains or lacerations.


CONCLUSIONS
Prolonged displacement is associated with increased risk of fracture in older adults. Emergency planners should screen temporary housing for injury hazards, and clinicians should regard displaced older adults as a vulnerable population in need of interventions such as risk communication messaging.
Uscher-Pines
Lori
L
Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. luscher@jhsph.edu
Vernick
Jon S
JS
Curriero
Frank
F
Lieberman
Richard
R
Burke
Thomas A
TA
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D055867:Cyclonic Storms / Q000706:statistics & numerical data*; D004190:Disasters / Q000706:statistics & numerical data*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology; D006302:Health Services Research; D006620:Hip Fractures / Q000453:epidemiology; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D022125:Lacerations / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D055820:New Orleans / Q000453:epidemiology; D018570:Risk Assessment; D015144:Southeastern United States / Q000453:epidemiology; D013180:Sprains and Strains / Q000453:epidemiology; D013997:Time Factors; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000453:epidemiology*