title: To evacuate or shelter in place: implications of universal hurricane evacuation policies on nursing home residents.
abstract: OBJECTIVE
  To examine the differential morbidity/mortality associated with evacuation versus sheltering in place for nursing home (NH) residents exposed to the 4 most recent Gulf hurricanes.
  
  
  METHODS
  Observational study using Medicare claims and NH data sources. We compared the differential mortality/morbidity for long-stay residents exposed to 4 recent hurricanes (Katrina, Rita, Gustav, and Ike) relative to those residing at the same NHs over the same time periods during the prior 2 nonhurricane years as a control. Using an instrumental variable analysis, we then evaluated the independent effect of evacuation on outcomes at 90 days.
  
  
  RESULTS
  Among 36,389 NH residents exposed to a storm, the 30- and 90-day mortality/hospitalization rates increased compared with nonhurricane control years. There were a cumulative total of 277 extra deaths and 872 extra hospitalizations at 30 days. At 90 days, 579 extra deaths and 544 extra hospitalizations were observed. Using the instrumental variable analysis, evacuation increased the probability of death at 90 days from 2.7% to 5.3% and hospitalization by 1.8% to 8.3%, independent of other factors.
  
  
  CONCLUSIONS
  Among residents exposed to hurricanes, evacuation significantly exacerbated subsequent morbidity/mortality.
authors: Division of Primary Care, Providence VA Medical Center, Providence, RI, USA. david_dosa@brown.edu
authors: David
authors: D
authors: Dosa
authors: Kathryn
authors: K
authors: Hyer
authors: Kali
authors: K
authors: Thomas
authors: Shailender
authors: S
authors: Swaminathan
authors: Zhanlian
authors: Z
authors: Feng
authors: Lisa
authors: L
authors: Brown
authors: Vincent
authors: V
authors: Mor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055867:Cyclonic Storms / Q000401:mortality*; D004189:Disaster Planning / Q000458:organization & administration; D004190:Disasters; D060447:Emergency Shelter / Q000458:organization & administration*; D005260:Female; D006707:Homes for the Aged / Q000458:organization & administration*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D009735:Nursing Homes / Q000458:organization & administration*; D011050:Policy Making; D012016:Reference Values; D018635:Rescue Work / Q000458:organization & administration*; D014187:Transportation of Patients / Q000458:organization & administration; D014481:United States