title: Acute post-disaster medical needs of patients with diabetes: emergency department use in New York City by diabetic adults after Hurricane Sandy.
abstract: OBJECTIVE
  To evaluate the acute impact of disasters on diabetic patients, we performed a geospatial analysis of emergency department (ED) use by New York City diabetic adults in the week after Hurricane Sandy.
  
  
  METHODS
  Using an all-payer claims database, we retrospectively analyzed the demographics, insurance status, and medical comorbidities of post-disaster ED patients with diabetes who lived in the most geographically vulnerable areas. We compared the patterns of ED use among diabetic adults in the first week after Hurricane Sandy's landfall to utilization before the disaster in 2012.
  
  
  RESULTS
  In the highest level evacuation zone in New York City, postdisaster increases in ED visits for a primary or secondary diagnosis of diabetes were attributable to a significantly higher proportion of Medicare patients. Emergency visits for a primary diagnosis of diabetes had an increased frequency of certain comorbidities, including hypertension, recent procedure, and chronic skin ulcers. Patients with a history of diabetes visited EDs in increased numbers after Hurricane Sandy for a primary diagnosis of myocardial infarction, prescription refills, drug dependence, dialysis, among other conditions.
  
  
  CONCLUSIONS
  We found that diabetic adults aged 65 years and older are especially at risk for requiring postdisaster emergency care compared to other vulnerable populations. Our findings also suggest that there is a need to support diabetic adults particularly in the week after a disaster by ensuring access to medications, aftercare for patients who had a recent procedure, and optimize their cardiovascular health to reduce the risk of heart attacks.
authors.affiliation: Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York, USA; Department of Population Health, New York University School of Medicine, New York, New York, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Lee
authors.affiliation: Ronald O. Perelman Department of Emergency Medicine , New York University School of Medicine , New York, New York , USA.
authors.forename: Vibha K
authors.initials: VK
authors.lastname: Gupta
authors.affiliation: Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA; Department of Health & Human Services, Emergency Care Coordination Center, Office of the Assistant Secretary for Preparedness & Response, Washington, DC, USA.
authors.forename: Brendan G
authors.initials: BG
authors.lastname: Carr
authors.affiliation: Ronald O. Perelman Department of Emergency Medicine , New York University School of Medicine , New York, New York , USA.
authors.forename: Sidrah
authors.initials: S
authors.lastname: Malik
authors.affiliation: Ronald O. Perelman Department of Emergency Medicine , New York University School of Medicine , New York, New York , USA.
authors.forename: Brandy
authors.initials: B
authors.lastname: Ferguson
authors.affiliation: Ronald O. Perelman Department of Emergency Medicine , New York University School of Medicine , New York, New York , USA.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Wall
authors.affiliation: Ronald O. Perelman Department of Emergency Medicine , New York University School of Medicine , New York, New York , USA.
authors.forename: Silas W
authors.initials: SW
authors.lastname: Smith
authors.affiliation: Ronald O. Perelman Department of Emergency Medicine , New York University School of Medicine , New York, New York , USA.
authors.forename: Lewis R
authors.initials: LR
authors.lastname: Goldfrank
keywords: Emergency Medicine; Population Health; Public Health/Surveillance