Displacement following Disaster and Incidence of Injury: A Study of the Older Adult Victims of Hurricane Katrina

Background: Hurricane Katrina, which struck the Gulf Coast in August 2005, initially displaced over a million people. Relocated older adults subsequently faced challenges such as new living conditions which could increase vulnerability to life-threatening injuries such as hip fracture. Aim: To describe the change in incidence of hip fracture in displaced and non-displaced older adult victims of Hurricane Katrina. Methods: We tracked a cohort of 31,069 65+ adults enrolled in People's Health, a Medicare-Advantage Plan, one year pre- and post-Katrina. At 6 months post-Katrina, the cohort was stratified into two groups: non-displaced (remaining within home parish) and displaced. We used medical claims to obtain injury incidence and plan to use Johns Hopkins ACG case-mix system to adjust for pre-Katrina morbidity status. We report preliminary results of incidence rates pre-and post-Katrina by displacement status. Results: 23,997 (77%) older adults were not displaced, 1215 (4%) were displaced within the New Orleans metropolitan area, and 5857 (19%) were displaced out-of-area. Incidence of hip fracture increased for both groups. However, the increase was only significant in the displaced group, where incidence increased from 5.1/1,000 population pre-Katrina to 7.9 post-Katrina (rate ratio of 1.6, 95% CI 1.7-4.4). Conclusions: Post-disaster displacement is associated with increased risk of hip fracture in older adults. This finding is concerning because as many as 30% of older adults who fracture the hip die within one year. Emergency planners should expand their understanding of disaster effects beyond the immediate impact phase and intervene to prevent delayed injury in displaced older populations.