2009 Southern Regional Meeting Abstracts

Purpose of Study: In August 2005, New Orleans was hit by Hurricane Katrina, the biggest natural disaster in the United States. 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 Used: This was a single center retrospective cohort observational study. Patients admitted with AMI to Tulane University Hospital, in the two years before Katrina and in the two years after the hospital reopened (5 months after Katrina) were identified from hospital records. The two groups (pre- and post- Katrina) were compared for pre-specified demographic and clinical data.
Summary of 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 to 150 AMI admissions out of a total 21,229 patients (0.71%) in the pre-Katrina group (p<0.0001). The post-Katrina group had 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 (p<0.0001), and people living in temporary housing (p=0.003). There was no significant difference in the racial distribution in the two groups.
Conclusions: The role of chronic stress in pathogenesis of AMI is poorly understood, especially in the aftermath of natural disasters. Our data suggests that Katrina led to 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 foster tobacco abuse and medication and therapeutic noncompliance.
We found a three-fold increased incidence of AMI more than two years after Hurricane Katrina. Even allowing for the loss of some local hospitals after the disaster, this represents a significant change in overall population health, and supports the need for further study into the health effects of chronic stress.