Adverse health outcomes after Hurricane Katrina among children and adolescents with chronic conditions

Children and teenagers in New Orleans with chronic medical conditions at the time of Hurricane Katrina were more likely than other children to have worsening of physical and psychological symptoms, develop new symptoms, miss doctor appointments and run out of medications in the wake of the disaster.

Barbara Rath, M.D., in her affiliation with the Tulane University Health Sciences Center, and colleagues assessed medical and psychological characteristics in 531 children, including 209 children with preexisting chronic medical conditions like asthma, diabetes and allergies.

Whether the worse outcomes in the chronically ill children were more the result of hurricane aftereffects — such as mold and flooding — or disruptions in medical care is not entirely clear.

“If you ask me as a pediatrician to single out specific causes, I would have to look at such outcomes one by one,” said Rath, who is currently with the University Children's Hospital Basel in Switzerland. “For example, missed asthma medications may trigger asthma attacks as much as an increased exposure to mold or stress. Cough can be due to asthma, but is also seen in a patient with too much fluid in the lungs due to a missed dialysis treatment or cardiac medications.”

The study appears in the May issue of the Journal of Health Care for the Poor and Underserved .

Of the youths studied, nearly 80 percent were younger than 13 years. Forty-three percent were white, 40 percent were black and 17 percent were of another racial group. Girls and boys were equally represented.

The children with chronic medical conditions had problems such as allergies, HIV/AIDS, ADHD, heart disease or defect, mental or behavioral disorders and seizure disorders.

Children with chronic medical conditions were more likely than children without to develop new symptoms such as asthma (12.4 percent vs. 1.5 percent), shortness of breath (16.3 percent vs. 4.2 percent), difficulty breathing (12.9 percent vs. 5.2 percent) and headaches (8.6 percent vs. 3.5 percent). In addition, 41.1 percent missed a physician visit due to the hurricane, 19.7 percent ran out of medications and 8.4 percent missed immunizations.

After the hurricane, children with chronic conditions were more likely to visit a clinic or emergency room with a new health problem (47.1 percent) and more likely to report worsening of a preexisting health condition.

“Children are far more vulnerable to traumatic events than adults and thus are at a greater risk for emotional, social and mental health problems,” said Bruce Perry, M.D., director of Child Trauma Programs at Baylor College of Medicine in Houston.

Rath said to improve the care of children and adolescents in future events, “planning ahead of time is crucial, even though unpredicted events such as earthquakes will continue to be a challenge to all involved.” She continued, “Disaster drills may be useful to prepare health care professionals as well as the general public in areas with an increased risk of natural disasters.”

Rath B, et al. Adverse health outcomes after Hurricane Katrina among children and adolescents with chronic conditions. Journal of Health Care for the Poor and Underserved 18(2), 2007.