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Funding: This study was funded by the US Centers for Disease Control and Prevention (1U01IP000411-01).
Introduction
Understanding the impact of disasters on patient outcomes and patient flows between hospitals and other providers is important for preparedness planning and analysis of hospitals' surge capacity. During Hurricane Katrina, which hit the US Gulf Coast in August of 2005, dialysis centers struggled to maintain continuity of care. Forty-three centers closed during the storm, and 26 of these remained shuttered one month after Katrina. 1 Evacuated patients often presented at receiving facilities without information about their dialysis regimens, medications, or comorbidities. 2
Despite anecdotal evidence of inadequate preparedness among some dialysis centers and patients, it remains an open question whether end-stage renal disease patients suffered medical injury during Katrina or received dialysis care at hospitals. A survey of patients from nine dialysis units in New Orleans found that 16.8% missed three or more dialysis sessions, and 23% were hospitalized in the month following Katrina. 3 Many suffered from depressive symptoms. 4
A descriptive analysis of pre- and post-Katrina trends by the United States Renal Data System (USRDS) national registry of patients with end-stage renal disease (ESRD) found that Katrina was associated with a number of adverse outcomes, including mortality, decreased receipt of vitamin D and iron injections, anemia, and hospitalization. 5 However, results may be biased by changes in the composition of patients in the sample pre- and post-Katrina. Prior to Katrina, the USRDS identified 3,609 patients receiving dialysis in the affected areas. Post-Katrina, only 2,602 patients received dialysis. If the patients that remained were sicker than the patients who migrated, then it is difficult to determine the causal impact of Katrina on outcomes. A recent analysis of the impact of Katrina on mortality found that Katrina was not associated with an increase in mortality rates in patients receiving dialysis in the affected areas prior to the Katrina landfall (August 29, 2005). 6 By following a fixed cohort of patients over time, the analysis avoided bias due to changes in the patient population.
In this study, the impact of Katrina on hospitalization rates was estimated using two approaches: (1) a simple descriptive analysis of trends in hospitalization rates; and (2) a repeated events...