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Research: Hurricane Katrina Deaths, Louisiana, 2005

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Research: Hurricane Katrina Deaths, Louisiana, 2005 Published on August 28, 2008 RESEARCH Hurricane Katrina Deaths, Louisiana, 2005 Joan Brunkard, PhD, Gonza Namulanda, MS, and Raoult Ratard, MD ABSTRACT Objective: Hurricane Katrina struck the US Gulf Coast on August 29, 2005, causing unprecedented damage to numerous communities in Louisiana and Mississippi. Our objectives were to verify, document, and characterize Katrina-related mortality in Louisiana and help identify strategies to reduce mortality in future disasters. Methods: We assessed Hurricane Katrina mortality data sources received in 2007, including Louisiana and out-of-state death certificates for deaths occurring from August 27 to October 31, 2005, and the Disaster Mortuary Operational Response Team’s confirmed victims’ database. We calculated age-, race-, and sex-specific mortality rates for Orleans, St Bernard, and Jefferson Parishes, where 95% of Katrina victims resided and conducted stratified analyses by parish of residence to compare differ- ences between observed proportions of victim demographic characteristics and expected values based on 2000 US Census data, using Pearson chi square and Fisher exact tests. Results: We identified 971 Katrina-related deaths in Louisiana and 15 deaths among Katrina evacuees in other states. Drowning (40%), injury and trauma (25%), and heart conditions (11%) were the major causes of death among Louisiana victims. Forty-nine percent of victims were people 75 years old and older. Fifty-three percent of victims were men; 51% were black; and 42% were white. In Orleans Parish, the mortality rate among blacks was 1.7 to 4 times higher than that among whites for all people 18 years old and older. People 75 years old and older were significantly more likely to be storm victims (P Ͻ .0001). Conclusions: Hurricane Katrina was the deadliest hurricane to strike the US Gulf Coast since 1928. Drowning was the major cause of death and people 75 years old and older were the most affected population cohort. Future disaster preparedness efforts must focus on evacuating and caring for vulnerable populations, including those in hospitals, long-term care facilities, and personal residences. Improving mortality reporting timeliness will enable response teams to provide appropriate interventions to these populations and to prepare and implement preventive measures before the next disaster. (Disaster Med Public Health Preparedness. 2008;:1–1) Key Words: Hurricane Katrina, Louisiana, mortality, drowning, flooding, disaster preparedness urricane Katrina struck the US Gulf Coast Our objectives were to verify and document the num- on August 29, 2005 as a category 3 hurricane ber of deaths from Hurricane Katrina among people Hon the Saffir-Simpson scale, causing unprec- in Louisiana at the time of the storm and to charac- edented damage to numerous Louisiana and Missis- terize the storm’s mortality burden by victim demo- sippi communities.1 During the hours and days after graphics, geographic location, timeline, and cause of Hurricane Katrina, breaches in the levee infrastructure death. This report is the first to combine multiple death resulted in flooding throughout approximately 80% of databases to assess the number of storm-related deaths New Orleans. A massive rescue and recovery effort among Louisiana residents and people who were in was launched by local, state, and federal governments Louisiana at the time of the storm and to provide and nongovernmental organizations. Before Hurri- information regarding the causes of death. The find- cane Katrina, the deadliest hurricane to make landfall ings in this report will aid public health and emer- in the United States during the previous 50 years was gency preparedness efforts and may help reduce the Hurricane Audrey (1957), with an estimated 416 mortality burden in future natural disasters. deaths.2 Hurricane Andrew (1995), the last category 5 hurricane to strike the United States, caused 26 METHODS deaths.2 Although several preliminary estimates exist Data Sources of the deaths attributable to Hurricane Katrina,1,3,4 Data sources included the Hurricane Katrina Disaster no prior report has systematically reviewed all of the Mortuary Operational Response Team (DMORT) da- available death databases to accurately document tabase and death certificates collected through Louisi- Hurricane Katrina mortality in Louisiana. ana vital statistics and out-of-state coroners’ offices. Disaster Medicine and Public Health Preparedness 1 Copyright 2008 by American Medical Association. Hurricane Katrina Deaths, Louisiana, 2005 DMORT is a federal response team that provides assistance isted, to determine whether there was an age-specific effect of with mortuary activities during disaster situations. Out-of- race among victims. We limited our comparative analyses to state death certificates of Louisiana residents during the pe- Orleans, St Bernard, and Jefferson Parishes. riod of August 27 to October 1, 2005, and others that state coroners deemed worth consideration for potential associa- Mapping Using Geographic Information Systems tion with Hurricane Katrina were forwarded to the Louisiana To identify high-mortality geographic areas, Louisiana death coroner’s office from coroners’ offices in 26 states and the records with addresses (n ϭ 687) were geocoded using Envi- District of Columbia. ronmental Systems Research Institute’s ArcGIS version 9.2 (Redlands, CA). Most records were geocoded using the En- Katrina Classification vironmental Systems Research Institute street file reference The primary classification of Katrina-related deaths assigned geospatial layer, which was used to match the address for by parish (county) coroners on death certificates was Inter- location of death to the street file address. Records with only national Classification of Diseases-10 code X37, victim of cat- a nursing facility name were matched to the address of the aclysmic storm. The majority of deaths had multiple hierar- nursing facility in the Homeland Security Infrastructure Pro- chical cause-of-death classifications; however, if trauma, gram Public Health, Nursing Home geospatial layer. injury, or drowning was listed as a contributing cause of Ethical Review death, these victims were categorized as drowning or injury The study protocol was reviewed by the human subjects victims in our database. A systematic review of all of the coordinator at the Office of Workforce and Career Develop- records in the DMORT database and of Louisiana death ment, Centers for Disease Control and Prevention, and de- certificates yielded a final database of confirmed victims. A termined to be a public health response that did not require number of quality-assurance cross-checks were conducted, further human subjects review. including ensuring no duplication of records across data sources and date of death occurring within a plausible time- RESULTS line (August 27–October 31, 2005) and within the geo- We identified 971 Katrina-related deaths that occurred in graphic location for Katrina-related deaths (ie, death occur- Louisiana and at least 15 deaths that occurred among Loui- ring in or victim evacuated from the affected southeastern siana Katrina evacuees in other states, for a conservative Louisiana parishes). All deaths occurring before August 29, storm-related death total of 986 victims. The state coroner 2005 and after October 1, 2005 were reviewed to verify that was forwarded 446 out-of-state death certificates for Louisi- Hurricane Katrina was listed as a contributing cause of death, ana residents. Of these, 15 were clearly related to Hurricane and all of the deaths occurring after September 23, 2005 were Katrina, and 431 were classified as indeterminate because no reviewed to determine whether they were associated with indication of hurricane association was listed on the death Hurricane Rita, which struck southwest Louisiana on Sep- certificate. Our total mortality estimate of 986 victims likely tember 24, 2005. The final case definition for Katrina-related represents a lower bound estimate for Katrina mortality in deaths in this analysis included all of the deaths in the Louisiana. Including all deaths classified as indeterminate DMORT database that were determined to be Katrina re- (DMORT, n ϭ 23; and out-of-state, n ϭ 431) yields an upper lated, all Louisiana death certificates with victim of cataclys- bound estimate of 1440. We limited all subsequent analyses mic storm listed as the primary or a contributing cause of to deaths we determined to be related to Hurricane Katrina death, and out-of-state death certificates for Louisiana resi- (n ϭ 986). dents that were classified as related to Hurricane Katrina. Cause of Death Data from Louisiana vital statistics were collected at the local Excluding the 15 out-of-state deaths, we found that of the levels through parish coroners’ offices and then sent to the 971 people who died in Louisiana as a result of Hurricane state level. Data from all 3 sources (DMORT, vital statistics, Katrina, data on cause of death were available for 800 people. and out-of-state death certificates) were entered into an Three hundred eighty-seven victims drowned, and 246 peo- Access (Microsoft Corporation, Seattle, WA) database. De- ple sustained trauma or injuries severe enough to cause their scriptive and inferential statistics were calculated using Stata deaths. The mechanism of injury was unspecified for 226 version 9.1 (StataCorp LP, College Station, TX). We calcu- trauma or injury deaths; specified injury-related causes of lated age-, race-, and sex-specific mortality
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