After Hurricane Katrina hit the Gulf Coast two weeks ago, doctors at Grady Memorial Hospital in Atlanta saw a diabetic evacuee who had gone without medication for several days, his blood sugar level alarmingly high. They saw a breast cancer patient who didn't know what her medication was called, only that she took "red pills."
Many of the evacuees seen at Grady were poor and African American, said Otis Brawley, professor of hematology, oncology and epidemiology at Emory University in Atlanta, and faced serious underlying medical conditions that put their health in jeopardy. Much of this illness is the result of long-standing disparities in disease rates and care that often affect minority communities in the United States, he said.
Essentially, many storm-ravaged areas contained "a bunch of people who have less than optimal health care to begin with, and they have a large number of these diseases that people who get less than optimal health care end up getting," Brawley said. Katrina's aftermath left this high-risk group in greater peril than those with better health and access to care.
"The same things that lead to disparities in health in this country on a day-to-day basis led to disparities in the impact of Hurricane Katrina," said former U.S. surgeon general David Satcher, interim president of the Morehouse School of Medicine in Atlanta.
Health officials expect many of the storm-related deaths to result not from trauma or drowning, but from lack of medicine and treatment for people with chronic illnesses such as diabetes, asthma, heart disease and hypertension.
"I'm sure that many of the deaths that have occurred [after the hurricane] have resulted from people with chronic diseases either suffering from dehydration or [the] inability to access their medications," said Satcher. "All of these risks of suffering from chronic diseases and dying from them were greatest for the poor and the other people who could not get out of there."
New Orleans and other Gulf Coast areas fall within what some call the "stroke belt, the diabetic belt and the so-called health black belt of America," said Winston Price, immediate past president of the Washington-based National Medical Association, which calls itself "the collective voice of physicians of African descent."
A Louisiana health department report paints a detailed picture of the state's disparities. About 11.9 percent of African Americans have diabetes, compared with 7.2 percent of whites, according to the 2004 Louisiana Health Report Card. About 15.8 percent of those who lived in households with income of less than $15,000 per year had diabetes. And "this prevalence steadily decreases as the yearly income rises with the lowest prevalence for those with annual incomes of more than $50,000 (4.8 percent)," according to the report.
Diabetes rates among evacuees seem to reflect -- and even intensify -- those statistics. At a shelter in Lafayette, La., last week, 500 of the 2,000 to 3,000 people housed there had diabetes, according to Steven R. Smith, an endocrinologist at Louisiana State University's Pennington Biomedical Research Center.
People with kidney failure -- a common complication of diabetes and hypertension -- were especially vulnerable. The most common method used to treat permanent and advanced kidney failure -- hemodialysis, in which a patient's blood is filtered of impurities by machine -- requires electricity, purified water and skilled medical staff (or a friend or family member trained to use the equipment).
"I suspect that a week out [of not getting treatment after the hurricane], the preponderance of those patients had died," said Jack Moore, director of nephrology at Washington Hospital Center. "It's going to take months, if not years, to actually go back and find what proportion of the dead were actually dialysis patients."
People with diabetes also face crucial risks when they are left without drinking water, food or medication. Because many are dependent on injected insulin, which must be refrigerated, even those who had their medications with them had to worry about spoilage. (How long the medication remains effective largely depends on how well it is kept cool.)
Low blood sugar -- which can cause headaches, sweating, weakness, fatigue, hunger and neurological difficulties -- is a risk, particularly for those who were able to take their medications but couldn't eat afterwards. Not taking diabetes medications, on the other hand, can lead to high blood sugar -- which can result in frequent urination, dehydration, weakness, nausea, confusion, convulsions, fatigue, increased thirst and dry mouth. Unstabilized blood sugar levels, either high or low, can lead to a coma.
Some experts were critical of the lack of planning for such a disaster, given the known disproportionate disease rates.
"It's unfortunate that those individuals who are most in need of health care access, those . . . who most need prescription drug medicines," were affected, Price said. "So it's that very population that, independent of the hurricane, that our country -- particularly at federal and state levels -- should have been poised to provide increased services [and] resources."
Health experts said they worry that storm survivors won't seek proper medical care even after they've reached safety. They emphasize how important it is that patients resume taking their medications as soon as possible -- even if that means going to a medical facility they're not familiar with.
Price hopes that officials who study the health impacts of Hurricane Katrina over the next several years will appreciate the way underlying disparities in health care create serious, and real, threats.
When "in that vulnerable belt of poor-health states, we have not reached our [health care] goals, it will be very easy . . . to look at the impact of Hurricane Katrina" to see the consequences, he said.
Other experts wondered what lessons Hurricane Katrina should teach about the effects of disparities on other disasters, such as a bioterror attack. Poor people and those without their own doctors are those most likely to miss early warning signs of disease caused by a bioterrorism agent, Satcher said.
"What worries me is that in a country where there are so many people who don't have a personal physician, who don't have access to health care, if somebody wants to attack us using that kind of weapon," a virus or other bioterrorism agent "is going to spread rapidly because people there are not going to have ready access to health care."
Staff researchers Bridget R. Roeber and Karl Evanzz contributed to this report.