Changes in asthma and general health after Hurricane Harvey: A natural experiment utilizing an asthma clinical trial, Harris County, TX

Abstract

BACKGROUND AND AIM: On August 25, 2017, roughly two-thirds through a clinical trial (HIITBAC1) targeting low-income African-American adults with poorly controlled asthma, Hurricane Harvey made landfall along the Gulf coast. Of the 263 HIITBAC1 enrollees, we re-enrolled 75 of 107 who had exited HIITBAC1 during the 12 months before Harvey to assess their health and resilience before and after the disaster. Here we report on the change observed in several key measures. METHODS: Data collected before and after Harvey were largely the same, and included clinical measures, Asthma Control Test (ACT), Asthma Quality of Life Questionnaire (MiniAQLQ), PROMIS global health, PROMIS emotional support, an exposure history, healthcare utilization, and (in most pre- and all post-Harvey enrollees) an in-home assessment of environmental hazards. In addition, we obtained blood samples; information about their Harvey experience, including trauma scores; and exhaled nitric oxide and airborne mold samples from the post-Harvey enrollees. A linear mixed model was used to assess pre- versus post-Harvey changes in health outcomes and the association with flooding damage, and quantile regression to assess eNO association with spore count. Analyses controlled for potential confounders. RESULTS:The average age was 55 years (83% female) and 57% of participants had a household income $15,000. Compared to pre-Harvey, post-Harvey scores on key health outcomes (i.e., ACT, MiniAQLQ, global physical health, global mental health) decreased significantly. Post Harvey, global physical health was significantly lower for those who flooded, compared with those who did not, whereas global mental health was lower for those reporting Harvey-related home damage. Neither flooding nor Harvey-related home damage were associated with ACT and MiniAQLQ after adjusting for pre-disaster characteristics. Post Harvey, no statistically significant association between eNO and spore counts was found. CONCLUSIONS:Our initial analyses suggest that Hurricane Harvey adversely affected health in this vulnerable population. KEYWORDS: Asthma, Environmental disparities, Environmental epidemiology, Exposure assessment, Natural disaster