Department of Geographical and Sustainability Sciences, University of Iowa, Iowa City.
Department of Internal Medicine, University of Iowa, Iowa City.
JAMA Netw Open. 2021 Dec 1;4(12):e2138535. doi: 10.1001/jamanetworkopen.2021.38535.
Hurricanes and flooding can interrupt health care utilization. Understanding the magnitude and duration of interruptions, as well as how they vary according to hazard exposure, race, and income, are important for identifying populations in need of greater retention in care.
To determine how the differential exposure to Hurricane Harvey in August 2017 is associated with changes in utilization of Veterans Health Administration health care.
DESIGN, SETTING, AND PARTICIPANTS: This is a retrospective cohort analysis of primary care practitioner (PCP) visits, emergency department visits, and inpatient admissions in the Veterans Health Administration among Texas veterans residing in counties impacted by Hurricane Harvey from 2016 to 2018. Data analysis was performed from September 2020 to May 2021.
Residential flooding after Hurricane Harvey.
Interrupted time series analysis measured changes in health care utilization over time, stratified by residential flood exposure, race, and income.
Of the 99 858 patients in the cohort, 89 931 (90.06%) were male, and their median (range) age was 58 (21 to 102) years. Compared with veterans in nonflooded areas, veterans living in flooded areas were more likely to be Black (24 715 veterans [33.80%] vs 4237 veterans [15.85%]) and low-income (14 895 veterans [20.37%] vs 4853 veterans [18.15%]). Rates of PCP visits decreased by 49.78% (95% CI, -64.52% to -35.15%) for veterans in flooded areas and by 45.89% (95% CI, -61.93% to -29.91%) for veterans in nonflooded areas and did not rebound until more than 8 weeks after the hurricane. Rates of PCP visits in flooded areas remained lower than expected for 11 weeks among White veterans (-6.99%; 95% CI, -14.36% to 0.81%) and for 13 weeks among racial minority veterans (-7.22%; 95% CI, -14.11% to 0.30%). Low-income veterans, regardless of flood status, experienced greater suppression of PCP visits in the 8 weeks following the hurricane (-13.72%; 95% CI, -20.51% to -6.68%) compared with their wealthier counterparts (-9.63%; 95% CI, -16.74% to -2.26%).
These findings suggest that flood disasters such as Hurricane Harvey may be associated with declines in health care utilization that differ according to flood status, race, and income strata. Patients most exposed to the disaster also had the greatest delay or nonreceipt of care.
飓风和洪水可能会中断医疗保健的利用。了解中断的程度和持续时间，以及它们如何根据危险暴露、种族和收入而有所不同，对于确定需要更大程度保留护理的人群非常重要。
确定 2017 年 8 月的哈维飓风的不同暴露程度如何与退伍军人健康管理局医疗保健利用的变化相关。
设计、设置和参与者：这是对居住在 2016 年至 2018 年期间受哈维飓风影响的德克萨斯州退伍军人的退伍军人健康管理局初级保健医生（PCP）就诊、急诊就诊和住院的利用情况进行的回顾性队列分析。数据分析于 2020 年 9 月至 2021 年 5 月进行。
哈维飓风后的住宅洪水。
中断时间序列分析衡量了随着时间的推移医疗保健利用的变化，按住宅洪水暴露、种族和收入进行分层。
在队列中的 99858 名患者中，89931 名（90.06%）为男性，中位（范围）年龄为 58 岁（21 岁至 102 岁）。与未受洪水影响地区的退伍军人相比，居住在洪灾区的退伍军人更有可能是黑人（24715 名退伍军人[33.80%]与 4237 名退伍军人[15.85%]）和低收入（14895 名退伍军人[20.37%]与 4853 名退伍军人[18.15%]）。洪灾区退伍军人的 PCP 就诊率下降了 49.78%（95%CI，-64.52%至-35.15%），非洪灾区退伍军人的 PCP 就诊率下降了 45.89%（95%CI，-61.93%至-29.91%），直到飓风后超过 8 周才出现反弹。在白人退伍军人中，洪灾区的 PCP 就诊率仍持续低于预期 11 周（-6.99%；95%CI，-14.36%至 0.81%），在少数族裔退伍军人中，洪灾区的 PCP 就诊率仍持续低于预期 13 周（-7.22%；95%CI，-14.11%至 0.30%）。无论洪水状况如何，低收入退伍军人在飓风后 8 周内经历了更大程度的 PCP 就诊率抑制（-13.72%；95%CI，-20.51%至-6.68%），而他们的富裕同行则下降了 9.63%（95%CI，-16.74%至-2.26%）。
这些发现表明，哈维飓风等洪水灾害可能与医疗保健利用的下降有关，这种下降因洪水状况、种族和收入阶层而异。受灾最严重的患者也延迟或未获得护理。
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