Department of Community-Based Medical System, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551, Hiroshima-shi, Hiroshima-ken, Japan.
Department of General Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, 734-8551, Hiroshima-shi, Hiroshima-ken, Japan.
BMC Public Health. 2023 Feb 8;23(1):288. doi: 10.1186/s12889-023-15205-w.
Floods and torrential rains are natural disasters caused by climate change. Unfortunately, such events are more frequent and are increasingly severe in recent times. The 2018 Japan Floods in western Japan were one of the largest such disasters. This study aimed to evaluate the effect of the 2018 Japan Floods on healthcare costs and service utilization.
This retrospective cohort study included all patients whose receipts accrued between July 2017 and June 2019 in Hiroshima, Okayama, and Ehime prefectures using the National Database of Health Insurance Claims. We used Generalized Estimating Equations (GEEs) to investigate yearly healthcare costs during the pre-and post-disaster periods, quarterly high-cost patients (top 10%), and service utilization (outpatient care, inpatient care, and dispensing pharmacy) during the post-disaster period. After the GEEs, we estimated the average marginal effects as the attributable disaster effect.
The total number of participants was 5,534,276. Victims accounted for 0.65% of the total number of participants (n = 36,032). Although there was no significant difference in pre-disaster healthcare costs (p = 0.63), post-disaster costs were $3,382 (95% CI: 3,254-3,510) for victims and $3,027 (95% CI: 3,015-3,038) for non-victims (p < 0.001). The highest risk difference among high-cost patients was 0.8% (95% CI: 0.6-1.1) in the fourth quarter. In contrast, the highest risk difference of service utilization was in the first quarter (outpatient care: 7.0% (95% CI: 6.7-7.4), inpatient care: 1.3% (95% CI: 1.1-1.5), and dispensing pharmacy: 5.9% (95% CI: 5.5-6.4)).
Victims of the 2018 Japan Floods had higher medical costs and used more healthcare services than non-victims. In addition, the risk of higher medical costs was highest at the end of the observation period. It is necessary to estimate the increase in healthcare costs according to the disaster scale and plan for appropriate post-disaster healthcare service delivery.
洪水和暴雨是由气候变化引起的自然灾害。不幸的是，此类事件在最近变得更加频繁，且日益严重。2018 年日本西部洪水是此类最大灾害之一。本研究旨在评估 2018 年日本洪水对医疗保健费用和服务利用的影响。
本回顾性队列研究纳入了广岛、冈山和爱媛县 2017 年 7 月至 2019 年 6 月期间使用国民健康保险索赔数据库的所有患者。我们使用广义估计方程（GEEs）来研究灾难前和灾难后期间的年度医疗保健费用、每季度的高费用患者（前 10%）以及灾难后期间的服务利用（门诊护理、住院护理和配药药房）。在 GEEs 之后，我们估计了平均边际效应作为归因于灾难的效应。
总共有 5534276 名参与者。受灾者占总人数的 0.65%（n=36032）。尽管灾难前的医疗保健费用没有显著差异（p=0.63），但受灾者的灾后费用为 3382 美元（95%CI：3254-3510），非受灾者为 3027 美元（95%CI：3015-3038）（p<0.001）。高费用患者中风险差异最高的是第四季度的 0.8%（95%CI：0.6-1.1）。相比之下，服务利用的风险差异最高的是第一季度（门诊护理：7.0%（95%CI：6.7-7.4），住院护理：1.3%（95%CI：1.1-1.5），配药药房：5.9%（95%CI：5.5-6.4））。
2018 年日本洪水的受灾者比非受灾者的医疗费用更高，使用的医疗保健服务更多。此外，在观察期结束时，高医疗费用的风险最高。有必要根据灾害规模估计医疗保健费用的增加，并计划适当的灾后医疗保健服务提供。
