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Sugg MM, Runkle JD, Ryan S, Wertis L. A Difference-In Difference Analysis of the South Carolina 2015 Extreme Floods and the Association with Maternal Health. INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION : IJDRR 2023; 97:104037. [PMID: 38525445 PMCID: PMC10956501 DOI: 10.1016/j.ijdrr.2023.104037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Research documenting the public health impacts of natural disasters often focuses on adults and children. Little research has examined the influence of extreme events, like floods, on maternal health, and less has examined the effect of disasters on maternal indicators like severe maternal morbidity (SMM) or unexpected outcomes of labor and delivery that result in significant short-or long-term consequences to a woman's health. The aim of this study is to identify the impacts of the 2015 flood events on maternal health outcomes in South Carolina, USA. We employ a quasi-experimental design using a difference-in-difference analysis with log-binomial regressions to evaluate maternal outcomes for impacted and control locations during the disaster event. Unlike previous studies, we extended our difference-in-difference analysis to include a trimester of exposure to assess the timing of flood exposure. We did not find evidence of statistically significant main effects on maternal health from the 2015 flood events related to preterm birth, gestational diabetes, mental disorders of pregnancy, depression, and generalized anxiety. However, we did find a statistically significant increase in SMM and low birth weight during the flood event for women in select trimester periods who were directly exposed. Our work provides new evidence on the effects of extreme flood events, like the 2015 floods, which can impact maternal health during specific exposure periods of pregnancy. Additional research is needed across other extreme weather events, as the unique context of the 2015 floods limits the generalizability of our findings.
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Affiliation(s)
- Maggie M Sugg
- Department of Geography and Planning, Appalachian State University, Boone, North Carolina
| | - Jennifer D Runkle
- North Carolina Institute for Climate Studies, North Carolina State University, Asheville, North Carolina
| | - Sophie Ryan
- Department of Geography and Planning, Appalachian State University, Boone, North Carolina
| | - Luke Wertis
- Department of Geography and Planning, Appalachian State University, Boone, North Carolina
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Sugg MM, Wertis L, Ryan SC, Green S, Singh D, Runkle JD. Cascading disasters and mental health: The February 2021 winter storm and power crisis in Texas, USA. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 880:163231. [PMID: 37023802 PMCID: PMC10874649 DOI: 10.1016/j.scitotenv.2023.163231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/17/2023] [Accepted: 03/29/2023] [Indexed: 05/27/2023]
Abstract
In February 2021, the state of Texas and large parts of the US were affected by a severe cold air outbreak and winter weather event. This event resulted in large-scale power outages and cascading impacts, including limited access to potable water, multiple days without electricity, and large-scale infrastructure damage. Little is known about the mental health implications of these events, as most research has predominantly focused on the mental health effects of exposure to hurricanes, wildfires, or other natural disasters that are more commonly found in the summer months. This study aimed to analyze the crisis responses from the 2021 winter weather event in Texas using Crisis Text Line, a text-based messaging service that provides confidential crisis counseling nationwide. To date, Crisis Text Line is the largest national crisis text service, with over 8 million crisis conversations since its inception in 2013. We employed multiple analytic techniques, including segmented regression, interrupted time series, autoregressive integrated moving average (ARIMA), and difference-in-difference (DID), to investigate distinct time periods of exposure for all crisis conversations. ARIMA and DID were further utilized to examine specific crisis outcomes, including depression, stress/anxiety, and thoughts of suicide. Results found increases in total crisis conversations and for thoughts of suicide after the initial winter weather event; however, crisis outcomes varied in time. Thoughts of suicide in high-impact regions were higher across multiple time periods (e.g., 4-weeks, 3-months, 6-months, 9-months and 11-months) compared to low-impact regions and were elevated compared to pre-event time periods for 6-months and 11-months from the initial event. Total crisis volume also remained elevated for high-impact regions compared to low-impact regions up to 11-months after the beginning of the winter event. Our work highlights that cascading winter weather events, like the Texas 2021 Winter storm, negatively impacted mental health. Future research is needed across different disaster types (e.g., cascading, concurrent events) and for specific crisis outcomes (e.g., depression, suicidal ideation) to understand the optimal timing of crisis intervention post-disaster.
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Affiliation(s)
- Margaret M Sugg
- Department of Geography and Planning, P.O. Box 32066, Appalachian State University, Boone, NC 28608, United States of America.
| | - Luke Wertis
- Department of Geography and Planning, P.O. Box 32066, Appalachian State University, Boone, NC 28608, United States of America
| | - Sophia C Ryan
- Department of Geography and Planning, P.O. Box 32066, Appalachian State University, Boone, NC 28608, United States of America
| | - Shannon Green
- Crisis Text Line, PO Box 1144, New York, NY 10159, United States of America
| | - Devyani Singh
- Crisis Text Line, PO Box 1144, New York, NY 10159, United States of America
| | - Jennifer D Runkle
- North Carolina Institute for Climate Studies, North Carolina State University, 151 Patton Avenue, Asheville, NC 28801, United States of America
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McCann ZH, Szaflarski M. Differences in county-level cardiovascular disease mortality rates due to damage caused by hurricane Matthew and the moderating effect of social capital: a natural experiment. BMC Public Health 2023; 23:60. [PMID: 36624492 PMCID: PMC9830798 DOI: 10.1186/s12889-022-14919-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND As the climate continues to warm, hurricanes will continue to increase in both severity and frequency. Hurricane damage is associated with cardiovascular events, but social capital may moderate this relationship. Social capital is a multidimensional concept with a rich theoretical tradition. Simply put, social capital refers to the social relationships and structures that provide individuals with material, financial, and emotional resources throughout their lives. Previous research has found an association between high levels of social capital and lower rates of cardiovascular (CVD) mortality. In post-disaster settings, social capital may protect against CVD mortality by improving access to life-saving resources. We examined the association between county-level hurricane damage and CVD mortality rates after Hurricane Matthew, and the moderating effect of several aspects of social capital and hurricane damage on this relationship. We hypothesized that (1) higher (vs. lower) levels of hurricane damage would be associated with increased CVD mortality rates and (2) in highly damaged counties, higher (vs. lower) levels of social capital would be associated with lower CVD mortality. METHODS Analysis used yearly (2013-2018) county-level sociodemographic and epidemiological data (n = 183). Sociodemographic data were compiled from federal surveys before and after Hurricane Matthew to construct, per prior literature, a social capital index based on four dimensions of social capital (sub-indices): family unity, informal civil society, institutional confidence, and collective efficacy. Epidemiological data comprised monthly CVD mortality rates constructed from monthly county-level CVD death counts from the CDC WONDER database and the US Census population estimates. Changes in CVD mortality based on level of hurricane damage were assessed using regression adjustment. We used cluster robust Poisson population average models to determine the moderating effect of social capital on CVD mortality rates in both high and low-damage counties. RESULTS We found that mean levels of CVD mortality increased (before and after adjustment for sociodemographic controls) in both low-damage counties (unadjusted. Mean = 2.50, 95% CI [2.41, 2.59], adjusted mean = 2.50, 95% CI [2.40, 2.72]) and high-damage counties (mean = 2.44, CI [2.29, 2.46], adj. Mean = 2.51, 95% CI [2.49, 2.84]). Among the different social capital dimensions, institutional confidence was associated with reduced initial CVD mortality in low-damage counties (unadj. IRR 1.00, 95% CI [0.90, 1.11], adj. IRR 0.91 CI [0.87, 0.94]), but its association with CVD mortality trends was null. The overall effects of social capital and its sub-indices were largely nonsignificant. CONCLUSION Hurricane damage is associated with increased CVD mortality for 18 months after Hurricane Matthew. The role of social capital remains unclear. Future research should focus on improving measurement of social capital and quality of hurricane damage and CVD mortality data.
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Affiliation(s)
- Zachary H. McCann
- grid.189967.80000 0001 0941 6502Department of Environmental Health, Rollins School of Public Health-Emory University, Atlanta, Georgia
| | - Magdalena Szaflarski
- grid.265892.20000000106344187Department of Sociology, University of Alabama at Birmingham, Birmingham, AL United States
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Khunti K, Aroda VR, Aschner P, Chan JCN, Del Prato S, Hambling CE, Harris S, Lamptey R, McKee M, Tandon N, Valabhji J, Seidu S. The impact of the COVID-19 pandemic on diabetes services: planning for a global recovery. Lancet Diabetes Endocrinol 2022; 10:890-900. [PMID: 36356612 PMCID: PMC9640202 DOI: 10.1016/s2213-8587(22)00278-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/01/2022] [Accepted: 09/30/2022] [Indexed: 11/09/2022]
Abstract
The COVID-19 pandemic has disproportionately affected certain groups, such as older people (ie, >65 years), minority ethnic populations, and people with specific chronic conditions including diabetes, cardiovascular disease, kidney disease, and some respiratory diseases. There is now evidence of not only direct but also indirect adverse effects of COVID-19 in people with diabetes. Recurrent lockdowns and public health measures throughout the pandemic have restricted access to routine diabetes care, limiting new diagnoses, and affecting self-management, routine follow-ups, and access to medications, as well as affecting lifestyle behaviours and emotional wellbeing globally. Pre-pandemic studies have shown that short-term delays in delivery of routine care, even by 12 months, are associated with adverse effects on risk factor control and worse microvascular, macrovascular, and mortality outcomes in people with diabetes. Disruptions within the short-to-medium term due to natural disasters also result in worse diabetes outcomes. However, the true magnitude of the indirect effects of the COVID-19 pandemic on long-term outcomes and mortality in people with diabetes is still unclear. Disasters tend to exacerbate existing health disparities; as we recover ambulatory diabetes services in the aftermath of the pandemic, there is an opportunity to prioritise those with the greatest need, and to target resources and interventions aimed at improving outcomes and reducing inequality.
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Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK; NIHR Applied Research Collaboration East Midlands, Leicester, UK.
| | | | - Pablo Aschner
- Asociación Colombiana de Diabetes, Bogotá, Colombia; Oficina de Investigaciones, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Stefano Del Prato
- Diabetology Divisions, Pisa University Hospital, University of Pisa, Pisa, Italy
| | | | - Stewart Harris
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Roberta Lamptey
- Department of Family Medicine, Korle Bu Teaching Hospital, Accra, Ghana; Department of Community Health, University of Ghana Medical School, Accra, Ghana
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Jonathan Valabhji
- Division of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; NHS England, London, UK; NHS Improvement, London, UK; Department of Diabetes and Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Samuel Seidu
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK; NIHR Applied Research Collaboration East Midlands, Leicester, UK
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Tarabochia‐Gast AT, Michanowicz DR, Bernstein AS. Flood Risk to Hospitals on the United States Atlantic and Gulf Coasts From Hurricanes and Sea Level Rise. GEOHEALTH 2022; 6:e2022GH000651. [PMID: 36203949 PMCID: PMC9521195 DOI: 10.1029/2022gh000651] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 08/16/2022] [Accepted: 09/05/2022] [Indexed: 06/16/2023]
Abstract
Hurricanes have caused major healthcare system disruptions. No systematic assessment of hurricane risk to United States hospital-based healthcare delivery has been performed. Here, we show that 25 of 78 metropolitan statistical areas (MSAs) on the United States Atlantic and Gulf Coasts have half or more of their hospitals at risk of flooding from relatively weak hurricanes. 0.82 m of sea level rise expected within this century from climate change increases the odds of hospital flooding 22%. Furthermore, in 18 MSAs at least half of the roads within 1.6 km of hospitals were at risk of flooding from a category 2 storm. These findings identify previously undescribed risks to hospital-based care delivery in Atlantic and Gulf Coast communities. They suggest that lower intensity hurricanes can have outsized impacts on healthcare access, particularly in places where per capita bed availability is low.
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Affiliation(s)
- A. T. Tarabochia‐Gast
- Center for Climate, Health and the Global EnvironmentHarvard T.H. Chan School of Public HealthBostonMAUSA
- Department of Family MedicineBoston University School of MedicineBostonMAUSA
| | - D. R. Michanowicz
- Center for Climate, Health and the Global EnvironmentHarvard T.H. Chan School of Public HealthBostonMAUSA
- Physicians, Scientists, and Engineers for Healthy EnergyOaklandCAUSA
| | - A. S. Bernstein
- Center for Climate, Health and the Global EnvironmentHarvard T.H. Chan School of Public HealthBostonMAUSA
- Boston Children's HospitalBostonMAUSA
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The long term participation trend for the colorectal cancer screening after the 2011 triple disaster in Minamisoma City, Fukushima, Japan. Sci Rep 2021; 11:23851. [PMID: 34903779 PMCID: PMC8668878 DOI: 10.1038/s41598-021-03225-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/26/2021] [Indexed: 11/29/2022] Open
Abstract
Colorectal cancer (CRC) screening is a well-established cancer screening method, and its effectiveness depends on maintaining a high participation rate in the target population. In this study, we analyzed the trends in CRC screening participation rates over 10 years in Minamisoma City, where residents were forced to evacuate after the 2011 triple disaster in Fukushima, Japan. The immunochemical fecal occult blood test is provided as municipal CRC screening. We calculated the annual CRC screening participation rate and analyzed the factors associated with participation in screening. Overall, 4069 (12.3%) and 3839 (11.7%) persons participated in CRC screening in 2009 and 2010, respectively; however, the number decreased significantly to 1090 (3.4%) in 2011 when the earthquake occurred. Over the following 3 years, the rate gradually recovered. Multivariable logistic analysis showed that age < 65 years, living alone, and evacuation were significant associated factors for non-participation after 2011 (p < 0.05). In conclusion, the CRC screening participation rate decreased significantly during the Great East Japan Earthquake but recovered over the next 3 years. Further analysis of factors preventing CRC screening participation and research on the long-term effects of its post-disaster decline are important to consider in assessing the need for intervention in post-disaster cancer screening.
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Shin SH, Ji H. Health risks of natural hazards and resilience resources: Evidence from a U.S. nationwide longitudinal study. Soc Sci Med 2021; 281:114110. [PMID: 34139633 DOI: 10.1016/j.socscimed.2021.114110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/28/2021] [Accepted: 06/03/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although natural disasters can threaten health and well-being, some people show greater resilience to their effects than others. Identifying the characteristics related to resilience has important implications for reducing the health risks in the aftermath of a disaster. OBJECTIVE Using the Conservation of Resources Theory as a framework, we study the role of resources in moderating the adverse effects of natural disasters on people's health and coping behaviors. METHOD We match 20,658 unique individuals aged 50 or older from the 2012-2016 waves of the Health and Retirement Study to the county-level annual natural hazard data provided by the Federal Emergency Management Agency. Using individual-fixed effect models, we first model whether the experience of natural disasters can predict people's health and coping behaviors. We then explore heterogeneity in such effects by interacting individual- and county-level resilience resources with the number of natural disasters. RESULTS The results show that with increased exposure to natural disasters, older adults are more likely to experience difficulties performing instrumental daily activities. They also tend to have fewer overnight hospital stays, higher out-of-pocket medical expenses, and increased alcohol dependency. However, older adults with certain socio-economic characteristics ‒ white, higher education, higher income, and homeownership ‒ are better able than others to mitigate any adverse health effects of natural disasters. One significant community-level resource is a robust healthcare capacity in a county with a high ratio of healthcare practitioners, where older adults are more likely to seek hospital care and have lower alcohol dependency. CONCLUSIONS Health resilience can be improved by strengthening community-level healthcare capacity, with a particular focus on residents with lower socio-economic resources. Failing to address healthcare provision inequalities may exacerbate health disparities.
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Affiliation(s)
- Su Hyun Shin
- University of Utah, Department of Family & Consumer Studies, 225 South 1400 East, Alfred Emery Building, Room 236, Salt Lake City, UT, 84112, USA.
| | - Hyunjung Ji
- University of Alabama, Department of Political Science, Ten Hoor Hall, Suite 310. Tuscaloosa, AL, 35487, USA.
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Abstract
PURPOSE OF REVIEW Studies have shown that disasters may exacerbate the comorbidities in vulnerable populations such as those with a pre-existing chronic medical condition like diabetes. This article highlights recent studies that look at the impact of disasters on people with diabetes and also shows recent resources for consumers, health care providers, and policy makers to improve resiliency in people with diabetes. RECENT FINDINGS Recent articles have looked at the short-term impact of disasters upon people with diabetes and its comorbidities such as Hurricane Sandy in 2012, the triple disaster of 2011 in Japan (earthquake, tsunami, and nuclear accident), and the 2016 Kumamoto earthquake in Japan as well as the long-term impact of disasters such as Hurricane Katrina in 2005. Several public and private partners have used the past and recent findings to develop resources that help consumers with diabetes and the people who care for them, prepare for a disaster BEFORE the event.
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Quast T, Andel R, Sadhu AR. Long-term Effects of Disasters on Seniors With Diabetes: Evidence From Hurricanes Katrina and Rita. Diabetes Care 2019; 42:2090-2097. [PMID: 31548250 PMCID: PMC6804607 DOI: 10.2337/dc19-0567] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 08/21/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To estimate the long-run mortality effects of Hurricanes Katrina and Rita on seniors with diabetes. RESEARCH DESIGN AND METHODS We performed a retrospective cohort analysis of Medicare enrollment and claims data covering four states and ∼10 years. Affected individuals were identified by whether they lived in a county that suffered a high impact and were stratified by whether they moved to a different county following the storms. Propensity scores matched affected and comparison subjects based on demographic and socioeconomic characteristics and the presence of chronic conditions. Our sample consisted of 170,328 matched affected subjects. RESULTS The affected subjects had a nearly 40% higher all-cause mortality risk in the 1st month after the storms, but the difference fell to <6% by the end of the full observation period. The mortality risks of heart disease and nephritis also exhibited the largest differences immediately following the storms. Among the affected subjects, the all-cause mortality risk was higher for those who moved to a different county, with an especially large difference among those who moved to an affected county. CONCLUSIONS The propensity matching procedure resulted in the comparison and affected groups having similar observable characteristics. However, we only examined the extreme outcome of mortality, our definition of affected was somewhat crude, and our sample did not include individuals enrolled in Medicare Advantage. Our findings highlight the importance of the immediate response to disasters, yet also demonstrate the long-lasting impact disasters can have.
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Affiliation(s)
- Troy Quast
- College of Public Health, University of South Florida, Tampa, FL
| | - Ross Andel
- College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, and Department of Neurology, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Archana R Sadhu
- Weill Cornell Medical College, Texas A&M Health Science Center, and Houston Methodist, Houston, Texas
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Emergency Department Visits by and Hospitalizations of Senior Diabetics in the Three Years Following Hurricanes Katrina and Rita. ACTA ACUST UNITED AC 2019; 3:151-160. [PMID: 31681907 DOI: 10.1007/s41885-019-0039-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
While prior studies have investigated health care utilization immediately following disasters, few have examined utilization beyond that period. We use individual-level U.S. Medicare claims data for three years prior to (2002-2004) and after (2006-2008) Hurricanes Katrina and Rita to investigate whether senior diabetics affected by the storms had a greater number of emergency department visits and days hospitalized in the three years following the storms. An event study was conducted using regression analysis that controlled for all fixed individual characteristics. While the 2006 and 2007 rates of increase in utilization were relatively similar across the control group and the two affected groups, in 2008 the affected groups exhibited substantially greater increases in both emergency department visits and days hospitalized. The differences correspond to an additional 380,907 days hospitalized and 21,583 emergency department visits in 2008. The results indicate that, in addition to short term effects previously estimated, disasters may have longer term effects on utilization of healthcare services. These potential effects suggest that improved post-disaster care may significantly reduce the healthcare costs of disasters.
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