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Health Care Utilization Among Texas Veterans Health Administration Enrollees Before and After Hurricane Harvey, 2016-2018
Journal article   Open access   Peer reviewed

Health Care Utilization Among Texas Veterans Health Administration Enrollees Before and After Hurricane Harvey, 2016-2018

Margaret Carrel, Gosia S Clore, Seungwon Kim, Mary Vaughan Sarrazin, Eric Tate, Eli N Perencevich and Michihiko Goto
JAMA network open, Vol.4(12), pp.e2138535-e2138535
12/01/2021
DOI: 10.1001/jamanetworkopen.2021.38535
PMCID: PMC8665372
PMID: 34889944
url
https://doi.org/10.1001/jamanetworkopen.2021.38535View
Published (Version of record) Open Access

Abstract

Importance: 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. Objective: 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. Exposures: Residential flooding after Hurricane Harvey. Main Outcomes and Measures: Interrupted time series analysis measured changes in health care utilization over time, stratified by residential flood exposure, race, and income. Results: Of the 99858 patients in the cohort, 89931 (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 (24715 veterans [33.80%] vs 4237 veterans [15.85%]) and low-income (14895 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%). Conclusions and Relevance: 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..

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