Medicaid Outpatient Utilization for Waterborne Pathogenic Illness following Hurricane Floyd

Abstract

SYNOPSISObjectives. Flooding provides an opportunity for epidemics of waterborne viral, protozoan, or bacterial diseases to develop in affected areas. Epidemic levels of disease may translate into higher than average levels of health services use, depending in part on help-seeking behaviors. The authors investigated whether the flooding that occurred as a result of Hurricane Floyd in September 1999 was associated with an increase in outpatient visits for waterborne diseases among Medicaid enrollees in eastern North Carolina.Methods. Using a difference-in-differences estimation technique, the authors examined the change in outpatient visits by North Carolina Medicaid enrollees for selected waterborne diseases following the hurricane. The study focused on counties with high concentrations of hog farming that were mildly/moderately or severely affected by the hurricane, using unaffected counties and the year before the hurricane as controls.Results. Small increases in Medicaid-covered outpatient visits were found in severely affected counties for two of the six pathogens selected for analysis, relative to unaffected counties. Larger increases in visits were found for nonspecific intestinal infections in both severely and moderately affected counties following the hurricane, relative to unaffected counties.Conclusions. The large increase in visits for ill-defined intestinal infection is noteworthy. The relative lack of increase in visits with specific pathogenic diagnoses may be attributable, at least in part, to a number of factors, including incomplete diagnostic information provided by treating clinicians, low treatment-seeking behavior, and use of non-Medicaid-funded emergency services.

No Calm After the Storm: A Systematic Review of Human Health Following Flood and Storm Disasters

“…Within five weeks of landfall, the proportion of visits to treatment facilities for diarrhea remained significantly higher than pre-storm levels at an ECF, 80 the RR for visiting an ECF for diarrhea was elevated (RR: 2.0; 95% CI, 1.4-2.8) compared to a same week in the previous year, 79 and a community survey found a slightly higher risk of diarrhea in two of four storm-affected areas (Area 1 OR: 1.6; 95% CI, 1.52-1.65 and Area 2 OR: 1.3; 95% CI, 1.21-1.32) compared to the previous two years 84 . In the long-term, atypical and significant increases were seen in the incidence of acute diarrhea and dysentery in the eight months after a storm, 85 and the average number of cases utilizing health services for intestinal infections doubled in the year after storm landfall (6.5 cases/month to 13.1 cases/month; P<.01) 86 . Alternatively, two surveillance system studies and one ECF study found no change in gastrointestinal illnesses in the post-storm period 78 …”

Untangling the Impacts of Climate Change on Waterborne Diseases: a Systematic Review of Relationships between Diarrheal Diseases and Temperature, Rainfall, Flooding, and Drought

“…10, 127, 129, 130, 132, 133, 135, 141, 144, 148, 163 Many studies also report higher diarrhea rates in flood-affected compared to unaffected groups, 58, 138, 139, 142, 145, 147 although two studies did not detect such a difference. 134, 137 Some studies report exposure-response effects, with increasing contact with flood waters 140, 146 or flood depth 139 associated with increased risk of diarrhea.…”

Artificial Aquatic Ecosystems

“…Two well-studied examples of 20th-century environmental injustice in the United States, in Anniston, Alabama, and Hyde Park, Georgia, both involved predominantly black communities contaminated and sickened in part by ditches bearing water laced with toxic industrial waste [179,180]. Recently, hog waste lagoons associated with industrial swine facilities in eastern North Carolina have proved resistant to regulation despite repeated flooding during hurricanes and tropical storms and persistent strong detrimental effects on the health and quality of life of neighbors, who are disproportionately black and low in income [181,182]. Thus, what artificial aquatic systems go unregulated may say as much about what we socially undervalue as what we ecologically undervalue.…”