Over 1.5 million people evacuated the U.S. Gulf Coast following Hurricane Katrina (Groen and Polivka, 2007) and over 250,000 were estimated to have continued to reside in Texas nearly one year later (Texas HHS, 2006). Not only were these evacuees exposed to physical and emotional trauma, but many were from vulnerable populations and of low socio-economic status that further worsened their condition. Roughly 80% of all individuals displaced to Texas following Katrina were African American, while 60% came from households whose income was less than $20,000 per year (Texas HHSC, 2006). Children were especially vulnerable, with many missing health provider visits (Rath et al., 2007) and reporting a new onset of mental health symptoms following Katrina (Roberts, 2010). This goal of this proposal is to analyze the diagnoses and treatment of selected chronic conditions for Displaced Louisiana Children (DLCs) from low socio-economic backgrounds following Hurricane Katrina. The analysis will employ individual-level administrative data to examine the health care utilization of the roughly 30,000 DLCs enrolled in TexKat, the temporary emergency Medicaid waiver program for Katrina evacuees in Texas. The use of these data represents a potential improvement over the vast majority of existing post-disaster studies which typically employ survey data. The investigation will focus on healthcare for three chronic conditions: asthma, mental health, and diabetes. The analysis will focus on encounter rates in outpatient, emergency department, and inpatient settings as well as prescription rates for treatment medications. A difference-in-differences estimation strategy will be employed to identify changes due to displacement. Changes in utilization by DLCs before and after displacement will be compared to changes in utilization by non-displaced children. The analysis is expected to indicate that displacement was very disruptive to DLCs with chronic conditions (Rath et al., 2007). The project will provide critical information to federal, state and local agencies planning care for low-income children following disasters. The analyses of diagnoses and health care use both immediately following displacement and in the following months will provide insight into the health care needs for conditions known to be exacerbated by discontinuous medical care. By determining the services obtained by these children, our findings will assist evacuation destinations to more efficiently prepare for an influx of evacuees. Finally, policymakers may be able to use our findings to improve future Medicaid emergency waivers.

Public Health Relevance

This project will investigate the health effects of displacement on low-income children by analyzing the health care utilization of evacuees following Hurricane Katrina. Newly available individual-level administrative data will be used to investigate the healt care received for asthma, diabetes, and mental health conditions by the predominantly minority, low-income children enrolled in an emergency Medicaid program in Texas. The results of this study may add new insight into the health effects of displacement on child health and provide guidance to future efforts to assist vulnerable children following a disaster.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Small Research Grants (R03)
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Study Section
Pediatrics Subcommittee (CHHD)
Program Officer
Bures, Regina M
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University of South Florida
Public Health & Prev Medicine
Schools of Public Health
United States
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Quast, Troy (2018) Healthcare utilization by children with asthma displaced by Hurricane Katrina. J Asthma 55:416-423
Quast, Troy; Mortensen, Karoline (2015) Diabetes Care Provided to Children Displaced by Hurricane Katrina. Disaster Med Public Health Prep 9:480-3