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Sept. 11 , 2006
Study finds health care usage significantly altered after 9/11

BY Dana Goldman

A report in the September issue of the journal Biosecurity and Bioterrorism provides the most comprehensive picture to date of health care usage in the New York City region in the months after the Sept. 11, 2001 terrorist attacks. The study reveals that while usage markedly declined in the three weeks immediately after the events, health care claims then rose above expected levels during the following months.

Researchers from Emory‘s Rollins School of Public Health analyzed insurance claims from January 2000 to March 2002 for more than two million people living in the New York City region and enrolled in health care plans with Aetna. They then evaluated overall and specific health care usage in relationship to how far people lived from the World Trade Center (WTC). The study examined insurance claims for mental health conditions as well as a variety of physical conditions that may be triggered or aggravated by emotional stress.

The researchers found that health care use slowed in the weeks immediately following the terrorist attacks. In addition, distance from the WTC affected the utilization of some health services, with the greatest declines observed among those residing closest to the WTC. For example, office visits—the most frequent form of health care use—declined 11 percent overall and 15 percent for those living within the 10-mile radius of the WTC. This drop in office visits represented 75,000 fewer office visits than expected during the three weeks after 9/11.

“This decline was probably related to the disruptions in access to health care services or transportation, particularly for those living closest to the WTC. In addition, many people may have decided to postpone routine health care visits in order to attend to more immediate concerns,” said corresponding author James Buehler, research professor, Rollins Center for Public Health Preparedness and Research and department of epidemiology.

While increased mental health care needs were widely reported following Sept. 11, 2001, mental health claims remained below expected levels for six months following the attacks on the WTC. According to Buehler, one possible explanation is that disaster-related stress may have appeared as physical illness, and this led to increases in health care use for conditions such as irregular heat beats, fainting, chest pain or ulcers.

Following declines in use in September, the greatest climbs in claims in the remaining months of 2001 were concentrated in such conditions, and the increases were greatest among those living within 10 miles of the WTC. Overall, the increase in office visits represented an increase of more than 200,000 visits over expected levels between October 2001 and March 2002.

“The particular cardiovascular, gastrointestinal and skin diseases we examined are known to have a link to stress,” Buehler said. “Additionally, cases of skin infections and severe respiratory disease caused by anthrax subsequent to the WTC attacks were featured prominently in the media, and it is also possible that some of the increase in health care use may have been prompted by concerns about anthrax.”

The hope is that if a similar episode of terrorism were to happen in the United States, the researchers’ findings will help health care providers anticipate health care needs and usage.

Principal investigators for the project were Ruth L. Berkelman, professor and director, Emory Center for Public Health Preparedness and Research, and Diane C. Green, currently at the CDC but formerly at the Emory Center on Health Outcomes and Quality.

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