Skip to main content
PMC home page
Public Health Reports logoLink to Public Health Reports
. 2004 Sep-Oct;119(5):472–478. doi: 10.1016/j.phr.2004.07.004

Medicaid outpatient utilization for waterborne pathogenic illness following Hurricane Floyd.

Christian Setzer 1, Marisa Elena Domino 1
PMCID: PMC1497662  PMID: 15313110

Abstract

OBJECTIVES: 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.

Full Text

The Full Text of this article is available as a PDF (101.1 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bowie W. R., King A. S., Werker D. H., Isaac-Renton J. L., Bell A., Eng S. B., Marion S. A. Outbreak of toxoplasmosis associated with municipal drinking water. The BC Toxoplasma Investigation Team. Lancet. 1997 Jul 19;350(9072):173–177. doi: 10.1016/s0140-6736(96)11105-3. [DOI] [PubMed] [Google Scholar]
  2. Brooks R. W., Parker B. C., Gruft H., Falkinham J. O., 3rd Epidemiology of infection by nontuberculous mycobacteria. V. Numbers in eastern United States soils and correlation with soil characteristics. Am Rev Respir Dis. 1984 Oct;130(4):630–633. doi: 10.1164/arrd.1984.130.4.630. [DOI] [PubMed] [Google Scholar]
  3. Cole D., Todd L., Wing S. Concentrated swine feeding operations and public health: a review of occupational and community health effects. Environ Health Perspect. 2000 Aug;108(8):685–699. doi: 10.1289/ehp.00108685. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Curriero F. C., Patz J. A., Rose J. B., Lele S. The association between extreme precipitation and waterborne disease outbreaks in the United States, 1948-1994. Am J Public Health. 2001 Aug;91(8):1194–1199. doi: 10.2105/ajph.91.8.1194. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Domino Marisa Elena, Fried Bruce, Moon Yoosun, Olinick Joshua, Yoon Jangho. Disasters and the public health safety net: Hurricane Floyd hits the North Carolina Medicaid program. Am J Public Health. 2003 Jul;93(7):1122–1127. doi: 10.2105/ajph.93.7.1122. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Dworkin M. S., Goldman D. P., Wells T. G., Kobayashi J. M., Herwaldt B. L. Cryptosporidiosis in Washington State: an outbreak associated with well water. J Infect Dis. 1996 Dec;174(6):1372–1376. doi: 10.1093/infdis/174.6.1372. [DOI] [PubMed] [Google Scholar]
  7. Eisenberg J. N., Seto E. Y., Colford J. M., Jr, Olivieri A., Spear R. C. An analysis of the Milwaukee cryptosporidiosis outbreak based on a dynamic model of the infection process. Epidemiology. 1998 May;9(3):255–263. [PubMed] [Google Scholar]
  8. Elkana Y., Gal N., Rishpon S. Study of the association between waterborne diseases and microbial water quality in Israel. Public Health Rev. 1996;24(1):49–63. [PubMed] [Google Scholar]
  9. Hirata M., Kuropakornpong V., Arun S., Sapchatura M., Kumnurak S., Sukpipatpanont B., Chongsuvivatwong V., Funahara Y., Sato S. A case-control study of acute diarrheal disease among school-age children in southern Thailand. Southeast Asian J Trop Med Public Health. 1997;28 (Suppl 3):18–22. [PubMed] [Google Scholar]
  10. Kean B. H., William D. C., Luminais S. K. Epidemic of amoebiasis and giardiasis in a biased population. Br J Vener Dis. 1979 Oct;55(5):375–378. doi: 10.1136/sti.55.5.375. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Kent G. P., Greenspan J. R., Herndon J. L., Mofenson L. M., Harris J. A., Eng T. R., Waskin H. A. Epidemic giardiasis caused by a contaminated public water supply. Am J Public Health. 1988 Feb;78(2):139–143. doi: 10.2105/ajph.78.2.139. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Levine W. C., Stephenson W. T., Craun G. F. Waterborne disease outbreaks, 1986-1988. MMWR CDC Surveill Summ. 1990 Mar;39(1):1–13. [PubMed] [Google Scholar]
  13. Mac Kenzie W. R., Hoxie N. J., Proctor M. E., Gradus M. S., Blair K. A., Peterson D. E., Kazmierczak J. J., Addiss D. G., Fox K. R., Rose J. B. A massive outbreak in Milwaukee of cryptosporidium infection transmitted through the public water supply. N Engl J Med. 1994 Jul 21;331(3):161–167. doi: 10.1056/NEJM199407213310304. [DOI] [PubMed] [Google Scholar]
  14. Tulchinsky T. H., Burla E., Clayman M., Sadik C., Brown A., Goldberger S. Safety of community drinking-water and outbreaks of waterborne enteric disease: Israel, 1976-97. Bull World Health Organ. 2003 Nov 17;78(12):1466–1473. [PMC free article] [PubMed] [Google Scholar]
  15. Weniger B. G., Blaser M. J., Gedrose J., Lippy E. C., Juranek D. D. An outbreak of waterborne giardiasis associated with heavy water runoff due to warm weather and volcanic ashfall. Am J Public Health. 1983 Aug;73(8):868–872. doi: 10.2105/ajph.73.8.868. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Wing S., Cole D., Grant G. Environmental injustice in North Carolina's hog industry. Environ Health Perspect. 2000 Mar;108(3):225–231. doi: 10.1289/ehp.00108225. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Wing S., Wolf S. Intensive livestock operations, health, and quality of life among eastern North Carolina residents. Environ Health Perspect. 2000 Mar;108(3):233–238. doi: 10.1289/ehp.00108233. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Wing Steve, Freedman Stephanie, Band Lawrence. The potential impact of flooding on confined animal feeding operations in eastern North Carolina. Environ Health Perspect. 2002 Apr;110(4):387–391. doi: 10.1289/ehp.02110387. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Public Health Reports are provided here courtesy of SAGE Publications

RESOURCES