Abstract
The collapse of the World Trade Center on September 11, 2001, released a substantial amount of respiratory irritants into the air. To assess the asthma status of Medicaid managed care enrollees who may have been exposed, the New York State Department of Health, Office of Managed Care, conducted a mail survey among enrollees residing in New York City. All enrollees, aged 5–56 with persistent asthma before September 11, 2001, were surveyed during summer 2002. Administrative health service utilization data from the Medicaid Encounter Data System were used to validate and supplement survey responses. A total of 3.664 enrollees responded. Multivariate logistic regression models were developed to examine factors associated with self-reported worsened asthma post September 11, 2001, and with emergency department/inpatient hospitalizations related to asthma from September 11, 2001, through December 31, 2001. Forty-five percent of survey respondents reported worsened asthma post 9/11. Respondents who reported worsened asthma were significantly more likely to have utilized health services for asthma than those who reported stable or improved asthma. Residence in both lower Manhattan (adjusted OR=2.28) and Western Brooklyn (adjusted OR=2.40) were associated with self-reported worsened asthma. However, only residents of Western Brooklyn had an elevated odds ratio for emergency department/inpatient hospitalizations with diagnoses of asthma post 9/11 (adjusted OR=1.52). Worsened asthma was reported by a significant proportion of this low-income, largely minority population and was associated with the location of residence. Results from this study provide guidance to health care organizations in the development of plans to ensure the health of people with asthma during disaster situations.
Keywords: Asthma, Medicaid managed care, Terrorism, World Trade Center
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References
- 1.September 11 News.com. December 2001 Daily Timeline & Chronology of New Events. Available at: http://www.september11news.com/DailyTimelineDec.htm. Accessed October, 2002.
- 2.Lioy PJ, Weisel CP, Millette JR, et al. Characterization of the dust/smoke aerosol that settled east of the World Trade Center (WTC) in Lower Manhattan after the collapse of the WTC 11 September 2001. Environ Health Perspect. 2002;110:703–714. doi: 10.1289/ehp.02110703. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Centers for Disease Control and Prevention Potential exposures to airborne and settled surface dust in residential areas of Lower Manhattan following the collapse of the World Trade Center—New York City, November 4–December 11, 2001. MMWR Morb Mortal Wkly Rep. 2003;52:131–136. [PubMed] [Google Scholar]
- 4.Centers for Disease Control and Prevention Psychological and emotional effects of the September 11 attacks on the World Trade Center — Connecticut, New Jersey and New York, 2001. MMWR Morb Mortal Wkly Rep. 2002;51:784–786. [PubMed] [Google Scholar]
- 5.Galea S, Ahern J, Resnick H, et al. Psychological sequelae of the September 11 terrorist attacks in New York City. N Engl J Med. 2002;346:982–987. doi: 10.1056/NEJMsa013404. [DOI] [PubMed] [Google Scholar]
- 6.HEDIS® 2003 Technical Specifications. Washington, DC: National Committee for Quality Assurance; 2003. pp. 104–106. [Google Scholar]
- 7.International Classification of Diseases, Ninth Revision, Clinical Modification. American Medical Association. Washington, DC: US Government Printing Office; 2000.
- 8.Adult Asthma, Version 2.0: FACCT Quality Measures Measurement Guide. The Foundation for Accountability; 1999. Available at: http://www.markle.org/resources/facet/doclibFiles/documentFile_118.pdf. Accessed February 2, 2005.
- 9.SAS Release. Version 8.02. Cary, NC: SAS Institute; 2001.
- 10.Banauch GI, Alleyne D, Sanchez R, et al. Persistent hyperreactivity and reactive airway dysfunction in firefighters at the World Trade Center. Am J Respir Crit Care Med. 2003;168:54–62. doi: 10.1164/rccm.200211-1329OC. [DOI] [PubMed] [Google Scholar]
- 11.Prezant DJ, Weiden M, Banauch GI, et al. Cough and bronchial responsiveness in firefighters at the World Trade Center site. N Engl J Med. 2002;347:806–815. doi: 10.1056/NEJMoa021300. [DOI] [PubMed] [Google Scholar]
- 12.Centers for Disease Control and Prevention Self-reported increase in asthma severity after the September 11 attacks on the World Trade Center — Manhattan, 2001, New York. MMWR Morb Mortal Wkly Rep. 2002;51:781–784. [PubMed] [Google Scholar]