title: Disaster and subsequent healthcare utilization: a longitudinal study among victims, their family members, and control subjects.
abstract: BACKGROUND
  The impact of disasters on primary healthcare utilization is largely unknown. Moreover, it is often overlooked how disaster affects those closest to the primary victims, their family members.
  
  
  OBJECTIVE
  The objective of this study was to examine the long-term effects of a catastrophic fire on primary healthcare utilization.
  
  
  METHODS
  We conducted a prospective, population-based cohort study covering 1 year pre- and 3 years postfire. Utilization data were extracted from primary care records.
  
  
  METHODS
  Subjects consisted of 286 disaster victims, 802 family members of disaster victims, 3722 community control subjects, and 10,230 patients from a national reference population.
  
  
  METHODS
  As outcome measures, we studied 1) the annual number of contacts in primary care and 2) the annual number of contacts for problems related to mental health. Determinants are injury characteristics of victims and bereavement. All analyses control for age, gender, and insurance status.
  
  
  RESULTS
  Being an uninjured victim who witnessed the disaster increases the number of contacts by a factor of 1.55 during the first year postfire (95% confidence interval [CI], 1.35-1.78). Uninjured victims contact the family practitioner more often for mental health-related problems than adolescent community control subjects (incidence rate ratio [IRR], 4.54; 95% CI, 1.69-12.20). In adult family members, the loss of a child predicts overall utilization (IRR, 1.88; 95% CI, 1.35-2.63) and utilization for mental health (IRR, 8.69; 95% CI, 2.10-35.92) during the first year postfire.
  
  
  CONCLUSIONS
  Attention should be paid to the primary care needs of bereaved individuals and those who have witnessed the disaster.
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands. t.dorn@nivel.nl
authors.forename: Tina
authors.initials: T
authors.lastname: Dorn
authors.forename: C Joris
authors.initials: CJ
authors.lastname: Yzermans
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Kerssens
authors.forename: Peter M M
authors.initials: PM
authors.lastname: Spreeuwenberg
authors.forename: Jouke
authors.initials: J
authors.lastname: van der Zee
mesh_terms: D000293:Adolescent; D001601:Bereavement; D002056:Burns / Q000523:psychology / Q000628:therapy*; D005190:Family / Q000523:psychology*; D005260:Female; D005390:Fires; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D017741:Survivors / Q000523:psychology*