title: Trends in healthcare use in the New York City region following the Terrorist Attacks of 2001.
abstract: BACKGROUND
  In 2001, terrorism led to emotional stress, disruptions in adherence to treatments and access to services, and exposure to environmental contaminants in New York City (NYC).
  
  
  METHODS
  To describe healthcare use following the terrorist attacks of 2001, we examined insurance claims for January 2000 to March 2002 among more than 2 million residents of the NYC region who were enrolled in the health plans of a large insurer, including overall use by care setting and use for selected conditions that may be associated with stress or other disaster consequences. For all enrollees and for those residing at varying distances from the World Trade Center (WTC), we compared observed use to expected use, based on comparable intervals in prior years and adjusted for seasonal and secular trends.
  
  
  RESULTS
  Use declined across all care settings in the 3 weeks following September 11. From October 1 to December 31, 2001, outpatient visits rose beyond expected both overall and for specific cardiovascular, gastrointestinal, and dermatologic conditions. Declines in overall mental health service use began immediately after September 11 and were sustained through March 2002. Changes in healthcare use were more marked among those residing within 10 miles of the WTC than those residing at greater distances.
  
  
  CONCLUSIONS
  A transient decline in visits across all settings occurred immediately after September 11, followed by a sustained increase in demand for health care for conditions that may be associated with stress or other disaster consequences.
authors.affiliation: Emory Center on Health Outcomes and Quality, Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA.
authors.forename: Diane C
authors.initials: DC
authors.lastname: Green
authors.forename: James W
authors.initials: JW
authors.lastname: Buehler
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Silk
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Thompson
authors.forename: Laura A
authors.initials: LA
authors.lastname: Schild
authors.forename: Mitchel
authors.initials: M
authors.lastname: Klein
authors.forename: Ruth L
authors.initials: RL
authors.lastname: Berkelman
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D007345:Insurance Claim Review; D009515:New Jersey / Q000453:epidemiology; D009519:New York City / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D047851:September 11 Terrorist Attacks / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000628:therapy; D014600:Utilization Review / Q000706:statistics & numerical data*
chemical_list: D000900:Anti-Bacterial Agents