title: Changes in the pattern of service utilisation and health problems of women, men and various age groups following a destructive disaster: a matched cohort study with a pre-disaster assessment.
abstract: OBJECTIVE
  Female gender and young age are known risk factors for psychological morbidity after a disaster, but this conclusion is based on studies without a pre-disaster assessment. The aim of this study in family practice was to investigate if these supposed risk factors would still occur in a study design with a pre-disaster measurement.
  
  
  METHODS
  A matched cohort study with pre-disaster (one year) and post-disaster (five years) data. Community controls (N = 3164) were matched with affected residents (N = 3164) on gender, age and socioeconomic status. Main outcome measures were utilization rates measured by family practice attendances and psychological, musculoskeletal and digestive health problems as registered by the family practitioner using the International Classification of Primary Care (ICPC).
  
  
  RESULTS
  Affected residents of female and male gender and in five age groups all showed increases in utilization rates in the first post-disaster year and in psychological problems when compared to their pre-disaster baseline levels. The increases showed no statistically significant changes, however, between women and men and between all age groups.
  
  
  CONCLUSIONS
  Gender and age did not appear to be disaster-related risk factors in this study in family practice with a pre-disaster base line assessment, a comparison group and using existing registries. Family practitioners should not focus specifically on these risk groups.
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands. soetwaay@xs4all.nl
authors.forename: Rik J H
authors.initials: RJ
authors.lastname: Soeteman
authors.forename: C Joris
authors.initials: CJ
authors.lastname: Yzermans
authors.forename: Peter
authors.initials: P
authors.lastname: Spreeuwenberg
authors.forename: Toine A L M
authors.initials: TA
authors.lastname: Lagro-Janssen
authors.forename: Wil J H M
authors.initials: WJ
authors.lastname: van den Bosch
authors.forename: Jouke
authors.initials: J
authors.lastname: van der Zee