Health care, unmet needs & demographic characteristics of

CSHCN who fled the 2005 Gulf Coast Hurricanes

Kathleen S. O’Connor, MPHCenters for Disease Control and Prevention

National Center for Health Statistics

2008 AcademyHealth Annual Research Meeting June 8, 2008

Washington, DC

Centers for Disease Control and PreventionNational Center for Health Statistics

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Acknowledgement

Rosa M. Avila

Bonnie Strickland

Michael D. Kogan

Stephen J. Blumberg

Peter C. van Dyck

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1 Defined as Alabama, Florida, Louisiana, Mississippi & Texas2 Durable medical equipment (DME)

Presentation goalsall comparisons 0-17 years old (with one exception)

(1)Compare children with & without special health care needs

(2)Compare Gulf Coast1 CSHCN who did & did not evacuate

(3)Describe CSHCN evacuees• demographic & SES characteristics• health care use, unmet health care & DME2 needs (during & post-

evacuation)• housing status @ 2006 interview

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Data source

• 2005 – 2006 National Survey of Children with Special Health Care Needs (NS-CSHCN)

• Funder: Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB)

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2005 – 2006 NS-CSHCN

• Data collection: Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), State & Local Area Integrated Telephone Survey (SLAITS) mechanism

• Sample frame: CDC’s National Immunization Survey (NIS)

How were CSHCN identified?

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CSHCN Screener• Identified CSHCN using MCHB operative

definition• 5-item parent-reported battery on the child’s

health consequences– Need or use services, RX meds, specialized

therapies, functional difficulties– If “yes” to any one of the 5 stem items and

associated follow-up Qs = CSHCN• Non-condition specific approach reflects

the intentionally broad definition of CSHCNBethell et al., 2002; McPherson et al., 1998

2005-2006 NS-CSHCNdesign features

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Design features

• Population-based cross-sectional study • Landline household telephone survey • Random-digit-dial (RDD)• R = parent/guardian knowledgeable about

child’s health

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LARGE survey• Sample split to screen for CSHCN two different

ways• Main sample:

– Screened 192,083 households that contained 364,841 children

– Identified 56,014 CSHCN who lived in 44,923 screened households

– Completed 40,480 detailed interviews about CSHCN

• Referent sample: – 6,113 completed interviews with CSHCN

(n=1,168) & non-CSHCN (n=4,945)

All was well with the 2005 – 2006 survey

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…until Katrina & Rita visited

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Hurricane questions (1) • Immediately stopped fielding the survey

in affected areas through Fall 2005

• November 2005: MCHB requested additional questions to learn about evacuees

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Hurricane questions (2) • Screening item for hurricane section:

“Last year, did your child leave (his/her) home for one night or longer because of Hurricane Katrina or Rita?”

If “yes”, child was defined as evacuee• Data collection: January 5, 2006 –

February 7, 2007• Did not go back to people interviewed

prior to hurricane landfall to ask this item

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Evacuees and non-evacuees by CSHCN status

CSHCN % non-CSHCN %

EvacueesAny child who screened as evacueeat 2006 interview - could live anywhere in US

23.6 17.7

Non-evacueesat 2006 interview - resident of Gulf Coast who did not evacuate due to Katr/Rita

76.4 82.4

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Average # nights away from home after evacuation (p < 0.05)

• CSHCN evacuees: 11.5

• non-CSHCN evacuees: 6.6

Given that…

a higher percentage of CSHCN evacuated than non-CSHCN

and when CSHCN left, they spent more nights away than non-CSHCN…

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How did CSHCN evacuees & non-evacuees fare after the hurricanes?

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Two comparison groups Specifications 2005 Gulf Coast

hurricane CSHCN evacuees

2005 Gulf Coast hurricane CSHCN

non-evacuees

# cases 1,008 1,561

Inclusion / Exclusion Criteria

Evacuated home due to Hurricanes Katrina or Rita.

At the time of the 2006 interview, evacuees could live in any state or DC

Resident of one of the Gulf Coast States (Alabama, Florida, Louisiana, Mississippi, or Texas) at the time of the 2006 interview who did not evacuate due to Katrina or Rita

Statistical Analyses

Bi- and multivariate: SES, demographics, health indicators, evacuation questionsNOTE: (dep) evacuee status & (dep) severity of condition run in two separate log reg models

Bi- and multivariate: SES, demographics, health indicators

NOTE: (dep) evacuee status in log reg model

Demographic & SES characteristics, health care & health status estimates

CSHCN evacuees vs.

CSHCN non-evacuees

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Demographic characteristics (p < 0.05)

Demographic characteristics

Percent

CSHCN non-evacuees

(lived in Gulf Coast region)

CSHCN evacuees(could live

anywhere in 2006)

(N =1,561) (N = 1,008)

Hispanic 20.7 14.9

Non-Hispanic Black 18.7 35.3

HH income 0-99% of FPL1 20.0 26.6

HH income 400% + of FPL1 27.6 19.2

Lived outside a Metropolitan Statistical Area (MSA)

13.7 21.8

Single mother, no father present 32.6 41.41FPL indicates Federal poverty level (derived from income-to-household size ratio & DHHS Federal poverty guidelines)

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Health status (p < 0.05)

• CSHCN evacuees were more likely to have a condition(s) that moderately/greatly affected their daily activities (33.1%) than CSHCN non-evacuees (23.3%) – Effect remained significant after controlling for SES &

demographic factors • CSHCN 5 – 17 years old: CSHCN evacuees were more

likely to miss 10+ school days due to illness (19.8%) than CSHCN non-evacuees (13.7%)

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Health care (p < 0.05)

• CSHCN evacuees were more likely to live in families that spent > 11 hours per week to provide and/or coordinate their health care (14.1%) than CSHCN non-evacuees (8.7%)– Effect remained significant after controlling for SES &

demographic factors

Unmet needs: CSHCN evacuees

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During evacuation• CSHCN required special arrangements to

leave home: open-ended question• 14.0% of CSHCN evacuees required

special arrangements to leave home - of these CSHCN:– 25.8% needed electricity for DME– 35.8% needed more medications, refills, or medical supplies

After controlling for SES & demographic factors, CSHCN evacuees with condition(s) that moderately or greatly affected daily activities were more likely to need special arrangements during evacuation (p < 0.05)

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Post-evacuation

• 3.4% of CSHCN evacuee’s families had trouble finding temporary shelter due to the CSHCN’s health condition(s)

• 28.5% of CSHCN evacuees needed health care while away from home

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Post-evacuation • 13.1% of CSHCN evacuees needed medical

equipment while away from home

– After controlling for SES & demographic factors: • evacuees with condition(s) that greatly affected daily

activities were more likely to need medical equipment • CSHCN evacuees who needed medical equipment

post-evacuation were more likely to:– be 12 to 17 years old– live in a household with total household income of

0 to 99% FPL

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Evacuee housing status @ time of 2006 interview

• 89.6% of CSHCN evacuees moved back to their same home

• Of those who did not move back home– 45.5% were still in temporary/short-term housing

• After controlling for SES & demographic factors:– evacuees with condition(s) that greatly affected daily

activities were less likely to move back home– CSHCN who moved back home post-evacuation were:

• less likely to be non-Hispanic black• less likely to live in a single mother-led household

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Conclusions (1)

• Approximately 24% of CSHCN who lived within five Gulf Coast states evacuated b/c of the hurricanes

• CSHCN evacuees were significantly more likely:– to be non-Hispanic black– lived in lower income and single mother-led

households

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Conclusions (2)• CSHCN evacuees were more likely to:

– have more severe condition(s) that required additional:• care coordination• special arrangements to leave home• medical equipment

• The majority of CSHCN evacuees moved back to the same home

• CSHCN evacuees who were less likely to move back home post-evacuation: – had condition(s) that greatly impacted daily activities– were non-Hispanic black– lived in single mother-led households

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ReferencesBethell CD, Read D, Stein RE, et al. Identifying children with

special health care needs: development and evaluation of a short screening tool. Ambulatory Pediatrics 2002;2:38-48.

*Blumberg SJ, Olsen L, Frankel M, et al. Design and Operation of the National Survey of Children with Special Health Care Needs, 2001. National Center for Health Statistics. Vital Health Stat 1(41). 2003.

*Blumberg SJ, Welch EM, Chowdhury SR, et al. Design and Operation of the National Survey of Children with Special Health Care Needs, 2005-06. National Center for Health Statistics. Vital Health Stat 1. Forthcoming. Advance access online version (November 28, 2007).

McPherson M, Arango P, Fox H, et al. A new definition of children with special health care needs. Pediatrics 1998;102:137-140.

* immediately available at: www.cdc.gov/nchs/slaits.htm

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Contact information

Kathy O’Connor

koconnor1@cdc.gov

301.458.4181

Thanks for your interest!