Abstract
This paper examined the effect of Hurricane Katrina on children’s access to personal healthcare providers and evaluated the
use of propensity score methods to compare a nationally representative sample of children, as a proxy for an unexposed group,
with a smaller exposed sample. 2007 data from the Gulf Coast Child and Family Health (G-CAFH) Study, a longitudinal cohort
of households displaced or greatly impacted by Hurricane Katrina, were matched with 2007 National Survey of Children’s Health
(NSCH) data using propensity score techniques. Propensity scores were created using poverty level, household educational attainment,
and race/ethnicity, with and without the addition of child age and gender. The outcome was defined as having a personal healthcare
provider. Additional confounders (household structure, neighborhood safety, health and insurance status) were also examined.
All covariates except gender differed significantly between the exposed (G-CAFH) and unexposed (NSCH) samples. Fewer G-CAFH
children had a personal healthcare provider (65 %) compared to those from NSCH (90 %). Adjusting for all covariates, the propensity
score analysis showed exposed children were 20 % less likely to have a personal healthcare provider compared to unexposed
children in the US (OR = 0.80, 95 % CI 0.76, 0.84), whereas the logistic regression analysis estimated a stronger effect (OR = 0.28,
95 % CI 0.21, 0.39). Two years after Hurricane Katrina, children exposed to the storm had significantly lower odds of having
a personal health care provider compared to unexposed children. Propensity score matching techniques may be useful for combining
separate data samples when no clear unexposed group exists.
use of propensity score methods to compare a nationally representative sample of children, as a proxy for an unexposed group,
with a smaller exposed sample. 2007 data from the Gulf Coast Child and Family Health (G-CAFH) Study, a longitudinal cohort
of households displaced or greatly impacted by Hurricane Katrina, were matched with 2007 National Survey of Children’s Health
(NSCH) data using propensity score techniques. Propensity scores were created using poverty level, household educational attainment,
and race/ethnicity, with and without the addition of child age and gender. The outcome was defined as having a personal healthcare
provider. Additional confounders (household structure, neighborhood safety, health and insurance status) were also examined.
All covariates except gender differed significantly between the exposed (G-CAFH) and unexposed (NSCH) samples. Fewer G-CAFH
children had a personal healthcare provider (65 %) compared to those from NSCH (90 %). Adjusting for all covariates, the propensity
score analysis showed exposed children were 20 % less likely to have a personal healthcare provider compared to unexposed
children in the US (OR = 0.80, 95 % CI 0.76, 0.84), whereas the logistic regression analysis estimated a stronger effect (OR = 0.28,
95 % CI 0.21, 0.39). Two years after Hurricane Katrina, children exposed to the storm had significantly lower odds of having
a personal health care provider compared to unexposed children. Propensity score matching techniques may be useful for combining
separate data samples when no clear unexposed group exists.
- Content Type Journal Article
- Pages 1-8
- DOI 10.1007/s10995-012-1006-y
- Authors
- Tasha Stehling-Ariza, National Center for Disaster Preparedness, Mailman School of Public Health, Columbia University, 215 W. 125th Street, Suite 303, New York, NY 10027, USA
- Yoon Soo Park, National Center for Disaster Preparedness, Mailman School of Public Health, Columbia University, 215 W. 125th Street, Suite 303, New York, NY 10027, USA
- Jonathan J. Sury, National Center for Disaster Preparedness, Mailman School of Public Health, Columbia University, 215 W. 125th Street, Suite 303, New York, NY 10027, USA
- David Abramson, National Center for Disaster Preparedness, Mailman School of Public Health, Columbia University, 215 W. 125th Street, Suite 303, New York, NY 10027, USA
- Journal Maternal and Child Health Journal
- Online ISSN 1573-6628
- Print ISSN 1092-7875