Healthcare access, utilization, and quality after a disaster: results from the Brumadinho Health Project

In January 2019 a dam at the Córrego do Feijão mine suffered a catastrophic failure that killed 270 people and caused extensive damage. It is unknown how exposure to such a disaster might affect healthcare utilization.

Methods:

We assessed survey data from the Brumadinho Health Project, a cohort study that includes people who were exposed to the dam failure and two comparison groups: people unexposed to mining or the disaster and people from a mining community, but not exposed to the disaster. Main outcomes include any doctor visit or hospitalization in the past year, having a usual source of healthcare, having blood pressure and blood sugar checked, and being up to date with vaccinations, for adults 18 years and over. We used survey-weighted robust Poisson regression to assess differences between those exposed and the two comparison groups while controlling for confounders.

Results:

In multivariable models, the exposed group had a 15% higher chance of having a doctor visit than the unexposed group. For hospitalization and reports of blood pressure and blood sugar assessments, there was no significant difference among any of the groups. The exposed group had a 24% higher chance and the unexposed mining community had a 143% higher chance of being up to date with immunizations, as compared to the unexposed group.

Conclusion:

There were some differences in healthcare utilization among individuals exposed to the dam failure. Continued monitoring of the situation is warranted, as the full consequences of such a traumatic event may take considerable time to unfold.

Keywords:
Disaster; Healthcare; Mining; Cohort

	Unexposed n=1,453	Exposed n=881	Mining only n=471	Total n=2,805
Age (mean)	48.60	45.07	43.71	48.42^* * p<0.001;
Age (mean)	[47.37–49.83]	[43.71–46.42]	[42.03–45.38]	[47.25–49.60]
Female	56.84	51.73	54.91	56.65
Female	[54.44–59.20]	[49.51–53.95]	[51.79–58.00]	[54.37–58.91]
Partnered (v single)	59.57	63.5	57.03	59.65
Partnered (v single)	[56.14–62.91]	[59.45–67.38]	[51.63–62.27]	[56.37–62.84]
White (v others)	43.04	28.04	22.1	42.23^* * p<0.001;
White (v others)	[39.46–46.69]	[24.72–31.62]	[18.21–26.56]	[38.82–45.72]
Secondary education +	63.33	52.72	56.72	62.92^* * p<0.001;
Secondary education +	[60.39–66.17]	[48.96–56.46]	[51.84–61.46]	[60.11–65.65]
Wealth 1 (poorest)	31.37	30.26	36.92	31.43
Wealth 1 (poorest)	[27.57–35.44]	[26.04–34.85]	[30.42–43.94]	[27.80–35.31]
Wealth 2 (middle)	29.4	35.21	33.9	29.65
Wealth 2 (middle)	[25.49–33.63]	[30.36–40.39]	[27.59–40.85]	[25.91–33.68]
Wealth 3 (richest)	39.23	34.53	29.17	38.92
Wealth 3 (richest)	[34.94–43.70]	[29.55–39.86]	[22.97–36.27]	[34.82–43.19]
Health needs^† † Health needs (low, medium, high) were assessed by a measure created from principal components analysis of the number of chronic conditions and poor self-rated health and divided into tertiles where the category “few” refers to those with the smallest number of health problems. (low)	35.25	30.6	34.77	35.1^* * p<0.001;
	[32.06–38.58]	[27.72–33.64]	[30.54–39.27]	[32.06–38.27]
Health needs^† † Health needs (low, medium, high) were assessed by a measure created from principal components analysis of the number of chronic conditions and poor self-rated health and divided into tertiles where the category “few” refers to those with the smallest number of health problems. (medium)	35.23	29.51	32.74	35.01
	[32.17–38.41]	[26.71–32.47]	[28.88–36.85]	[32.10–38.05]
Health needs^† † Health needs (low, medium, high) were assessed by a measure created from principal components analysis of the number of chronic conditions and poor self-rated health and divided into tertiles where the category “few” refers to those with the smallest number of health problems. (high)	29.52	39.89	32.49	29.88
	[26.51–32.73]	[36.74–43.13]	[28.38–36.88]	[27.00–32.94]
Doctor visit <12 months	73.25	83.93	78.1	73.64^* * p<0.001;
Doctor visit <12 months	[70.52–75.81]	[81.37–86.20]	[73.89–81.79]	[71.04–76.09]
Hospital visit <12 months	9.38	8.9	13.87	9.44
Hospital visit <12 months	[7.48–11.69]	[7.22–10.93]	[10.97–17.39]	[7.62–11.63]
Usual source of care	59.16	38.99	76.92	58.85^* * p<0.001;
Usual source of care	[55.89–62.34]	[35.91–42.17]	[72.47–80.85]	[55.75–61.89]
All vaccines up to date	38.12	38.64	71.1	38.66^* * p<0.001;
All vaccines up to date	[35.04–41.29]	[35.11–42.30]	[65.06–76.46]	[35.71–41.69]
BP checked	78.88	80.28	83.92	79
BP checked	[76.06–81.44]	[77.00–83.19]	[80.13–87.11]	[76.31–81.46]
Blood sugar checked	56.47	53.47	58.18	56.41
Blood sugar checked	[53.25–59.64]	[49.31–57.59]	[53.54–62.68]	[53.33–59.45]
Private health plan	35.66	24.14	28.44	35.19^* * p<0.001;
Private health plan	[32.33–39.13]	[20.71–27.94]	[23.24–34.29]	[32.01–38.50]

	Doctor visit	Hospital	USC	BP check	Diabetes check	All vaccines
Exposed (v not)	1.15^* * p<0.001;	0.89	0.71^* * p<0.001;	1.05	0.86	1.24^* * p<0.001;
Exposed (v not)	1.09–1.20	0.65–1.2	0.64–0.7	0.99–1.1	0.65–1.15	1.10–1.41
Miners (v not)	1.12^* * p<0.001;	1.49^† † p<0.05;	1.42^* * p<0.001;	1.11^* * p<0.001;	1.27	2.43^* * p<0.001;
Miners (v not)	1.05–1.19	1.08–2.0	1.31–1.5	1.04–1.1	0.94–1.70	2.11–2.78
Age	1.00	1.00	1.01^* * p<0.001;	1.01^* * p<0.001;	1.03^* * p<0.001;	1.03^* * p<0.001;
Age	1.00–1.00	0.99–1.0	1.00–1.0	1.00–1.0	1.02–1.04	1.03–1.04
Female (v male)	1.13^* * p<0.001;	1.1	1.22^* * p<0.001;	1.05	1.41	1.02
Female (v male)	1.06–1.22	0.71–1.6	1.11–1.3	0.99–1.1	0.99–2.02	0.91–1.15
Partnered (v single)	1	0.95	0.99	0.96	0.91	0.99
Partnered (v single)	0.93–1.07	0.64–1.4	0.89–1.1	0.90–1.0	0.66–1.26	0.84–1.16
White (v others)	1.03	0.96	1.11^† † p<0.05;	1.04	1.09	1.11
White (v others)	0.97–1.10	0.62–1.4	1.00–1.2	0.98–1.1	0.79–1.50	0.96–1.28
Secondary ed (v less)	0.97	0.91	1.19^‡ ‡ p<0.01.	1.00	0.93	1.09
Secondary ed (v less)	0.90–1.05	0.56–1.4	1.06–1.3	0.93–1.0	0.62–1.37	0.91–1.30
Wealth 2 (v poor)	1.11	1.02	1.04	1.08	1.47	1.04
Wealth 2 (v poor)	1.00–1.24	0.65–1.6	0.89–1.2	0.98–1.1	1.03–2.11	0.84–1.27
Wealth 3 (v poor)	1.19^‡ ‡ p<0.01.	0.9	1.00	1.09	0.75	1.29^† † p<0.05;
Wealth 3 (v poor)	1.07–1.32	0.51–1.5	0.84–1.1	1.00–1.2	0.45–1.25	1.04–1.58
Health 2 (v low)	1.33^* * p<0.001;	1.57	1.17^† † p<0.05;	1.2^* * p<0.001;	5.47^‡ ‡ p<0.01.	1.19^† † p<0.05;
Health 2 (v low)	1.20,1.47	0.85–2.9	1.03–1.3	1.10–1.3	1.94–15.46	1.00–1.40
Health 3 (v low)	1.5^* * p<0.001;	2.76^* * p<0.001;	1.32^* * p<0.001;	1.31^* * p<0.001;	10.52^* * p<0.001;	1.22^† † p<0.05;
Health 3 (v low)	1.36–1.65	1.56–4.8	1.16–1.5	1.20–1.4	3.76–29.43	1.02–1.46
Private plan	1.2^* * p<0.001;	1.34	1.23^* * p<0.001;	1.17^* * p<0.001;	1.09	1.22^† † p<0.05;
Private plan	1.10–1.30	0.88–2.0	1.09–1.4	1.08–1.2	0.68–1.74	1.01–1.47
N	2,676	2,755	2,765	2,757	2,766	2,738

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E-mail: revbrepi@usp.br

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[1] CORRESPONDING AUTHOR: James Macinko. 650 Charles E. Young Dr. South, room 71-267, Center for Health Sciences, Los Angeles, CA 90095-1772 USA. E-mail: jmacinko@ucla.edu