Objective: The impact of natural disasters on medical utilization is largely unknown and often overlooked how it affects bereaving and non-bereaving survivors. The aim of this study is to determine the medical utilization between both survivor groups and long-term effects.

Study design: A 10-year 1999-2009 population-based retrospective study by using the National Health Insurance claim database and the Household Registration database from the Department of Health, Executive Yuan, Taiwan.

Settings: Taiwan 1999 Chi-Chi earthquake-affected areas.

Participants: A total of 49 834 individuals which included 1183 bereaving survivors and 48 651 non-bereaving earthquake survivors.

Intervention(s): None.

Main Outcome Measures: Medical utilization of bereaving and non-bereaving survivors.

Results: The results showed that bereaving survivors had significantly more outpatient visits before the earthquake, within 3-month period and 1 year after earthquake (odds ratio (OR) = 1.11, 1.16 and 1.08). However, after 1 year after earthquake their outpatient visits were not significantly different from non-bereaving, and even significantly less in some years. Inpatient visits of bereaving survivors had similar trend to outpatient visits, i.e. visits were more both before earthquake and within 3-month period after earthquake (OR = 1.59 and 1.89), however, they were not significantly higher than non-bereaving survivors for the following years of the study.

Conclusion: Our study reveals that compared to non-bereaving survivors, bereaving survivors slightly had higher medical utilization in the beginning stage of earthquake, i.e. for the first 3-month period or 1 year after earthquake. However, there were no differences between these two groups in medical utilization including outpatient and inpatient visits in long run.

Original languageEnglish
Pages (from-to)64-69
Number of pages6
JournalInternational Journal for Quality in Health Care
Issue number1
Publication statusPublished - Feb 1 2019


  • bereaving survivors
  • earthquake
  • health expenditure
  • health risk
  • medical utilization
  • nature disasters

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health


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