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Northrop AJ, Flores NM, Do V, Sheffield PE, Casey JA. Power outages and pediatric unintentional injury hospitalizations in New York State. Environ Epidemiol 2024; 8:e287. [PMID: 38343741 PMCID: PMC10852386 DOI: 10.1097/ee9.0000000000000287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/23/2023] [Indexed: 03/28/2024] Open
Abstract
Background In the past decade, electrical power disruptions (outages) have increased in the United States, especially those attributable to weather events. These outages have a range of health impacts but are largely unstudied in children. Here, we investigated the association between outages and unintentional injury hospitalizations, a leading cause of childhood morbidity. Methods The study setting was New York State (NYS) from 2017 to 2020. Outage exposure was defined as ≥10%, ≥20%, and ≥50% of customers from a power operating locality without power, ascertained from NYS Department of Public Service records and stratified by rural, urban non-New York City (NYC), and NYC regions. Outcome daily block group-level pediatric injury hospitalization data was from the Statewide Planning and Research Cooperative System (SPARCS). We leveraged a case-crossover study design with logistic conditional regression. Results We identified 23,093 unintentional injury hospitalizations in children <18 years with complete block group and exposure data. Most hospitalizations occurred in urban regions (90%), whereas outages were more likely in rural than urban areas. In urban non-NYC regions, outages ≥4 hours were associated with 30% increased odds of all-cause unintentional injury hospitalizations when ≥50% of customers were without power. Analyses by injury subtype revealed increasing point estimates as the proportion of customers exposed increased. These results, however, had wide confidence intervals. Conclusions Outage exposure differed significantly across rural, urban non-NYC, and NYC regions across New York. Especially at the highest outage threshold, we observed an increased risk of pediatric unintentional injury hospitalizations.
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Affiliation(s)
- Alexander J. Northrop
- Vagelos College of Physicians and Surgeons, Columbia University, New York
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City
| | - Nina M. Flores
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York
| | - Vivian Do
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York
| | - Perry E. Sheffield
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City
| | - Joan A. Casey
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington
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Alfaro S, Sen-Crowe B, Autrey C, Elkbuli A. Trends in carbon monoxide poisoning deaths in high frequency hurricane states from 2014-19: the need for prevention intervention strategies. J Public Health (Oxf) 2022:6576186. [PMID: 35511082 DOI: 10.1093/pubmed/fdac053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Hurricanes often result in power outages, which increase generator usage and carbon monoxide (CO) deaths. We aim to identify states with the highest frequency of hurricanes and evaluate the number of unintentional CO poisoning deaths by region, age, race and metropolitan distribution. METHODS The number of hurricanes was determined using the FEMA database, and the number of unintentional CO poisoning deaths was determined using the CDC WONDER database from 2014-19. Hurricane-associated consumer outages were obtained from the Department of Energy. RESULTS The number of unintentional CO poisoning deaths was as follows: Florida, South Carolina, North Carolina, Georgia and Alabama. Adults displayed a significantly higher number of unintentional CO poisoning deaths than pediatrics (P < 0.001). The total number of unintentional CO poisoning deaths was highest in the White population (P < 0.001); however, unintentional CO poisoning death rates were nearly two times higher among Black population in adults (0.5 versus 0.3) and pediatrics (0.2 versus 0.1). Medium metropolitan areas exhibited significantly more unintentional CO poisoning deaths (P < 0.001). CONCLUSIONS Hurricanes and unintentional CO poisoning deaths were most common in Florida. Death rates were higher among Black individuals. Medium metropolitan areas displayed significantly more unintentional CO poisoning deaths than all other areas.
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Affiliation(s)
- Sophie Alfaro
- A.T. Still University School of Osteopathic Medicine, Mesa, Arizona, USA
| | | | - Cody Autrey
- Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA.,Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA
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Abstract
PURPOSE OF REVIEW Tropical cyclones impact human health, sometimes catastrophically. Epidemiological research characterizes these health impacts and uncovers pathways between storm hazards and health, helping to mitigate the health impacts of future storms. These studies, however, require researchers to identify people and areas exposed to tropical cyclones, which is often challenging. Here we review approaches, tools, and data products that can be useful in this exposure assessment. RECENT FINDINGS Epidemiological studies have used various operational measures to characterize exposure to tropical cyclones, including measures of physical hazards (e.g., wind, rain, flooding), measures related to human impacts (e.g., damage, stressors from the storm), and proxy measures of distance from the storm's central track. The choice of metric depends on the research question asked by the study, but there are numerous resources available that can help in capturing any of these metrics of exposure. Each has strengths and weaknesses that may influence their utility for a specific study. Here we have highlighted key tools and data products that can be useful for exposure assessment for tropical cyclone epidemiology. These results can guide epidemiologists as they design studies to explore how tropical cyclones influence human health.
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Casey JA, Fukurai M, Hernández D, Balsari S, Kiang MV. Power Outages and Community Health: a Narrative Review. Curr Environ Health Rep 2020; 7:371-383. [PMID: 33179170 PMCID: PMC7749027 DOI: 10.1007/s40572-020-00295-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW Power outages, a common and underappreciated consequence of natural disasters, are increasing in number and severity due to climate change and aging electricity grids. This narrative review synthesizes the literature on power outages and health in communities. RECENT FINDINGS We searched Google Scholar and PubMed for English language studies with titles or abstracts containing "power outage" or "blackout." We limited papers to those that explicitly mentioned power outages or blackouts as the exposure of interest for health outcomes among individuals living in the community. We also used the reference list of these studies to identify additional studies. The final sample included 50 articles published between 2004 and 2020, with 17 (34%) appearing between 2016 and 2020. Exposure assessment remains basic and inconsistent, with 43 (86%) of studies evaluating single, large-scale power outages. Few studies used spatial and temporal control groups to assess changes in health outcomes attributable to power outages. Recent research linked data from electricity providers on power outages in space and time and included factors such as number of customers affected and duration to estimate exposure. The existing literature suggests that power outages have important health consequences ranging from carbon monoxide poisoning, temperature-related illness, gastrointestinal illness, and mortality to all-cause, cardiovascular, respiratory, and renal disease hospitalizations, especially for individuals relying on electricity-dependent medical equipment. Nonetheless the studies are limited, and more work is needed to better define and capture the relevant exposures and outcomes. Studies should consider modifying factors such as socioeconomic and other vulnerabilities as well as how community resiliency can minimize the adverse impacts of widespread major power outages.
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Affiliation(s)
- Joan A Casey
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Mihoka Fukurai
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Diana Hernández
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Satchit Balsari
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
- FXB Center for Health and Human Rights, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Mathew V Kiang
- FXB Center for Health and Human Rights, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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Carbon monoxide poisoning at a Florida Hospital following Hurricane Irma. Am J Emerg Med 2019; 37:1800-1801. [DOI: 10.1016/j.ajem.2019.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 11/22/2022] Open
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Lessons From an Extreme Hurricane Season. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2017.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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No Calm After the Storm: A Systematic Review of Human Health Following Flood and Storm Disasters. Prehosp Disaster Med 2017; 32:568-579. [PMID: 28606191 DOI: 10.1017/s1049023x17006574] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Introduction How the burden of disease varies during different phases after floods and after storms is essential in order to guide a medical response, but it has not been well-described. The objective of this review was to elucidate the health problems following flood and storm disasters. METHODS A literature search of the databases Medline (US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA); Cinahl (EBSCO Information Services; Ipswich, Massachusetts USA); Global Health (EBSCO Information Services; Ipswich, Massachusetts USA); Web of Science Core Collection (Thomson Reuters; New York, New York USA); Embase (Elsevier; Amsterdam, Netherlands); and PubMed (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA) was conducted in June 2015 for English-language research articles on morbidity or mortality and flood or storm disasters. Articles on mental health, interventions, and rescue or health care workers were excluded. Data were extracted from articles that met the eligibility criteria and analyzed by narrative synthesis. RESULTS The review included 113 studies. Poisonings, wounds, gastrointestinal infections, and skin or soft tissue infections all increased after storms. Gastrointestinal infections were more frequent after floods. Leptospirosis and diabetes-related complications increased after both. The majority of changes occurred within four weeks of floods or storms. CONCLUSION Health changes differently after floods and after storms. There is a lack of data on the health effects of floods alone, long-term changes in health, and the strength of the association between disasters and health problems. This review highlights areas of consideration for medical response and the need for high-quality, systematic research in this area. Saulnier DD , Brolin Ribacke K , von Schreeb J . No calm after the storm: a systematic review of human health following flood and storm disasters. Prehosp Disaster Med. 2017;32(5):568-579.
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Abstract
OBJECTIVE This project aimed to describe demographic patterns and circumstances surrounding injury deaths in New York City (NYC) related to Hurricane Sandy. METHODS Injury deaths related to Hurricane Sandy were classified by using data from multiple sources: NYC's Office of Vital Statistics death records, Office of Chief Medical Examiner case investigation files, and American Red Cross disaster mortality data. Injury deaths were classified as being related to Hurricane Sandy if they were caused directly by the storm's environmental forces or if they were indirectly caused by an interruption of services, displacement, or other lifestyle disruption. RESULTS We identified 52 injury deaths in NYC related to Hurricane Sandy. Most decedents were male (75%); nearly half were aged 65 years and older (48%). Most (77%) deaths were caused by injuries directly related to Hurricane Sandy. Ninety percent of direct deaths were caused by drowning; most (73%) occurred within 3 days of landfall. Half (50%) of the 12 indirect deaths that occurred up to 30 days after the storm were caused by a fall. Nearly two-thirds (63%) were injured at home. Three-quarters (75%) of fatal injuries occurred in evacuation Zone A. CONCLUSIONS Risk communication should focus on older adults, males, and those living in evacuation zones; more evacuation assistance is necessary. NYC's fatal injury profile can inform future coastal storm planning efforts. (Disaster Med Public Health Preparedness. 2016;10:378-385).
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Hampson NB, Dunn SL. Carbon Monoxide Poisoning from Portable Electrical Generators. J Emerg Med 2015; 49:125-9. [PMID: 26032763 DOI: 10.1016/j.jemermed.2014.12.091] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 10/28/2014] [Accepted: 12/21/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Portable electrical generators have been responsible for over 800 accidental carbon monoxide (CO) poisoning deaths in the United States from 1999-2012. OBJECTIVES Because mortality figures are typically the only data reported with regard to the adverse effects of generators, we describe a nonfatal segment of the poisoned population to further emphasize the significance of the problem. METHODS Unidentifiable information about patients treated in the United States with hyperbaric oxygen for acute CO poisoning was prospectively reported by participating centers. Those patients poisoned by portable generators were selected for analysis. RESULTS Of 1604 patients reported from August 1, 2008 to July 31, 2011, there were 264 accidentally poisoned by portable generators. Exposures occurred in 151 incidents in 33 states. In 99 incidents, poisoning occurred in a residence. Average patient age was 37 ± 20 years (range 1 to 90+ years). Of those poisoned, 146 (55%) were non-Hispanic white, 57 (22%) were black, 52 (20%) were Hispanic white, 4 (2%) were Asian, and 4 (2%) were Native American. English was spoken by 96%. The most common symptoms included headache (62%), dizziness (52%), and loss of consciousness (50%). Blood carboxyhemoglobin levels averaged 22.7 ± 9.0% (range 2.3-48.3%). Thirty-six patients demonstrated evidence of cardiac ischemia. CONCLUSIONS Acute, severe CO poisoning from portable electric generators is common in the United States, likely affecting an estimated 4000 individuals annually, occurring predominantly in residential settings, and affecting English language-speaking individuals.
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Affiliation(s)
- Neil B Hampson
- Section of Pulmonary, Critical Care, and Hyperbaric Medicine, Virginia Mason Medical Center, Seattle, Washington
| | - Susan L Dunn
- Section of Pulmonary, Critical Care, and Hyperbaric Medicine, Virginia Mason Medical Center, Seattle, Washington
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Johnson-Arbor KK, Quental AS, Li D. A comparison of carbon monoxide exposures after snowstorms and power outages. Am J Prev Med 2014; 46:481-6. [PMID: 24745638 DOI: 10.1016/j.amepre.2014.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 12/23/2013] [Accepted: 01/09/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Unintentional carbon monoxide poisoning occurs frequently after natural disasters. Although the epidemiology of carbon monoxide exposures that occur after power loss storms has been reported, few publications detail the characteristics of carbon monoxide exposures after massive snowstorms. PURPOSE To compare the differences in patient characteristics of carbon monoxide exposures after a snowstorm and power loss storm. METHODS In 2013, a retrospective review was conducted of patient characteristics and exposure data from all carbon monoxide cases reported to the Connecticut Poison Control Center in the days following both a major snowstorm in 2013 and a winter storm that caused extensive power outages in 2011. RESULTS Portable generators were the most common source of carbon monoxide exposure after a storm that resulted in power losses; car exhaust was the most frequent source of exposure after an extensive snowstorm. Most exposures occurred within the first day after the snowstorm, and on the second and third days after the power outage storm. There were no significant differences between the two storms in terms of patient age, gender, or median carboxyhemoglobin concentration. CONCLUSIONS Future public health and medical education regarding the dangers of carbon monoxide in the aftermath of storms should include attention to the differences in the typical exposure sources and timing.
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Affiliation(s)
| | - Angela S Quental
- Department of Medical Education, Hartford Hospital, Hartford, Connecticut; Department of Biology, Fairfield University, Fairfield, Connecticut
| | - Dadong Li
- Department of Research Administration, Hartford Hospital, Hartford, Connecticut
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Alderman K, Turner LR, Tong S. Floods and human health: a systematic review. ENVIRONMENT INTERNATIONAL 2012; 47:37-47. [PMID: 22750033 DOI: 10.1016/j.envint.2012.06.003] [Citation(s) in RCA: 228] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 06/07/2012] [Indexed: 05/26/2023]
Abstract
Floods are the most common type of disaster globally, responsible for almost 53,000 deaths in the last decade alone (23:1 low- versus high-income countries). This review assessed recent epidemiological evidence on the impacts of floods on human health. Published articles (2004-2011) on the quantitative relationship between floods and health were systematically reviewed. 35 relevant epidemiological studies were identified. Health outcomes were categorized into short- and long-term and were found to depend on the flood characteristics and people's vulnerability. It was found that long-term health effects are currently not well understood. Mortality rates were found to increase by up to 50% in the first year post-flood. After floods, it was found there is an increased risk of disease outbreaks such as hepatitis E, gastrointestinal disease and leptospirosis, particularly in areas with poor hygiene and displaced populations. Psychological distress in survivors (prevalence 8.6% to 53% two years post-flood) can also exacerbate their physical illness. There is a need for effective policies to reduce and prevent flood-related morbidity and mortality. Such steps are contingent upon the improved understanding of potential health impacts of floods. Global trends in urbanization, burden of disease, malnutrition and maternal and child health must be better reflected in flood preparedness and mitigation programs.
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Affiliation(s)
- Katarzyna Alderman
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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