A Longitudinal Study of Hospital Safety From Disasters in Kermanshah Province, Iran: Insights for Disaster Risk Reduction

OBJECTIVE

The Hospital Safety Index (HSI) developed by the World Health Organization (WHO) was adopted by most countries to evaluate the safety of hospitals against disasters. This study aimed to assess the status of hospital safety from disasters between 2016 and 2022 in Kermanshah province in Iran.

METHODS

This is a retrospective longitudinal study which investigated HSI data from 23 hospitals. Data were gathered by Farsi Hospital Safety Index (FHSI) and analyzed with a repeated measures analysis of variance (ANOVA).

RESULTS

The risk of hydro-meteorological (from 43.1 to 32.7) and biological hazards (51.3 to 35.5) significantly decreased. Although structural safety remained constant (from 67.8 to 70.1), nonstructural (from 51.5 to 71.2), and functional (from 47.1 to 71.2) safety scores increased significantly over study period.

CONCLUSIONS

The findings revealed hospitals safety in Kermanshah province gradually improved. However, the health-care stakeholders should pay the necessary attention to improving the structural safety of hospitals.

Association Between Hurricane Sandy and Emergency Department Visits in New York City by Age and Cause

The magnitude, timing, and etiology of morbidity associated with tropical cyclones remains incompletely quantified. We examined the relative change in cause-specific emergency department (ED) visits among residents of New York City during and after Hurricane Sandy, a tropical cyclone that affected the northeastern United States in October 2012. We used quasi-Poisson constrained distributed lag models to compare the number of ED visits on and after Hurricane Sandy with all other days, 2005-2014, adjusting for temporal trends. Among residents aged ≥65 years, Hurricane Sandy was associated with a higher rate of ED visits due to injuries and poisoning (relative risk (RR) = 1.19, 95% confidence interval (CI): 1.10, 1.28), respiratory disease (RR = 1.35, 95% CI: 1.21, 1.49), cardiovascular disease (RR = 1.10, 95% CI: 1.02, 1.19), renal disease (RR = 1.44, 95% CI: 1.22, 1.72), and skin and soft tissue infections (RR = 1.20, 95% CI: 1.03, 1.39) in the first week following the storm. Among adults aged 18-64 years, Hurricane Sandy was associated with a higher rate of ED visits for renal disease (RR = 2.15, 95% CI: 1.79, 2.59). Among those aged 0-17 years, the storm was associated with lower rates of ED visits for up to 3 weeks. These results suggest that tropical cyclones might result in increased health-care utilization due to a wide range of causes, particularly among older adults.

Association Between Hurricane Sandy and Emergency Department Visits in New York City by Age and Cause

The magnitude, timing, and etiology of morbidity associated with tropical cyclones remains incompletely quantified. We examined the relative change in cause-specific emergency department (ED) visits among residents of New York City during and after Hurricane Sandy, a tropical cyclone that affected the northeastern United States in October 2012. We used quasi-Poisson constrained distributed lag models to compare the number of ED visits on and after Hurricane Sandy with all other days, 2005-2014, adjusting for temporal trends. Among residents aged ≥65 years, Hurricane Sandy was associated with a higher rate of ED visits due to injuries and poisoning (relative risk (RR) = 1.19, 95% confidence interval (CI): 1.10, 1.28), respiratory disease (RR = 1.35, 95% CI: 1.21, 1.49), cardiovascular disease (RR = 1.10, 95% CI: 1.02, 1.19), renal disease (RR = 1.44, 95% CI: 1.22, 1.72), and skin and soft tissue infections (RR = 1.20, 95% CI: 1.03, 1.39) in the first week following the storm. Among adults aged 18-64 years, Hurricane Sandy was associated with a higher rate of ED visits for renal disease (RR = 2.15, 95% CI: 1.79, 2.59). Among those aged 0-17 years, the storm was associated with lower rates of ED visits for up to 3 weeks. These results suggest that tropical cyclones might result in increased health-care utilization due to a wide range of causes, particularly among older adults.

Causal Inference in Studying the Long-Term Health Effects of Disasters: Challenges and Potential Solutions

Two frequently encountered but underrecognized challenges for causal inference in studying the long-term health effects of disasters among survivors include 1) time-varying effects of disasters on a time-to-event outcome and 2) selection bias due to selective attrition. In this paper, we review approaches for overcoming these challenges and demonstrate application of the approaches to a real-world longitudinal data set of older adults who were directly affected by the 2011 Great East Japan Earthquake and Tsunami (n = 4,857). To illustrate the problem of time-varying effects of disasters, we examined the association between degree of damage due to the tsunami and all-cause mortality. We compared results from Cox regression analysis assuming proportional hazards with those derived using adjusted parametric survival curves allowing for time-varying hazard ratios. To illustrate the problem of selection bias, we examined the association between proximity to the coast (a proxy for housing damage from the tsunami) and depressive symptoms. We corrected for selection bias due to attrition in the 2 postdisaster follow-up surveys (conducted in 2013 and 2016) using multivariable adjustment, inverse probability of censoring weighting, and survivor average causal effect estimation. Our results demonstrate that analytical approaches which ignore time-varying effects on mortality and selection bias due to selective attrition may underestimate the long-term health effects of disasters.

Large-scale experiment to assess the collision impact force from a tsunami wave on a drifting castaway

Although most fatalities in tsunami-related disasters are conjectured to be a result of drowning, injury risk owing to collision with other floating debris or fixed buildings has not been studied sufficiently. In this study, the impact force corresponding to the collision of a concrete block and drifting test body in a tsunami wave was experimentally investigated, and the injury risk was evaluated in terms of different biomechanical indexes; specifically, maximum acceleration, head injury criterion, and impact force. The injury risk indicated by the considered indexes was reasonably low. It was noted that if a healthy adult collided with a concrete wall under a velocity of 2.5 m s^-1 and wave height of 0.59 m, the adult would likely not be critically injured. However, a similar collision impact poses considerable risk to infants and children, as well as the more sensitive regions of the adult body. Moreover, in the case of large tsunamis, such as that in the 2011 Great East Japan Earthquake, a drifting person may be at considerable risk for injuries. The collision impact occurring on the tip of a surge flow is notably significantly larger than that on a bore flow. This is because a surge flow, which arrives at the concrete block earlier than a bore flow, forms a certain water layer along the concrete wall and that layer acts as a cushion for any body drifting on the bore flow, indicating the importance of such a buffering effect. These findings can provide practical guidance regarding the formulation of effective tsunami-protection measures.

Exploring the Relationship between Rising Temperatures and the Number of Climate-Related Natural Disasters in China

Warming has strongly influenced the quantity and variability of natural disasters around the globe. This study aims to characterize the varying patterns between rising temperatures and climate-related natural disasters in China from 1951 to 2010. We examined the overall trend in the patterns of an 11-year cycle, and climate-related natural disaster responses to periods of rising and dropping temperature. We used Morlet wavelet analysis to determine the length of a temperature cycle period, and the arc elasticity coefficient to assess the number of climate-related natural disasters in response to the changing temperature. We found that: (1) the overall relationship between temperature and the number of climate-related natural disasters was positive; (2) however, on the cycle level, the pattern of climate-related natural disasters was found to be independent of temperature variation; (3) on the rise-drop level, temperature increases were associated with declines in the number of climate-related natural disasters. Moreover, as temperature decreased, the number of climate-related natural disasters increased substantially, such that temperature had a more considerable influence on the quantity of climate-related natural disasters during the temperature-drop period. Findings in this study can help enhance the dissemination of warning and mitigation efforts to combat natural disasters in the changing climate.

The social impact of natural hazards: a multi-level analysis of disasters and forms of trust in mainland China

This study aimed to assess the multi-level effects of natural hazards on trust in Chinese society. Drawing on the Chinese General Social Survey conducted in 2012 and provincial disaster damage records, it examined the association between individuals' past experiences of disasters and province-level damage (measured by the number of affected people, deaths, and economic loss) and various forms of trust: in-group; out-group; generalised; and political. The findings indicate that Chinese individuals with experience of disasters have higher levels of out-group trust but lower levels of political trust. Similarly, at the province level, damage owing to disasters over the past three years (2009-11) positively impacted on residents' out-group trust while negatively affecting their political trust. However, when provincial damage was aggregated for disasters over the past five years (2007-11), which included the devastating Sichuan earthquake on 12 May 2008, only total deaths had a positive effect on generalised trust.

Development of a Weighted Well-Being Assessment Mobile App for Trauma Affected Communities: A Usability Study

A well-being mobile app was built and tested by performing a usability study in a trauma affected community (TAC). Seven usability tasks were given to social workers during Phase 1. Phase 2 of the usability study was a re-test of the same tasks with the same social workers after refinements were applied. The results showed that most users preferred darker foreground colors, lighter background colors, larger fonts, and larger sized UI components. Statistically significant improvements were found after changes were implemented to the app and included time for page navigation (Z = -2.366, p = 0.018), logout (Z = -1.997, p = 0.046), and item selection in a page (Z = -2.371, p = 0.018). UI positioning and size changes proved to be a significant determinant of user satisfaction based on the positive feedback received from the computer systems usability questionnaire (CSUQ). (User1: p = .000, User 2 withdrew; User3: p = .010, User4: p = .000, User5: p = .001, User6: p = .006, User7: p = .025). HIM professionals assisted in the design, development, and administration of the usability study. This is another area in which HIM professionals are needed when assessing health and wellness in communities affected by trauma.

Predicting commercial fishing vessel disasters through a novel application of the theory of man-made disasters

INTRODUCTION

Vessel disasters (e.g., sinkings, capsizings) are a leading contributor to fatalities in the U.S. commercial fishing industry. Primary prevention strategies are needed to reduce the occurrence of vessel disasters, which can only be done by developing an understanding of their causes and risk factors. If less serious vessel casualties (e.g., loss of propulsion, fire, flooding) are predictors of future disasters, then reducing vessel casualties should in turn reduce vessel disasters and the accompanying loss of life.

METHOD

This case-control study examined the association between vessel casualties and disasters using fishing vessels in Alaska during 2010-2015.

RESULTS

The findings show that vessels that experienced casualties within a preceding 10-year period were at increased odds of disaster. Other significant predictors included safety decal status and hull material. Practical Applications: The results of this analysis emphasize the importance of implementing vessel-specific preventive maintenance plans. At an industry level, specific prevention policies should be developed focusing on high-risk fleets to identify and correct a wide range of safety deficits before they have catastrophic and fatal consequences.

Spatial and temporal patterns and the socioeconomic impacts of landslides in the tropical and mountainous Colombian Andes

Landslides are a natural hazard that presents a major threat to human life and infrastructure. Although they are a very common phenomenon in Colombia, there is a lack of analysis that entails national and comprehensive spatial, temporal, and socioeconomic evaluations of such events based on historical records. This study provides a detailed assessment of the spatial and temporal patterns and the socioeconomic impacts associated with landslides that occurred in the country between 1900 and 2018. Two national landslide databases were consulted and this information was complemented by local and regional landslide catalogues. A total of 30,730 landslides were recorded in the 118-year period. Rainfall is the most common trigger of landslides, responsible for 92 per cent of those registered, but most fatalities (68 per cent) are due to landslides caused by volcanic activity and earthquakes. An 'fN curve' revealed a very high frequency of small and moderate fatal landslides in the time frame.

Florida Department of Agriculture and Consumer Services Mosquito Control Incident Response Team: An Exercise in Using the National Incident Management System's Incident Command System for Disaster Response

The Florida Department of Agriculture and Consumer Services (FDACS) uses a Mosquito Control Incident Response Team (MCIRT) to respond to natural disasters and mosquito borne-disease threats. Since 2001, this team has responded to 9 different events and is responsible for organizing treatment to more than 15 million acres in Florida using wide-area adulticide applications. The MCIRT implements the Incident Command Structure (ICS) to coordinate response efforts because it enables FDACS to quickly deploy staff to the devastated areas, conduct necessary mosquito surveillance, communicate with multiple agencies, and direct mosquito control measures. It also allows for easier transfer of leadership, cross-training of employees, and postevent evaluation.

GIS-based flood hazard mapping using relative frequency ratio method: A case study of Panjkora River Basin, eastern Hindu Kush, Pakistan

Flood is the most devastating and prevalent disaster among all-natural disasters. Every year, flood claims hundreds of human lives and causes damage to the worldwide economy and environment. Consequently, the identification of flood-vulnerable areas is important for comprehensive flood risk management. The main objective of this study is to delineate flood-prone areas in the Panjkora River Basin (PRB), eastern Hindu Kush, Pakistan. An initial extensive field survey and interpretation of Landsat-7 and Google Earth images identified 154 flood locations that were inundated in 2010 floods. Of the total, 70% of flood locations were randomly used for building a model and 30% were used for validation of the model. Eight flood parameters including slope, elevation, land use, Normalized Difference Vegetation Index (NDVI), topographic wetness index (TWI), drainage density, and rainfall were used to map the flood-prone areas in the study region. The relative frequency ratio was used to determine the correlation between each class of flood parameter and flood occurrences. All of the factors were resampled into a pixel size of 30×30 m and were reclassified through the natural break method. Finally, a final hazard map was prepared and reclassified into five classes, i.e., very low, low, moderate, high, very high susceptibility. The results of the model were found reliable with area under curve values for success and prediction rate of 82.04% and 84.74%, respectively. The findings of this study can play a key role in flood hazard management in the target region; they can be used by the local disaster management authority, researchers, planners, local government, and line agencies dealing with flood risk management.

Survival-oriented personality factors are associated with various types of social support in an emergency disaster situation

Mutual help is common in human society, particularly during a disaster. The psychological processes underlying such social support are of interest in social and evolutionary psychology, as well as in the promotion of community resilience. However, research in terms of personality factors or support types is sporadic and has yet to address actual emergency situations. In this study, we analyzed survey data from survivors of the 2011 Tohoku earthquake and tsunami. The data included five types of social support occurring during the evacuation from a potential tsunami area: providing and receiving actual help and oral encouragement, as well as perceived support. The personality factor items included the Big Five dimensions and eight “power to live” factors, which were identified as advantageous for survival during this disaster. While none of the Big Five dimensions were associated with social support, six of the power to live factors were. Altruism, problem solving, etiquette, and self-transcendence contributed to the provision of actual help. Leadership and active well-being contributed to oral encouragement with the latter contributing also to perceived support. The findings were largely consistent with the literature in a non-emergency context. The relevance of the majority of these pro-survival personality factors to social support appeared to support the view that the propensity to cooperate in service of human survival in a disaster situation is primarily a social, rather than an individual, phenomenon, and encourages research on the mechanisms underlying how personality factors provide a benefit to both the individual and their community.

Disaster Risk Perception, Sense of Pace, Evacuation Willingness, and Relocation Willingness of Rural Households in Earthquake-Stricken Areas: Evidence from Sichuan Province, China

Based on survey data from 327 rural households in the areas affected by the Wenchuan Earthquake and Lushan Earthquake in Sichuan Province, this study systematically analyzed disaster risk perception, sense of place, evacuation willingness, and relocation willingness among residents in these earthquake-stricken areas. Further, this study constructed an ordinal logistic regression analysis to probe the correlations between residents’ disaster risk perception or sense of place and evacuation willingness and relocation willingness, respectively. The results showed that (1) faced with the threat of earthquake disasters, residents have a strong willingness to evacuate and relocate. Specifically, 93% and 78% of the residents in the Wenchuan Earthquake and Lushan Earthquake areas were willing to evacuate and relocate, respectively, whereas 4% and 17% of the residents were unwilling to evacuate and relocate, respectively. (2) Place dependence and the severity of disaster occurrence were significantly positively correlated with residents’ evacuation willingness, while the interaction term between place dependence and the severity of disaster occurrence was negatively related to residents’ evacuation willingness. Specifically, when everything else remains constant, every one-unit increase in place dependence and severity corresponds to increases in the odds of willingness to evacuate by factors of 0.042 and 0.051, respectively; every one-unit increase in place dependence × severity corresponds to a decrease in the odds of willingness to evacuation by a factor of 0.004. (3) Place identity was significantly negatively correlated with residents’ relocation willingness, while place dependence and severity of disaster occurrence were positively related to residents’ relocation willingness. The interaction term between place dependence and the severity of disaster occurrence as well as the interaction term between place identity and severity of disaster occurrence were significantly negatively correlated with residents’ relocation willingness. Specifically, every one-unit increase in place identity corresponds to a decrease in the odds of willingness to relocate by a factor of 0.034, while every one-unit increase in place dependence and severity corresponds to increases in the odds of willingness to relocate by factors of 0.041 and 0.028, respectively, and every one-unit increase in place dependence × severity and place identity × severity corresponds to decreases in the odds of willingness to relocate by factors of 0.003 and 0.003, respectively.

Disaster Risk Perception, Sense of Pace, Evacuation Willingness, and Relocation Willingness of Rural Households in Earthquake-Stricken Areas: Evidence from Sichuan Province, China

Based on survey data from 327 rural households in the areas affected by the Wenchuan Earthquake and Lushan Earthquake in Sichuan Province, this study systematically analyzed disaster risk perception, sense of place, evacuation willingness, and relocation willingness among residents in these earthquake-stricken areas. Further, this study constructed an ordinal logistic regression analysis to probe the correlations between residents' disaster risk perception or sense of place and evacuation willingness and relocation willingness, respectively. The results showed that (1) faced with the threat of earthquake disasters, residents have a strong willingness to evacuate and relocate. Specifically, 93% and 78% of the residents in the Wenchuan Earthquake and Lushan Earthquake areas were willing to evacuate and relocate, respectively, whereas 4% and 17% of the residents were unwilling to evacuate and relocate, respectively. (2) Place dependence and the severity of disaster occurrence were significantly positively correlated with residents' evacuation willingness, while the interaction term between place dependence and the severity of disaster occurrence was negatively related to residents' evacuation willingness. Specifically, when everything else remains constant, every one-unit increase in place dependence and severity corresponds to increases in the odds of willingness to evacuate by factors of 0.042 and 0.051, respectively; every one-unit increase in place dependence × severity corresponds to a decrease in the odds of willingness to evacuation by a factor of 0.004. (3) Place identity was significantly negatively correlated with residents' relocation willingness, while place dependence and severity of disaster occurrence were positively related to residents' relocation willingness. The interaction term between place dependence and the severity of disaster occurrence as well as the interaction term between place identity and severity of disaster occurrence were significantly negatively correlated with residents' relocation willingness. Specifically, every one-unit increase in place identity corresponds to a decrease in the odds of willingness to relocate by a factor of 0.034, while every one-unit increase in place dependence and severity corresponds to increases in the odds of willingness to relocate by factors of 0.041 and 0.028, respectively, and every one-unit increase in place dependence × severity and place identity × severity corresponds to decreases in the odds of willingness to relocate by factors of 0.003 and 0.003, respectively.

Spatial and temporal distribution of infectious disease epidemics, disasters and other potential public health emergencies in the World Health Organisation Africa region, 2016-2018

BACKGROUND

Emerging and re-emerging diseases with pandemic potential continue to challenge fragile health systems in Africa, creating enormous human and economic toll. To provide evidence for the investment case for public health emergency preparedness, we analysed the spatial and temporal distribution of epidemics, disasters and other potential public health emergencies in the WHO African region between 2016 and 2018.

METHODS

We abstracted data from several sources, including: the WHO African Region's weekly bulletins on epidemics and emergencies, the WHO-Disease Outbreak News (DON) and the Emergency Events Database (EM-DAT) of the Centre for Research on the Epidemiology of Disasters (CRED). Other sources were: the Program for Monitoring Emerging Diseases (ProMED) and the Global Infectious Disease and Epidemiology Network (GIDEON). We included information on the time and location of the event, the number of cases and deaths and counter-checked the different data sources.

DATA ANALYSIS

We used bubble plots for temporal analysis and generated graphs and maps showing the frequency and distribution of each event. Based on the frequency of events, we categorised countries into three: Tier 1, 10 or more events, Tier 2, 5-9 events, and Tier 3, less than 5 or no event. Finally, we compared the event frequencies to a summary International Health Regulations (IHR) index generated from the IHR technical area scores of the 2018 annual reports.

RESULTS

Over 260 events were identified between 2016 and 2018. Forty-one countries (87%) had at least one epidemic between 2016 and 2018, and 21 of them (45%) had at least one epidemic annually. Twenty-two countries (47%) had disasters/humanitarian crises. Seven countries (the epicentres) experienced over 10 events and all of them had limited or developing IHR capacities. The top five causes of epidemics were: Cholera, Measles, Viral Haemorrhagic Diseases, Malaria and Meningitis.

CONCLUSIONS

The frequent and widespread occurrence of epidemics and disasters in Africa is a clarion call for investing in preparedness. While strengthening preparedness should be guided by global frameworks, it is the responsibility of each government to finance country specific needs. We call upon all African countries to establish governance and predictable financing mechanisms for IHR implementation and to build resilient health systems everywhere.

Long-term Effects of Disasters on Seniors With Diabetes: Evidence From Hurricanes Katrina and Rita

OBJECTIVE

To estimate the long-run mortality effects of Hurricanes Katrina and Rita on seniors with diabetes.

RESEARCH DESIGN AND METHODS

We performed a retrospective cohort analysis of Medicare enrollment and claims data covering four states and ∼10 years. Affected individuals were identified by whether they lived in a county that suffered a high impact and were stratified by whether they moved to a different county following the storms. Propensity scores matched affected and comparison subjects based on demographic and socioeconomic characteristics and the presence of chronic conditions. Our sample consisted of 170,328 matched affected subjects.

RESULTS

The affected subjects had a nearly 40% higher all-cause mortality risk in the 1st month after the storms, but the difference fell to <6% by the end of the full observation period. The mortality risks of heart disease and nephritis also exhibited the largest differences immediately following the storms. Among the affected subjects, the all-cause mortality risk was higher for those who moved to a different county, with an especially large difference among those who moved to an affected county.

CONCLUSIONS

The propensity matching procedure resulted in the comparison and affected groups having similar observable characteristics. However, we only examined the extreme outcome of mortality, our definition of affected was somewhat crude, and our sample did not include individuals enrolled in Medicare Advantage. Our findings highlight the importance of the immediate response to disasters, yet also demonstrate the long-lasting impact disasters can have.

Persistent Hearing Loss among World Trade Center Health Registry Residents, Passersby and Area Workers, 2006-2007

Background: Prior studies have found that rescue and recovery workers exposed to the 9/11 World Trade Center (WTC) disaster have evidence of increased persistent hearing and other ear-related problems. The potential association between WTC disaster exposures and post-9/11 persistent self-reported hearing problems or loss among non-rescue and recovery survivors has not been well studied. Methods: We used responses to the World Trade Center Health Registry (Registry) enrollment survey (2003–2004) and first follow-up survey (2006–2007) to model the association between exposure to the dust cloud and persistent hearing loss (n = 22,741). Results: The prevalence of post-9/11 persistent hearing loss among survivors was 2.2%. The adjusted odds ratio (aOR) of hearing loss for those who were in the dust cloud and unable to hear was 3.0 (95% CI: 2.2, 4.0). Survivors with persistent sinus problems, headaches, PTSD and chronic disease histories had an increased prevalence of reported hearing problems compared to those without symptoms or chronic problems. Conclusions: In a longitudinal study, we observed an association between WTC-related exposures and post-9/11 self-reported hearing loss among disaster survivors.

Debris Flow Syndrome: Injuries and Outcomes after the Montecito Debris Flow

On January 9, 2018, a catastrophic debris flow devastated Montecito, California. A 30-foot wall of boulders, mud, and debris ran down the hillsides at 15 miles per hour injuring dozens and causing 21 prehospital deaths. A retrospective review was conducted of the victims from the debris flow presenting to Cottage Health. Injury patterns, procedures performed, complications, length of stay, and outcomes were analyzed. Twenty-four patients were evaluated; 15 were admitted. Of the patients admitted, the most common presenting symptoms were soft tissue injuries (100%), hypothermia (67%), craniofacial injuries (67%), corneal abrasions (53%), and orthopedic injuries (47%), as well as loss of an immediate family member during the incident (73%). Procedures included skin irrigation (93%), operative soft tissue debridement (47%), body orifice irrigation due to mud impaction (40%), and orthopedic repair of fractures and ligaments (40%). All survived to discharge. "Debris flow syndrome" can be defined as a pattern of injuries, including soft tissue injuries, hypothermia, craniofacial trauma, corneal abrasions, orthopedic injuries, and mud impaction. Managing the debris flow syndrome requires co-ordinated and specialized care.

Cord blood perfluoroalkyl substances in mothers exposed to the World Trade Center disaster during pregnancy

Perfluoroalkyl substances (PFAS) may have been released during the collapse of the World Trade Center (WTC) on 9/11. Evidence suggests PFAS can cross the placental barrier in humans and cause harm to the developing fetus; however, no studies have measured PFAS in mothers exposed to the WTC disaster during pregnancy. We measured PFAS in maternal plasma (n = 48) or cord blood (n = 231) from pregnant women in the Columbia University WTC birth cohort, enrolled between December 13, 2001 and June 26, 2002 at one of three hospitals located near the WTC site. In order to maximize sample size, we used a linear regression to transform the 48 maternal plasma samples to cord blood equivalents in our study; cord blood and transformed maternal plasma-to-cord blood samples were then analyzed together. We evaluated the association between WTC exposure and PFAS concentrations using three exposure variables: 1) living/working within two miles of WTC; 2) living within two miles of WTC regardless of work location; and 3) working but not living within two miles of WTC. Exposure was compared with those not living/working within two miles of WTC (reference group). Living/working within two miles of WTC was associated with 13% higher perfluorooctanoic acid (PFOA) concentrations compared with the reference group [GMR (95% CI): 1.13 (1.01, 1.27)]. The association was stronger when comparing only those who lived within two miles of WTC to the reference group [GMR (95% CI): 1.17 (1.03, 1.33)], regardless of work location. Our results provide evidence that exposure to the WTC disaster during pregnancy resulted in increases in PFAS concentrations, specifically PFOA. This work identifies a potentially vulnerable and overlooked population, children exposed to the WTC disaster in utero, and highlights the importance of future longitudinal studies in this cohort to investigate later life effects resulting from these early life exposures.

Emerging Trends and New Developments in Disaster Research after the 2008 Wenchuan Earthquake

On the tenth anniversary of the 2008 Wenchuan Earthquake, investigating the evolution of disaster science is worthwhile and can be used to improve the future execution of disaster risk management. Based on more than 55,786 articles on the relative topic of “Disaster” derived from the Web of Science Core Collection from 1999–2017, this study employs CiteSpace and Google Earth to identify and visualize the spatial distribution of publications, bursts of keywords and categories, highly cited references, and interdisciplinary levels and then identify the emerging trends of disaster research over the past 20 years. The results show that the earthquake indeed jumpstarted a massive wave of disaster research around the world and increased international cooperation over the last decade. However, in terms of both the quantity and quality of publications in disaster research fields, China is lagging behind the U.S. and European countries. Moreover, although designing disaster prevention and mitigation strategies is a new popular field of disaster science, geological environment changes and geologic hazards triggered by earthquakes are more popular research topics than disaster emergency and recovery. In addition, the transdisciplinary level of disaster science increased after the earthquake. This interdisciplinary characteristic of disaster science gradually increased in popularity, which demonstrates that people can learn from catastrophes. These emerging trends could serve as a scientific basis to clearly understand disaster science progress over the last 20 years and provide a reference for rapidly identifying frontier issues in disaster science.

Simulation modeling for a resilience improvement plan for natural disasters in a coastal area

Floods are threats to ecosystems that are caused by natural disasters such as typhoons and heavy rain, and to respond to these threats, resilience needs to be improved. In this study, the response of the social-ecological system of Haeundae-gu (Busan, Republic of Korea) to disasters is analyzed by using a causal loop diagram, and a resilience improvement plan is presented by simulating the disaster resilience using green infrastructure through the System Resilience Dynamics Model. First, the resilience values are highest when green infrastructure is applied at the maximum applicable ratio (30%) compared with no application. Second, in the public and private areas of Haeundae-gu, resilience according to green roof scenario was higher until approximately 8 h after the beginning of rainfall, but then the resilience according to infiltration storage facility scenario was higher. In the transportation and industrial areas, the overall resilience according to infiltration storage facility scenario was higher than the resilience according to porous pavement scenario. This study demonstrates that a resilience improvement plan based on simulation can support decision making to respond to disasters such as typhoons.

Long-term effects of disaster on depressive symptoms: Type of exposure matters

RATIONALE

Natural disasters have the potential to change the lives of older people, yet most studies rely on small convenience samples, few include assessments of people prior to the disaster, and only a handful examine the effects of different types of exposure.

OBJECTIVE

Our analyses add new knowledge to the literature by examining the ways in which four types of exposure (i.e., geographic, peri-traumatic stress, personal and property loss, and post-storm hardship) affect depressive symptoms experienced by older people over a five-year period.

METHOD

We analyzed four waves of data from the ORANJ BOWL panel using multilevel mixed effects models.

RESULTS

We found that although each type of exposure had an independent effect on depressive symptoms, the effects of peri-traumatic stress were dominant.

CONCLUSIONS

As nearly 20% of people in the United States will experience a natural disaster during the course of their lives, it is critical to understand how disaster exposure can influence mental health because each type of exposure demands a different response. Finding that an individual's emotional response during the disaster plays an important role in the development of depressive symptoms suggests that reduction of exposure to traumatic stress during a storm (i.e., evacuation from a storm area) is important for older people. Likewise, immediate interventions following a disaster that target people experiencing high levels of peri-traumatic distress may be particularly effective and that failing to attend to these people may miss a critical opportunity and result in years of suffering.

An Assessment of the Relationships between Extreme Weather Events, Vulnerability, and the Impacts on Human Wellbeing in Latin America

Climate change and variability are known to have an influence on human wellbeing in a variety of ways. In Latin America, such forces are especially conspicuous, particularly in respect of extreme climatological, hydrological, and weather events (EWEs) and climate-sensitive disasters (CSDs). Consistent with the need to study further such connections, this paper presents an analysis of some of the vulnerabilities of environmental health issues and climate-related impacts that are focusing on EWEs and CSDs in Latin American countries. The research includes an analysis of the (i) human and socio-economic development; (ii) geographical and socio-economic determinants of vulnerability and adaptability of environmental health issues (exposure, sensitivity, and adaptive capacity); (iii) occurrence of CSDs from 1988 to 2017 and their direct impacts on human wellbeing (Total death and Affected people); (iv) an online survey on the perceptions of the effects of EWEs on human wellbeing in a sample of countries in the region; and (v) discussion of possible solutions. The socio-economic and development indices, and the International Disaster Database (EM-DAT) and Climate-Risk Index (CRI) disaster statistics suggest that the impacts of CSDs are primarily related to socio-economic determinants of human wellbeing and health inequalities. Also, >80% respondents to the survey say that the leading causes of climate-related human impacts are the lack of (i) public awareness; (ii) investment and (iii) preparedness. The paper concludes by adding some suggestions that show how countries in Latin America may better cope with the impacts of Climate-sensitive Disasters.

Mortality in Puerto Rico after Hurricane Maria

BACKGROUND

Quantifying the effect of natural disasters on society is critical for recovery of public health services and infrastructure. The death toll can be difficult to assess in the aftermath of a major disaster. In September 2017, Hurricane Maria caused massive infrastructural damage to Puerto Rico, but its effect on mortality remains contentious. The official death count is 64.

METHODS

Using a representative, stratified sample, we surveyed 3299 randomly chosen households across Puerto Rico to produce an independent estimate of all-cause mortality after the hurricane. Respondents were asked about displacement, infrastructure loss, and causes of death. We calculated excess deaths by comparing our estimated post-hurricane mortality rate with official rates for the same period in 2016.

RESULTS

From the survey data, we estimated a mortality rate of 14.3 deaths (95% confidence interval [CI], 9.8 to 18.9) per 1000 persons from September 20 through December 31, 2017. This rate yielded a total of 4645 excess deaths during this period (95% CI, 793 to 8498), equivalent to a 62% increase in the mortality rate as compared with the same period in 2016. However, this number is likely to be an underestimate because of survivor bias. The mortality rate remained high through the end of December 2017, and one third of the deaths were attributed to delayed or interrupted health care. Hurricane-related migration was substantial.

CONCLUSIONS

This household-based survey suggests that the number of excess deaths related to Hurricane Maria in Puerto Rico is more than 70 times the official estimate. (Funded by the Harvard T.H. Chan School of Public Health and others.).

Health Impacts of Citywide and Localized Power Outages in New York City

BACKGROUND

Previous studies investigated potential health effects of large-scale power outages, including the massive power failure that affected the northeastern United States and Ontario, Canada, in August 2003, and outages associated with major storms. However, information on localized outages is limited.

OBJECTIVE

The study sought to examine potential health impacts of citywide and localized outages in New York City (NYC).

METHODS

Along with the citywide 2003 outage, localized outages in July 1999 and July 2006 were identified. We additionally investigated localized, warm- and cold-weather outages that occurred in any of 66 NYC electric-grid networks during 2002–2014 using New York State Public Service Commission data. Mortality and hospitalizations were geocoded and linked to the networks. Associations were estimated using Poisson time-series regression, including examining distributed lags and adjusting for temperature and temporal trends. Network-specific estimates were pooled by season.

RESULTS

Respiratory disease hospitalizations were associated with the 2006 localized outage [cumulative relative risk [CRR] over 0–1 lag day, lag₀₁=2.26 (95% confidence interval [CI]: 1.08, 4.74)] and the 2003 citywide outage, but not with other localized, warm-weather outages. Renal disease hospitalizations were associated with the 2003 citywide outage, and with localized, warm-weather outages, pooled across networks [RR at lag₃=1.16 (95% CI: 1.00, 1.34)], but not the 2006 localized outage. All-cause mortality was positively associated with the 1999, 2003, and 2006 outages (significant for the 2003 outage only), but not with other localized, warm-weather outages. Localized, cold-weather outages were associated with all-cause mortality [lag₀₁ CRR=1.06 (95% CI: 1.01, 1.12)] and cardiovascular disease hospitalizations [lag₀₁ CRR=1.14 (95% CI: 1.03, 1.26)], and fewer respiratory disease hospitalizations [lag₀₃ CRR=0.77 (95% CI: 0.61, 0.97)].

CONCLUSIONS

Localized outages may affect health. This information can inform preparedness efforts and underscores the public health importance of ensuring electric grid resiliency to climate change. https://doi.org/10.1289/EHP2154.

Adolescent health in the Eastern Mediterranean Region: findings from the global burden of disease 2015 study

OBJECTIVES

The 22 countries of the East Mediterranean Region (EMR) have large populations of adolescents aged 10-24 years. These adolescents are central to assuring the health, development, and peace of this region. We described their health needs.

METHODS

Using data from the Global Burden of Disease Study 2015 (GBD 2015), we report the leading causes of mortality and morbidity for adolescents in the EMR from 1990 to 2015. We also report the prevalence of key health risk behaviors and determinants.

RESULTS

Communicable diseases and the health consequences of natural disasters reduced substantially between 1990 and 2015. However, these gains have largely been offset by the health impacts of war and the emergence of non-communicable diseases (including mental health disorders), unintentional injury, and self-harm. Tobacco smoking and high body mass were common health risks amongst adolescents. Additionally, many EMR countries had high rates of adolescent pregnancy and unmet need for contraception.

CONCLUSIONS

Even with the return of peace and security, adolescents will have a persisting poor health profile that will pose a barrier to socioeconomic growth and development of the EMR.

Measuring the Impact of Disasters Using Publicly Available Data: Application to Hurricane Sandy (2012)

The unexpected nature of disasters leaves little time or resources for organized health surveillance of the affected population, and even less for those who are unaffected. An ideal epidemiologic study would monitor both groups equally well, but would typically be decided against as infeasible or costly. Exposure and health outcome data at the level of the individual can be difficult to obtain. Despite these challenges, the health effects of a disaster can be approximated. Approaches include 1) the use of publicly available exposure data in geographic detail, 2) health outcomes data-collected before, during, and after the event, and 3) statistical modeling designed to compare the observed frequency of health outcomes with the counterfactual frequency hidden by the disaster itself. We applied these strategies to Hurricane Sandy, which struck the northeastern United States in October 2012. Hospital admissions data from the state of New York with information on primary payer as well as patient demographic characteristics were analyzed. To illustrate the method, we present multivariate logistic regression results for the first 2 months after the hurricane. Inferential implications of admissions data on nearly the entire target population in the wake of a disaster are discussed.

Recurrent failings of medical humanitarianism: intractable, ignored, or just exaggerated?

Humanitarian health workers operate in dangerous and uncertain contexts, in which mistakes and failures are common, often have severe consequences, and are regularly repeated, despite being documented by many reviews. This Series paper aims to discuss the failures of medical humanitarianism. We describe why some of these recurrent failings, which are often not identified until much later, seem intractable: they are so entrenched in humanitarian action that they cannot be addressed by simple technical fixes. We argue that relief health-care interventions should be contextualised. Perhaps medical humanitarianism deserves a better reputation than the one at times tarnished by unfair criticism, resulting from inapplicable guiding principles and unrealistic expectations. The present situation is not conducive to radical reforms of humanitarian medicine; complex crises multiply and no political, diplomatic, or military solutions are in sight. Relief agencies have to compete for financial resources that do not increase at the same pace as health needs. Avoiding the repetition of failures requires recognising previous mistakes and addressing them through different policies by donors, stronger documentation and analysis of humanitarian programmes and interventions, increased professionalisation, improved, opportunistic relationships with the media, and better ways of working together with local health stakeholders and through indigenous institutions.

Research on Storm-Tide Disaster Losses in China Using a New Grey Relational Analysis Model with the Dispersion of Panel Data

Owing to the difference of the sequences’ orders and the surface structure in the current panel grey relational models, research results will not be unique. In addition, individual measurement of indicators and objects and the subjectivity of combined weight would significantly weaken the effective information of panel data and reduce the reliability and accuracy of research results. Therefore, we propose the concept and calculation method of dispersion of panel data, establish the grey relational model based on dispersion of panel data (DPGRA), and prove that DPGRA exhibits the effective properties of uniqueness, symmetry, and normality. To demonstrate its applicability, the proposed DPGRA model is used to research on storm-tide disaster losses in China’s coastal areas. Comparing research results of three models, which are DPGRA, Euclidean distance grey relational model, and grey grid relational model, it was shown that DPGRA is more effective, feasible, and stable. It is indicated that DPGRA can entirely utilize the effective information of panel data; what’s more, it can not only handle the non-uniqueness of the grey relational model’s results but also improve the reliability and accuracy of research results. The research results are of great significance for coastal areas to focus on monitoring storm–tide disasters hazards, strengthen the protection measures of natural disasters, and improve the ability of disaster prevention and reduction.

Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016

BACKGROUND

Monitoring levels and trends in premature mortality is crucial to understanding how societies can address prominent sources of early death. The Global Burden of Disease 2016 Study (GBD 2016) provides a comprehensive assessment of cause-specific mortality for 264 causes in 195 locations from 1980 to 2016. This assessment includes evaluation of the expected epidemiological transition with changes in development and where local patterns deviate from these trends.

METHODS

We estimated cause-specific deaths and years of life lost (YLLs) by age, sex, geography, and year. YLLs were calculated from the sum of each death multiplied by the standard life expectancy at each age. We used the GBD cause of death database composed of: vital registration (VR) data corrected for under-registration and garbage coding; national and subnational verbal autopsy (VA) studies corrected for garbage coding; and other sources including surveys and surveillance systems for specific causes such as maternal mortality. To facilitate assessment of quality, we reported on the fraction of deaths assigned to GBD Level 1 or Level 2 causes that cannot be underlying causes of death (major garbage codes) by location and year. Based on completeness, garbage coding, cause list detail, and time periods covered, we provided an overall data quality rating for each location with scores ranging from 0 stars (worst) to 5 stars (best). We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to generate estimates for each location, year, age, and sex. We assessed observed and expected levels and trends of cause-specific deaths in relation to the Socio-demographic Index (SDI), a summary indicator derived from measures of average income per capita, educational attainment, and total fertility, with locations grouped into quintiles by SDI. Relative to GBD 2015, we expanded the GBD cause hierarchy by 18 causes of death for GBD 2016.

FINDINGS

The quality of available data varied by location. Data quality in 25 countries rated in the highest category (5 stars), while 48, 30, 21, and 44 countries were rated at each of the succeeding data quality levels. Vital registration or verbal autopsy data were not available in 27 countries, resulting in the assignment of a zero value for data quality. Deaths from non-communicable diseases (NCDs) represented 72·3% (95% uncertainty interval [UI] 71·2-73·2) of deaths in 2016 with 19·3% (18·5-20·4) of deaths in that year occurring from communicable, maternal, neonatal, and nutritional (CMNN) diseases and a further 8·43% (8·00-8·67) from injuries. Although age-standardised rates of death from NCDs decreased globally between 2006 and 2016, total numbers of these deaths increased; both numbers and age-standardised rates of death from CMNN causes decreased in the decade 2006-16-age-standardised rates of deaths from injuries decreased but total numbers varied little. In 2016, the three leading global causes of death in children under-5 were lower respiratory infections, neonatal preterm birth complications, and neonatal encephalopathy due to birth asphyxia and trauma, combined resulting in 1·80 million deaths (95% UI 1·59 million to 1·89 million). Between 1990 and 2016, a profound shift toward deaths at older ages occurred with a 178% (95% UI 176-181) increase in deaths in ages 90-94 years and a 210% (208-212) increase in deaths older than age 95 years. The ten leading causes by rates of age-standardised YLL significantly decreased from 2006 to 2016 (median annualised rate of change was a decrease of 2·89%); the median annualised rate of change for all other causes was lower (a decrease of 1·59%) during the same interval. Globally, the five leading causes of total YLLs in 2016 were cardiovascular diseases; diarrhoea, lower respiratory infections, and other common infectious diseases; neoplasms; neonatal disorders; and HIV/AIDS and tuberculosis. At a finer level of disaggregation within cause groupings, the ten leading causes of total YLLs in 2016 were ischaemic heart disease, cerebrovascular disease, lower respiratory infections, diarrhoeal diseases, road injuries, malaria, neonatal preterm birth complications, HIV/AIDS, chronic obstructive pulmonary disease, and neonatal encephalopathy due to birth asphyxia and trauma. Ischaemic heart disease was the leading cause of total YLLs in 113 countries for men and 97 countries for women. Comparisons of observed levels of YLLs by countries, relative to the level of YLLs expected on the basis of SDI alone, highlighted distinct regional patterns including the greater than expected level of YLLs from malaria and from HIV/AIDS across sub-Saharan Africa; diabetes mellitus, especially in Oceania; interpersonal violence, notably within Latin America and the Caribbean; and cardiomyopathy and myocarditis, particularly in eastern and central Europe. The level of YLLs from ischaemic heart disease was less than expected in 117 of 195 locations. Other leading causes of YLLs for which YLLs were notably lower than expected included neonatal preterm birth complications in many locations in both south Asia and southeast Asia, and cerebrovascular disease in western Europe.

INTERPRETATION

The past 37 years have featured declining rates of communicable, maternal, neonatal, and nutritional diseases across all quintiles of SDI, with faster than expected gains for many locations relative to their SDI. A global shift towards deaths at older ages suggests success in reducing many causes of early death. YLLs have increased globally for causes such as diabetes mellitus or some neoplasms, and in some locations for causes such as drug use disorders, and conflict and terrorism. Increasing levels of YLLs might reflect outcomes from conditions that required high levels of care but for which effective treatments remain elusive, potentially increasing costs to health systems.

FUNDING

Bill & Melinda Gates Foundation.

Individual-level exposure to disaster, neighborhood environmental characteristics, and their independent and combined associations with depressive symptoms in women

PURPOSE

The severity of the stress response to experiencing disaster depends on individual exposure and background stress prior to the event. To date, there is limited research on the interaction between neighborhood environmental stress and experiencing an oil spill, and their effects on depression. The objective of the current study was to assess if the association between exposure to the Deepwater Horizon Oil Spill (DHOS) and depressive symptoms varied by neighborhood characteristics.

METHODS

US Census data (2010) and longitudinal data collected in two waves (2012-2014 and 2014-2016) from female residents [N = 889 (Wave I), 737 (Wave II)] of an area highly affected by the DHOS were analyzed. Multilevel and individual-level negative binomial regressions were performed to estimate associations with depressive symptoms in both waves. An interaction term was included to estimate effect modification of the association between DHOS exposure and depressive symptoms by neighborhood characteristics. Generalized estimating equations were applied to the negative binomial regression testing longitudinal associations.

RESULTS

Census tract-level neighborhood characteristics were not associated with depressive symptoms. Exposure to the DHOS and neighborhood physical disorder were associated with depressive symptoms cross-sectionally. There was no evidence of effect modification; however, physical/environmental exposure to the DHOS was associated with increased depressive symptoms only among women living in areas with physical disorder. Exposure to the DHOS remained associated with depressive symptoms over time.

CONCLUSIONS

Findings support the enduring consequences of disaster exposure on depressive symptoms in women and identify potential targets for post-disaster intervention based on residential characteristics.

Perception of recovery of households affected by 2008 Wenchuan earthquake: A structural equation model

Much of the literature on recovery focuses on the economy, the physical environment and infrastructure at a macro level, which may ignore the personal experiences of affected individuals during recovery. This paper combines internal factors at a micro level and external factors at a macro level to model for understanding perception of recovery (PoR). This study focuses on areas devastated by the 2008 Wenchuan earthquake in China. With respect to three recovery-related aspects (house recovery condition (HRC), family recovery power (FRP) and reconstruction investment (RI)), structural equation modeling (SEM) was applied. It was found that the three aspects (FRP, HRC and RI) effectively explain how earthquake affected households perceive recovery. Internal factors associated with FRP contributed the most to favourable PoR, followed by external factors associated with HRC. Findings identified that for PoR the importance of active recovery within households outweighed an advantageous house recovery condition. At the same time, households trapped in unfavourable external conditions would invest more in housing recovery, which result in wealth accumulation and improved quality of life leading to a high level of PoR. In addition, schooling in households showed a negative effect on improving PoR. This research contributes to current debates around post-disaster permanent housing policy. It is implied that a one-size-fits-all policy in disaster recovery may not be effective and more specific assistance should be provided to those people in need.

Longitudinal effects of disaster-related experiences on mental health among Fukushima nuclear plant workers: The Fukushima NEWS Project Study

BACKGROUND

The Fukushima Nuclear Energy Workers' Support (NEWS) Project Study previously showed that experiences related to the Fukushima nuclear disaster on 11 March 2011 had a great impact on psychological states, including post-traumatic stress response (PTSR) and general psychological distress (GPD), among the Fukushima nuclear plant workers. To determine the causal relationship between disaster-related experiences and levels of psychological states, we conducted a 3-year longitudinal study from 2011 to 2014.

METHOD

PTSR and GPD of the nuclear plant workers were assessed by annual questionnaires conducted from 2011 to 2014. The present study included a total of 1417 workers who provided an assessment at baseline (2011). A total of 4160 observations were used in the present analysis. The relationship between disaster-related experiences and psychological states over time was analysed using mixed-effects logistic regression models.

RESULTS

A declining influence of disaster-related experiences on PTSR over time was found. However, the impact on PTSR remained significantly elevated even 3 years after the disaster in several categories of exposure including the experience of life-threatening danger, experiences of discrimination, the witnessing of plant explosion, the death of a colleague and home evacuation. The associations between GPD and disaster-related experiences showed similar effects.

CONCLUSIONS

The effects of disaster-related experiences on psychological states among the nuclear plant workers reduced over time, but remained significantly high even 3 years after the event.

Separation from parents during childhood trauma predicts adult attachment security and post-traumatic stress disorder

BACKGROUND

Prolonged separation from parental support is a risk factor for psychopathology. This study assessed the impact of brief separation from parents during childhood trauma on adult attachment tendencies and post-traumatic stress.

METHOD

Children (n = 806) exposed to a major Australian bushfire disaster in 1983 and matched controls (n = 725) were assessed in the aftermath of the fires (mean age 7-8 years) via parent reports of trauma exposure and separation from parents during the fires. Participants (n = 500) were subsequently assessed 28 years after initial assessment on the Experiences in Close Relationships scale to assess attachment security, and post-traumatic stress disorder (PTSD) was assessed using the PTSD checklist.

RESULTS

Being separated from parents was significantly related to having an avoidant attachment style as an adult (B = -3.69, s.e. = 1.48, β = -0.23, p = 0.013). Avoidant attachment was associated with re-experiencing (B = 0.03, s.e. = 0.01, β = 0.31, p = 0.045), avoidance (B = 0.03, s.e. = 0.01, β = 0.30, p = 0.001) and numbing (B = 0.03, s.e. = 0.01, β = 0.30, p < 0.001) symptoms. Anxious attachment was associated with re-experiencing (B = 0.03, s.e. = 0.01, β = 0.18, p = 0.001), numbing (B = 0.03, β = 0.30, s.e. = 0.01, p < 0.001) and arousal (B = 0.04, s.e. = 0.01, β = 0.43, p < 0.001) symptoms.

CONCLUSIONS

These findings demonstrate that brief separation from attachments during childhood trauma can have long-lasting effects on one's attachment security, and that this can be associated with adult post-traumatic psychopathology.

Epidemiology and outcomes of bloodstream infections in 177 severe burn patients from an industrial disaster: a multicentre retrospective study

OBJECTIVES

To determine the characteristics of bloodstream infections (BSIs) and to evaluate the impact of BSIs on mortality in severe burn patients.

METHODS

A retrospective observational study was conducted in 20 tertiary hospitals. A total of 185 patients who experienced a massive dust explosion in eastern China were included.

RESULTS

After exclusion, 177 patients were analysed. The median total body surface area (TBSA) burned was 95% (interquartile range 85%-98%). Inhalation injuries occurred in 97.2%. The overall 90-day mortality was 35% (62/177). During the study period, 120 (67.8%) patients developed 253 episodes of BSI with 323 unique causative pathogens. Sixty-six episodes were polymicrobial infections. Catheter-related BSIs (CRBSIs) accounted for 41.5% of the episodes. Acinetobacter baumannii (19.5%), Klebsiella pneumoniae (13.9%) and Candida (12.7%) were the most common organisms. Antimicrobial resistance was found in 63.5% of the isolates, particularly in Gram-negative bacteria. Patients who developed BSIs had a greater illness severity at admission to the intensive care unit, and worse outcomes. After adjusting for demographics, severity of illness and treatment characteristics in a multivariate logistic model, there was a trend toward BSI increasing the risk of 90-day mortality (adjusted OR 3.4; 95% CI 0.9-12.9; p=0.069). In subgroup analyses, CRBSIs (adjusted OR 5.7; 95% CI 1.3-24.9; p=0.021 versus no BSI) and polymicrobial BSIs (adjusted OR 6.1; 95% CI 1.3-28.1; p=0.020 versus no BSI) had greater risk of 90-day mortality.

CONCLUSIONS

A strikingly high rate of BSIs was observed in severe burn patients. Gram-negative organisms and fungi were the leading causes. CRBSIs and polymicrobial BSIs were associated with high mortality.