Long-Term Impact of Environmental Public Health Disaster on Health System Performance

Abstract

Objective In the aftermath of an Environmental Public Health Disaster (EPHD) a healthcare system may be the least equipped to respond. Preventable visits for ambulatory care sensitive conditions (ACSCs) may be used as a population-based indicator to monitor health system access post-disaster. The objective of this study was to examine whether ACSCs rates among vulnerable sub-populations are sensitive to the impact of a disaster. Methods We conducted a retrospective analysis using Poisson regression with generalized estimating equations to calculate change in monthly ACSC visits at the disaster site in the post-disaster period compared to the pre-disaster period after adjusting for parallel changes in two control groups. Results The adjusted rate of an ACSC hospital visit pre-disaster for the direct group was 1.68 times the rate for the primary control group (95% CI: 1.47, 1.93), while the adjusted ACSC hospital rate post-disaster for the direct group was 3.10 times the rate for the primary control group (95% CI: 1.97, 5.18). For emergency department ACSC visits, the adjusted rate among those directly affected pre-disaster were 1.82 times the rate for the primary control group (95% CI: 1.61, 2.08), while the adjusted ACSC rate post-disaster was 2.81 times the rate for the primary control group (95% CI: 1.92, 5.17). Conclusions Results revealed increased demand on the health system altered health services delivery for vulnerable populations directly impacted by the disaster. Preventable visits for ACSCs may advance meaningful use practice and public health surveillance by identifying and characterizing healthcare disparities during disaster recovery.

Persistent effects of chlorine inhalation on respiratory health

“…Using validated plume models, individual chlorine exposures were estimated . Over the 3 years following the chlorine release, rates of hospitalization and emergency department visits for ambulatory care–sensitive conditions increased significantly in the Graniteville population compared with a nearby population not exposed to chlorine . In the year following the accident, Graniteville millworkers had significantly reduced FEV 1 , and the prevalence of millworkers with accelerated FEV 1 decline was increased …”

Hyaluronan mediates airway hyperresponsiveness in oxidative lung injury

“…The accidental release of large amounts of Cl 2 in 30 large cities worldwide during the last 20 years (49) and the deliberate release of Cl 2 during acts of terrorism (37) caused significant mortality and morbidity to humans and animals (3,10,49,64). Cl 2 generated from the mixing of household products (bleach with acidic solutions) as well as swimming pool accidents results in bronchoconstriction especially in people with preexisting lung diseases (70,74).…”

Summary on the Charleston Area Pollution Prevention Partnership Environmental Justice Conference and Summit

“…These two studies use of CBPR, stakeholder engagement including engagement of economic development groups and the medical community, and mixed methods including Photovoice, interviews, lung epidemiology, and secondary data analysis have been instrumental in understanding environmental health problems in Graniteville and contribute to long-term recovery efforts post-disaster. [24][25][26] And in Orangeburg, SC, the local Community Health Center in conjunction with the University of South Carolina and local farmers started a farmer's market and produced a documentary film to chronicle the development process and the impact on residents. [26][27][28] The project's success led to a state legislature decision to match voucher subsidies to shoppers.…”

“…[24][25][26] And in Orangeburg, SC, the local Community Health Center in conjunction with the University of South Carolina and local farmers started a farmer's market and produced a documentary film to chronicle the development process and the impact on residents. [26][27][28] The project's success led to a state legislature decision to match voucher subsidies to shoppers. This was particularly relevant for other communities in South Carolina that experience comparable environmental health concerns.…”