Work-Related Unintentional Injuries Associated With Hurricane Sandy in New Jersey

Health Effects of Cyclones: A Systematic Review and Meta-Analysis of Epidemiological Studies

BACKGROUND

More intense cyclones are expected in the future as a result of climate change. A comprehensive review is urgently needed to summarize and update the evidence on the health effects of cyclones.

OBJECTIVES

We aimed to provide a systematic review with meta-analysis of current evidence on the risks of all reported health outcomes related to cyclones and to identify research gaps and make recommendations for further research.

METHODS

We systematically searched five electronic databases (MEDLINE, Embase, PubMed, Scopus, and Web of Science) for relevant studies in English published before 21 December 2022. Following the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines, we developed inclusion criteria, screened the literature, and included epidemiological studies with a quantitative risk assessment of any mortality or morbidity-related outcomes associated with cyclone exposures. We extracted key data and assessed study quality for these studies and applied meta-analyses to quantify the overall effect estimate and the heterogeneity of comparable studies.

RESULTS

In total, 71 studies from eight countries (the United States, China, India, Japan, the Philippines, South Korea, Australia, Brazil), mostly the United States, were included in the review. These studies investigated the all-cause and cause-specific mortality, as well as morbidity related to injury, cardiovascular diseases (CVDs), respiratory diseases, infectious diseases, mental disorders, adverse birth outcomes, cancer, diabetes, and other outcomes (e.g., suicide rates, gender-based violence). Studies mostly included only one high-amplitude cyclone (cyclones with a Saffir-Simpson category of 4 or 5, i.e., Hurricanes Katrina or Sandy) and focused on mental disorders morbidity and all-cause mortality and hospitalizations. Consistently elevated risks of overall mental health morbidity, post-traumatic stress disorder (PTSD), as well as all-cause mortality or hospitalizations, were found to be associated with cyclones. However, the results for other outcomes were generally mixed or limited. A statistically significant overall relative risk of 1.09 [95% confidence interval (CI): 1.04, 1.13], 1.18 (95% CI: 1.12, 1.25), 1.15 (95% CI: 1.13, 1.18), 1.26 (95% CI: 1.05, 1.50) was observed for all-cause mortality, all-cause hospitalizations, respiratory disease, and chronic obstructive pulmonary disease hospitalizations, respectively, after cyclone exposures, whereas no statistically significant risks were identified for diabetes mortality, heart disease mortality, and preterm birth. High between-study heterogeneity was observed.

CONCLUSIONS

There is generally consistent evidence supporting the notion that high-amplitude cyclones could significantly increase risks of mental disorders, especially for PTSD, as well as mortality and hospitalizations, but the evidence for other health outcomes, such as chronic diseases (e.g., CVDs, cancer, diabetes), and adverse birth outcomes remains limited or inconsistent. More studies with rigorous exposure assessment, of larger spatial and temporal scales, and using advanced modeling strategy are warranted in the future, especially for those small cyclone-prone countries or regions with low and middle incomes. https://doi.org/10.1289/EHP12158.

Assessing short-term and long-term mental health effects among older adults after Hurricane Sandy

BACKGROUND

Few studies have evaluated the long-term effects of disasters on older adults. We examined if older individuals experienced increased mental health (MH) effects immediately and long-term after Hurricane Sandy and if these effects varied by socioeconomic status (SES), disease subtypes, number of comorbidities, and length of stay.

METHODS

We identified older patients (≥64 years) with hospital admissions and Emergency Department (ED) visits (2001-2015) with primary diagnosis of MH diseases using the New York State discharged data. We quantified both short-term (immediately post-Sandy) and long-term effects (3-month, 1-year, 2-year, and 3-year) following Hurricane Sandy, and used the pre-Sandy period in the affected counties as the control period. Poisson regression was used to compare daily counts of MH cases overall and by multiple strata pre-/post Sandy.

FINDINGS

Older individuals had significantly increased risk of MH ED visits immediately (32%), and 3-months, 1, 2, and 3-years after Sandy (2%, 9%, 15%, and 10%, respectively). MH hospital admissions did not increase immediately, but significantly increased by 8% a year later. Males and those with low SES had delayed, but increased risks of MH 1-3 years after Sandy (RRs range: 1.14-1.71). The top MH subtypes after Sandy were psychosis, mood disorders, substance abuse, suicide, and anxiety (RRs range: 1.12-2.62). After Sandy, patients with ≥8 comorbidities increased from 15% to >25%, along with their length of hospital stay.

CONCLUSION

We found long-term adverse effects of MH after Sandy, especially among vulnerable populations, which may help plan future disaster preparedness and recovery efforts.

Powerless in the Virgin Islands: Emergency Department and Wound Care Clinic Utilization Following the 2017 Hurricanes Irma and Maria on St. Thomas, U.S. Virgin Islands

OBJECTIVE

The main objective of this work was to characterize the prevalence of acute medical needs by examining emergency department (ED) and outpatient wound care clinic (WCC) visits before, during, and after the 2017 Hurricanes Irma and Maria, in St. Thomas, United States (U.S.) Virgin Islands.

METHODS

Descriptive statistics and logistic regression were used to assess associations between the occurrence of the storms and visits due to injuries and chronic conditions presented to the ED and WCC from September 1, 2016 to May 31, 2018.

RESULTS

ED visits increased and the rate of injury care was higher during the storms (12 patient visits per day) than before or after the storms (9 patient visits per day). WCC visits increased during (12%) and after the storms (45%), and were associated with patients 60 years and older. The odds of ED and WCC visits due to injury during the storms were significantly higher (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 1.17, 1.40) than prior to the storms. The odds for visits due to injuries were 1.19 (95% CI: 1.12, 1.28) times higher after the storms.

CONCLUSIONS

Increases occurred in ED and WCC visits for injury care during the storms and in WCC visits after the storms. Public health preparedness mandates understanding how major hurricanes impact the prevalence of acute medical needs, and the factors that influence decisions to seek medical care, in their wake.

Perspectives on the Health Effects of Hurricanes: A Review and Challenges

Hurricanes are devastating natural disasters which dramatically modify the physical landscape and alter the socio-physical and biochemical characteristics of the environment, thus exposing the affected communities to new environmental stressors, which persist for weeks to months after the hurricane. This paper has three aims. First, it conceptualizes potential direct and indirect health effects of hurricanes and provides an overview of factors that exacerbate the health effects of hurricanes. Second, it summarizes the literature on the health impact of hurricanes. Finally, it examines the time lag between the hurricane (landfall) and the occurrence of diseases. Two major findings emerge from this paper. Hurricanes are shown to cause and exacerbate multiple diseases, and most adverse health impacts peak within six months following hurricanes. However, chronic diseases, including cardiovascular disease and mental disorders, continue to occur for years following the hurricane impact.

Injury-Related Emergency Department Visits After Hurricane Maria in a Southern Puerto Rico Hospital

OBJECTIVE

The aim of this study was to describe individuals seeking care for injury at a major emergency department (ED) in southern Puerto Rico in the months after Hurricane Maria on September 20, 2017.

METHODS

After informed consent, we used a modified version of the Natural Disaster Morbidity Surveillance Form to determine why patients were visiting the ED during October 16, 2017-March 28, 2018. We analyzed visits where injury was reported as the primary reason for visit and whether it was hurricane-related.

RESULTS

Among 5 116 patients, 573 (11%) reported injury as the primary reason for a visit. Of these, 10% were hurricane-related visits. The most common types of injuries were abrasions, lacerations, and cuts (43% of all injury visits and 50% of hurricane-related visits). The most common mechanisms of injury were falls, slips, trips (268, 47%), and being hit by/or against an object (88, 15%). Most injury visits occurred during the first 3 months after the hurricane.

CONCLUSIONS

Surveillance after Hurricane Maria identified injury as the reason for a visit for about 1 in 10 patients visiting the ED, providing evidence on the patterns of injuries in the months following a hurricane. Public health and emergency providers can use this information to anticipate health care needs after a disaster.

Unveiling the Natural History of Category 4 Tropical Cyclones: The Puerto Rico Trauma Hospital Experience after Hurricane Maria

OBJECTIVES

The hazardous environmental conditions hurricanes create might increase injury incidence almost 7 times. Therefore, a cohort study was performed at the Puerto Rico Trauma Hospital to compare morbidity and mortality patterns of patients after Hurricane Maria with a control period.

METHODS

Admissions from September 20, 2017, through January 20, 2018, constituted the post-Maria period (473 patients); the corresponding months of the previous year comprised the pre-Maria period (439 patients). Comparisons were done using Pearson's chi-square or Mann-Whitney U-tests, as appropriate. A logistic regression was performed to assess the association between mortality and the study period.

RESULTS

Postlandfall admissions among patients aged 40-64 y increased by 6.6%, while among subjects between ages 18 and 39 y dropped by 7.0% (P = 0.03). Falls, gunshots, and burns were the injury mechanisms that varied the most across the exposure period. The median Injury Severity Score (13 vs 12; P = 0.05) and the frequency of Glasgow Coma Scale scores ≤8 (17.1% vs 10.9%; P = 0.03) were higher among poststorm patients. Moreover, a 2-fold (odds ratio = 1.93; 95% CI: 1.07-3.47) increase in mortality was observed after Maria, when adjusting for covariates.

CONCLUSIONS

Following a hurricane, trauma centers might expect an older population, with more severe injuries and a 2-fold increased mortality risk.

Estimating the Health-Related Costs of 10 Climate-Sensitive U.S. Events During 2012

Climate change threatens human health, but there remains a lack of evidence on the economic toll of climate-sensitive public health impacts. We characterize human mortality and morbidity costs associated with 10 climate-sensitive case study events spanning 11 US states in 2012: wildfires in Colorado and Washington, ozone air pollution in Nevada, extreme heat in Wisconsin, infectious disease outbreaks of tick-borne Lyme disease in Michigan and mosquito-borne West Nile virus in Texas, extreme weather in Ohio, impacts of Hurricane Sandy in New Jersey and New York, allergenic oak pollen in North Carolina, and harmful algal blooms on the Florida coast. Applying a consistent economic valuation approach to published studies and state estimates, we estimate total health-related costs from 917 deaths, 20,568 hospitalizations, and 17,857 emergency department visits of $10.0 billion in 2018 dollars, with a sensitivity range of $2.7-24.6 billion. Our estimates indicate that the financial burden of deaths, hospitalizations, emergency department visits, and associated medical care is a key dimension of the overall economic impact of climate-sensitive events. We found that mortality costs (i.e., the value of a statistical life) of $8.4 billion exceeded morbidity costs and lost wages ($1.6 billion combined). By better characterizing health damages in economic terms, this work helps to shed light on the burden climate-sensitive events already place on U.S. public health each year. In doing so, we provide a conceptual framework for broader estimation of climate-sensitive health-related costs. The high health-related costs associated with climate-sensitive events highlight the importance of actions to mitigate climate change and adapt to its unavoidable impacts.

Trees down, hazards abound: Observations and lessons from Hurricane Sandy

BACKGROUND

Given predictions that climate change will lead to an increase in severe storms, it is important to more fully understand the risks experienced by workers charged with the cleanup and removal of storm damaged trees. These hazards have received little attention in the occupational safety and health literature.

METHODS

This paper is based on semi-structured interviews with 23 stakeholders involved in the Hurricane Sandy cleanup effort.

RESULTS

Interview participants identified at risk sectors, gaps in training and preparedness, and raised particular concerns about storm downed trees, electrical hazards, and fatigue and suggested steps to reduce these hazards.

CONCLUSIONS

Stakeholders' observations about storm response suggest directions for improving the health and safety of this critical workforce.

Tree-Related Injuries Associated With Response and Recovery From Hurricane Sandy, New Jersey, 2011-2014

OBJECTIVES

Extreme weather events require extensive tree removal and disposal, tasks associated with severe injury risks among workers and residents. To help understand the risks of such activities, we evaluated the impact of a large and destructive storm (Hurricane Sandy in 2012) on the incidence of tree-related injuries.

METHODS

We searched chief-complaint text fields for patients aged 18-65 from 2011-2014 emergency department visit records submitted by New Jersey hospitals through the state-based syndromic surveillance system. Tree-related keywords (eg, saw, branch, wood chip, woodchip, tree) identified possible injuries that we then reviewed to exclude unrelated cases and classify mechanisms of tree-related injury. We used Poisson regression analysis to evaluate changes in the rates of probable tree-related injuries, adjusting for total emergency department visits and seasonal variation.

RESULTS

We identified 698 probable tree-related injuries from 2011-2014 among patients aged 18-65, including 104 (14.9%) falls, 241 (34.5%) machine-related injuries, 311 (44.6%) struck-by injuries, and 42 (6.0%) other tree-related injuries. Tree-related injuries increased significantly in the quarter immediately after Hurricane Sandy (November 2012-January 2013) compared with the same quarter the year before (rate ratio [RR] = 1.67; 95% confidence interval [CI], 1.13-2.47) and the year after (RR = 2.47; 95% CI, 1.62-3.78) Hurricane Sandy, especially for struck-by injuries compared with the year before (RR = 2.74; 95% CI, 1.47-5.12) and the year after (RR = 4.17; 95% CI, 2.09-8.32) Hurricane Sandy. More than one-third of the injuries (33.4%) involved chainsaws.

CONCLUSIONS

A major hurricane was associated with an increase in tree-related injuries in emergency departments, especially for mechanisms consistent with handling downed and damaged trees. Further research should confirm these findings and evaluate opportunities for preventing tree-related injuries.

Hurricane Season Public Health Preparedness, Response, and Recovery Guidance for Health Care Providers, Response and Recovery Workers, and Affected Communities - CDC, 2017

CDC and the Agency for Toxic Substances and Disease Registry (ATSDR) have guidance and technical materials available in both English and Spanish to help communities prepare for hurricanes and floods (Table 1). To help protect the health and safety of the public, responders, and clean-up workers during response and recovery operations from hurricanes and floods, CDC and ATSDR have developed public health guidance and other resources; many are available in both English and Spanish (Table 2).