Food and Waterborne Disease in the Greater New York City Area Following Hurricane Sandy in 2012

NPCC4: Climate change and New York City's health risk

This chapter of the New York City Panel on Climate Change 4 (NPCC4) report considers climate health risks, vulnerabilities, and resilience strategies in New York City's unique urban context. It updates evidence since the last health assessment in 2015 as part of NPCC2 and addresses climate health risks and vulnerabilities that have emerged as especially salient to NYC since 2015. Climate health risks from heat and flooding are emphasized. In addition, other climate-sensitive exposures harmful to human health are considered, including outdoor and indoor air pollution, including aeroallergens; insect vectors of human illness; waterborne infectious and chemical contaminants; and compounding of climate health risks with other public health emergencies, such as the COVID-19 pandemic. Evidence-informed strategies for reducing future climate risks to health are considered.

Tailoring Household Disaster Preparedness Interventions to Reduce Health Disparities: Nursing Implications from Machine Learning Importance Features from the 2018-2020 FEMA National Household Survey

Tailored disaster preparedness interventions may be more effective and equitable, yet little is known about specific factors associated with disaster household preparedness for older adults and/or those with African American/Black identities. This study aims to ascertain differences in the importance features of machine learning models of household disaster preparedness for four groups to inform culturally tailored intervention recommendations for nursing practice. A machine learning model was developed and tested by combining data from the 2018, 2019, and 2020 Federal Emergency Management Agency National Household Survey. The primary outcome variable was a composite readiness score. A total of 252 variables from 15,048 participants were included. Over 10% of the sample self-identified as African American/Black and 30.3% reported being 65 years of age or older. Importance features varied regarding financial and insurance preparedness, information seeking and transportation between groups. These results reiterate the need for targeted interventions to support financial resilience and equitable resource access. Notably, older adults with Black racial identities were the only group where TV, TV news, and the Weather Channel was a priority feature for household disaster preparedness. Additionally, reliance on public transportation was most important among older adults with Black racial identities, highlighting priority needs for equity in disaster preparedness and policy.

Waterborne Infectious Diseases Associated with Exposure to Tropical Cyclonic Storms, United States, 1996-2018

In the United States, tropical cyclones cause destructive flooding that can lead to adverse health outcomes. Storm-driven flooding contaminates environmental, recreational, and drinking water sources, but few studies have examined effects on specific infections over time. We used 23 years of exposure and case data to assess the effects of tropical cyclones on 6 waterborne diseases in a conditional quasi-Poisson model. We separately defined storm exposure for windspeed, rainfall, and proximity to the storm track. Exposure to storm-related rainfall was associated with a 48% (95% CI 27%-69%) increase in Shiga toxin-producing Escherichia coli infections 1 week after storms and a 42% (95% CI 22%-62%) in increase Legionnaires' disease 2 weeks after storms. Cryptosporidiosis cases increased 52% (95% CI 42%-62%) during storm weeks but declined over ensuing weeks. Cyclones are a risk to public health that will likely become more serious with climate change and aging water infrastructure systems.

How neighborhood environment modified the effects of power outages on multiple health outcomes in New York state?

Background

Although power outage (PO) is one of the most important consequences of increasing weather extremes and the health impact of POs has been reported previously, studies on the neighborhood environment underlying the population vulnerability in such situations are limited. This study aimed to identify dominant neighborhood environmental predictors which modified the impact of POs on multiple health outcomes in New York State.

Methods

We applied a two-stage approach. In the first stage, we used time series analysis to determine the impact of POs (versus non-PO periods) on multiple health outcomes in each power operating division in New York State, 2001-2013. In the second stage, we classified divisions as risk-elevated and non-elevated, then developed predictive models for the elevation status based on 36 neighborhood environmental factors using random forest and gradient boosted trees.

Results

Consistent across different outcomes, we found predictors representing greater urbanization, particularly, the proportion of residents having access to public transportation (importance ranging from 4.9-15.6%), population density (3.3-16.1%), per capita income (2.3-10.7%), and the density of public infrastructure (0.8-8.5%), were associated with a higher possibility of risk elevation following power outages. Additionally, the percent of minority (-6.3-27.9%) and those with limited English (2.2-8.1%), the percent of sandy soil (6.5-11.8%), and average soil temperature (3.0-15.7%) were also dominant predictors for multiple outcomes. Spatial hotspots of vulnerability generally were located surrounding New York City and in the northwest, the pattern of which was consistent with socioeconomic status.

Conclusion

Population vulnerability during power outages was dominated by neighborhood environmental factors representing greater urbanization.

Projecting the Impacts of a Changing Climate: Tropical Cyclones and Flooding

PURPOSE OF REVIEW

There is clear evidence that the earth's climate is changing, largely from anthropogenic causes. Flooding and tropical cyclones have clear impacts on human health in the United States at present, and projections of their health impacts in the future will help inform climate policy, yet to date there have been few quantitative climate health impact projections.

RECENT FINDINGS

Despite a wealth of studies characterizing health impacts of floods and tropical cyclones, many are better suited for qualitative, rather than quantitative, projections of climate change health impacts. However, a growing number have features that will facilitate their use in quantitative projections, features we highlight here. Further, while it can be difficult to project how exposures to flood and tropical cyclone hazards will change in the future, climate science continues to advance in its capabilities to capture changes in these exposures, including capturing regional variation. Developments in climate epidemiology and climate science are opening new possibilities in projecting the health impacts of floods and tropical cyclones under a changing climate.

Tropical cyclone exposure is associated with increased hospitalization rates in older adults

Hurricanes and other tropical cyclones have devastating effects on society. Previous case studies have quantified their impact on some health outcomes for particular tropical cyclones, but a comprehensive assessment over longer periods is currently missing. Here, we used data on 70 million Medicare hospitalizations and tropical cyclone exposures over 16 years (1999-2014). We formulated a conditional quasi-Poisson model to examine how tropical cyclone exposure (days greater than Beaufort scale gale-force wind speed; ≥34 knots) affect hospitalizations for 13 mutually-exclusive, clinically-meaningful causes. We found that tropical cyclone exposure was associated with average increases in hospitalizations from several causes over the week following exposure, including respiratory diseases (14.2%; 95% confidence interval [CI]: 10.9-17.9%); infectious and parasitic diseases (4.3%; 95%CI: 1.2-8.1%); and injuries (8.7%; 95%CI: 6.0-11.8%). Average decadal tropical cyclone exposure in all impacted counties would be associated with an estimated 16,772 (95%CI: 8,265-25,278) additional hospitalizations. Our findings demonstrate the need for targeted preparedness strategies for hospital personnel before, during, and after tropical cyclones.

How community vulnerability factors jointly affect multiple health outcomes after catastrophic storms

BACKGROUND

While previous studies uncovered individual vulnerabilities to health risks during catastrophic storms, few evaluated the population vulnerability which is more important for identifying areas in greatest need of intervention.

OBJECTIVES

We assessed the association between community factors and multiple health outcomes, and developed a community vulnerability index.

METHODS

We retained emergency department visits for several health conditions from the 2005-2014 New York Statewide Planning and Research Cooperative System. We developed distributed lag nonlinear models at each spatial cluster across eight counties in downstate New York to evaluate the health risk associated with Superstorm Sandy (10/28/2012-11/9/2012) compared to the same period in other years, then defined census tracts in clusters with an elevated risk as "risk-elevated communities", and all others as "unelevated". We used machine-learning techniques to regress the risk elevation status against community factors to determine the contribution of each factor on population vulnerability, and developed a community vulnerability index (CVI).

RESULTS

Overall, community factors had positive contributions to increased community vulnerabilities to Sandy-related substance abuse (91.35%), injuries (70.51%), cardiovascular diseases (8.01%), and mental disorders (2.71%) but reversely contributed to respiratory diseases (-34.73%). The contribution of low per capita income (max: 22.08%), the percentage of residents living in group quarters (max: 31.39%), the percentage of areas prone to flooding (max: 38.45%), and the percentage of green coverage (max: 29.73%) tended to be larger than other factors. The CVI based on these factors achieved an accuracy of 0.73-0.90 across outcomes.

CONCLUSIONS

Our findings suggested that substance abuse was the most sensitive disease susceptible to less optimal community indicators, whereas respiratory diseases were higher in communities with better social environment. The percentage of residents in group quarters and areas prone to flooding were among dominant predictors for community vulnerabilities. The CVI based on these factors has an appropriate predictive performance.

Aging in Flood-Prone Coastal Areas: Discerning the Health and Well-Being Risk for Older Residents

Coastal communities are increasingly exposed to more intense and frequent hurricanes, accelerated sea-level rise, and prolonged tidal inundation, yet they are often a preferred retirement destination for older adults vulnerable to flooding and extreme weather events. The unique physical and psychosocial challenges of older population age 65 and over may affect their level of preparedness, capacity to cope with, and ability to respond and recover from a hazard event. Despite the clear vulnerabilities of older residents living in high-risk areas when compared to younger coastal populations, there is a lack of empirical research on the integrated flood risks to this population group in the coastal context. This paper provides a holistic assessment of this emerging problem along the U.S. East Coast by measuring the exposure of older population to sea level rise and storm surge in coastal counties. It further evaluates how age-related vulnerabilities differ between rural and urban settings using the case study approach and geospatial and statistical analysis the paper also conducts a review of scientific literature to identify gaps in the current understanding of health and well-being risks to aging populations in coastal communities. The results show that older populations are unevenly distributed along the U.S. East Coast with some states and counties having significantly higher percent of residents age 65 and older living along the shoreline. Many places with larger older populations have other attributes that further shape the vulnerability of this age group such as older housing stock, disabilities, and lower income and that often differ between rural and urban settings. Lastly, our study found that vast majority of research on aging in high-risk coastal locations has been conducted in relation to major disasters and almost none on the recurrent nuisance flooding that is already affecting many coastal communities.