Intra-ethnic disparities in respiratory health problems among Hispanic residents impacted by a flood

Health Disparities in the Aftermath of Flood Events: A Review of Physical and Mental Health Outcomes with Methodological Considerations in the USA

PURPOSE OF REVIEW

This review applies an environmental justice perspective to synthesize knowledge of flood-related health disparities across demographic groups in the USA. The primary aim is to examine differential impacts on physical and mental health outcomes while also assessing methodological considerations such as flood exposure metrics, baseline health metrics, and community engagement.

RECENT FINDINGS

In our review (n = 27), 65% and 72% of studies identified racial, ethnic, or socio-economic disparities in physical and mental health outcomes post-flooding, respectively. The majority of racial/ethnic disparities were based on Black race, while most socio-economic disparities were based on lower household income. Forty-two percent of studies lacked flood exposure metrics, but often identified disparities. Common flood exposure metrics included self-reported flooding, flood risk models, and satellite-based observations. Seventy percent of studies lacked baseline health measurements or suitable alternatives, and only 19% incorporated community engagement into their research design. The literature consistently finds that both physical and mental health burdens following flooding are unequally shared across racial, ethnic, and socio-economic groups. These findings emphasize the need for disaster risk reduction policies that address underlying vulnerabilities to flooding, unequal exposure to flooding, and progressive funding for recovery efforts. Findings also underscore the importance of methodological enhancements to facilitate precise assessments of flood exposure and health outcomes.

Hurricane Harvey and the risk of spontaneous preterm and early-term birth

Background

Hurricane Harvey made landfall in August 2017 and resulted in catastrophic flooding in Houston, Texas. Prior studies of hurricanes and preterm birth have found conflicting results. We tested the hypotheses that exposure to Hurricane Harvey was associated with a higher risk of spontaneous pre- and early-term birth and assessed vulnerable subpopulations.

Methods

We conducted a retrospective study of singleton births using administrative birth records in the nine-county greater Houston area from 2015 to 2019. We estimated the likelihood of pre- and early-term births using logistic regression, comparing births occurring during or within 1, 2, or 4 weeks of Hurricane Harvey to unexposed reference periods encompassing the same dates 2 years prior and after. Stratified models assessed effect modification by degree of flooding, birth parent age, high- vs. low-risk pregnancy, race/ethnicity, and prenatal care.

Results

Among 15,564 births, we found no association between exposure to Hurricane Harvey and spontaneous preterm birth within 1 week adjusted (odds ratio [OR], 1.06; 95% confidence interval [CI] = 0.91, 1.25) but a 14% higher odds of spontaneous early-term birth (OR, 1.14; 95% CI = 1.04, 1.25). The odds of early-term birth were even higher in neighborhoods with severe flooding (OR, 1.21; 95% CI = 1.05, 1.38), segregated neighborhoods (OR, 1.23; 95% CI = 1.03, 1.47), and among foreign-born Hispanics (OR, 1.21; 95% CI = 1.04, 1.53) and pregnant people receiving no prenatal care (OR, 1.37; 95% CI = 1.03, 1.82). Effect estimates were attenuated or null when considering 2-week or 4-week lags to define exposure.

Conclusions

Hurricane Harvey was associated with higher odds of spontaneous early-term birth up to 1 week later, especially among socially marginalized populations.

Respiratory and Otolaryngology Symptoms Following the 2019 Spring Floods in Quebec

BACKGROUND

Although floods may have important respiratory health impacts, few studies have examined this issue. This study aims to document the long-term impacts of the spring floods of 2019 in Quebec by (1) describing the population affected by the floods; (2) assessing the impacts on the respiratory system according to levels of exposure; and (3) determining the association between stressors and respiratory health.

METHODS

A population health survey was carried out across the six most affected regions 8-10 months post-floods. Data were collected on self-reported otolaryngology (ENT) and respiratory symptoms, along with primary and secondary stressors. Three levels of exposure were examined: flooded, disrupted and unaffected.

RESULTS

One in ten respondents declared being flooded and 31.4% being disrupted by the floods. Flooded and disrupted participants reported significantly more ENT symptoms (adjusted odds ratio (aOR): 3.18; 95% CI: 2.45-4.14; aOR: 1.76; 95% CI: 1.45-2.14) and respiratory symptoms (aOR: 3.41; 95% CI: 2.45-4.75; aOR: 1.45; 95% CI: 1.10-1.91) than the unaffected participants. All primary stressors and certain secondary stressors assessed were significantly associated with both ENT and respiratory symptoms, but no "dose-response" gradient could be observed.

CONCLUSION

This study highlights the long-term adverse effects of flood exposure on respiratory health.

Pediatric Emergency Departments and Urgent Care Visits in Houston after Hurricane Harvey

Introduction

Natural disasters are increasingly common and devastating. It is essential to understand children’s health needs during disasters as they are a particularly vulnerable population. The objective of this study was to evaluate pediatric disease burden after Hurricane Harvey compared to the preceding month and the same period in the previous year to inform pediatric disaster preparedness.

Methods

This was a retrospective cross-sectional study of patients seen at pediatric emergency departments (ED) and urgent care centers (UCC) 30 days before (late summer) and after (early fall) the hurricane and from the same time period in 2016. We collected demographic information and the first five discharge diagnoses from a network of EDs and UCCs affiliated with a quaternary care children’s hospital in Houston, Texas. We calculated the odds of disease outcomes during various timeframes using binary logistic regression modeling.

Results

There were 20,571 (median age: 3.5 years, 48.1% female) and 18,943 (median age: 3.5 years, 47.3% female) patients in 2016 and 2017, respectively. Inpatient admission rates from the ED a month after Harvey were 20.5%, compared to 25.3% in the same period in 2016 (P<0.001). In both years, asthma and other respiratory illnesses increased from late summer to early fall. After controlling for these seasonal trends, the following diseases were more commonly seen after the hurricane: toxicological emergencies (adjusted odds ratio [aOR]: 2.61, 95% [confidence interval] CI, 1.35–5.05); trauma (aOR: 1.42, 95% CI, 1.32–1.53); and dermatological complaints (aOR: 1.34, 95% CI, 1.23–1.46).

Conclusion

We observed increases in rashes, trauma, and toxicological diagnoses in children after a major flood. These findings highlight the need for more medication resources and public health and education measures focused on pediatric disaster preparedness and management.

A Multi-Decadal Spatial Analysis of Demographic Vulnerability to Urban Flood: A Case Study of Birmingham City, USA

Flooding, including hurricanes and tornadoes, accounts for approximately 40 percent of natural disasters worldwide and kills 100 people on average in the United States each year, which is more than any other single weather hazard. Since flooding is a common hazard in the U.S. and flood-related casualties have been increasing in recent years, it is important to understand the spatial patterns of different vulnerable population groups in the flooding regions. To achieve this objective, spatial scan statistics were used to identify the spatial clusters of different demographic groups (children and elderly, poor, White, African American, and Hispanic) in the 100-year floodplain areas of Birmingham. Using the decennial census data from 1990 to 2015, this research examined whether these vulnerable population groups had aggregated more in the flooding areas or moved away from the flooding areas in the past thirty years. The findings of this research indicate that most of the minorities are increasingly aggregating in the floodplain areas of Village Creek in Birmingham. The findings also suggest that the non-minorities are moving away from the flooding regions in Birmingham, AL. As part of the minorities and non-minorities group, approximately 50 percent of African Americans and 4 percent of White populations aggregated in the Village Creek flooding areas in 2015. Although the percentage of White populations is very low, the findings suggest that they are still exposed to floods. The multi-decadal analysis of flood risk will help the local governments to understand which population groups could be more affected by floods historically and need more attention in future flood hazards. This understanding will help them prepare for future flood hazards by allocating resources efficiently among the different racial and ethnic groups.

Hurricane Harvey and Greater Houston households: comparing pre-event preparedness with post-event health effects, event exposures, and recovery

Most disaster studies rely on convenience sampling and 'after-only' designs to assess impacts. This paper, focusing on Hurricane Harvey (2017) and leveraging a pre-/post-event sample of Greater Houston households (n=71) in the United States, establishes baselines for disaster preparedness and home structure flood hazard mitigation, explores household-level ramifications, and examines how preparedness and mitigation relate to health effects, event exposures, and recovery. Between 70 and 80 per cent of participants instituted preparedness measures. Mitigation actions varied: six per cent had interior drainage systems and 83 per cent had elevated indoor heating/cooling components. Sixty per cent reported home damage. One-half highlighted allergies and two-thirds indicated some level of post-traumatic stress (PTS). Three-quarters worried about family members/friends. The results of generalised linear models revealed that greater pre- event mitigation was associated with fewer physical health problems and adverse experiences, lower PTS, and faster recovery. The study design exposed the broad benefits of home structure flood hazard mitigation for households after Harvey.

Environmental injustice and flood risk: A conceptual model and case comparison of metropolitan Miami and Houston, USA

This article outlines a conceptual model and comparatively applies it to results from environmental justice (EJ) studies of flood risk in the Miami, Florida, and Houston, Texas, metropolitan areas. In contrast to most EJ studies of air pollution, which have found that socially-vulnerable groups experience disproportionate risk, distributive EJ studies of flooding reveal inconsistent findings regarding the relationship between social vulnerability and flood exposure. Counterintuitively (from a conventional EJ perspective), some pre-flood EJ studies have found that socially-advantaged people experience the highest residential exposure to flood risks. To integrate those anomalous findings within an EJ perspective, our conceptual model focuses on (1) the differential capacities of social groups to deploy/access protective resources for reducing the threat of loss, even while they reside amid flood-prone environments, and (2) both flood hazards and water-based benefits. Application of this model in Miami reveals that environmental injustices materialize as socially-privileged groups expose themselves to residential flood risks by seeking coastal amenities, as the costs of mitigating risks are conveyed to the broader public; in the process, socially-vulnerable residents are relegated to areas with air pollution and/or inland flood risks, where they experience constrained access to protective resources and coastal amenities. Findings from Houston better align with conventional EJ expectations-with flood zones disproportionately inhabited by socially-vulnerable people-because many coastal lands there are used by petrochemical industries, which produce major residential-environmental disamenities. Results underscore the need to consider protective resources and locational benefits in future empirical research on the EJ implications of flood hazards.

Factors increasing vulnerability to health effects before, during and after floods

Identifying the risk factors for morbidity and mortality effects pre-, during and post-flood may aid the appropriate targeting of flood-related adverse health prevention strategies. We conducted a systematic PubMed search to identify studies examining risk factors for health effects of precipitation-related floods, among Organisation for Economic Co-Operation and Development (OECD) member countries. Research identifying flood-related morbidity and mortality risk factors is limited and primarily examines demographic characteristics such as age and gender. During floods, females, elderly and children appear to be at greater risk of psychological and physical health effects, while males between 10 to 29 years may be at greater risk of mortality. Post-flood, those over 65 years and males are at increased risk of physical health effects, while females appear at greater risk of psychological health effects. Other risk factors include previous flood experiences, greater flood depth or flood trauma, existing illnesses, medication interruption, and low education or socio-economic status. Tailoring messages to high-risk groups may increase their effectiveness. Target populations differ for morbidity and mortality effects, and differ pre-, during, and post-flood. Additional research is required to identify the risk factors associated with pre- and post-flood mortality and post-flood morbidity, preferably using prospective cohort studies.