Flooding and Emergency Room Visits for Gastrointestinal Illness in Massachusetts: A Case-Crossover Study

Abstract

IntroductionFloods and other severe weather events are anticipated to increase as a result of global climate change. Floods can lead to outbreaks of gastroenteritis and other infectious diseases due to disruption of sewage and water infrastructure and impacts on sanitation and hygiene. Floods have also been indirectly associated with outbreaks through population displacement and crowding.MethodsWe conducted a case-crossover study to investigate the association between flooding and emergency room visits for gastrointestinal illness (ER-GI) in Massachusetts for the years 2003 through 2007. We obtained ER-GI visits from the State of Massachusetts and records of floods from the National Oceanic and Atmospheric Association’s Storm Events Database. ER-GI visits were considered exposed if a flood occurred in the town of residence within three hazard periods of the visit: 0–4 days; 5–9 days; and 10–14 days. A time-stratified bi-directional design was used for control selection, matching on day of the week with two weeks lead or lag time from the ER-GI visit. Fixed effect logistic regression models were used to estimate the risk of ER-GI visits following the flood.Results and ConclusionsA total of 270,457 ER-GI visits and 129 floods occurred in Massachusetts over the study period. Across all counties, flooding was associated with an increased risk for ER-GI in the 0–4 day period after flooding (Odds Ratio: 1.08; 95% Confidence Interval: 1.03–1.12); but not the 5–9 days (Odds Ratio: 0.995; 95% Confidence Interval: 0.955–1.04) or the 10–14 days after (Odds Ratio: 0.966, 95% Confidence Interval: 0.927–1.01). Similar results were observed for different definitions of ER-GI. The effect differed across counties, suggesting local differences in the risk and impact of flooding. Statewide, across the study period, an estimated 7% of ER-GI visits in the 0–4 days after a flood event were attributable to flooding.

Climate Change–Related Water Disasters’ Impact on Population Health

“…Increases in water temperature, precipitation frequency and severity, evaporation–transpiration rates, persistent humidity, and changes in coastal ecosystems increase the incidence of water contamination with harmful pathogens and chemicals, resulting in increased human exposure and waterborne disease (Ahmed, Scholz, Al‐Faraj, & Niaz, ; Alderman, Turner, & Tong, ; Davies et al., ; De Man et al., ; Dura et al., ; Gao, Zhang, Ding, Liu, & Jiang, ; Kang et al., ; Lin, Wade, & Hilborn, ; Phung et al., ; Wade, Lin, Jagai, & Hilborn, ). Flooding events in particular increased the incidence of the following three diseases: hepatitis A virus (Gao, Zhang, Ding, Liu, & Jiang, , Gao, Zhang, Ding, Liu, Wang, & Jiang, ), bacillary dysentery (Liu, Liu, Zhang, & Jiang, ; Liu, Li, et al., ; Lin, Wade, & Hilborn, ; Ni, Ding, Li, Li, & Jiang, ; Ni, Ding, Li, Li, Liu, & Jiang, ; Zhang, Ding, Liu, Zhang, & Jiang, ), and Campylobacter (Soneja et al., ).…”

Are Wastewater Systems Adapting to Climate Change?

“…); wastewater system failures damage the environment and raise rates of gastrointestinal disease putting public health at risk (Wade et al. ; Jagai et al. ).…”

“…Well-functioning wastewater systems provide a critical service to society by collecting and treating liquid organic wastes and discharging effluent water of sufficient quality to protect the environment and public health. The combined effects of aging infrastructure and extreme precipitation events contribute to wastewater system failures (Howard et al 2016); wastewater system failures damage the environment and raise rates of gastrointestinal disease putting public health at risk (Wade et al 2014;Jagai et al 2017). Climate change is expected to aggravate these failures by increasing sewer overflows, changing treatment effectiveness, decreasing the absorptive capacity of receiving waters, and exposing more infrastructure to damage and inundation from sea level rise (Butler et al 2007;Pl osz et al 2009;Nilsen et al 2011;Arkell et al 2012;Langeveld et al 2013;Campos and Darch 2015a;Weirich et al 2015;Zouboulis and Tolkou 2015;Sweetapple et al 2017).…”

“…Wastewater systemsincluding wastewater collection, pump stations, and wastewater treatment plants (WWTP)play a critical function in society; yet, they are increasingly at risk of failing to protect public health and the environment because they are old, incredibly underfunded (EPA 2008;NACWA and AMWA 2009), and vulnerable to the impacts of extreme events and sea level rise (Patz et al 2008;Campos and Darch 2015a;Howard et al 2016). For example, hurricanes caused widespread power outages, flooding, and bypassing of billions of gallons of untreated or partially treated sewage into local waterways (Altimari 2011;Kenward et al 2013;Wade et al 2014). But, it is not just hurricanes.…”

Architecture Concern of the Emergency Room: An Important Issue to be Discussed in Emergency Medicine

“…Finally, there must be preparedness for the possible crises (such as fire, flooding, earthquake, etc.) or terrorist attacks [5]. The execution way and system is needed.…”