Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA.
Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27514, USA.
Sci Total Environ. 2022 Feb 25;809:151108. doi: 10.1016/j.scitotenv.2021.151108. Epub 2021 Oct 22.
Hurricanes often flood homes and industries, spreading pathogens. Contact with pathogen-contaminated water can result in diarrhea, vomiting, and/or nausea, known collectively as acute gastrointestinal illness (AGI). Hurricanes Matthew and Florence caused record-breaking flooding in North Carolina (NC) in October 2016 and September 2018, respectively. To examine the relationship between hurricane flooding and AGI in NC, we first calculated the percent of each ZIP code flooded after Hurricanes Matthew and Florence. Rates of all-cause AGI emergency department (ED) visits were calculated from NC's ED surveillance system data. Using controlled interrupted time series, we compared AGI ED visit rates during the three weeks after each hurricane in ZIP codes with a third or more of their area flooded to the predicted rates had these hurricanes not occurred, based on AGI 2016-2019 ED trends, and controlling for AGI ED visit rates in unflooded areas. We examined alternative case definitions (bacterial AGI) and effect measure modification by race and age. We observed an 11% increase (rate ratio (RR): 1.11, 95% CI: 1.00, 1.23) in AGI ED visit rates after Hurricanes Matthew and Florence. This effect was particularly strong among American Indian patients and patients aged 65 years and older after Florence and elevated among Black patients for both hurricanes. Florence's effect was more consistent than Matthew's effect, possibly because little rain preceded Florence and heavy rain preceded Matthew. When restricted to bacterial AGI, we found an 85% (RR: 1.85, 95% CI: 1.37, 2.34) increase in AGI ED visit rate after Florence, but no increase after Matthew. Hurricane flooding is associated with an increase in AGI ED visit rate, although the strength of effect may depend on total storm rainfall or antecedent rainfall. American Indians and Black people-historically pushed to less desirable, flood-prone land-may be at higher risk for AGI after storms.
飓风经常淹没房屋和工业设施，传播病原体。接触受病原体污染的水可能导致腹泻、呕吐和/或恶心，统称为急性胃肠道疾病（AGI）。飓风马修和佛罗伦萨分别于 2016 年 10 月和 2018 年 9 月在北卡罗来纳州（NC）造成创纪录的洪水。为了研究 NC 飓风洪水与 AGI 之间的关系，我们首先计算了飓风马修和佛罗伦萨之后每个邮政编码区的洪水泛滥百分比。我们根据 NC 的 ED 监测系统数据计算了所有原因 AGI 急诊科（ED）就诊率。使用受控中断时间序列，我们比较了在洪水泛滥面积达三分之一或以上的邮政编码区，在每个飓风后三周内的 AGI ED 就诊率，与假设这些飓风没有发生的情况下的预测率，这是基于 AGI 2016-2019 年 ED 趋势，并控制了未泛滥地区的 AGI ED 就诊率。我们研究了替代病例定义（细菌性 AGI）和种族和年龄的效量修饰作用。我们观察到，在飓风马修和佛罗伦萨之后，AGI ED 就诊率增加了 11%（相对比率（RR）：1.11，95%置信区间（CI）：1.00，1.23）。这种影响在佛罗伦萨之后的美国印第安患者和 65 岁及以上的患者中尤为明显，在两次飓风后在黑人群体中也有所升高。佛罗伦萨的影响比马修的影响更一致，这可能是因为在佛罗伦萨之前降雨量较小，而在马修之前降雨量较大。当限制为细菌性 AGI 时，我们发现佛罗伦萨之后 AGI ED 就诊率增加了 85%（RR：1.85，95%CI：1.37，2.34），但马修之后没有增加。飓风洪水与 AGI ED 就诊率增加有关，尽管效应的强度可能取决于总风暴降雨量或前序降雨量。历史上被推向条件较差、洪水多发地区的美国印第安人和黑人，在风暴后可能面临更高的 AGI 风险。
