Northrop Alexander J, Do Vivian, Flores Nina M, Wilner Lauren Blair, Sheffield Perry E, Casey Joan A
Vagelos College of Physicians and Surgeons, Columbia University, New York, NY.
Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, New York City, NY.
medRxiv. 2024 Jul 21:2024.07.20.24310120. doi: 10.1101/2024.07.20.24310120.
Children's risk of exposure to carbon monoxide (CO) increases after disasters, likely due to improper generator use during power outages. Here, we evaluate the impact of outages on children's CO-related emergency department (ED) visits in New York State (NYS). We leveraged power outage data spanning 2017-2020 from the NYS Department of Public Service for 1,865 power operating localities (i.e., communities) and defined all-size and large-scale power outage hours. All-size outage hours affected ≥1% of customers, and large-scale outage hours affected ≥20%. We identified CO poisoning using diagnostic codes among those aged <18 between 2017 and 2020 using the Statewide Planning and Research Cooperative System (SPARCS), an all-payer reporting system in NYS. We linked community power outage exposure to patients using the population-weighted centroid of their block group of residence. We estimated the impact of power outages on CO poisoning using a time-stratified case-crossover study design with conditional logistic regression, controlling for daily relative humidity, mean temperature, and total precipitation. Analyses were stratified by urban and rural communities. From 2017-2020, there were 917 pediatric CO poisoning ED visits in NYS. Most cases (83%) occurred in urban region of the state. We observed an association statewide between all-size and large-scale outages and CO ED visits on the index day and the following two days before a return to baseline on lag day 3. Four hours without power increased the odds of a pediatric CO poisoning ED visit by ≥50% for small-scale and ≥150% for large-scale outages, and associations were stronger in urban versus rural areas. While CO poisoning is a relatively rare cause of pediatric ED visits in NYS, it can be deadly and is also preventable. Expanded analyses of the health impacts of outages and advocacy for reliable energy access are needed to support children's health in a changing climate.
灾难过后，儿童接触一氧化碳（CO）的风险会增加，这可能是由于停电期间发电机使用不当所致。在此，我们评估停电对纽约州（NYS）儿童因一氧化碳相关问题前往急诊科（ED）就诊的影响。我们利用了纽约州公共服务部提供的2017年至2020年期间1865个电力运营地区（即社区）的停电数据，并确定了各种规模和大规模停电时长。各种规模停电时长影响了≥1%的客户，大规模停电时长影响了≥20%。我们使用全州规划与研究合作系统（SPARCS）（纽约州的一个全付费者报告系统），通过诊断代码在2017年至2020年期间识别年龄<18岁人群中的一氧化碳中毒情况。我们利用患者居住街区组的人口加权质心将社区停电暴露情况与患者联系起来。我们采用时间分层病例交叉研究设计和条件逻辑回归方法，控制每日相对湿度、平均温度和总降水量，评估停电对一氧化碳中毒的影响。分析按城市和农村社区进行分层。2017年至2020年期间，纽约州有917例儿童一氧化碳中毒前往急诊科就诊。大多数病例（83%）发生在该州的城市地区。我们观察到，在全州范围内，各种规模和大规模停电与指数日以及滞后第3天恢复到基线之前的接下来两天的一氧化碳相关急诊科就诊之间存在关联。停电4小时使小规模停电时儿童因一氧化碳中毒前往急诊科就诊的几率增加≥50%，大规模停电时增加≥150%，且城市地区的关联比农村地区更强。虽然一氧化碳中毒在纽约州儿童前往急诊科就诊的原因中相对少见，但可能致命且可预防。需要对停电的健康影响进行更广泛的分析，并倡导可靠的能源供应，以在气候变化的情况下保障儿童健康。
