Cargando…

Temporal Trends in Cardiovascular Hospital Discharges Following a Mass Chlorine Exposure Event in Graniteville, South Carolina

Background: On January 6, 2005, a train derailed in Graniteville, South Carolina, releasing nearly 60,000 kg of toxic chlorine gas. The disaster left nine people dead and was responsible for hundreds of hospitalizations and outpatient visits in the subsequent weeks. While chlorine gas primarily affe...

Descripción completa

Detalles Bibliográficos
Autores principales: Howell, Ashley V., Vena, John E., Cai, Bo, Lackland, Daniel T., Ingram, Lucy A., Lawson, Andrew B., Svendsen, Erik R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6517492/
https://www.ncbi.nlm.nih.gov/pubmed/31134174
http://dx.doi.org/10.3389/fpubh.2019.00112
_version_ 1783418287082700800
author Howell, Ashley V.
Vena, John E.
Cai, Bo
Lackland, Daniel T.
Ingram, Lucy A.
Lawson, Andrew B.
Svendsen, Erik R.
author_facet Howell, Ashley V.
Vena, John E.
Cai, Bo
Lackland, Daniel T.
Ingram, Lucy A.
Lawson, Andrew B.
Svendsen, Erik R.
author_sort Howell, Ashley V.
collection PubMed
description Background: On January 6, 2005, a train derailed in Graniteville, South Carolina, releasing nearly 60,000 kg of toxic chlorine gas. The disaster left nine people dead and was responsible for hundreds of hospitalizations and outpatient visits in the subsequent weeks. While chlorine gas primarily affects the respiratory tract, a growing body of evidence suggests that acute exposure may also cause vascular injury and cardiac toxicity. Here, we describe the incidence of cardiovascular hospitalizations among residents of the zip codes most affected by the chlorine gas plume, and compare the incidence of cardiovascular discharges in the years leading up to the event (2000–2004) to the incidence in the years following the event (2005–2014). Methods: De-identified hospital discharge information was collected from the South Carolina Revenue and Fiscal Affairs Office for individuals residing in the selected zip codes for the years 2000 to 2014. A quasi-experimental study design was utilized with a population-level interrupted time series model to examine hospital discharge rates for Graniteville-area residents for three cardiovascular diagnoses: hypertension (HTN), acute myocardial infarction (AMI), and coronary heart disease (CHD). We used linear regression with autoregressive error correction to compare slopes for pre- and post-spill time periods. Data from the 2000 and 2010 censuses were used to calculate rates and to provide information on potential demographic shifts over the course of the study. Results: A significant increase in hypertension-related hospital discharge rates was observed for the years following the Graniteville chlorine spill (slope 8.2, p < 0.001). Concurrent changes to CHD and AMI hospital discharge rates were in the opposite direction (slopes −3.2 and −0.3, p < 0.01 and 0.14, respectively). Importantly, the observed trend cannot be attributed to an aging population. Conclusions: An unusual increase in hypertension-related hospital discharge rates in the area affected by the Graniteville chlorine spill contrasts with national and state-level trends. A number of factors related to the spill may be contributing the observation: disaster-induced hypertension, healthcare services access issues, and, possibly, chlorine-induced susceptibility to vascular pathologies. Due to the limitations of our data, we cannot determine whether the individuals who visited the hospital were the ones exposed to chlorine gas, however, the finding warrants additional research. Future studies are needed to determine the etiology of the increase and whether individuals exposed to chlorine are at a heightened risk for hypertensive heart disease.
format Online
Article
Text
id pubmed-6517492
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-65174922019-05-27 Temporal Trends in Cardiovascular Hospital Discharges Following a Mass Chlorine Exposure Event in Graniteville, South Carolina Howell, Ashley V. Vena, John E. Cai, Bo Lackland, Daniel T. Ingram, Lucy A. Lawson, Andrew B. Svendsen, Erik R. Front Public Health Public Health Background: On January 6, 2005, a train derailed in Graniteville, South Carolina, releasing nearly 60,000 kg of toxic chlorine gas. The disaster left nine people dead and was responsible for hundreds of hospitalizations and outpatient visits in the subsequent weeks. While chlorine gas primarily affects the respiratory tract, a growing body of evidence suggests that acute exposure may also cause vascular injury and cardiac toxicity. Here, we describe the incidence of cardiovascular hospitalizations among residents of the zip codes most affected by the chlorine gas plume, and compare the incidence of cardiovascular discharges in the years leading up to the event (2000–2004) to the incidence in the years following the event (2005–2014). Methods: De-identified hospital discharge information was collected from the South Carolina Revenue and Fiscal Affairs Office for individuals residing in the selected zip codes for the years 2000 to 2014. A quasi-experimental study design was utilized with a population-level interrupted time series model to examine hospital discharge rates for Graniteville-area residents for three cardiovascular diagnoses: hypertension (HTN), acute myocardial infarction (AMI), and coronary heart disease (CHD). We used linear regression with autoregressive error correction to compare slopes for pre- and post-spill time periods. Data from the 2000 and 2010 censuses were used to calculate rates and to provide information on potential demographic shifts over the course of the study. Results: A significant increase in hypertension-related hospital discharge rates was observed for the years following the Graniteville chlorine spill (slope 8.2, p < 0.001). Concurrent changes to CHD and AMI hospital discharge rates were in the opposite direction (slopes −3.2 and −0.3, p < 0.01 and 0.14, respectively). Importantly, the observed trend cannot be attributed to an aging population. Conclusions: An unusual increase in hypertension-related hospital discharge rates in the area affected by the Graniteville chlorine spill contrasts with national and state-level trends. A number of factors related to the spill may be contributing the observation: disaster-induced hypertension, healthcare services access issues, and, possibly, chlorine-induced susceptibility to vascular pathologies. Due to the limitations of our data, we cannot determine whether the individuals who visited the hospital were the ones exposed to chlorine gas, however, the finding warrants additional research. Future studies are needed to determine the etiology of the increase and whether individuals exposed to chlorine are at a heightened risk for hypertensive heart disease. Frontiers Media S.A. 2019-05-08 /pmc/articles/PMC6517492/ /pubmed/31134174 http://dx.doi.org/10.3389/fpubh.2019.00112 Text en Copyright © 2019 Howell, Vena, Cai, Lackland, Ingram, Lawson and Svendsen. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Public Health
Howell, Ashley V.
Vena, John E.
Cai, Bo
Lackland, Daniel T.
Ingram, Lucy A.
Lawson, Andrew B.
Svendsen, Erik R.
Temporal Trends in Cardiovascular Hospital Discharges Following a Mass Chlorine Exposure Event in Graniteville, South Carolina
title Temporal Trends in Cardiovascular Hospital Discharges Following a Mass Chlorine Exposure Event in Graniteville, South Carolina
title_full Temporal Trends in Cardiovascular Hospital Discharges Following a Mass Chlorine Exposure Event in Graniteville, South Carolina
title_fullStr Temporal Trends in Cardiovascular Hospital Discharges Following a Mass Chlorine Exposure Event in Graniteville, South Carolina
title_full_unstemmed Temporal Trends in Cardiovascular Hospital Discharges Following a Mass Chlorine Exposure Event in Graniteville, South Carolina
title_short Temporal Trends in Cardiovascular Hospital Discharges Following a Mass Chlorine Exposure Event in Graniteville, South Carolina
title_sort temporal trends in cardiovascular hospital discharges following a mass chlorine exposure event in graniteville, south carolina
topic Public Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6517492/
https://www.ncbi.nlm.nih.gov/pubmed/31134174
http://dx.doi.org/10.3389/fpubh.2019.00112
work_keys_str_mv AT howellashleyv temporaltrendsincardiovascularhospitaldischargesfollowingamasschlorineexposureeventingranitevillesouthcarolina
AT venajohne temporaltrendsincardiovascularhospitaldischargesfollowingamasschlorineexposureeventingranitevillesouthcarolina
AT caibo temporaltrendsincardiovascularhospitaldischargesfollowingamasschlorineexposureeventingranitevillesouthcarolina
AT lacklanddanielt temporaltrendsincardiovascularhospitaldischargesfollowingamasschlorineexposureeventingranitevillesouthcarolina
AT ingramlucya temporaltrendsincardiovascularhospitaldischargesfollowingamasschlorineexposureeventingranitevillesouthcarolina
AT lawsonandrewb temporaltrendsincardiovascularhospitaldischargesfollowingamasschlorineexposureeventingranitevillesouthcarolina
AT svendsenerikr temporaltrendsincardiovascularhospitaldischargesfollowingamasschlorineexposureeventingranitevillesouthcarolina