Paul Garbe

Acute health effects after exposure to chlorine gas released after a train derailment

In January 2005, a train derailment on the premises of a textile mill in South Carolina released 42 to 60 tons of chlorine gas in the middle of a small town. Medical records and autopsy reports were reviewed to describe the clinical presentation, hospital course, and pathology observed in persons hospitalized or deceased as a result of chlorine gas exposure. Eight persons died before reaching medical care; of the 71 persons hospitalized for acute health effects as a result of chlorine exposure, 1 died in the hospital. The mean age of the hospitalized persons was 40 years (range, 4 months-76 years); 87% were male. The median duration of hospitalization was 4 days (range, 1-29 days). Twenty-five (35%) persons were admitted to the intensive care unit; the median length of stay was 3 days. Many surviving victims developed significant pulmonary signs and severe airway inflammation; 41 (58%) hospitalized persons met PO2/FiO2 criteria for acute respiratory distress syndrome or acute lung injury. During their hospitalization, 40 (57%) developed abnormal x-ray findings, 74% of those within the first day. Hypoxia on room air and PO2/FiO2 ratio predicted severity of outcome as assessed by the duration of hospitalization and the need for intensive care support. This community release of chlorine gas caused widespread exposure and resulted in significant acute health effects and substantial health care requirements. Pulse oximetry and arterial blood gas analysis provided early indications of outcome severity.

Racial and Ethnic Disparities in Current Asthma and Emergency Department Visits: Findings from the National Health Interview Survey, 2001–2010

Objectives. Racial/ethnic disparities in current asthma prevalence and medical care are a major public health concern. We examined the differences in asthma prevalence and morbidity among major racial/ethnic populations in the US. Methods. We analyzed data from the 2001–2010 National Health Interview Survey for adults (≥18 years) and children and adolescents (<18 years). Outcome variables were current asthma prevalence, at least one attack in the past 12 months, and at least one asthma-related emergency department/urgent care center (ED/UCC) visit in the past 12 months. We used multivariate logistic regression to calculate the model-adjusted prevalence and risk ratios (ARR). Results. In our study, 9.0% of the children and 7.2% of the adults had current asthma. Non-Hispanic black and Puerto Rican children were more likely to have current asthma (ARR 1.46, 1.66, respectively) and to visit the ED/UCC (ARR 1.61, 1.67, respectively) than non-Hispanic whites. American Indian/Alaskan Native children were more likely to have current asthma (ARR 1.76) than non-Hispanic whites. Mexican/Mexican American children and adults had lower prevalence of current asthma but higher ED/UCC use (adults only) than non-Hispanic whites. Among adults, Puerto Ricans and American Indian/Alaskan Natives were more likely to have current asthma (ARR 1.60, 1.39, respectively) than non-Hispanic whites, and all the studied racial/ethnic groups except Asians were more likely to have visited the ED/UCC than non-Hispanic whites. Adults and children who received emergency care for asthma in the past 12 months more frequently received multiple components of asthma management and control (e.g., taking long-term medication, having an asthma management plan) compared to those without emergency care. Conclusions. Racial/ethnic differences in current asthma prevalence, asthma attacks, and increased utilization of emergency room visits for asthma among minorities persist among children and adults. Appropriate and effective asthma management and education may lead to better asthma control and reduce emergency care utilization.

Autoimmune thyroid disease associated with environmental thyroidal irradiation.

Reports of increased rates of thyroid disease in populations exposed to radiation as a result of the Chernobyl accident have increased awareness and concern about the risk of autoimmune-related thyroid disease possibly associated with environmental radiation exposure. While the association between thyroidal irradiation and an increased risk of thyroid neoplasia is well established, much less attention has been devoted to the potential effects of environmental irradiation on the function of the thyroid. However, since the Chernobyl accident new studies have been published that appear to link radiation exposure to an increased risk of autoimmune thyroiditis. In order to assess the plausibility of this association, we reviewed published studies that evaluate the possible association between environmental thyroidal radiation and the presence of antithyroid antibodies as well as autoimmune thyroid disease (hypothyroidism and hyperthyroidism). These data have not been summarized elsewhere. Although some epidemiologic evidence of an association exists, long-term, well-designed studies are needed to accurately evaluate the complex association between low-dose environmental radiation exposure and clinically significant non-neoplastic thyroid disease. The results of these studies will be important in determining the appropriate clinical follow-up of persons exposed to environmental thyroidal irradiation.

Carbon monoxide-related hospitalizations in the U.S.: evaluation of a web-based query system for public health surveillance.

Objective. Carbon monoxide (CO) poisoning is preventable, yet it remains one of the most common causes of poisoning in the U.S. In the absence of a national data reporting system for CO-poisoning surveillance, the burden of CO-related hospitalizations is unknown. Our objective was to generate the first national estimates of CO-related hospitalizations and to evaluate the use of a Web-based query system for public health surveillance. Methods. The Healthcare Cost and Utilization Projects (HCUPs) 2005 Nationwide Inpatient Sample (NIS) data were used for CO-related hospitalization estimates. Data for confirmed, probable, and suspected cases were generated using the HCUPnet Web-based query system. We used data from 1993 through 2005 NIS to describe trends in CO-related hospitalizations. We used the Centers for Disease Control and Preventions surveillance evaluation guidelines to evaluate the system. Results. In 2005, there were 24,891 CO-related hospitalizations nationwide: 16.9% (n=4,216) were confirmed, 1.1% (n=279) were probable, and 81.9% (n=20,396) were suspected CO-poisoning cases. Of the confirmed cases (1.42/100,000 population), the highest hospitalization rates occurred among males, older adults (aged ≥85 years), and Midwestern residents. CO-related hospitalization rates declined from 1993 through 2000 and plateaued from 2001 through 2005. The simplicity, acceptability, sensitivity, and representativeness of the HCUPnet surveillance system were excellent. However, HCUPnet showed limited flexibility and specificity. Conclusions. Nationwide, the burden of CO exposure resulting in hospitalization is substantial. HCUPnet is a useful surveillance tool that efficiently characterized CO-related hospitalizations for the first time. Public health practitioners can utilize this data source for state-level surveillance.

The Economic Burden of Asthma in the United States, 2008–2013

Rationale: Asthma is a chronic disease that affects quality of life, productivity at work and school, and healthcare use; and it can result in death. Measuring the current economic burden of asthma provides important information on the impact of asthma on society. This information can be used to make informed decisions about allocation of limited public health resources. Objectives: In this paper, we provide a comprehensive approach to estimating the current prevalence, medical costs, cost of absenteeism (missed work and school days), and mortality attributable to asthma from a national perspective. In addition, we estimate the association of the incremental medical cost of asthma with several important factors, including race/ethnicity, education, poverty, and insurance status. Methods: The primary source of data was the 2008‐2013 household component of the Medical Expenditure Panel Survey. We defined treated asthma as the presence of at least one medical or pharmaceutical encounter or claim associated with asthma. For the main analysis, we applied two‐part regression models to estimate asthma‐related annual per‐person incremental medical costs and negative binomial models to estimate absenteeism associated with asthma. Results: Of 213,994 people in the pooled sample, 10,237 persons had treated asthma (prevalence, 4.8%). The annual per‐person incremental medical cost of asthma was

Outdoor PM2.5, Ambient Air Temperature, and Asthma Symptoms in the Past 14 Days among Adults with Active Asthma.

3,266 (in 2015 U.S. dollars), of which

Radon Awareness and Testing Behavior: Findings from the Behavioral Risk Factor Surveillance System, 1989–1992

1,830 was attributable to prescription medication,

Vital Signs: Asthma in Children — United States, 2001–2016

640 to office visits,

Assessing Community-Based Approaches to Asthma Control: The Controlling Asthma in American Cities Project

529 to hospitalizations,

Chernobyl and iodine deficiency in the Russian Federation: an environmental disaster leading to a public health opportunity.

176 to hospital‐based outpatient visits, and