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Flooding and Health Care Visits for Clostridium Difficile Infection: A Case-Crossover Analysis
Lin, C., Tim Wade, AND E Hilborn. Flooding and Health Care Visits for Clostridium Difficile Infection: A Case-Crossover Analysis. Presented at International Society for Environmental Epidemiology Conference, Seattle, WA, August 24 - 28, 2014.
Floods are expected to increase during climate change as intense, episodic rainfall events are increasing over time. We evaluate the effect of flooding on reported human infection with Clostridium difficile, a fecal / oral pathogen of high public health impact and importance. We find a significant association between flood events and Emergency Room visits for C. difficile infection 7-13 days after the flood. C. difficile is an emerging waterborne pathogen and may be considered for future CCL listing.
Floods can contaminate potable water and other resources, thus increasing the potential for fecal-oral transmission of pathogens. Clostridium difficile is a bacterium that can spread by water and cause acute gastrointestinal illness. It often affects older adults who are hospitalized and/or receiving antibiotics; however, community-acquired C. difficile infections have become more commonly reported. We study the impact of flooding on health care visits for C. difficile infection. A case-crossover design was used to assess the impact of flooding on health care visits for C. difficile infection in Massachusetts. Emergency room (ER) and outpatient data were obtained from the State of Massachusetts for the years 2003-2007. Flood data came from the National Oceanic and Atmospheric Administration database of severe weather events. Town-matched control periods were selected at 4 and 5 weeks prior to each health care visit. Exposure status was based on whether or not a flood occurred prior to the case/control date during the following risk periods: 0-6 days, 7-13 days, 14-20 days, and 21-27 days. Fixed-effects logistic regression was used to estimate the risk of seeking health care for C. difficile infection following a flood. From 2003 through 2007, there were 129 flood events and 1,575 visits for C. difficile infection (1,023 ER; 552 outpatient). Among adults (19-64 years), ER visits for C. difficile infection were elevated during the 7-13 days following a flood, with odds ratios (95% confidence intervals) of 2.14 (1.03, 4.44). After combining ER and outpatient visits, however, this association was attenuated to 1.67 (0.92, 3.02). Associations were not observed during other risk periods or among other age groups. This is the first evaluation of health care visits for C. difficile infection following flood events. ER visits for C. difficile infection increased among adults during the 7-13 day period following a flood. This abstract does not necessarily reflect EPA policy.
URLs/Downloads:EPHD-14-069-ISEE ABSTRACT_LIN_FINAL (2) EH (3).DOCX
Record Details:Record Type: DOCUMENT (PRESENTATION/ABSTRACT)
Organization:U.S. ENVIRONMENTAL PROTECTION AGENCY
OFFICE OF RESEARCH AND DEVELOPMENT
NATIONAL HEALTH AND ENVIRONMENTAL EFFECTS RESEARCH LABORATORY
ENVIRONMENTAL PUBLIC HEALTH DIVISION