title: Long-term impact of environmental public health disaster on health system performance: experiences from the Graniteville, South Carolina chlorine spill.
abstract: OBJECTIVE
  In the aftermath of an environmental public health disaster (EPHD) a healthcare system may be the least equipped entity to respond. Preventable visits for ambulatory care-sensitive conditions (ACSCs) may be used as a population-based indicator to monitor health system access postdisaster. The objective of this study was to examine whether ACSC rates among vulnerable subpopulations are sensitive to the impact of a disaster.
  
  
  METHODS
  We conducted a retrospective analysis on the 2005 chlorine spill in Graniteville, South Carolina using a Medicaid claims database. Poisson regression was used to calculate change in monthly ACSC visits at the disaster site in the postdisaster period compared with the predisaster period after adjusting for parallel changes in a control group.
  
  
  RESULTS
  The adjusted rate of a predisaster ACSC hospital visit for the direct group was 1.68 times the rate for the control group (95% confidence interval [CI] 1.47-1.93), whereas the adjusted ACSC hospital rate postdisaster for the direct group was 3.10 times the rate for the control group (95% CI 1.97-5.18). For ED ACSC visits, the adjusted rate among those directly affected predisaster were 1.82 times the rate for the control group (95% CI 1.61-2.08), whereas the adjusted ACSC rate postdisaster was 2.81 times the rate for the control group (95% CI 1.92-5.17).
  
  
  CONCLUSIONS
  Results revealed that an increased demand on the health system altered health services delivery for vulnerable populations directly affected by a disaster. Preventable visits for ACSCs may advance public health practice by identifying healthcare disparities during disaster recovery.
authors.affiliation: Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA. jennifer.r.runkle@emory.edu
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Runkle
authors.forename: Hongmei
authors.initials: H
authors.lastname: Zhang
authors.forename: Wilfried
authors.initials: W
authors.lastname: Karmaus
authors.forename: Amy
authors.initials: A
authors.lastname: Brock-Martin
authors.forename: Erik R
authors.initials: ER
authors.lastname: Svendsen
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D055884:Chemical Hazard Release; D002713:Chlorine; D004189:Disaster Planning; D004190:Disasters; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008484:Medicaid / Q000706:statistics & numerical data; D008875:Middle Aged; D009657:North Carolina; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D012044:Regression Analysis; D012189:Retrospective Studies; D014481:United States; D035862:Vulnerable Populations
chemical_list: D002713:Chlorine