title: Lung Function before and after a Large Chlorine Gas Release in Graniteville, South Carolina.
abstract: BACKGROUND
  On January 6, 2005 a train derailment led to an estimated 54,915-kg release of chlorine at a local textile mill in Graniteville, South Carolina.
  
  
  OBJECTIVE
  We used the employee health spirometry records of the textile to identify enduring effects of chlorine gas exposure resulting from the incident on the lung function of workers employed at the textile mill.
  
  
  METHODS
  Spirometry records from 1,807 mill workers (7,332 observations) were used from 4 years before and 18 months after the disaster. Longitudinal analysis using marginal regression models produced annual population mean estimates for FEV1, FVC, and FEV1/FVC ratio. Covariate adjustment was made for sex, age, smoking, height, season tested, technician, obesity, season × year interactions, and smoker × year interactions. The increased prevalence of mill workers having accelerated FEV1 decline was also evaluated after the chlorine spill.
  
  
  RESULTS
  In the year of the accident, we observed a significant reduction in mean FEV1 (-4.2% predicted; P = 0.019) when compared with the year before the incident. In the second year, partial recovery in the mean FVC % predicted level was seen, but the cohort's average FEV1/FVC ratio continued to decrease over time. Severe annual FEV1 decline was most prevalent in the year of the accident, and independent of mill worker smoking status.
  
  
  CONCLUSIONS
  The Graniteville mill worker cohort revealed significant reductions in lung function immediately after the chlorine incident. Improvement was seen in the second year; but the proportion of mill workers experiencing accelerated FEV1 annual decline significantly increased in the 18 months after the chlorine incident.
authors.affiliation: 1 University of South Carolina, Columbia, South Carolina.
authors.forename: Kathleen A
authors.identifier: http://orcid.org/0000-0002-8554-9654
authors.initials: KA
authors.lastname: Clark
authors.affiliation: 2 University of Memphis, Memphis, Tennessee.
authors.forename: Wilfried J J
authors.initials: WJ
authors.lastname: Karmaus
authors.affiliation: 3 Medical University of South Carolina, Charleston, and.
authors.forename: Lawrence C
authors.initials: LC
authors.lastname: Mohr
authors.affiliation: 1 University of South Carolina, Columbia, South Carolina.
authors.forename: Bo
authors.initials: B
authors.lastname: Cai
authors.affiliation: 1 University of South Carolina, Columbia, South Carolina.
authors.forename: Pallavi
authors.initials: P
authors.lastname: Balte
authors.affiliation: 4 South Carolina Department of Health and Environmental Control, Columbia, South Carolina; and.
authors.forename: James J
authors.initials: JJ
authors.lastname: Gibson
authors.affiliation: 5 Georgia Regents University, Augusta, Georgia.
authors.forename: Dennis
authors.initials: D
authors.lastname: Ownby
authors.affiliation: 3 Medical University of South Carolina, Charleston, and.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Lawson
authors.affiliation: 3 Medical University of South Carolina, Charleston, and.
authors.forename: John E
authors.initials: JE
authors.lastname: Vena
authors.affiliation: 3 Medical University of South Carolina, Charleston, and.
authors.forename: Erik R
authors.initials: ER
authors.lastname: Svendsen
mesh_terms: D000328:Adult; D055884:Chemical Hazard Release / Q000266:history*; D002713:Chlorine / Q000009:adverse effects*; D004190:Disasters / Q000266:history; D005260:Female; D049674:History, 21st Century; D006801:Humans; D019570:Inhalation Exposure / Q000009:adverse effects*; D008137:Longitudinal Studies; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011890:Railroads; D012044:Regression Analysis; D013022:South Carolina; D013147:Spirometry; D013783:Textile Industry
chemical_list: D002713:Chlorine
keywords: Graniteville; chlorine gas; disaster epidemiology; lung function; rapid FEV1 decline; toxic gas exposure