ABSTRACT

Children’s risk of exposure to carbon monoxide (CO) increases after disasters, likely due to improper generator use during power outages. Here, we evaluate the impact of outages on children’s CO-related emergency department (ED) visits in New York State (NYS). We leveraged power outage data spanning 2017-2020 from the NYS Department of Public Service for 1,865 power operating localities (i.e., communities) and defined all-size and large-scale power outage hours. All-size outage hours affected ≥1% of customers, and large-scale outage hours affected ≥20%. We identified CO poisoning using diagnostic codes among those aged <18 between 2017 and 2020 using the Statewide Planning and Research Cooperative System (SPARCS), an all-payer reporting system in NYS. We linked community power outage exposure to patients using the population-weighted centroid of their block group of residence. We estimated the impact of power outages on CO poisoning using a time-stratified case-crossover study design with conditional logistic regression, controlling for daily relative humidity, mean temperature, and total precipitation. Analyses were stratified by urban and rural communities. From 2017-2020, there were 917 pediatric CO poisoning ED visits in NYS. Most cases (83%) occurred in urban region of the state. We observed an association statewide between all-size and large-scale outages and CO ED visits on the index day and the following two days before a return to baseline on lag day 3. Four hours without power increased the odds of a pediatric CO poisoning ED visit by ≥50% for small-scale and ≥150% for large-scale outages, and associations were stronger in urban versus rural areas. While CO poisoning is a relatively rare cause of pediatric ED visits in NYS, it can be deadly and is also preventable. Expanded analyses of the health impacts of outages and advocacy for reliable energy access are needed to support children’s health in a changing climate

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This work was support by grant R01ES030717 from the National Institute of Environmental Health Sciences. This work was also supported by grant T32ES007322, 2T32ES007322, P30ES009089, and R00ES027023 of the National Institute of Environmental Health Sciences.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The IRB of the Icahn School of Medicine at Mount Sinai gave ethical approval for this work (#19-00355).

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Footnotes

Conflict of Interest Disclosures (includes financial disclosures): None declared

Funding: This work was supported by grant R01ES030717 from the National Institute of Environmental Health Sciences. This work was also supported by grant T32ES007322, 2T32ES007322, P30ES009089, and R00ES027023 of the National Institute of Environmental Health Sciences.

Data Availability: Power outage data and related code are available upon request. The meteorological data used in the analyses are publicly available (https://ldas.gsfc.nasa.gov/nldas). Health data from the analyses may be available upon SPARCS approval (https://www.health.ny.gov/statistics/sparcs/access/).

Role of Funder (if any): The NIH had no role in the design and conduct of the study.

AbbreviationsCOCarbon monoxideEDEmergency departmentICD-10International Classification of Diseases-10NHNon-HispanicNYSNew York State