Abstract #368532 Frances Garca 2 Authors MPH Biostatistics MPH - PowerPoint PPT Presentation

Prevalence of respiratory, dermatologic and reproductive conditions in a community exposed to coal ash and other industrial contaminants in Guayama, and a reference community in Fajardo: A cross-sectional study in Puerto Rico Presented by: Abstract #368532 Frances García

2 Authors MPH Biostatistics MPH Epidemiology Jorge Albarracín Dayanara Belén Omar Dávila Carol Canales Inelia Otero Carlos Litovich Camille Delgado Jeremy Pérez Glorimar Meléndez Gilberto Fernández Stephany Pérez Eric Miranda Viery Franco Fabiola Robles Marangelí Olán Frances García Rafael Ruiz Maylisa Romero Noemí Hernández Lilliana Serrano Jonathan Sánchez María Martínez Coralys Soto Israel Méndez Camila Villa Daniela Ojeda Wesley Villavicencio Mentors: Dr. Rosa Rosario Rosado & Dr. Gilberto Ramos Valencia

3 General Information ¡ This study served as part of a practicum course required for the completion of a MPH degree in Biostatistics and Epidemiology. ¡ Community leaders were invited to voice their concerns in regards to public health issues in their community.

4 Background: Why Guayama? ¡ This study was conducted in response to the community’s concern of coal ash exposure and perceived increased frequency in health conditions: ¡ Respiratory diseases ¡ Dermatological diseases ¡ Currently Guayama has a variety of industries that contribute to environmental contamination, such as: ¡ Coal fired power plant ¡ Various Pharmaceuticals

5 Background: Why Guayama? ¡ According to the Toxic Release Inventory (TRI), the coal fired power plant in Guayama placed second for total air emissions in Puerto Rico for the year 2014. (EPA, 2016)

6 Objective ¡ The main objective of this study was to compare the prevalence of respiratory, dermatological, and reproductive conditions in two communities. ¡ Guayama: Community exposed to coal ash and other industrial contaminants ¡ Fajardo: Reference community

7 Study Population Guayama Fajardo ¡ Puente de Jobos ¡ Santa Isidra ¡ Miramar ¡ Rafael Bermudez Communities within a 2-3 Km Communities not proximal to radius from industrial zone industrial zone

8 Fajardo Guayama

9 Guayama Fajardo 1. Puente de Jobos 2. Miramar 3. Coal Fired Power Plant 4. Pharmaceutical 5. Pharmaceutical 7. Pharmaceutical 1. Rafael Bermudez 2. Santa Isidra

10 Study Population Guayama Fajardo ¡ Puente de Jobos ¡ Santa Isidra ¡ Miramar ¡ Rafael Bermudez Communities within a 2-3 Km Communities not proximal to radius from industrial zone industrial zone Sociodemographic similarities between both populations were taken into consideration.

11 Study Population (US Census 2010) Distribution by sex Guayama Fajardo Total Male population 1,054 (42%) 776 (45%) Total Female population 1,427 (58%) 960 (55%) Sociodemographic characteristics Guayama Fajardo Total Population 2,481 1,736 Income median $15,639 $19,409 Total number of families 672 431 Average Family size 3.25 3.93

12 Study Question Are the respiratory and dermatological disease prevalence greater in Guayama in comparison to those in Fajardo?

13 Method s

14 Sample design ¡ Subjects in each community were selected using a probabilistic stratified cluster design: ¡ Guayama= 276 ¡ Fajardo= 195 ¡ Non-institutionalized residents ¡ Sample size adjusted for: no-response rates, absent residents, and uninhabited units

15 Data Collection ¡ Interviewers were trained on study protocol to reduce interviewer bias ¡ Instrument: Standardized Questionnaire ¡ Home interview ¡ Duration: 25-30 minutes

16 Subject to be interviewed ¡ Head of the household or person with the most knowledge about household ¡ one person ( ≥ 21 years) from each household was interviewed, regarding family members ¡ Resident of the community for at least 5 years

17 Data Processing ¡ Data Entry: ¡ RED Cap ¡ Quality Control ¡ Double data entry ¡ Randomized selection of questionnaires (20%) for revision ¡ Data was exported to SPSS 17.0 for statistical analysis

18 Statistical Analysis Univariable Bivariable Multivariable • Frequency • Z test • Logistic distribution Regression • x 2 Test • Central tendency and dispersion measures

19 Result s

20 Study Sample ¡ Total number of ¡ Response Rate households interview: 176 ¡ Guayama: 81% ¡ Guyama: 102 ¡ Fajardo: 64% ¡ Fajardo: 74 ¡ Total sample size: 471 ¡ Guayama: 276 ¡ Fajardo: 195

21 Age group distribution in weighted population 40 37.4 Guayama (N=2,561) 34.8 35 Fajardo (N=1,802) Porcentage (%) 30 25.8 25.1 25.0 24.1 25 20 16.0 15 11.8 10 5 0 0 a 17 years 18 a 44 years 45 a 64 years ≥ 65 years Age group

22 Sample Description Guayama Fajardo Male 42.6% 45.6% Female 57.4% 54.4% Smoker in household 4.7% 7.4% Education level < 12th grade 15% 16.5% 12 th grade < Bachelor’s 75% 52.8% ≥ Bachelor’s 10% 30.7%

23 Perceived environmental contamination in the weighted population Guayama (N=2445) 70 62.2 Fajardo (N=1008) 60 53.4 Porcentage (%) 50 40 30 21.6 21.0 16.0 20 10.9 9.0 10 1.4 0 None Slight Moderate Severe Perceived Environmental Pollution

24 Air quality perception in the weighted population 70 63.4 60 [VALUE].0 Porcentage (%) 50 Guayama (N=2,561) 40 Fajardo (N=1,802) 33.8 33.4 30 20 15.6 10 2.8 0 Poor Good Excellent Air quality perception

25 Weighted Estimates Prevalence (%) Disease or Condition Guayama Fajardo Any Respiratory Disease 35.5 15.7 Sinusitis 20.0 10.2 Asthma 16.8 1.1 Chronic Bronchitis 5.1 1.0 Any Dermatologic Disease 4.1 1.8 Rash 2.3 0.2 Spontaneous Abortions (15-49 years old) 22.4 3.6 Adjusted by age

26 Odds Ratio: Any Respiratory Disease Crude Adjusted CI 95% CI 95% OR OR Any Respiratory 2.51 1.57 - 4.00 2.24 1.86 – 3.64 Disease Adjusted by age, smoker in household & education level

27 Odds Ratio: Asthma Crude Adjusted CI 95% CI 95% OR OR Asthma 2.5 1.3 - 4.7 2.3 1.19 – 4.45 Adjusted by: age, smoker in household & education level

28 Odds Ratio: Sinusitis Crude Adjuste CI 95% CI 95% OR d OR Sinusitis 2.2 1.2 - 3.9 1.93 1.07 – 3.48 Adjusted by age, smoker in household & education level

29 Odds Ratio: Chronic Bronquitis Crude Adjusted CI 95% CI 95% OR OR Chronic Bronchitis 3.2 1.2 - 8.5 3.87 1.22 – 3.48 Adjusted by age, smoker in household & education level

30 Odds Ratio: Any Dermtological Disease Crude Adjusted CI 95% CI 95% OR OR Any Dermatological 3.7 1.2 – 11.2 2.94 0.95 – 9.01 Disease Adjusted by age, smoker in household & education level

31 Odds Ratio: Rash Crude Adjusted CI 95% CI 95% OR OR Rash 7.6 1.6 - 35.9 7.5 3.0 – 16.2 Adjusted by: age

32 Odds Ratio: Spontaneuos Abortions OR CI 95% Spontaneous Abortions 7.8 0.9 - 69.3 (15-49 years old)

33 Limitations ¡ A clear temporal relationship between exposure and outcome cannot be determined. ¡ Time and resources were limited

34 Conclusion ¡ Study findings suggest that the prevalence of respiratory, dermatologic, and reproductive conditions are significantly higher in the exposed community of Guayama than in the reference community. ¡ Findings seem to confirm the community’s concern

35 Recommendations ¡ Control, regulation and industrial waste management compliance. ¡ Early screening and treatment of diseases associated with exposure. ¡ Improve quality of life and reduce preventable diseases and mortality

36 Recommendations ¡ Keep community active and engaged in the pursue of public policy enforcement through community initiatives and empowerment. ¡ Conduct analytical studies to establish a clear temporal relationship between exposure and outcome. Photo from: Periódico Primera Hora