Associations between hospital readmissions and residential proximity to brownfields in North Carolina
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Background: Contaminated sites known as brownfields contribute to air, water, and land pollution and also prevent the beneficial use of lands by the community. The health effects surrounding brownfields have been understudied which can impair efforts to quantify the benefits of their remediation.
Methods: Our study cohort was composed of 21,776 heart failure patients diagnosed between 2004 and 2016 at a University of North Carolina Healthcare System affiliated hospital or clinic. We examined the associations between brownfields and hospital readmissions. We used proximity to the nearest brownfield as our exposure based on the primary residence at the time of heart failure diagnosis. Zero-inflated Poisson models were used to associate distance to the nearest brownfield with readmissions while adjusting for age, race, sex, and socioeconomic status indicators based on the 2010 US Census. In sensitivity analyses we examined log transformed distance, restricted to only those brownfields within 2 km of an individual, and further adjusted for county-level indicators of access to healthcare.
Results: A 1 km increase in distance to the nearest brownfield was associated with a 1.29% (95% confidence interval = 0.43-2.14%) decrease in 7-day readmissions as well as a 0.55% decrease (95% confidence interval = 0.20-0.90%) in 30-day readmissions. Associations with 7-day readmissions remained when restricting to brownfields within 2km, in the log-transformed distance models, and after adjusting for county-level indicators of access to healthcare. Associations with 30-day readmissions were substantially attenuated under all sensitivity analyses.
Conclusion: Proximity to brownfields is associated with increases in hospital visits and readmissions among heart failure patients. These associations may reflect exposure to chemicals present in the brownfields as well as land disinvestment. Understanding the health risks surrounding brownfields may help communities to better protect their environmental health. This abstract does not necessarily represent the views or policies of the US EPA.