Assessing the Burden of and Factors Contributing to Injuries Associated with Chemical Exposures in the State of Florida

BACKGROUND:  Chemical incidents are a serious public health concern in Florida.  The Florida Poison Information Center received over 2,500 calls in 2012 categorized as possible exposure to chemicals or fumes/gases/vapors.  The Chemical Disease Surveillance Program, located within the Florida Department of Health, performs surveillance and investigation activities related to chemical exposures.  The purpose of this study is to better understand the burden of and factors contributing to injuries associated with chemical exposures in Florida.

METHODS:  Emergency Department (ED) visit and inpatient hospitalization data from 2008 through 2012 were obtained from the Florida Agency for Health Care Administration (AHCA).  To identify ED visits and hospitalizations resulting from exposure to chemical substances, the principal diagnosis and other diagnoses fields were searched for relevant International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes.  External cause of injury fields were also searched for relevant codes.  ED visits and hospitalizations that resulted from exposure to chemicals purposely inflicted were excluded.  To calculate an average annual rate per 100,000 persons, population data from 2010 (midpoint) were obtained from State of Florida estimates.  Other variables of interest included age, gender, race, ethnicity, charges, and principal payer.  Due to predefined population estimate categories, race was defined as white and black/other.

RESULTS:  For the 5-year period, from 2008 through 2012, 49,205 ED visits and 8,008 hospitalizations were identified as being associated with chemical exposures.  Of the ED visits, 52% were male, 65% were white, and 82% were non-Hispanic.  Among the hospitalizations, 45% were male, 76% were white, and 84% were non-Hispanic.  The average annual rate for ED visits associated with chemical exposures was 52.3 per 100,000 persons.  The rate was 162.8 among children 5 years of age and younger compared to 41.7 and 44.7 among 6-17 year olds and 18+ years, respectively.  ED patients 18+ years of age categorized as black/other had a rate of 73.1 compared to 37.5 among whites.  The average annual rate for hospitalizations associated with chemical exposures was 8.5.  The rate was 9.9, 1.7, and 9.6 among ages 0-5, 6-17, and 18+, respectively.  Among patients 18+ years of age, 16% of ED visits and 4% of hospitalizations had a principal payer recorded as Workers’ Compensation.  Median charges were $951 and $24,329 for ED visits and hospitalizations, respectively.

CONCLUSIONS:  Analysis of ED and hospitalization data can help identify at risk populations for chemical exposures and guide prevention and syndromic surveillance efforts.