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For Peer Review Only BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-003334 on 20 September 2013. Downloaded from Burden of disease attributable to the Hebei Spirit oil spill in Taean, Korea ForJournal: peerBMJ Open review only Manuscript ID: bmjopen-2013-003334 Article Type: Research Date Submitted by the Author: 06-Jun-2013 Complete List of Authors: Kim, Young-Min; Rollins School of Public Health, Emory University, Department of Environmental Health Park, Jae-Hyun; Sungkyunkwan University School of Medicine, Department of Social and Preventive Medicine Choi, Kyusik; Sungkyunkwan University School of Medicine, Department of Social and Preventive Medicine Noh, Su Ryeon; Taean Environmental Health Center, Choi, Young-Hyun; Taean Environmental Health Center, Cheong, Hae-Kwan; Sungkyunkwan University School of Medicine, Department of Social and Preventive Medicine <b>Primary Subject Public health Heading</b>: Secondary Subject Heading: Epidemiology, Health economics, Occupational and environmental medicine EPIDEMIOLOGY, HEALTH ECONOMICS, Epidemiology < THORACIC http://bmjopen.bmj.com/ Keywords: MEDICINE, MENTAL HEALTH, TOXICOLOGY on October 1, 2021 by guest. Protected copyright. For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 1 of 25 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-003334 on 20 September 2013. Downloaded from 1 2 3 4 Burden of disease attributable to the Hebei Spirit oil spill in 5 6 7 Taean, Korea 8 9 10 Young-Min Kim1 , Jae-Hyun Park2, Kyusik Choi2, Su Ryeon Noh3, Young-Hyun Choi3, Hae- 11 12 Kwan Cheong2 13 14 1Department of Environmental Health, Rollins School of Public Health, Emory University, 15 For peer review only 16 17 1518 Clifton Road NE, Atlanta, GA, USA 18 19 2Department of Social and Preventive Medicine, Sungkyunkwan University School of 20 21 Medicine, 2066 Seobu-ro, Jangan-gu, Suwon, 440-746, Republic of Korea 22 23 3 24 Taean Environmental Health Center, 1952-16 Seohae-ro, Taean, Chungnam, 357-902, Re 25 26 public of Korea 27 28 29 30 * Corresponding author: Hae-Kwan Cheong 31 32 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, 440-746, Korea 33 34 35 Tel: +82-31-299-6300, Fax: +82-031-299-6299 http://bmjopen.bmj.com/ 36 37 E-mail: [email protected] 38 39 40 41 * Keywords: oil spill, disability-adjusted life-year (DALY), polycyclic aromatic 42 43 on October 1, 2021 by guest. Protected copyright. 44 hydrocarbons (PAHs), post-traumatic stress disorder (PTSD), disability weight 45 46 47 48 Word count: 49 Abstract: 257 words 50 51 Main text: 2915 words 52 No. of tables: 3 53 No. of Figures: 2 54 No. of references: 27 55 56 57 1 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 2 of 25 BMJ Open: first published as 10.1136/bmjopen-2013-003334 on 20 September 2013. Downloaded from 1 2 3 4 ARTICLE SUMMARY 5 6 7 Article focus 8 ▶ This study aimed at assessing the burden of disease (BOD) of the residents of 9 10 the contaminated coastal area 11 ▶ and at analyzing the BOD attributable to the oil spill by disease, group, and 12 region. 13 14 15 Key messagesFor peer review only 16 17 ▶ This study provided an opportunity to assess the disease burden of the 18 residents integrating mental and physical symptoms. 19 20 ▶ Among diseases, years lost due to disabilities (YLDs) for mental disease such 21 as PTSD and depression attributable to the oil spill are higher in males than 22 23 females and those for asthma and allergies are higher in females than males. 24 ▶ Oil spills near coastlines can cause considerable adverse health effects and that 25 26 the summation of disease burden is not negligible, even though the size of the 27 population affected may be small. 28 29 Strength and limitations 30 31 ▶ This is the first study to quantify the BOD of a single environmental disaster. 32 33 ▶ This study demonstrates that BOD is an objective and comprehensive metric for 34 estimating and comparing the health effects of environmental hazards and 35 disasters across different regions and time periods. http://bmjopen.bmj.com/ 36 Long-term health outcomes such as cancers and chronic degenerative diseases 37 ▶ 38 could not be estimated. 39 40 41 42 43 on October 1, 2021 by guest. Protected copyright. 44 45 46 47 48 49 50 51 52 53 54 55 56 57 2 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 25 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-003334 on 20 September 2013. Downloaded from 1 2 3 4 5 6 7 8 9 10 11 ABSTRACT 12 13 Objectives: We aimed at assessing the burden of disease (BOD) of the residents of the 14 15 contaminatedFor coastal area peer and at analyzing review the BOD attributable only to the oil spill by disease, 16 17 group, and region. 18 19 20 Design: Health impact assessment study of a specific environmental exposure from oil spill 21 22 Setting: Use of secondary health outcome data. A whole population of a community affected 23 24 by an anthropogenic environmental disaster. 25 26 Participants: 63,053 individuals (male: 31,636; female: 31,417) and 3,420 individuals (male: 27 28 1,805; female: 1,615) from two counties, respectively 29 30 31 Interventions: None. Observational study on the effect of a specific environmental health 32 33 hazard. 34 35 Primary and secondary outcome measures: BOD was measured using disability-adjusted http://bmjopen.bmj.com/ 36 37 life-year (DALY) method based on the incidence and prevalence of the health outcome 38 39 40 related to the oil spill. 41 42 Results: Years lost due to disabilities (YLD) attributable to the oil spill were estimated to be 43 on October 1, 2021 by guest. Protected copyright. 44 14,724 DALYs (male: 7,425 DALYs; female: 7,299 DALYs) for the year 2008. The YLD for 45 46 males for mental diseases were higher than for females, and the YLD for females was higher 47 48 in asthma and allergies than for males. The effects of asthma and allergies were the greatest 49 50 51 for people in their 40s, with the burden of mental illness being the greatest for those in their 52 53 20s. Proximity to the spill site was associated with increased burden of disease. 54 55 Conclusions: An oil spill near a coastline can cause substantial adverse health effects. As the 56 57 3 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 4 of 25 BMJ Open: first published as 10.1136/bmjopen-2013-003334 on 20 September 2013. Downloaded from 1 2 3 4 health effects of hazardous pollutants from oil spills are long-lasting, close follow-up studies 5 6 are required to identify chronic health effects. 7 8 Trial registration: Not applicable 9 10 11 12 INTRODUCTION 13 14 On December 7, 2007, the Hebei Spirit oil tanker spilled 12,547 kl (10,900 tons) of crude 15 For peer review only 16 oil into the Yellow Sea, approximately 8 km away from the coast of Taean, Korea. This was 17 18 19 the largest oil spill in the history of Korea. Spilled oil contaminated over 1,000 km of the 20 21 western coast of Korea including the Taean Coast National Park.[1] Crude oil contains 22 23 various volatile organic compounds (VOCs) such as benzene, toluene, ethylbenzene, xylenes, 24 25 and polycyclic aromatic hydrocarbons (PAHs),[2] all of which are potential air-borne toxins. 26 27 Certain VOCs, benzene in particular, are carcinogenic to humans and are associated with 28 29 30 haematologic cancer.[3] Previous studies [4-11] have reported that oil spills have caused 31 32 adverse health effects for residents of contaminated areas and clean-up workers. Risk 33 34 analyses revealed that more frequent clean-ups and greater exposure to oil are strongly 35 http://bmjopen.bmj.com/ 36 associated with higher frequencies of psychological symptoms. [8-11] Rodriguez-Trigo [6] 37 38 39 reported that participation in a major oil spill clean-up is associated with chromosomal 40 41 damage, although they were unable to determine whether oil exposure itself caused the 42 43 abnormalities. on October 1, 2021 by guest. Protected copyright. 44 45 After the Hebei Spirit oil spill, more than 2,000,000 people (person-days), including over 46 47 1,200,000 person-days by volunteers, participated in clean-up activities during the first seven 48 49 50 months.[1] Among them were residents of Taean, a highly exposed group that experienced 51 52 adverse health effects, including both physical and psychological symptoms.[4, 12] Although 53 54 many studies have reported positive relationships between oil spills and acute and chronic 55 56 57 4 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 5 of 25 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-003334 on 20 September 2013. Downloaded from 1 2 3 4 health impacts, there have been no studies quantifying the burden of disease (BOD) due to oil 5 6 spills, which are necessary to assess the scale of health damage at the population level as well 7 8 as the associated compensation costs. 9 10 11 Therefore, we sought to quantify the adverse health impacts of exposure to oil spills by 12 13 applying the disability-adjusted life-year (DALY) measure developed by the World Health 14 15 OrganizationFor (WHO).[13] peer This approach review is practical because only the estimated adverse health 16 17 burden attributable to an oil spill can be compared with other BOD, including environmental 18 19 20 burdens of disease (EBD).
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