Radmila Choate Pilot Scope: UK-CARES - MOSAIC Study: Multimorbidity, Ongoing Symptoms, and Airway Disease in an Appalachian Community Following East Palestine Train Derailment Exposure

ABSTRACT Environmental disasters may produce sustained multisystem health effects that extend beyond the acute exposure period, particularly in communities with high baseline chronic disease burden.1-3 The 2023 train derailment in East Palestine, OH, resulted in widespread environmental exposure and substantial reports of acute respiratory and systemic symptoms.4 Although early health concerns have been documented, the long-term burden of chronic disease after derailment remains insufficiently characterized in these Appalachian communities. Research demonstrates that Appalachian populations experience elevated rates of multiple chronic conditions (or multimorbidity), aging-related vulnerability, environmental disadvantages, and constrained healthcare access.5-8 These underlying factors may amplify susceptibility to persistent symptom burden and functional decline after toxic exposure. However, little is known about how the multiple chronic disease burden and proximity to environmental exposure interact to shape ongoing multisystem health outcomes in this setting. This gap limits the ability to identify high-risk clinical phenotypes, guide surveillance strategies, and design targeted interventions for environmentally exposed communities. Understanding how environmental exposure interacts with existing chronic disease burden is essential for identifying populations most vulnerable to long- term health effects. The overall objective of the proposed Multimorbidity, Ongoing Symptoms, and Airway Disease in an Appalachian Community Following East Palestine Train Derailment Exposure (MOSAIC) study is to characterize multimorbidity patterns, including chronic lung disease burden, and persistent multisystem symptom phenotypes among residents of the East Palestine area several years after derailment-related exposure, and to determine how these factors intersect to in?uence current health status.9 We hypothesize that residents of East Palestine will demonstrate a high prevalence of multimorbidity and persistent symptom burden several years after derailment exposure, with greater burden among individuals residing closer to the derailment site and among adults aged 65 years and older compared with residents of Cambridge, OH.