Risk factors for and consequences of persistent lower respiratory symptoms among World Trade Center Health Registrants 10 years after the disaster

Friedman, Samuel; Farfel, Mark R.; Maslow, Carey B.; Jordan, Hannah; Li, Jiehui; Alper, Howard; Cone, James E.; Stellman, Steven D.; Brackbill, Robert M.

doi:10.1136/oemed-2015-103512

Cited by 25 publications

(33 citation statements)

References 33 publications

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“…These findings on acute pollution exposure on 9/11 are consistent with other analysis showing that persistent lower respiratory symptoms are strongly associated with a composite measure that included dust cloud exposure as well as experiencing or witnessing other traumatic events, which are ostensibly acute exposures (Friedman et al 2016). Other studies have reported the association between clinically based measures of lung function with arriving on 9/11/2001 among rescue workers up to 6 years after 9/11/2001 (Aldrich et al 2010; Wisnivesky et al 2011) and between dust or odor present more than 3 months with lower respiratory symptoms 2 years after 9/11/2001 among residents in lower Manhattan (Lin et al 2010; Reibman et al 2005).…”

Section: Discussionsupporting

confidence: 88%

“…PTSD at wave 1 was included as a risk factor in the multivariable model because it has been shown to be a contributing risk factor to the outcomes of interest in this study including heart disease (Jordan et al 2011) and lung problems (Friedman et al 2016). Multivariable analyses also included smoking status (current/former/never), and ever reporting hypertension.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Injury, intense dust exposure, and chronic disease among survivors of the World Trade Center terrorist attacks of September 11, 2001

Alper

Stellman

et al. 2017

Inj. Epidemiol.

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BackgroundThe World Trade Center attack of September 11, 2001 in New York City (9/11) exposed thousands of people to intense concentrations of hazardous materials that have resulted in reports of increased levels of asthma, heart disease, diabetes, and other chronic diseases along with psychological illnesses such as post-traumatic stress disorder (PTSD). Few studies have discriminated between health consequences of immediate (short-term or acute) intense exposures versus chronic residential or workplace exposures.MethodsWe used proportional hazards methods to determine adjusted hazard ratios (AHRs) for associations between several components of acute exposures (e.g., injury, immersion in the dust cloud) and four chronic disease outcomes: asthma, other non-neoplastic lung diseases, cardiovascular disease, and diabetes, in 8701 persons free of those conditions prior to exposure and who were physically present during or immediately after the World Trade Center attacks. Participants were followed prospectively up to 11 years post-9/11.ResultsHeart disease exhibited a dose-response association with sustaining injury (1 injury type: AHR =2.0, 95% CI (Confidence Interval) 1.1–3.6; 2 injury types: AHR = 3.1, 95% CI 1.2–7.9; 3 or more injury types: AHR = 6.8, 95% CI 2.0–22.6), while asthma and other lung diseases were both significantly associated with dust cloud exposure (AHR = 1.3, 95% CI 1.0–1.6). Diabetes was not associated with any of the predictors assessed in this study.ConclusionIn this study we demonstrated that the acute exposures of injury and dust cloud that were sustained on 9/11/2001 had significant associations with later heart and respiratory diseases. Continued monitoring of 9/11 exposed persons’ health by medical providers is warranted for the foreseeable future.

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Section: Discussionsupporting

confidence: 88%

Section: Methodsmentioning

confidence: 99%

Injury, intense dust exposure, and chronic disease among survivors of the World Trade Center terrorist attacks of September 11, 2001

Alper

Stellman

et al. 2017

Inj. Epidemiol.

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“…While most participants with post-9/11 LRS experienced symptom resolution during the study period, LRS persisted for a nearly one-third of those with initial symptoms. Most (85%) participants with persistent LRS had normal spirometry at follow-up; however, more than half had abnormal IOS results, including elevated resistance (R 5 ) and frequency dependence of resistance (R [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], suggesting that small airways dysfunction not detected on standard spirometry may underlie symptoms in this group. This was further supported by our finding that higher R 5 and R 5-20 values at exam 1 were associated with an increased odds of persistent LRS at follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Among participants with normal spirometry, cases were more likely than controls to have abnormal IOS findings, consistent with peripheral airway damage. 10 We and others have since documented the persistence of LRS among many 9/11-exposed persons [11][12][13] and have identified several factors that may cause or exacerbate LRS in this population. Among community members and local cleanup workers, persistent LRS were found to be associated with elevated markers of inflammation, including peripheral eosinophilia in those with wheezing 14 and C-reactive protein in those with abnormal IOS, 15 suggesting potential underlying mechanisms for the symptoms.…”

Section: Introductionmentioning

confidence: 96%

Risk factors for persistence of lower respiratory symptoms among community members exposed to the 2001 World Trade Center terrorist attacks

et al. 2017

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ObjectivesWe studied the course of lower respiratory symptoms (LRS; cough, wheeze or dyspnoea) among community members exposed to the 9/11/2001 World Trade Center (WTC) attacks during a period of 12–13 years following the attacks, and evaluated risk factors for LRS persistence, including peripheral airway dysfunction and post-traumatic stress disorder (PTSD).MethodsNon-smoking adult participants in a case-control study of post-9/11-onset LRS (exam 1, 2008–2010) were recruited for follow-up (exam 2, 2013–2014). Peripheral airway function was assessed with impulse oscillometry measures of R5 and R5-20. Probable PTSD was a PTSD checklist score ≥44 on a 2006–2007 questionnaire.ResultsOf 785 exam 1 participants, 545 (69%) completed exam 2. Most (321, 59%) were asymptomatic at all assessments. Among 192 participants with initial LRS, symptoms resolved for 110 (57%) by exam 2, 55 (29%) had persistent LRS and 27 (14%) had other patterns. The proportion with normal spirometry increased from 65% at exam 1 to 85% at exam 2 in the persistent LRS group (p<0.01) and was stable among asymptomatic participants and those with resolved LRS. By exam 2, spirometry results did not differ across symptom groups; however, R5 and R5-20 abnormalities were more common among participants with persistent LRS (56% and 46%, respectively) than among participants with resolved LRS (30%, p<0.01; 27%, p=0.03) or asymptomatic participants (20%, p<0.001; 8.2%, p<0.001). PTSD, R5 at exam 1, and R5-20 at exam 1 were each independently associated with persistent LRS.ConclusionsPeripheral airway dysfunction and PTSD may contribute to LRS persistence. Assessment of peripheral airway function detected pulmonary damage not evident on spirometry. Mental and physical healthcare for survivors of complex environmental disasters should be coordinated carefully.

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“…Furthermore, even in the absence of silicosis, the respiratory ailments associated with exposure to WTC dust have been well documented and may continue to develop in the future. Continued medical surveillance for respiratory conditions is required (Friedman et al, 2016).…”

Section: World Trade Center Dustmentioning

confidence: 99%

Silicosis: A Review with Special Concerns Related to 9/11

2019

ARJPH

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Introduction: Silicosis refers to an occupational fibrotic pulmonary disease associated with the inhalation of silica dioxide dust or respirable silica. While the use of personal protective equipment (PPE) has been shown to decrease the risk of the disease, the condition still remains one of the most common occupational lung diseases globally. A review was conducted to provide an overview of the disease, its presentation, treatment, and prevention. The review examined special concerns of silica exposure with relation to World Trade Center Dust. Purpose: The main purpose of this review was to provide practitioners with information on silicosis relating to occupational and environmental health and the events of the World Trade Center collapse. Methodology: A literature search of Medline and Google Scholar was conducted to locate peer-reviewed studies that discussed the disease and its presentation. Further information was obtained through the use of public health programs. Conclusion: The disease has no known cure at this time and causes significant mortality and morbidity, particularly in regions that do not routinely use PPE. While first responders utilize PPE routinely, events such as the destruction of the World Trade Center on September 11, 2001, may result in rapid conditions in which proper PPE is not readily available. However, in the weeks following the event, PPE should have been utilized consistently by workers. Improved use of PPE is recommended to reduce the mortality and morbidity of the condition.

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Risk factors for and consequences of persistent lower respiratory symptoms among World Trade Center Health Registrants 10 years after the disaster

Cited by 25 publications

References 33 publications

Injury, intense dust exposure, and chronic disease among survivors of the World Trade Center terrorist attacks of September 11, 2001

Injury, intense dust exposure, and chronic disease among survivors of the World Trade Center terrorist attacks of September 11, 2001

Risk factors for persistence of lower respiratory symptoms among community members exposed to the 2001 World Trade Center terrorist attacks

Silicosis: A Review with Special Concerns Related to 9/11

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