Associations of World Trade Center exposures with pulmonary and cardiometabolic outcomes among children seeking care for health concerns.
Trasande-L; Kajunski Fiorino-E; Attina-T; Berger-K; Goldring-R; Chemtob-C; Levy-Carrick-N; Shao-Y; Liu-M; Urbina-E; Reibman-J
Sci Total Environ 2013 Feb; 444:320-326
OBJECTIVE: Prior research on the physical health of children exposed to the World Trade Center (WTC) attacks has largely relied on parental report via questionnaire. We examined the impact of clinically-reported exposures on the physical health of children who lived and/or attended school in downtown Manhattan on September 11, 2001. STUDY DESIGN: We performed a cross-sectional study of 148 patients who presented to the WTC Environmental Health Center/Survivors Health Program, and were < / = 18 years old on September 11, 2001. RESULTS: 38.5% were caught in the dust cloud from the collapsing buildings on September 11; over 80% spent > / =1 day in their home between September 11 and 18, 2001; and 25.7% reported home dust exposure. New-onset nasal/sinus congestion was reported in 52.7%, while nearly one-third reported new gastroesophageal reflux (GERD) symptoms. Prehypertension or hypertension was identified in 45.5%. Multivariable regression with exposure variables, body mass index category, and age as covariates identified strongest associations of dust cloud with spirometry (17.1% decrease in maximum midexpiratory flow). Younger children experienced increased peripheral eosinophils (+0.098% per year, p=0.023), while older children experienced more new-onset GERD (OR 1.17, p=0.004), headaches (OR 1.10, p=0.011), and prehypertension (OR 1.09, p=0.024). Home dust exposure was associated with reduced high-density lipoprotein (-10.3mg/dL, p=0.027) and elevated triglycerides (+36.3mg/dL, p=0.033). CONCLUSIONS: While these findings cannot be assumed to generalize to all children exposed to the WTC attacks, they strongly suggest the need for more extensive study of respiratory, metabolic, and cardiovascular consequences.
Emergency-response; Health-care; Children; Physiological-effects; Physiological-response; Respiratory-irritants; Bronchial-asthma; Pulmonary-function; Pulmonary-system; Clinical-diagnosis; Hypertension; Cardiopulmonary-function; Metabolic-rate; Environmental-exposure; Environmental-health; Spirometry; Metabolic-activation; Cardiovascular-system;
Author Keywords: Disaster medicine; World Trade Center; Children's environmental health; Asthma;
Obesity; Blood pressure
Leonardo Trasande, Department of Pediatrics, NYU School of Medicine, 227 East 30th Street Rm 711, New York, NY 10016, USA
Science of the Total Environment
New York City Health and Hospitals Corporation