Friday, September 09, 2005

9/11 was fire and dust - community effects

9/11 was fire, and dust.  Katrina is water and sludge.  For the population and recovery workers, the problem is describing the exposure and the potential health effects of exposure.  It’s time to look back on 9/11 as data finally is reaching the literature.
This study combines forces of the NY State Department of Health, NYU and SUNY Albany.
Compared to upper NYC residents, the WTC area residents suffered about twice [or more than twice] the adverse outcomes, based on questionnaires.  Response rates in both areas to mailed questionnaires was about 23%.    
Whatever persons were exposed to, it’s clearly an effect level.  But what was the exposure?
Unfortunately, this paper did not seek exposure data.  EPA PM 10 and PM 2.5 exposure data, largely collected at rooftop levels, would have been available on an hourly basis from multiple sites in each locality.  Both sampling methods exclude large particles, which may be the cause of continuing rhinitis among workers.  Rooftop locations may exclude the large particles as well.
The same issue of AJE includes a critique and response, largely over the issue of response bias.  BrooklynDodger believes the authors win the argument on the results not being the result of such bias.
Now that the effect is known, it would be of value for someone to collect as much ground level and indoor sampling data as can be found, and reconstruct the exposures.
American Journal of Epidemiology 2005 162(6):499-507; doi:10.1093/aje/kwi233
Upper Respiratory Symptoms and Other Health Effects among Residents Living Near the World Trade Center Site after September 11, 2001
Shao Lin1, Joan Reibman2, James A. Bowers1, Syni-An Hwang1, Anne Hoerning2, Marta I. Gomez1 and Edward F. Fitzgerald3
1 Center for Environmental Health, New York State Department of Health, Troy, NY2 Department of Medicine, Division of Pulmonary and Critical Care Medicine, New York University School of Medicine, New York, NY3 Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Renssalaer, NY
Correspondence to Dr. Shao Lin, Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, 547 River Street, Room 200, Troy, NY 12180 (e-mail: (image placeholder)).
The authors investigated changes in respiratory health after September 11, 2001 ("9/11") among residents of the area near the World Trade Center (WTC) site in New York City as compared with residents of a control area. In 2002, self-administered questionnaires requesting information on the presence and persistence of respiratory symptoms, unplanned medical visits, and medication use were sent to 9,200 households (22.3% responded) within 1.5 km of the WTC site (affected area) and approximately 1,000 residences (23.3% responded) in Upper Manhattan, more than 9 km from the site (control area). Residents of the affected area reported higher rates of new-onset upper respiratory symptoms after 9/11 (cumulative incidence ratio = 2.22, 95% confidence interval (CI): 1.88, 2.63). Most of these symptoms persisted 1 year after 9/11 in the affected area. Previously healthy residents of the affected area had more respiratory-related unplanned medical visits (prevalence ratio = 1.73, 95% CI: 1.13, 2.64) and more new medication use (prevalence ratio = 2.89, 95% CI: 1.75, 4.76) after 9/11. Greater impacts on respiratory functional limitations were also found in the affected area. Although bias may have contributed to these increases, other analyses of WTC-related pollutants support their biologic plausibility. Further analyses are needed to examine whether these increases were related to environmental exposures and to monitor long-term health effects.

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