Personal exposure and long-term health effects in survivors of the union carbide disaster at bhopal.

Nine years after the Bhopal methyl isocyanate disaster, we examined the effects of exposures among a cross-section of current residents and a subset of those with persistent symptoms. We estimated individual exposures by developing exposure indices based on activity, exposure duration, and distance of residence from the plant. Most people left home after the gas leak by walking and running. About 60% used some form of protection (wet cloth on face, splashing water). Mean and median values of the exposure indices showed a declining trend with increasing distance from the plant. For those subjects reporting any versus no exposure, prevalence ratios were elevated for most respiratory and nonrespiratory symptoms. We examined exposure-response relationships using exposure indices to determine which were associated with health outcomes. The index total exposure weighted for distance was associated with most respiratory symptoms, one measure of pulmonary function in the cross-sectional sample [mid-expiratory flow (FEF)(25-75), p = 0.02], and two measures of pulmonary function in the hospitalized subset [forced expiratory volume (FEV)(1), p = 0.02; FEF(25-75), p = 0.08). Indices that correlated with FEV(1) and forced vital capacity in the hospitalized subset did not correlate with the cross-sectional sample, and most indices (except total exposure) that correlated with the hospitalized subset did not correlate with the cross-sectional sample. Incorporation of distance into every index increased the number of symptoms associated; an improvement was also noted in the strength of the association for respiratory symptoms, but not for pulmonary function. The sum of duration (p = 0.02) and total exposure (p = 0.03) indices independently demonstrated stronger associations with percent predicted FEF(25-75) than the distance variable (p = 0.04). The results show that total exposure weighted for distance has met the criteria for a successful index by being associated with most respiratory symptoms as well as FEF(25-75), features of obstructive airways disease.