Alper Howard E, Yu Shengchao, Stellman Steven D, Brackbill Robert M
New York City Department of Health and Mental Hygiene, 125 Worth Street, New York, 10013, USA.
Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA.
Inj Epidemiol. 2017 Dec;4(1):17. doi: 10.1186/s40621-017-0115-x. Epub 2017 Jul 3.
The 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.
We 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.
Heart 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.
In 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.
2001年9月11日发生在纽约市的世界贸易中心袭击事件（9·11事件）使数千人暴露于高浓度的有害物质中，导致哮喘、心脏病、糖尿病和其他慢性病的发病率上升，同时还出现了创伤后应激障碍（PTSD）等心理疾病。很少有研究区分即时（短期或急性）强烈暴露与长期居住或工作场所暴露对健康的影响。
我们采用比例风险方法，确定了8701名在暴露前无相关疾病且在世界贸易中心袭击期间或袭击后立即身处现场的人员中，急性暴露的几个组成部分（如受伤、置身于尘埃云中）与四种慢性病结局（哮喘、其他非肿瘤性肺病、心血管疾病和糖尿病）之间关联的调整风险比（AHRs）。对参与者进行了前瞻性随访，直至9·11事件发生后11年。
心脏病与受伤存在剂量反应关系（1种受伤类型：AHR = 2.0，95%置信区间（CI）1.1 - 3.6；2种受伤类型：AHR = 3.1，95% CI 1.2 - 7.9；3种或更多受伤类型：AHR = 6.8，95% CI 2.0 - 22.6），而哮喘和其他肺病均与尘埃云暴露显著相关（AHR = 1.3，95% CI 1.0 - 1.6）。糖尿病与本研究中评估的任何预测因素均无关联。
在本研究中，我们证明了2001年9月11日遭受的急性受伤和尘埃云暴露与后期的心脏和呼吸系统疾病存在显著关联。在可预见的未来，医疗服务提供者有必要继续监测9·11事件受害者的健康状况。
