Respiratory/Other Health Effects Reported in Kids Exposed to WTC Disaster
Respiratory/Other Health Effects Reported in Kids Exposed to WTC Disaster
Background: Effects of the World Trade Center (WTC) disaster on children's respiratory health have not been definitively established.
Objective: This report describes respiratory health findings among children who were < 18 years of age on 11 September 2001 (9/11) and examine associations between disaster-related exposures and respiratory health.
Methods: Children recruited for the WTC Health Registry (WTCHR) included child residents and students (kindergarten through 12th grade) in Manhattan south of Canal Street, children who were south of Chambers Street on 9/11, and adolescent disaster-related workers or volunteers. We collected data via computer-assisted telephone interviews in 2003-2004, with interview by adult proxy for children still < 18 years of age at that time. We compared age-specific asthma prevalence with National Health Interview Survey estimates.
Results: Among 3,184 children enrolled, 28% were < 5 years of age on 9/11 ; 34%, 5-11 years; and 39%, 12-17 years. Forty-five percent had a report of dust cloud exposure on 9/11. Half (53%) reported at least one new or worsened respiratory symptom, and 5.7% reported new asthma diagnoses. Before 9/11, age-specific asthma prevalence in enrolled children was similar to national estimates, but prevalence at interview was elevated among enrollees < 5 years of age. Dust cloud exposure was associated with new asthma diagnosis (adjusted odds ratio = 2.3 ; 95% confidence interval, 1.5-3.5).
Conclusions: Asthma prevalence after 9/11 among WTCHR enrollees < 5 years of age was higher than national estimates, and new asthma diagnosis was associated with dust cloud exposure in all age groups. We will determine severity of asthma and persistence of other respiratory symptoms on follow-up surveys.
An estimated 25,000 children < 18 years of age were living or attending school in lower Manhattan near the World Trade Center (WTC) on 11 September 2001 (9/11), and tens of thousands more were in the path of the plume of building debris and smoke, close enough to inhale particulates and toxic substances (U.S. Census Bureau 2000; U.S. Department of Education 2006). The effects of these exposures on children's health have not been definitively established.
Physical health consequences described in adult survivors of the disaster have included injuries sustained while fleeing the disaster (Boodram et al. 2002); pulmonary damage in rescuers, ironworkers, and others who had intense exposure to disaster-related fires (Asarnow et al. 2003; Banauch et al. 2003; Landrigan et al. 2004; Prezant et al. 2002; Skloot et al. 2004); and exacerbations of respiratory illness, including self-reported asthma (Brackbill et al. 2006; Fagan et al. 2002; Lin et al. 2005; Reibman et al. 2005; Wheeler et al. 2007). Pollutants included particulates blown from collapsing buildings and resuspended during cleanup, shown in laboratory studies to cause respiratory irritation; and a variety of toxic compounds from fires that burned until 20 December 2001, including polycyclic aromatic hydrocarbons, volatile organic compounds, lead, dioxin, and particulates [Butt et al. 2004; Gavett et al. 2003; Jeffery et al. 2003; Lioy et al. 2002; McGee et al. 2003; New York City Department of Health and Mental Hygiene (NYCDOHMH) and Agency for Toxic Substances and Disease Registry (ATSDR) 2002; Payne et al. 2004; Pleil et al. 2004; Service 2003].
Two studies suggested exacerbation of asthma among children during the autumn of 2001 (Szema et al. 2004; Wagner et al. 2005). Szema et al. (2004) examined asthma status in the year before and after 9/11 in 205 children of Chinese descent who had previously diagnosed asthma. They found that children living near the WTC site had increased asthma-related clinic visits during the year after 9/11, but rescue inhaler use was greater in children who lived farther away. In mid-2002, Wagner et al. (2005) conducted a mail survey and medical record review of adults and children with known asthma receiving Medicaid-managed care. Although they noted increased asthma exacerbation among persons living near the WTC, data were not provided specifically for children in that group. No follow-up has been reported.
After the 9/11 attacks in New York City, the WTC Health Registry (WTCHR) was established to evaluate short- and long-term physical and psychological effects of the disaster. The registry enrolled persons most likely to have been heavily exposed to traumatic events and air pollutants, including 3,184 children < 18 years of age on 9/11 (Brackbill et al. 2006). The purpose of this report is to present baseline data on respiratory health, and to examine associations between disaster-related exposures and health, among the children enrolled in the WTCHR, as reported on initial registry interviews of parents and adolescents conducted September 2003 through November 2004.
When the registry was undertaken, it was already known that all but two of the 25,000 children who were at home or in school in lower Manhattan had been successfully evacuated from downtown Manhattan (Schwartz et al. 2002). Two youths 15-19 years of age died in WTC buildings on 9/11 (NYCDOHMH, unpublished data). Hundreds of other children lost parents in the disaster. These children are the subject of other work and are not included in the WTCHR unless they themselves were in the vicinity of the disaster.
Abstract and Introduction
Abstract
Background: Effects of the World Trade Center (WTC) disaster on children's respiratory health have not been definitively established.
Objective: This report describes respiratory health findings among children who were < 18 years of age on 11 September 2001 (9/11) and examine associations between disaster-related exposures and respiratory health.
Methods: Children recruited for the WTC Health Registry (WTCHR) included child residents and students (kindergarten through 12th grade) in Manhattan south of Canal Street, children who were south of Chambers Street on 9/11, and adolescent disaster-related workers or volunteers. We collected data via computer-assisted telephone interviews in 2003-2004, with interview by adult proxy for children still < 18 years of age at that time. We compared age-specific asthma prevalence with National Health Interview Survey estimates.
Results: Among 3,184 children enrolled, 28% were < 5 years of age on 9/11 ; 34%, 5-11 years; and 39%, 12-17 years. Forty-five percent had a report of dust cloud exposure on 9/11. Half (53%) reported at least one new or worsened respiratory symptom, and 5.7% reported new asthma diagnoses. Before 9/11, age-specific asthma prevalence in enrolled children was similar to national estimates, but prevalence at interview was elevated among enrollees < 5 years of age. Dust cloud exposure was associated with new asthma diagnosis (adjusted odds ratio = 2.3 ; 95% confidence interval, 1.5-3.5).
Conclusions: Asthma prevalence after 9/11 among WTCHR enrollees < 5 years of age was higher than national estimates, and new asthma diagnosis was associated with dust cloud exposure in all age groups. We will determine severity of asthma and persistence of other respiratory symptoms on follow-up surveys.
Introduction
An estimated 25,000 children < 18 years of age were living or attending school in lower Manhattan near the World Trade Center (WTC) on 11 September 2001 (9/11), and tens of thousands more were in the path of the plume of building debris and smoke, close enough to inhale particulates and toxic substances (U.S. Census Bureau 2000; U.S. Department of Education 2006). The effects of these exposures on children's health have not been definitively established.
Physical health consequences described in adult survivors of the disaster have included injuries sustained while fleeing the disaster (Boodram et al. 2002); pulmonary damage in rescuers, ironworkers, and others who had intense exposure to disaster-related fires (Asarnow et al. 2003; Banauch et al. 2003; Landrigan et al. 2004; Prezant et al. 2002; Skloot et al. 2004); and exacerbations of respiratory illness, including self-reported asthma (Brackbill et al. 2006; Fagan et al. 2002; Lin et al. 2005; Reibman et al. 2005; Wheeler et al. 2007). Pollutants included particulates blown from collapsing buildings and resuspended during cleanup, shown in laboratory studies to cause respiratory irritation; and a variety of toxic compounds from fires that burned until 20 December 2001, including polycyclic aromatic hydrocarbons, volatile organic compounds, lead, dioxin, and particulates [Butt et al. 2004; Gavett et al. 2003; Jeffery et al. 2003; Lioy et al. 2002; McGee et al. 2003; New York City Department of Health and Mental Hygiene (NYCDOHMH) and Agency for Toxic Substances and Disease Registry (ATSDR) 2002; Payne et al. 2004; Pleil et al. 2004; Service 2003].
Two studies suggested exacerbation of asthma among children during the autumn of 2001 (Szema et al. 2004; Wagner et al. 2005). Szema et al. (2004) examined asthma status in the year before and after 9/11 in 205 children of Chinese descent who had previously diagnosed asthma. They found that children living near the WTC site had increased asthma-related clinic visits during the year after 9/11, but rescue inhaler use was greater in children who lived farther away. In mid-2002, Wagner et al. (2005) conducted a mail survey and medical record review of adults and children with known asthma receiving Medicaid-managed care. Although they noted increased asthma exacerbation among persons living near the WTC, data were not provided specifically for children in that group. No follow-up has been reported.
After the 9/11 attacks in New York City, the WTC Health Registry (WTCHR) was established to evaluate short- and long-term physical and psychological effects of the disaster. The registry enrolled persons most likely to have been heavily exposed to traumatic events and air pollutants, including 3,184 children < 18 years of age on 9/11 (Brackbill et al. 2006). The purpose of this report is to present baseline data on respiratory health, and to examine associations between disaster-related exposures and health, among the children enrolled in the WTCHR, as reported on initial registry interviews of parents and adolescents conducted September 2003 through November 2004.
When the registry was undertaken, it was already known that all but two of the 25,000 children who were at home or in school in lower Manhattan had been successfully evacuated from downtown Manhattan (Schwartz et al. 2002). Two youths 15-19 years of age died in WTC buildings on 9/11 (NYCDOHMH, unpublished data). Hundreds of other children lost parents in the disaster. These children are the subject of other work and are not included in the WTCHR unless they themselves were in the vicinity of the disaster.
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