Risk and resilience factors for adverse mental and physical health outcomes related to WTC exposure

摘要 参与2001年9月11日事件后救援和恢复工作的男女人员 暴露在极其危险的工作条件和有毒物质中。国家研究所 职业安全和健康（NIOSH）和疾病控制和预防中心（CDC） 实施了世界贸易中心健康计划（WTCHP），该计划提供健康监测， 并在参与紧急情况的救援/恢复工作人员中处理与WTC相关的健康后果 回应和清理。在登记进入该计划后，所有应答者都完成了一系列自我和 访问者管理的问卷和量表。持续随访监测健康状况的变化， 表明在第一反应者中，包括创伤后， 应激障碍（PTSD），胃食管反流病（GERD），呼吸结果（即，哮喘）和所有 癌的最近的证据表明，新的健康结果包括糖尿病，头痛和听力 损失/问题。尽管WTC暴露与疾病结果之间存在密切联系，但与WTC暴露相关的因素 疾病发展和轨迹异质性在很大程度上仍然无法解释。虽然有一些关于WTC的研究- 研究了与疾病发展相关的风险和保护因素， 轨迹，这些研究仅限于少数与WTC相关的暴露变量（即， 存在/不存在于灰尘/碎片云中，在现场工作超过90天，到达地面的时间 零等）基于疾病的先验选择。先前研究的潜在保护因素包括 教育、家庭和工作支持。潜在风险和保护性信息的丰富性和广度 WTC监测数据集中的因素在很大程度上尚未开发。在这个建议中，我们指的是这种混合物的世贸组织- 相关的风险和保护因素作为“世贸组织的麻烦”，并采用数据驱动的方法来研究 与WTC相关的健康结果。我们专注于创伤后应激障碍，胃食管 反流，呼吸系统的结果和所有的癌症。这一提议填补了我们对风险理解的一个关键空白 利用广义加权分位数和（gWQS） 回归，一种统计方法，旨在检查相关因素的混合物之间的关联， 健康结果。使用gWQS，我们将创建一个代表所有特征的加权指数 描述的WTC监测数据集，并检查a）如何整体指数（或“混合物”）与 WTC相关疾病的发病率和B）确定哪些基线因素最强烈 与这些关联的结果和方向相关联（即，增加患病风险， 预防疾病的风险）。这种方法的应用可以扩展到理解风险和 对其他与世卫组织相关疾病的抵御能力。最终，这将更好地识别有发展风险的响应者， 不良结果，并确定可能防止疾病发展或进展的因素。

Abstract The men and women involved in the rescue and recovery efforts following the events of September 11, 2001 were exposed to extraordinarily hazardous working conditions and toxic agents. The National Institute of Occupational Safety and Health (NIOSH) and the Centers for Disease Control and Prevention (CDC) implemented the World Trade Center Health Program (WTCHP), which provides health surveillance to monitor and treat WTC-related health consequences among rescue/recovery workers involved in the emergency response and cleanup. Upon enrollment into the program, all responders completed a battery of self- and interviewer-administered questionnaires and scales. Continued follow-up monitors changes in health status and indicates significant long term medical and psychological effects among first responders, including post-traumatic stress disorder (PTSD), gastroesophageal reflux disease (GERD), respiratory outcomes (i.e., asthma) and all cancers. Recent evidence suggest emerging health outcomes including diabetes, headaches, and hearing loss/problems. Despite strong links between WTC exposure and disease outcomes, factors associated with the heterogeneity of disease development and trajectory remain largely unexplained. While several studies of WTC- associated diseases have examined risk and protective factors associated with disease development and trajectory, these studies are limited to a small number of WTC-associated exposure variables (i.e., presence/absence in the dust/debris cloud, working more than 90 days at the site, time at arrived to Ground Zero, etc.) selected a priori based on the disease. Potential protective factors previously examined include education, family and work support. The richness and breadth of the information on potential risk and protective factors in the WTC surveillance dataset is largely untapped. In this proposal, we refer to this mixture of WTC- related risk and protective factors as the “WTC exposome” and adopt a data-driven approach to examine associations with WTC related health outcomes. We focus on posttraumatic stress disorder, gastroesophageal reflux, respiratory outcomes and all cancers. This proposal addresses a critical gap in our understanding of risk and protective factors for WTC-related diseases by leveraging generalized weighted quantile sum (gWQS) regression, a statistical approach designed to examine associations between a mixture of correlated factors and a health outcome. Using gWQS, we will create a weighted index representing the totality of characteristics described in the WTC-surveillance dataset and examine a) how the overall index (or “mixture”) is associated with the incidence of WTC-related disease and b) determine which of the baseline factors are most strongly associated with the outcome and the direction of those associations (i.e., increase the risk for disease vs. protect against the risk for disease). Application of this approach could be expanded to understand risk and resilience to other WTC-associated diseases. Ultimately, this will better identify responders at risk to developing adverse outcomes and identify factors that may protect against the development or progression of disease.