Health Effects of the Deepwater Horizon Disaster:the Coast Guard Responder Cohort

描述（由申请人提供）：尽管石油泄漏事件在世界范围内频繁发生，但人们对这些事件对应急工作者的健康影响知之甚少。深水地平线（DWH）灾难向墨西哥湾泄漏了大约2亿加仑原油，是美国历史上最大的石油泄漏事件。由美国海岸警卫队领导的史无前例的跨部门反应，涉及7000多名海岸警卫队工作人员，他们进行了广泛的反应/清理活动。在为数不多的评估石油泄漏对人类健康影响的研究中，几乎所有的研究都是横向的。呼吸道症状，包括咳嗽和呼吸短促，在这些研究中一直有报道。到目前为止，对清洁工人进行的最长随访发现，在应对工作结束后，下呼吸道症状仍持续两年。其他研究还发现了神经学、血液学、心理学、基因毒性和内分泌方面的影响。此外，作为原油的主要成分之一，苯是一种已知的血液毒素和致癌物，即使在低暴露水平下也是如此。目前迫切需要对石油泄漏应急人员进行长期研究。我们建议对海岸警卫队DWH响应者进行一项研究，通过利用有价值的现有军事数据来阐明石油泄漏暴露对健康的影响。本研究现有数据的主要来源包括每个答复者完成的离职调查，其中提供了自我报告的接触情况和健康数据；部分响应者的个人监测数据；以海岸警卫队电子健康记录（EHRs）和ICD-9编码监测数据形式提供的客观临床数据，可以进行泄漏前后的比较；以及海岸警卫队应急人员的血清样本，这些样本将为基因分型提供DNA。此外，某些高风险职业的成员被纳入监测计划，进行更密集的定期检查，从而提供更详细和全面的电子病历数据。这些客观的健康/生物标本数据来源仅由军队收集和用于个人临床护理或监测，但它们对于拟议的流行病学分析将是非常宝贵的。拟议研究的目的是通过分析出口调查的数据，并根据客观健康数据（如海岸警卫队EHR条目和ICD-9代码）比较DWH前后的疾病发病率，确定海岸警卫队DWH应答者队列的健康影响。据我们所知，没有其他研究能够比较泄漏后和泄漏前的客观健康数据，海岸警卫队提出的队列研究具有这种能力。此外，它将有效地为未来选定结果的巢式病例对照研究奠定基础，并为使用有价值的泄漏前和泄漏后系列血清样本进行有害生物效应的生物标志物的靶向研究奠定基础。通过仔细跟踪这一群体，我们可能能够预防或减轻这些工人的长期健康后果，并提供急需的信息，以帮助防止未来石油泄漏对健康的不利影响。

DESCRIPTION (provided by applicant): Little is known about the health effects from oil spills on response workers, despite the frequency of these events worldwide. The Deepwater Horizon (DWH) disaster, which released approximately 200 million gallons of crude oil into the Gulf of Mexico, was the largest oil spill in U.S. history. The unprecedented interagency response, led by the U.S. Coast Guard, involved over 7,000 Coast Guard workers, who carried out a wide range of response/clean-up activities. Of the few studies which have evaluated the human health consequences of oil spills, almost all have been cross-sectional. Respiratory symptoms, including cough and shortness of breath have been consistently reported among these studies. The longest follow- up to date of clean-up workers found lower respiratory tract symptoms persisting two years after response work ended. Other studies have found neurological, hematologic, psychological, genotoxic and endocrine effects. Additionally, benzene, a major component of crude oil, is a known hematotoxin and carcinogen, even at low exposure levels. Long-term studies of oil-spill responders are urgently needed. We propose a study of a cohort of Coast Guard DWH responders to elucidate the health consequences of oil spill exposures by capitalizing on valuable, existing military data. The key sources of existing data for this study include an exit survey completed by each responder, which provides self-reported exposure and health data; personal monitoring data on a subset of responders; objective clinical data in the form of Coast Guard electronic health records (EHRs) and ICD-9 coded surveillance data, which will enable pre- and post-spill comparisons; and serum samples of Coast Guard responders, which will provide DNA for genotyping. In addition, members of certain high risk occupations are enrolled in a surveillance program with more intensive periodic examinations, thus providing more detailed and comprehensive EHR data. These sources of objective health/bio-specimen data are collected and used by the military solely for individual clinical care or surveillance, but they will be invaluable for the proposed epidemiologic analyses. The objective of the proposed study is to identify health effects in the Coast Guard DWH responder cohort by analyzing data from the exit survey and by comparing pre- and post-DWH disease rates based on objective health data such as Coast Guard EHR entries and ICD-9 codes. The proposed Coast Guard cohort study has the ability that no other study to our knowledge will have to compare objective health data, post-spill to pre-spill. Additionally, it will efficiently lay the groundwork for future nested case-control studies of selected outcomes and for the targeted study of biomarkers of adverse biological effect using valuable pre- and post-spill serial serum samples. By carefully following up this cohort we may be able to prevent or mitigate long-term health consequences among these workers and provide much-needed information to help prevent adverse health effects in future oil spills. PUBLIC HEALTH RELEVANCE: The Deepwater Horizon disaster in 2010 was the largest oil spill in U.S. history. The proposed study of a cohort of Coast Guard Deepwater Horizon responders presents an extraordinary opportunity for elucidating the health consequences of oil spill exposures. Our proposed study will take advantage of existing data, including objective pre- and post-spill clinical information and serum samples, to investigate a wide range of health outcomes, based on the very limited epidemiologic literature on oil spills.