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

描述（由申请人提供）：尽管全球范围内发生的事件非常频繁，但人们对溢油对应急工作人员的健康影响知之甚少。深水地平线（DWH）灾难向墨西哥湾释放了大约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前所未有的机构间反应涉及7，000多名海岸警卫队工作人员，他们开展了广泛的响应/清理活动。在评估石油泄漏对人类健康影响的少数研究中，几乎所有研究都是跨部门的。这些研究中一直报告呼吸道症状，包括咳嗽和呼吸急促。迄今为止，对清理工作人员进行的最长时间的随访发现，在应对工作结束后，下呼吸道症状持续了两年。其他研究发现了神经、血液、心理、遗传毒性和内分泌影响。此外，原油的主要成分苯是一种已知的血毒素和致癌物质，即使在低接触水平下也是如此。迫切需要对石油泄漏应急人员进行长期研究。我们提出了一个队列的海岸警卫队DWH响应者的研究，阐明溢油暴露的健康后果，利用有价值的，现有的军事数据。本研究现有数据的主要来源包括：由每个应急人员完成的出口调查，该调查提供了自我报告的暴露和健康数据;对一部分应急人员的个人监测数据;以海岸警卫队电子健康记录（EHR）和ICD-9编码的监测数据形式提供的客观临床数据，这些数据将能够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，这将为基因分型提供DNA。此外，某些高风险职业的成员参加了一项监测计划，定期进行更深入的检查，从而提供更详细和全面的电子健康记录数据。这些客观健康/生物样本数据的来源由军方收集和使用，仅用于个人临床护理或监测，但它们对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，并根据海岸警卫队EHR条目和ICD-9代码等客观健康数据比较DWH前和后的疾病率，确定海岸警卫队DWH响应队列的健康影响。拟议的海岸警卫队队列研究有能力，没有其他研究，我们的知识将不得不比较客观的健康数据，泄漏后，泄漏前。此外，它将有效地奠定基础，为未来的巢式病例对照研究选定的结果，并为有针对性的研究生物标志物的不良生物效应使用宝贵的前和后泄漏系列血清样本。通过仔细跟踪这一队列，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，以帮助预防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.