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

摘要 2001年9月11日事件后参与救援和恢复工作的男性和女性 暴露在极其危险的工作条件和有毒物质中。美国国立卫生研究院 职业安全与健康(NIOSH)和疾病控制与预防中心(CDC) 实施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/恢复人员中治疗与WTC相关的健康后果 响应和清理。在登记参加该计划后，所有应答者都完成了一系列的自我和 面试者--发放问卷和量表。持续跟踪监测健康状态的变化和 表明急救人员的长期医疗和心理影响，包括创伤后的影响 应激障碍(PTSD)、胃食道反流病(GERD)、呼吸结局(即哮喘)和ALL 癌症。最近的证据表明，正在出现的健康后果包括糖尿病、头痛和听力 损失/问题。尽管WTC暴露与疾病结局之间存在密切联系，但与 疾病发展和轨迹的异质性在很大程度上仍未得到解释。而一些关于WTC的研究-- 相关疾病检查了与疾病发展和保护因素有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/不在尘埃/碎片云中，在现场工作超过90天，到达地面的时间 零等。)根据疾病选择先验。以前研究过的潜在保护因素包括 教育、家庭和工作方面的支持。关于潜在风险和防护的信息的丰富性和广度 世贸中心监测数据集中的因素基本上没有被利用。在这份提案中，我们指的是WTC- 相关的风险和保护因素，如“世贸中心暴露组”，并采用数据驱动的方法来审查 与WTC相关的健康结果的关联。我们关注的是创伤后应激障碍，胃食道 反流、呼吸结果和所有癌症。这项建议解决了我们对风险理解上的一个严重差距。 利用广义加权分位数和(GWQS)预测WTC相关疾病的保护因素 回归，一种统计方法，旨在检查一系列相关因素和 一个健康的结果。使用gWQS，我们将创建一个代表所有特征的加权指数 在WTC-监视数据集中描述，并检查a)总体指数(或“混合”)如何与 WTC相关疾病的发生率和b)决定哪些基线因素是最强烈的 与这些关联的结果和方向相关(即，与 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WTC相关疾病的复原力。最终，这将更好地识别面临开发风险的响应者 并找出可能预防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.