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Lowe SM, Haugen PT, Rosen R, Werth AS. World Trade Center psychological exposures and trauma related disorders: PTSD and adjustment disorders. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2023:1-6. [PMID: 36927280 DOI: 10.1080/19338244.2023.2188153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The relationship between exposure to the World Trade Center (WTC) disaster and elevated rates of trauma related psychiatric illnesses in 9/11 responders and survivors has been well documented. This paper is part of a series to promote the practice of evidence-based medicine when managing persons with WTC-related conditions and focuses on "Trauma and Stressor Related Disorders," a diagnostic category that includes posttraumatic stress disorder (PTSD) and adjustment disorder. It offers background on 9/11-related trauma exposure, a summary of research findings from this cohort, and is followed by brief diagnostic and treatment information from selected clinical practice guidelines.
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Affiliation(s)
- Sandra M Lowe
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- World Trade Center Health Program, Icahn School of Medicine at Mount Sinai Clinical Center of Excellence, New York, NY, USA
| | - Peter T Haugen
- NYU Grossman School of Medicine World Trade Center Health Program Clinical Center of Excellence, New York, NY, USA
- Department of Psychiatry, NYU Grossman School of Medicine, New York, New York, USA
| | - Rebecca Rosen
- NYU Grossman School of Medicine, New York, NY, USA
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY, USA
| | - Aditi S Werth
- NYU Grossman School of Medicine World Trade Center Health Program Clinical Center of Excellence, New York, NY, USA
- Department of Psychiatry, NYU Grossman School of Medicine, New York, New York, USA
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Zhang Y, Rosen R, Reibman J, Shao Y. Posttraumatic Stress Disorder Mediates the Association between Traumatic World Trade Center Dust Cloud Exposure and Ongoing Systemic Inflammation in Community Members. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148622. [PMID: 35886474 PMCID: PMC9322679 DOI: 10.3390/ijerph19148622] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 11/16/2022]
Abstract
Exposure to World Trade Center (WTC) dust/fumes and traumas on 11 September 2001 has been reported as a risk factor for post-traumatic stress disorder (PTSD) and other mental/physical health symptoms in WTC-affected populations. Increased systemic inflammation and oxidative stress from the exposure and subsequent illnesses have been proposed as contributors to the underlying biological processes. Many blood-based biomarkers of systemic inflammation, including C-reactive protein (CRP), are useful for non-invasive diagnostic and monitoring of disease process, and also potential targets for therapeutic interventions. Twenty years after 9/11, however, the relationships between WTC exposure, chronic PTSD, and systemic inflammation are only beginning to be systematically investigated in the WTC-affected civilian population despite the fact that symptoms of PTSD and systemic inflammation are still common and persistent. This paper aims to address this knowledge gap, using enrollees of the WTC Environmental Health Center (EHC), a federally designated treatment and surveillance program for community members (WTC Survivors) exposed to the 9/11 terrorist attack. We conducted a mediation analysis to investigate the association between acute WTC dust cloud traumatic exposure (WDCTE) on 9/11, chronic PTSD symptoms, and levels of systemic inflammation. The data indicate that the chronic PTSD symptoms and some specific symptom clusters of PTSD significantly mediate the WDCTE on systemic inflammation, as reflected by the CRP levels. As both chronic PTSD and systemic inflammation are long-term risk factors for neurodegeneration and cognitive decline, further research on the implications of this finding is warranted.
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Affiliation(s)
- Yian Zhang
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY 10016, USA;
- HHC World Trade Center Environmental Health Center, 462 First Avenue, New York, NY 10016, USA;
- NYU Alzheimer Disease Research Center, 145 E 32 Street, New York, NY 10016, USA
| | - Rebecca Rosen
- HHC World Trade Center Environmental Health Center, 462 First Avenue, New York, NY 10016, USA;
- Department of Psychiatry, NYU Grossman School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Joan Reibman
- HHC World Trade Center Environmental Health Center, 462 First Avenue, New York, NY 10016, USA;
- Department of Medicine, NYU Grossman School of Medicine, 550 First Avenue, New York, NY 10016, USA
- Correspondence: (J.R.); (Y.S.)
| | - Yongzhao Shao
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY 10016, USA;
- HHC World Trade Center Environmental Health Center, 462 First Avenue, New York, NY 10016, USA;
- NYU Alzheimer Disease Research Center, 145 E 32 Street, New York, NY 10016, USA
- Correspondence: (J.R.); (Y.S.)
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Grunig G, Durmus N, Zhang Y, Lu Y, Pehlivan S, Wang Y, Doo K, Cotrina-Vidal ML, Goldring R, Berger KI, Liu M, Shao Y, Reibman J. Molecular Clustering Analysis of Blood Biomarkers in World Trade Center Exposed Community Members with Persistent Lower Respiratory Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8102. [PMID: 35805759 PMCID: PMC9266229 DOI: 10.3390/ijerph19138102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/25/2022] [Accepted: 06/29/2022] [Indexed: 11/30/2022]
Abstract
The destruction of the World Trade Center (WTC) on September 11, 2001 (9/11) released large amounts of toxic dusts and fumes into the air that exposed many community members who lived and/or worked in the local area. Many community members, defined as WTC survivors by the federal government, developed lower respiratory symptoms (LRS). We previously reported the persistence of these symptoms in patients with normal spirometry despite treatment with inhaled corticosteroids and/or long-acting bronchodilators. This report expands upon our study of this group with the goal to identify molecular markers associated with exposure and heterogeneity in WTC survivors with LRS using a selected plasma biomarker approach. Samples from WTC survivors with LRS (n = 73, WTCS) and samples from healthy control participants of the NYU Bellevue Asthma Registry (NYUBAR, n = 55) were compared. WTCS provided information regarding WTC dust exposure intensity. Hierarchical clustering of the linear biomarker data identified two clusters within WTCS and two clusters within NYUBAR controls. Comparison of the WTCS clusters showed that one cluster had significantly increased levels of circulating matrix metalloproteinases (MMP1, 2, 3, 8, 12, 13), soluble inflammatory receptors (receptor for advanced glycation end-products-RAGE, Interleukin-1 receptor antagonist (IL-1RA), suppression of tumorigenicity (ST)2, triggering receptor expressed on myeloid cells (TREM)1, IL-6Ra, tumor necrosis factor (TNF)RI, TNFRII), and chemokines (IL-8, CC chemokine ligand- CCL17). Furthermore, this WTCS cluster was associated with WTC exposure variables, ash at work, and the participant category workers; but not with the exposure variable WTC dust cloud at 9/11. A comparison of WTC exposure categorial variables identified that chemokines (CCL17, CCL11), circulating receptors (RAGE, TREM1), MMPs (MMP3, MMP12), and vascular markers (Angiogenin, vascular cell adhesion molecule-VCAM1) significantly increased in the more exposed groups. Circulating biomarkers of remodeling and inflammation identified clusters within WTCS and were associated with WTC exposure.
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Affiliation(s)
- Gabriele Grunig
- Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY 10010, USA
- Division of Pulmonary Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (N.D.); (S.P.); (M.L.C.-V.); (R.G.); (K.I.B.)
| | - Nedim Durmus
- Division of Pulmonary Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (N.D.); (S.P.); (M.L.C.-V.); (R.G.); (K.I.B.)
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (Y.Z.); (Y.L.); (Y.W.); (M.L.)
| | - Yian Zhang
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (Y.Z.); (Y.L.); (Y.W.); (M.L.)
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Yuting Lu
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (Y.Z.); (Y.L.); (Y.W.); (M.L.)
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Sultan Pehlivan
- Division of Pulmonary Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (N.D.); (S.P.); (M.L.C.-V.); (R.G.); (K.I.B.)
| | - Yuyan Wang
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (Y.Z.); (Y.L.); (Y.W.); (M.L.)
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Kathleen Doo
- Pulmonary, Kaiser Permanente East Bay, Oakland, CA 94611, USA;
| | - Maria L. Cotrina-Vidal
- Division of Pulmonary Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (N.D.); (S.P.); (M.L.C.-V.); (R.G.); (K.I.B.)
| | - Roberta Goldring
- Division of Pulmonary Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (N.D.); (S.P.); (M.L.C.-V.); (R.G.); (K.I.B.)
| | - Kenneth I. Berger
- Division of Pulmonary Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (N.D.); (S.P.); (M.L.C.-V.); (R.G.); (K.I.B.)
| | - Mengling Liu
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (Y.Z.); (Y.L.); (Y.W.); (M.L.)
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Yongzhao Shao
- Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY 10010, USA
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (Y.Z.); (Y.L.); (Y.W.); (M.L.)
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Joan Reibman
- Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY 10010, USA
- Division of Pulmonary Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (N.D.); (S.P.); (M.L.C.-V.); (R.G.); (K.I.B.)
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (Y.Z.); (Y.L.); (Y.W.); (M.L.)
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Baba RY, Zhang Y, Shao Y, Berger KI, Goldring RM, Liu M, Kazeros A, Rosen R, Reibman J. COPD in Smoking and Non-Smoking Community Members Exposed to the World Trade Center Dust and Fumes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074249. [PMID: 35409931 PMCID: PMC8999000 DOI: 10.3390/ijerph19074249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 01/18/2023]
Abstract
Background: The characteristics of community members exposed to World Trade Center (WTC) dust and fumes with Chronic Obstructive Pulmonary Disease (COPD) can provide insight into mechanisms of airflow obstruction in response to an environmental insult, with potential implications for interventions. Methods: We performed a baseline assessment of respiratory symptoms, spirometry, small airway lung function measures using respiratory impulse oscillometry (IOS), and blood biomarkers. COPD was defined by the 2019 GOLD criteria for COPD. Patients in the WTC Environmental Health Center with <5 or ≥5 pack year smoking history were classified as nonsmoker-COPD (ns-COPD) or smoker-COPD (sm-COPD), respectively. Main Results: Between August 2005 and March 2018, 467 of the 3430 evaluated patients (13.6%) fit criteria for COPD. Among patients with COPD, 248 (53.1%) were ns-COPD. Patients with ns-COPD had measures of large airway function (FEV1) and small airway measures (R5−20, AX) that were less abnormal than those with sm-COPD. More ns-COPD compared to sm-COPD had a bronchodilator (BD) response measured by spirometry (24 vs. 14%, p = 0.008) or by IOS (36 vs. 21%, p = 0.002). Blood eosinophils did not differ between ns-COPD and sm-COPD, but blood neutrophils were higher in sm-COPD compared to ns-COPD (p < 0.001). Those with sm-COPD were more likely to be WTC local residents than ns-COPD (p = 0.007). Conclusions: Spirometry findings and small airway measures, as well as inflammatory markers, differed between patients with ns-COPD and sm-COPD. These findings suggest potential for differing mechanisms of airway injury in patients with WTC environmental exposures and have potential therapeutic implications.
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Affiliation(s)
- Ridhwan Y. Baba
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (R.Y.B.); (K.I.B.); (R.M.G.); (A.K.)
| | - Yian Zhang
- Division of Biostatistics, Department of Population Health and Environmental Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (Y.Z.); (Y.S.); (M.L.)
| | - Yongzhao Shao
- Division of Biostatistics, Department of Population Health and Environmental Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (Y.Z.); (Y.S.); (M.L.)
| | - Kenneth I. Berger
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (R.Y.B.); (K.I.B.); (R.M.G.); (A.K.)
| | - Roberta M. Goldring
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (R.Y.B.); (K.I.B.); (R.M.G.); (A.K.)
| | - Mengling Liu
- Division of Biostatistics, Department of Population Health and Environmental Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (Y.Z.); (Y.S.); (M.L.)
| | - Angeliki Kazeros
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (R.Y.B.); (K.I.B.); (R.M.G.); (A.K.)
| | - Rebecca Rosen
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY 10016, USA;
| | - Joan Reibman
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (R.Y.B.); (K.I.B.); (R.M.G.); (A.K.)
- Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA
- Correspondence:
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Rosen R, Shao Y, Zhang Q, Bao J, Zhang Y, Masurkar A, Wisniewski T, Urban N, Reibman J. Cognitive Function among World Trade Center-Exposed Community Members with Mental Health Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3440. [PMID: 35329128 PMCID: PMC8948727 DOI: 10.3390/ijerph19063440] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 12/20/2022]
Abstract
The World Trade Center Environmental Health Center (WTC EHC), is a federally designated clinical center of excellence for surveillance and treatment of WTC disaster exposed community members (WTC Survivors). Cognitive impairment (CI) has been extensively described in WTC responders and a concern for progressive impairment in all WTC disaster exposed groups has been raised. Cognitive status, however, has not been systematically characterized in the WTC Survivor population. We describe cognitive status in a subgroup of the Survivor population referred for mental health evaluation (N = 480) in the WTC EHC as measured by scores on the Montreal Cognitive Assessment (MoCA) instrument, and examine their association with WTC exposures and individual-level covariates including PTSD and depression screening inventory scores. In regression analyses, probable cognitive impairment (MoCA score < 26) was found in 59% of the study subjects and was significantly associated with age, race/ethnicity, education, income, depression and PTSD scores. Being caught in the dust cloud on 11 September 2011 was significantly associated with cognitive impairment even after controlling for the above. These data suggest an association with cognitive dysfunction in WTC Survivors with exposure to the toxic dust/fumes and psychological stress from the 9/11 terrorist attack and warrant further systematic study.
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Affiliation(s)
- Rebecca Rosen
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY 10016, USA;
- World Trade Center Environmental Health Center, NYC Health+Hospitals, New York, NY 10016, USA; (Q.Z.); (J.B.); (Y.Z.); (J.R.)
| | - Yongzhao Shao
- World Trade Center Environmental Health Center, NYC Health+Hospitals, New York, NY 10016, USA; (Q.Z.); (J.B.); (Y.Z.); (J.R.)
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA
- NYU Alzheimer’s Disease Research Center, New York, NY 10016, USA; (A.M.); (T.W.)
| | - Qiao Zhang
- World Trade Center Environmental Health Center, NYC Health+Hospitals, New York, NY 10016, USA; (Q.Z.); (J.B.); (Y.Z.); (J.R.)
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Jia Bao
- World Trade Center Environmental Health Center, NYC Health+Hospitals, New York, NY 10016, USA; (Q.Z.); (J.B.); (Y.Z.); (J.R.)
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Yian Zhang
- World Trade Center Environmental Health Center, NYC Health+Hospitals, New York, NY 10016, USA; (Q.Z.); (J.B.); (Y.Z.); (J.R.)
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Arjun Masurkar
- NYU Alzheimer’s Disease Research Center, New York, NY 10016, USA; (A.M.); (T.W.)
- Department of Neurology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Thomas Wisniewski
- NYU Alzheimer’s Disease Research Center, New York, NY 10016, USA; (A.M.); (T.W.)
- Department of Neurology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Nina Urban
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY 10016, USA;
- World Trade Center Environmental Health Center, NYC Health+Hospitals, New York, NY 10016, USA; (Q.Z.); (J.B.); (Y.Z.); (J.R.)
| | - Joan Reibman
- World Trade Center Environmental Health Center, NYC Health+Hospitals, New York, NY 10016, USA; (Q.Z.); (J.B.); (Y.Z.); (J.R.)
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
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Rigutto C, Sapara AO, Agyapong VIO. Anxiety, Depression and Posttraumatic Stress Disorder after Terrorist Attacks: A General Review of the Literature. Behav Sci (Basel) 2021; 11:bs11100140. [PMID: 34677233 PMCID: PMC8533613 DOI: 10.3390/bs11100140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 12/13/2022] Open
Abstract
Terrorism, though not well-defined, is a violent act that has been shown to have longstanding effects on the mental health of those who witness it. The aim of this general literature review is to explore the effect that terrorism has on posttraumatic stress disorder (PTSD), major depressive disorder (MDD) and anxiety disorders, as well as the bio-psycho-social determinants that mediate its impact. This paper describes the prevalence, risk factors, protective factors, common presentations and interventions identified for PTSD, depression and anxiety disorders occurring following terrorist attacks. We conducted a literature search in MEDLINE using a number of keywords detailed below. After applying inclusion and exclusion criteria, we kept 80 articles, which we summarized in tabular form. A majority of articles found detailed the impact of terrorism on PTSD, and took place in a Western, mainly American setting. The main factors that impacted the presentation of mental illness include gender, ethnicity, social supports, socioeconomic status, level of preparedness, level of exposure, pre-existing trauma and mental illness, and subsequent life stressors. The main intervention detailed in this article as showing evidence post-terrorism is trauma-focused cognitive-behavioural therapy. This study highlights the importance of this topic, and in particular, its implications for public health policy and practice.
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Durmus N, Pehlivan S, Zhang Y, Shao Y, Arslan AA, Corona R, Henderson I, Sterman DH, Reibman J. Lung Cancer Characteristics in the World Trade Center Environmental Health Center. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2689. [PMID: 33800009 PMCID: PMC7967411 DOI: 10.3390/ijerph18052689] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 12/16/2022]
Abstract
The destruction of the World Trade Center (WTC) towers on 11 September 2001 resulted in acute and chronic dust and fume exposures to community members, including local workers and residents, with well-described aerodigestive adverse health effects. This study aimed to characterize lung cancer in the WTC Environmental Health Center (WTC EHC) focusing on gender and smoking history. WTC EHC patients undergo an initial evaluation that includes WTC exposure information, demographics, and tobacco use. Detailed cancer characteristics are recorded from pathology reports. As of 31 December 2019, 248 WTC EHC patients had a diagnosis of lung cancer. More patients with lung cancer were women (57%) compared to men (43%). Many cases (47% women, 51% men) reported acute dust cloud exposure. Thirty-seven percent of lung cancer cases with available smoking history were never-smokers (≤1 pack-years) and 42% had a ≤5 pack-year history. The median age of cancer diagnosis in never-smoking women was 61 years compared to 66 years in men. Adenocarcinoma was more common in never-smokers compared to ever-smokers (72% vs. 65%) and in women compared to men (70% vs. 65%). We provide an initial description of lung cancers in local community members with documented exposure to the WTC dust and fumes.
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Affiliation(s)
- Nedim Durmus
- Department of Medicine, Division of Pulmonary Medicine, School of Medicine (SOM), New York University, New York, NY 10016, USA; (N.D.); (S.P.); (I.H.); (D.H.S.)
- World Trade Center Environmental Health Center, NYC H+HC, New York, NY 10016, USA; (Y.Z.); (Y.S.); (A.A.A.); (R.C.)
| | - Sultan Pehlivan
- Department of Medicine, Division of Pulmonary Medicine, School of Medicine (SOM), New York University, New York, NY 10016, USA; (N.D.); (S.P.); (I.H.); (D.H.S.)
- World Trade Center Environmental Health Center, NYC H+HC, New York, NY 10016, USA; (Y.Z.); (Y.S.); (A.A.A.); (R.C.)
| | - Yian Zhang
- World Trade Center Environmental Health Center, NYC H+HC, New York, NY 10016, USA; (Y.Z.); (Y.S.); (A.A.A.); (R.C.)
- Department of Population Health, Division of Biostatistics, School of Medicine (SOM), New York University, New York, NY 10016, USA
| | - Yongzhao Shao
- World Trade Center Environmental Health Center, NYC H+HC, New York, NY 10016, USA; (Y.Z.); (Y.S.); (A.A.A.); (R.C.)
- Department of Population Health, Division of Biostatistics, School of Medicine (SOM), New York University, New York, NY 10016, USA
- Department of Environmental Medicine, School of Medicine (SOM), New York University, New York, NY 10016, USA
- NYU Perlmutter Comprehensive Cancer Center, New York, NY 10016, USA
| | - Alan A. Arslan
- World Trade Center Environmental Health Center, NYC H+HC, New York, NY 10016, USA; (Y.Z.); (Y.S.); (A.A.A.); (R.C.)
- Department of Population Health, Division of Biostatistics, School of Medicine (SOM), New York University, New York, NY 10016, USA
- Department of Environmental Medicine, School of Medicine (SOM), New York University, New York, NY 10016, USA
- NYU Perlmutter Comprehensive Cancer Center, New York, NY 10016, USA
- Department of Obstetrics and Gynecology, School of Medicine (SOM), New York University, New York, NY 10016, USA
| | - Rachel Corona
- World Trade Center Environmental Health Center, NYC H+HC, New York, NY 10016, USA; (Y.Z.); (Y.S.); (A.A.A.); (R.C.)
| | - Ian Henderson
- Department of Medicine, Division of Pulmonary Medicine, School of Medicine (SOM), New York University, New York, NY 10016, USA; (N.D.); (S.P.); (I.H.); (D.H.S.)
| | - Daniel H. Sterman
- Department of Medicine, Division of Pulmonary Medicine, School of Medicine (SOM), New York University, New York, NY 10016, USA; (N.D.); (S.P.); (I.H.); (D.H.S.)
| | - Joan Reibman
- Department of Medicine, Division of Pulmonary Medicine, School of Medicine (SOM), New York University, New York, NY 10016, USA; (N.D.); (S.P.); (I.H.); (D.H.S.)
- World Trade Center Environmental Health Center, NYC H+HC, New York, NY 10016, USA; (Y.Z.); (Y.S.); (A.A.A.); (R.C.)
- Department of Environmental Medicine, School of Medicine (SOM), New York University, New York, NY 10016, USA
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Shao Y, Durmus N, Zhang Y, Pehlivan S, Fernandez-Beros ME, Umana L, Corona R, Addessi A, Abbott SA, Smyth-Giambanco S, Arslan AA, Reibman J. The Development of a WTC Environmental Health Center Pan-Cancer Database. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041646. [PMID: 33572220 PMCID: PMC7916067 DOI: 10.3390/ijerph18041646] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/23/2021] [Accepted: 02/01/2021] [Indexed: 12/11/2022]
Abstract
(1) Background: Recent studies have reported elevated risks of multiple cancers in the World Trade Center (WTC) affected community members (also called WTC “Survivors”). The large variety of WTC-cancers created a need to develop a comprehensive cancer database. This paper describes the development of a pan-cancer database at the WTC Environmental Health Center (EHC) Data Center. (2) Methods: A new REDCap-based pan-cancer database was created using the pathology reports and available biomarker data of confirmed cancer cases after review by a cancer epidemiologist, a pathologist, physicians and biostatisticians. (3) Results: The WTC EHC pan-cancer database contains cancer characteristics and emerging biomarker information for cancers of individuals enrolled in the WTC EHC and diagnosed after 11 September 2001 and up to 31 December 2019 obtained from WTC EHC clinical records, pathological reports and state cancer registries. As of 31 December 2019, the database included 3440 cancer cases with cancer characteristics and biomarker information. (4) Conclusions: This evolving database represents an important resource for the scientific community facilitating future research about the etiology, heterogeneity, characteristics and outcomes of cancers and comorbid mental health conditions, cancer economics and gene–environment interaction in the unique population of WTC survivors.
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Affiliation(s)
- Yongzhao Shao
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine (NYUGSOM), New York University, New York, NY 10016, USA; (Y.Z.); (A.A.A.)
- Department of Environmental Medicine, NYUG-SOM, New York University, New York, NY 10016, USA
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (N.D.); (S.P.); (M.-E.F.-B.); (L.U.); (R.C.); (A.A.); (S.A.A.); (S.S.-G.)
- NYU Perlmutter Comprehensive Cancer Center, New York, NY 10016, USA
- Correspondence: (Y.S.); (J.R.)
| | - Nedim Durmus
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (N.D.); (S.P.); (M.-E.F.-B.); (L.U.); (R.C.); (A.A.); (S.A.A.); (S.S.-G.)
- Division of Pulmonary Medicine, School of Medicine (SOM), NYUG-SOM, New York University, New York, NY 10016, USA
| | - Yian Zhang
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine (NYUGSOM), New York University, New York, NY 10016, USA; (Y.Z.); (A.A.A.)
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (N.D.); (S.P.); (M.-E.F.-B.); (L.U.); (R.C.); (A.A.); (S.A.A.); (S.S.-G.)
| | - Sultan Pehlivan
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (N.D.); (S.P.); (M.-E.F.-B.); (L.U.); (R.C.); (A.A.); (S.A.A.); (S.S.-G.)
- Division of Pulmonary Medicine, School of Medicine (SOM), NYUG-SOM, New York University, New York, NY 10016, USA
| | - Maria-Elena Fernandez-Beros
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (N.D.); (S.P.); (M.-E.F.-B.); (L.U.); (R.C.); (A.A.); (S.A.A.); (S.S.-G.)
- Division of Pulmonary Medicine, School of Medicine (SOM), NYUG-SOM, New York University, New York, NY 10016, USA
| | - Lisette Umana
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (N.D.); (S.P.); (M.-E.F.-B.); (L.U.); (R.C.); (A.A.); (S.A.A.); (S.S.-G.)
- Division of Pulmonary Medicine, School of Medicine (SOM), NYUG-SOM, New York University, New York, NY 10016, USA
| | - Rachel Corona
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (N.D.); (S.P.); (M.-E.F.-B.); (L.U.); (R.C.); (A.A.); (S.A.A.); (S.S.-G.)
- Division of Pulmonary Medicine, School of Medicine (SOM), NYUG-SOM, New York University, New York, NY 10016, USA
| | - Adrienne Addessi
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (N.D.); (S.P.); (M.-E.F.-B.); (L.U.); (R.C.); (A.A.); (S.A.A.); (S.S.-G.)
| | - Sharon A. Abbott
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (N.D.); (S.P.); (M.-E.F.-B.); (L.U.); (R.C.); (A.A.); (S.A.A.); (S.S.-G.)
| | - Sheila Smyth-Giambanco
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (N.D.); (S.P.); (M.-E.F.-B.); (L.U.); (R.C.); (A.A.); (S.A.A.); (S.S.-G.)
| | - Alan A. Arslan
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine (NYUGSOM), New York University, New York, NY 10016, USA; (Y.Z.); (A.A.A.)
- Department of Environmental Medicine, NYUG-SOM, New York University, New York, NY 10016, USA
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (N.D.); (S.P.); (M.-E.F.-B.); (L.U.); (R.C.); (A.A.); (S.A.A.); (S.S.-G.)
- NYU Perlmutter Comprehensive Cancer Center, New York, NY 10016, USA
- Department of Obstetrics and Gynecology, School of Medicine (SOM), NYUG-SOM, New York University, New York, NY 10016, USA
| | - Joan Reibman
- Department of Environmental Medicine, NYUG-SOM, New York University, New York, NY 10016, USA
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (N.D.); (S.P.); (M.-E.F.-B.); (L.U.); (R.C.); (A.A.); (S.A.A.); (S.S.-G.)
- Division of Pulmonary Medicine, School of Medicine (SOM), NYUG-SOM, New York University, New York, NY 10016, USA
- Correspondence: (Y.S.); (J.R.)
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Hamwey MK, Gargano LM, Friedman LG, Leon LF, Petrsoric LJ, Brackbill RM. Post-Traumatic Stress Disorder among Survivors of the September 11, 2001 World Trade Center Attacks: A Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4344. [PMID: 32560511 PMCID: PMC7344905 DOI: 10.3390/ijerph17124344] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 12/15/2022]
Abstract
Prior reviews of 9/11-related post-traumatic stress disorder (PTSD) have not focused on the civilian survivors most directly exposed to the attacks. Survivors include those individuals who were occupants of buildings in or near the World Trade Center (WTC) towers, those whose primary residence or workplace was in the vicinity, and persons who were on the street passing through the area. This review reports published information on the prevalence of and risk factors for PTSD, as well as comorbidities associated with PTSD among 9/11 survivors. Articles selected for inclusion met the following criteria: (1) full-length, original peer-reviewed empirical articles; (2) published in English from 2002-2019; (3) collected data from persons directly exposed; (4) adult populations; and (5) focused on non-rescue or recovery workers (i.e., survivors). Data were extracted with focus on study design, sample size, time frame of data collection post-9/11, PTSD assessment instrument, and PTSD prevalence, risk factors, and comorbidities. Our review identified the use of cross-sectional and longitudinal designs, finding multiple direct comorbidities with PTSD, as well as the prevalence and persistence of PTSD. Future research would benefit from incorporating more mixed methods designs, and exploring the mediating mechanisms and protective factors of the known associations of PTSD among the 9/11 survivor population.
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Affiliation(s)
| | | | | | | | | | - Robert M. Brackbill
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (M.K.H.); (L.M.G.); (L.G.F.); (L.F.L.); (L.J.P.)
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An Exploration of Discrepancies and Concordances Between Hospital Disaster Directors and General Health Care Providers in Gyeonggi Province, South Korea: Quantitative Analysis of a Multicenter Cross-Sectional Survey Study. Disaster Med Public Health Prep 2020; 15:608-614. [PMID: 32493521 DOI: 10.1017/dmp.2020.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate differences in the perception of disaster issues between disaster directors and general health care providers in Gyeonggi Province, South Korea. METHODS The Gyeonggi provincial committee distributed a survey to acute care facility personnel. Survey topics included awareness of general disaster issues, hospital preparedness, and training priorities. The questionnaire comprised multiple choices and items scored on a 10-point Likert scale. We analyzed the discrepancies and characteristics of the responses. RESULTS Completed surveys were returned from 43 (67%) of 64 directors and 145 (55.6%) of 261 health care providers. In the field of general awareness, the topic of how to triage in disaster response showed the greatest discrepancies. In the domain of hospital level disaster preparedness, individual opinions varied most within the topics of incident command, manual preparation. The responses to "accept additional patients in disaster situation" showed the biggest differences (> 21 versus 6~10). CONCLUSIONS In this study, there were disaster topics with discrepancies and concordances in perception between disaster directors and general health care providers. The analysis would present baseline information for the development of better training programs for region-specific core competencies, knowledge, and skills required for the effective response.
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Impact of Disasters on Community Medical Screening Examination and Vaccination Rates: The Case of the Sewol Ferry Disaster in Ansan, Korea. Disaster Med Public Health Prep 2020; 15:286-291. [PMID: 32241311 DOI: 10.1017/dmp.2020.29] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE In April 2014, the Sewol ferry sank off the coast of Korea, resulting in 304 deaths. Of these, 250 were local high school students from Ansan, and the disaster severely affected their community. This study investigated the association of this disaster with health examination, cancer screening rate, and vaccination rate. METHODS The study subjects were adults ages ≥19 years (11 026 Ansan residents and 1 361 624 non-residents of Ansan) who participated in the 2011-2016 Korea Community Health Survey. The national health screening program examination rate, cancer screening rate, and influenza vaccination rate in Ansan residents and non-residents were assessed and their responses compared using chi-square tests, multiple logistic regression analyses, and a stratification analysis according to depression. RESULTS After the disaster (2014-2016), non-residents received more health screening (adjusted odds ratio [aOR] = 1.13, P < 0.001), cancer screening (aOR = 1.41, P < 0.001), and vaccination (aOR = 1.10, P = 0.002) than Ansan residents. This difference was more evident in the group without a depressive mood. CONCLUSION People living in disaster areas show lower rates of medical screening examination and receive fewer vaccinations after the disaster. To decrease health impacts by disaster, efforts to increase community health screenings and vaccinations may be needed.
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Editorial for "Long-Term Health Effects of the 9/11 Disaster" in International Journal of Environmental Research and Public Health, 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183289. [PMID: 31500226 PMCID: PMC6765956 DOI: 10.3390/ijerph16183289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/04/2019] [Indexed: 12/17/2022]
Abstract
The call for articles on the long term health effects of the 11 September 2001 terrorist attacks (9/11) has resulted in twenty-three papers that add a significant amount of information to the growing body of research on the effects of the World Trade Center (WTC) disaster almost two decades later [...].
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