Self-Reported Skin Rash or Irritation Symptoms Among World ...€¦ · Self-Reported Skin Rash or...
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Self-Reported Skin Rash or Irritation Symptoms Among World Trade Center Health Registry Participants Monica J. Huang, MPH 2 , Jiehui Li, MBBS, MSc 1 , Jonathan Liff, Ph.D 2 , David E. Cohen, MD 3 , James Cone, MD, MPH 1 1 World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, NY; 2 Emory University Rollins School of Public Health, Atlanta, GA 3 New York University, School of Medicine, Department of Dermatology, New York, NY J Occup Environ Med. 2012 Apr;54(4):451-8 Little is known about whether skin rash was associated with the World Trade Center (WTC) dust cloud on the day of the disaster and continued exposure to dust in damaged homes and office buildings afterwards - The present analysis focuses on 42,025 adult participants who completed W1 and W2 surveys, were aged 18 years or older on 9/11, and were residents or area workers, or rescue/recovery workers or volunteers - Excluded are participants with unknown or incomplete information on skin rash or age and those who reported post-9/11 skin rash that began before 9/11 or reported skin cancer at W1. Passersby on 9/11 and students/school staff of local schools were also excluded because information regarding their extended exposure to dust after 9/11 is unavailable - Post-9/11 skin rash in W1: experienced skin rash/irritation symptoms starting after 9/11 - Continued report of post-9/11 skin rash in W2: experienced skin rash or irritation in the 30 days prior to W2 - 9/11-related exposures: • Dust cloud/debris exposure on 9/11 • Extent of home or workplace damage or number of days worked at the WTC site following 9/11 - Cumulative incidences of the outcomes are reported - Multivariate analyses using unconditional logistic regression were performed among those who were free from history of and coexisting posttraumatic stress disorder (PTSD) and nonspecific psychological distress - Exposure to dust from the WTC disaster is independently associated with greater self-reported post 9/11-skin rash or irritation at W1, without the influence of probable PTSD and nonspecific psychological distress - Effect of 9/11 exposures diminished for continued report of skin rash at W2 - Post-9/11 skin rash may be related to acute and long-term exposure to dust, though subjectivity of skin symptoms may bias findings - Along with other reported health effects, skin rash or irritation may be another 9/11- related health outcome among the exposed population - Skin protection may be an important consideration for future disaster preparedness Objectives: To describe self-reported skin rash 2-3 and 5-6 years after 9/11 and examine its association with exposures to dust/debris on 9/11 and in damaged homes and workplaces afterward . - 71,437 people completed the Wave 1 (W1) survey in 2003-04 - 68% of adult enrollees (n=46,602) completed the Wave 2 (W2) survey in 2006-07 Background & Objectives World Trade Center Health Registry Methods Results • Rescue/recovery workers & volunteers • Residents of lower Manhattan • Area workers and others present in lower Manhattan on the morning of 9/11 • Students & staff of local schools - Established in 2002 by CDC/ATSDR and the NYC DOHMH - Monitors the long term mental and physical health effects of 9/11 on directly exposed persons Results Strengths & Limitations Strengths: Diverse population of individuals directly exposed to the WTC disaster; range of data on socio-demographic characteristics. Limitations: Selection bias, recall bias, and potential bias due to the non-specificity and subjectivity of skin symptoms. Summary and Conclusions - 12% (n=2542) of Lower Manhattan residents and area workers reported skin rash or irritation beginning after 9/11 - 6% (n=1210) of residents and area workers reported skin rash after 9/11 that was also reported at W2 - Cumulative incidence of reported skin rash was similar among rescue and recovery workers 9/11-related exposure and post-9/11 skin rash among Lower Manhattan residents and area workers (N=21,280) Adjusted odds ratios (OR) and 95% confidence intervals (CI) for post-9/11 skin rash Acknowledgments This study was supported by NIOSH of CDC; the Agency for Toxic Substances and Disease Registry; and the New York City Department of Health and Mental Hygiene. 10 11 16 18 5 6 8 10 0 5 10 15 20 25 1-7 8-30 31-90 >90 days Cumulative Incidence (%) Days of work at the WTC site Post-9/11 skin rash in W1 Continued report of post-9/11 skin rash in W2 9/11-related exposure and post-9/11 skin rash among rescue/recovery workers and volunteers (N=20,745) Among residents and area workers Post-9/11 skin rash reported in W1 (n=8,591)* Continued report of post-9/11 skin rash in W2 (n=8,591)* Crude OR (95% CI) Adjusted OR (95% CI)** Crude OR (95% CI) Adjusted OR (95% CI)** Dust cloud/debris exposure (referent=None) Intense 1.7 (1.4-2.0) 1.6 (1.3-1.9) 1.9 (1.4-2.7) 1.8 (1.3-2.5) Some 1.3 (1.0-1.6) 1.3 (0.99-1.6) 1.4 (0.9-2.1) 1.3 (0.9-2.0) Damage to home or work place (referent=None) With heavy dust 1.9 (1.5-2.5) 1.8 (1.4-2.3) 1.7 (1.1-2.6) 1.4 (0.9-2.2) Without heavy dust 1.4 (1.1-1.7) 1.2 (0.95-1.6) 1.2 (0.8-1.9) 1.0 (0.7-1.6) * Excluding those with missing values from the model. ** Adjusted for source of enrollment, sex, age at enrollment, race, smoking status, history of asthma and hay fever or allergic rhinitis. Among rescue/recovery workers and volunteers Post-9/11 skin rash reported in W1 (n=8,803)* Continued report of post-9/11 skin rash in W2 (n=8,803)* Crude OR (95% CI) Adjusted OR (95% CI)** Crude OR (95% CI) Adjusted OR (95% CI)** Dust cloud/debris exposure (referent=None) Intense 2.1 (1.7-2.5) 1.6 (1.3-1.9) 1.9 (1.4-2.5) 1.3 (0.9-1.8) Some 1.7 (1.3-2.2) 1.3 (1.0-1.8) 1.8 (1.2-2.6) 1.3 (0.8-2.0) Days of work at WTC site (referent=1 to 7 days) >90 1.9 (1.5-2.5) 1.7 (1.3-2.2) 1.9 (1.3-2.7) 1.8 (1.2-2.6) 31-90 1.9 (1.5-2.4) 1.6 (1.3-2.1) 1.9 (1.3-2.7) 1.6 (1.1-2.3) 8-30 1.2 (0.95-1.5) 1.1 (0.9-1.4) 1.2 (0.8-1.6) 1.1 (0.8-1.6) 9 12 10 4 5 5 11 19 13 5 8 6 16 22 17 8 11 9 0 5 10 15 20 25 Dust cloud Damage to home with dust Damage to workplace with dust Dust cloud Damage to home with dust Damage to workplace with dust Cumulative Incidence (%) None (9/11-related exposure) Intermediate High Post-9/11 skin rash in W1 Continued report of skin rash in W2
Transcript of Self-Reported Skin Rash or Irritation Symptoms Among World ...€¦ · Self-Reported Skin Rash or...
Self-Reported Skin Rash or Irritation Symptoms Among World Trade Center Health Registry Participants
Monica J. Huang, MPH2, Jiehui Li, MBBS, MSc1, Jonathan Liff, Ph.D2, David E. Cohen, MD3, James Cone, MD, MPH1
1World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, NY; 2Emory University Rollins School of Public Health, Atlanta, GA 3 New York University, School of Medicine, Department of Dermatology, New York, NY
J Occup Environ Med. 2012 Apr;54(4):451-8
Little is known about whether skin rash was associated with the World Trade Center
(WTC) dust cloud on the day of the disaster and continued exposure to dust in
damaged homes and office buildings afterwards
- The present analysis focuses on 42,025 adult participants who completed W1
and W2 surveys, were aged 18 years or older on 9/11, and were residents or area
workers, or rescue/recovery workers or volunteers
- Excluded are participants with unknown or incomplete information on skin rash or
age and those who reported post-9/11 skin rash that began before 9/11 or
reported skin cancer at W1. Passersby on 9/11 and students/school staff of local
schools were also excluded because information regarding their extended
exposure to dust after 9/11 is unavailable
- Post-9/11 skin rash in W1: experienced skin rash/irritation symptoms starting
after 9/11
- Continued report of post-9/11 skin rash in W2: experienced skin rash or
irritation in the 30 days prior to W2
- 9/11-related exposures:
• Dust cloud/debris exposure on 9/11
• Extent of home or workplace damage or number of days worked at the WTC site
following 9/11
- Cumulative incidences of the outcomes are reported
- Multivariate analyses using unconditional logistic regression were performed
among those who were free from history of and coexisting posttraumatic stress
disorder (PTSD) and nonspecific psychological distress
- Exposure to dust from the WTC disaster is independently associated with greater
self-reported post 9/11-skin rash or irritation at W1, without the influence of probable
PTSD and nonspecific psychological distress
- Effect of 9/11 exposures diminished for continued report of skin rash at W2
- Post-9/11 skin rash may be related to acute and long-term exposure to dust, though
subjectivity of skin symptoms may bias findings
- Along with other reported health effects, skin rash or irritation may be another 9/11-
related health outcome among the exposed population
- Skin protection may be an important consideration for future disaster preparedness
Objectives: To describe self-reported skin rash 2-3 and 5-6 years after 9/11 and
examine its association with exposures to dust/debris on 9/11 and in damaged homes
and workplaces afterward
.
- 71,437 people completed the Wave 1 (W1)
survey in 2003-04
- 68% of adult enrollees (n=46,602)
completed the Wave 2 (W2) survey in 2006-07
Background & Objectives
World Trade Center Health Registry
Methods
Results
• Rescue/recovery workers & volunteers
• Residents of lower Manhattan
• Area workers and others present in lower
Manhattan on the morning of 9/11
• Students & staff of local schools
- Established in 2002 by CDC/ATSDR and the NYC DOHMH
- Monitors the long term mental and physical health effects of 9/11 on directly
exposed persons
Results
Strengths & Limitations
Strengths: Diverse population of individuals directly exposed to the WTC disaster;
range of data on socio-demographic characteristics. Limitations: Selection bias, recall
bias, and potential bias due to the non-specificity and subjectivity of skin symptoms.
Summary and Conclusions
- 12% (n=2542) of Lower Manhattan residents and area workers reported skin rash
or irritation beginning after 9/11
- 6% (n=1210) of residents and area workers reported skin rash after 9/11 that was
also reported at W2
- Cumulative incidence of reported skin rash was similar among rescue and recovery
workers
9/11-related exposure and post-9/11 skin rash among Lower Manhattan
residents and area workers (N=21,280)
Adjusted odds ratios (OR) and 95% confidence intervals (CI) for post-9/11 skin rash
Acknowledgments
This study was supported by NIOSH of CDC; the Agency for Toxic Substances and
Disease Registry; and the New York City Department of Health and Mental Hygiene.
10 11
16 18
5 6 8
10
0
5
10
15
20
25
1-7 8-30 31-90 >90 days
Cu
mu
lati
ve In
cid
en
ce (
%)
Days of work at the WTC site
Post-9/11 skin rash in W1 Continued report of post-9/11 skin rash in W2
9/11-related exposure and post-9/11 skin rash among rescue/recovery
workers and volunteers (N=20,745)
Among residents and area
workers Post-9/11 skin rash reported in
W1 (n=8,591)*
Continued report of post-9/11
skin rash in W2 (n=8,591)*
Crude OR
(95% CI)
Adjusted OR
(95% CI)**
Crude OR
(95% CI)
Adjusted OR
(95% CI)**
Dust cloud/debris exposure
(referent=None)
Intense 1.7 (1.4-2.0) 1.6 (1.3-1.9) 1.9 (1.4-2.7) 1.8 (1.3-2.5)
Some 1.3 (1.0-1.6) 1.3 (0.99-1.6) 1.4 (0.9-2.1) 1.3 (0.9-2.0)
Damage to home or work place
(referent=None)
With heavy dust 1.9 (1.5-2.5) 1.8 (1.4-2.3) 1.7 (1.1-2.6) 1.4 (0.9-2.2)
Without heavy dust 1.4 (1.1-1.7) 1.2 (0.95-1.6) 1.2 (0.8-1.9) 1.0 (0.7-1.6)
* Excluding those with missing values from the model.
** Adjusted for source of enrollment, sex, age at enrollment, race, smoking status, history of asthma and hay fever or allergic rhinitis.
Among rescue/recovery
workers and volunteers Post-9/11 skin rash reported in
W1 (n=8,803)*
Continued report of post-9/11
skin rash in W2 (n=8,803)*
Crude OR
(95% CI)
Adjusted OR
(95% CI)**
Crude OR
(95% CI)
Adjusted OR
(95% CI)**
Dust cloud/debris exposure (referent=None)
Intense 2.1 (1.7-2.5) 1.6 (1.3-1.9) 1.9 (1.4-2.5) 1.3 (0.9-1.8)
Some 1.7 (1.3-2.2) 1.3 (1.0-1.8) 1.8 (1.2-2.6) 1.3 (0.8-2.0)
Days of work at WTC site (referent=1 to 7
days)
>90 1.9 (1.5-2.5) 1.7 (1.3-2.2) 1.9 (1.3-2.7) 1.8 (1.2-2.6)
31-90 1.9 (1.5-2.4) 1.6 (1.3-2.1) 1.9 (1.3-2.7) 1.6 (1.1-2.3)
8-30 1.2 (0.95-1.5) 1.1 (0.9-1.4) 1.2 (0.8-1.6) 1.1 (0.8-1.6)
9
12 10
4 5 5
11
19
13
5
8
6
16
22
17
8
11
9
0
5
10
15
20
25
Dust cloud Damage tohome with
dust
Damage toworkplacewith dust
Dust cloud Damage tohome with
dust
Damage toworkplacewith dust
Cu
mu
lati
ve In
cid
en
ce (
%)
None (9/11-related exposure) Intermediate High
Post-9/11 skin rash in W1 Continued report of skin rash in W2
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