title: Surveillance for World Trade Center disaster health effects among survivors of collapsed and damaged buildings.
abstract: OBJECTIVE
  Survivors of collapsed or damaged buildings from the attack on the World Trade Center (WTC) were among those most exposed to injury hazards, air pollution, and traumatic events.
  
  
  METHODS
  This report summarizes data from health outcomes collected during interviews conducted from September 5, 2003, to the close of the World Trade Center Health Registry (WTCHR) enrollment on November 20, 2004.
  
  
  METHODS
  WTCHR will be used to monitor periodically the mental and physical health of 71,437 enrollees for 20 years. The analysis is limited to 8,418 adult survivors of collapsed buildings (n = 5,095) and buildings with major or moderate damage (n = 3,323), excluding those who were involved in rescue and recovery.
  
  
  RESULTS
  A total of 62.4% of survivors of collapsed or damaged buildings were caught in the dust and debris cloud that resulted from the collapse of the WTC towers, and 63.8% experienced three or more potentially psychologically traumatizing events. Injuries were common (43.6%), but few survivors reported injuries that would have required extensive treatment. More than half (56.6%) of survivors reported experiencing new or worsening respiratory symptoms after the attacks, 23.9% had heartburn/reflux, and 21.0% had severe headaches. At the time of the interview, 10.7% of building survivors screened positive for serious psychological distress (SPD) using the K6 instrument. After multiple adjustments, data indicated that survivors caught in the dust and debris cloud were more likely to report any injuries (adjusted odds ratio [AOR] = 3.9; p< or =0.05); any respiratory symptom (AOR = 2.7; p< or =0.05); severe headaches (AOR = 2.0; p< or =0.05); skin rash/irritation (AOR = 1.7; p< or =0.05); hearing problems or loss (AOR = 1.7; p< or =0.05); heartburn (AOR = 1.7; p< or =0.05); diagnosed stroke (AOR = 5.6; p< or =0.05); self-reported depression, anxiety, or other emotional problem (AOR = 1.4; p< or =0.05); and current SPD (AOR = 2.2; p< or =0.05). Adjustment for SPD did not diminish the observed associations between dust cloud exposure and physical health outcomes. Building type and time of evacuation were associated with injuries on September 11, 2001 and reported symptoms; building type (collapsed versus damaged) also was associated with mental distress.
  
  
  CONCLUSIONS
  Two to three years after September 11, survivors of buildings that collapsed or that were damaged as a result of the WTC attack reported substantial physical and mental health problems. The long-term ramifications of these effects are unknown. Many survivors were caught directly in the dust and debris of collapsing towers, a dense cloud of particulate matter that might have produced or exacerbated these health effects. PUBLIC HEALTH ACTION RECOMMENDED: Long-term follow-up of building survivors and all other persons enrolled in WTCHR should be maintained, with particular attention to those persons exposed to the dust cloud. Some of these findings might lead to building designs that can minimize injury hazards.
authors.affiliation: Agency for Toxic Substances and Disease Registry (ATSDR), Atlanta, Georgia, USA. rbrackbi@health.nyc.gov
authors.forename: Robert M
authors.initials: RM
authors.lastname: Brackbill
authors.forename: Lorna E
authors.initials: LE
authors.lastname: Thorpe
authors.forename: Laura
authors.initials: L
authors.lastname: DiGrande
authors.forename: Megan
authors.initials: M
authors.lastname: Perrin
authors.forename: James H
authors.initials: JH
authors.lastname: Sapp
authors.forename: David
authors.initials: D
authors.lastname: Wu
authors.forename: Sharon
authors.initials: S
authors.lastname: Campolucci
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Walker
authors.forename: Jim
authors.initials: J
authors.lastname: Cone
authors.forename: Paul
authors.initials: P
authors.lastname: Pulliam
authors.forename: Lisa
authors.initials: L
authors.lastname: Thalji
authors.forename: Mark R
authors.initials: MR
authors.lastname: Farfel
authors.forename: Pauline
authors.initials: P
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000397:Air Pollution; D003252:Construction Materials; D005107:Explosions; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008603:Mental Health; D009519:New York City; D011159:Population Surveillance; D012042:Registries; D012140:Respiratory Tract Diseases / Q000453:epidemiology; D047851:September 11 Terrorist Attacks; D013315:Stress, Psychological / Q000453:epidemiology; D017741:Survivors; D014947:Wounds and Injuries / Q000453:epidemiology