title: Associations of World Trade Center exposures with pulmonary and cardiometabolic outcomes among children seeking care for health concerns.
abstract: OBJECTIVE
  Prior research on the physical health of children exposed to the World Trade Center (WTC) attacks has largely relied on parental report via questionnaire. We examined the impact of clinically-reported exposures on the physical health of children who lived and/or attended school in downtown Manhattan on September 11, 2001.
  
  
  METHODS
  We performed a cross-sectional study of 148 patients who presented to the WTC Environmental Health Center/Survivors Health Program, and were ≤ 18 years old on September 11, 2001.
  
  
  RESULTS
  38.5% were caught in the dust cloud from the collapsing buildings on September 11; over 80% spent ≥ 1 day in their home between September 11 and 18, 2001; and 25.7% reported home dust exposure. New-onset nasal/sinus congestion was reported in 52.7%, while nearly one-third reported new gastroesophageal reflux (GERD) symptoms. Prehypertension or hypertension was identified in 45.5%. Multivariable regression with exposure variables, body mass index category, and age as covariates identified strongest associations of dust cloud with spirometry (17.1% decrease in maximum midexpiratory flow). Younger children experienced increased peripheral eosinophils (+0.098% per year, p=0.023), while older children experienced more new-onset GERD (OR 1.17, p=0.004), headaches (OR 1.10, p=0.011), and prehypertension (OR 1.09, p=0.024). Home dust exposure was associated with reduced high-density lipoprotein (-10.3mg/dL, p=0.027) and elevated triglycerides (+36.3mg/dL, p=0.033).
  
  
  CONCLUSIONS
  While these findings cannot be assumed to generalize to all children exposed to the WTC attacks, they strongly suggest the need for more extensive study of respiratory, metabolic, and cardiovascular consequences.
authors.affiliation: Department of Pediatrics, New York University School of Medicine, New York, NY, United States. Leonardo.trasande@nyumc.org
authors.forename: Leonardo
authors.initials: L
authors.lastname: Trasande
authors.forename: Elizabeth Kajunski
authors.initials: EK
authors.lastname: Fiorino
authors.forename: Teresa
authors.initials: T
authors.lastname: Attina
authors.forename: Kenneth
authors.initials: K
authors.lastname: Berger
authors.forename: Roberta
authors.initials: R
authors.lastname: Goldring
authors.forename: Claude
authors.initials: C
authors.lastname: Chemtob
authors.forename: Nomi
authors.initials: N
authors.lastname: Levy-Carrick
authors.forename: Yongzhao
authors.initials: Y
authors.lastname: Shao
authors.forename: Mengling
authors.initials: M
authors.lastname: Liu
authors.forename: Elaine
authors.initials: E
authors.lastname: Urbina
authors.forename: Joan
authors.initials: J
authors.lastname: Reibman
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000453:epidemiology; D001772:Blood Cell Count; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004391:Dust; D004804:Eosinophils / Q000166:cytology; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology*; D006261:Headache / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D012220:Rhinitis / Q000453:epidemiology*; D047851:September 11 Terrorist Attacks; D013147:Spirometry; D011795:Surveys and Questionnaires
chemical_list: D004391:Dust