Cardiometabolic diseases in the World Trade Center general responder cohort and the role of subsequent environmental exposures

世界贸易中心一般反应者队列中的心脏代谢疾病以及随后环境暴露的作用

• 批准号: 10579549
• 负责人: Maayan Yitshak Sade
• 金额: $ 50.37万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-12-12 至 2027-10-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10579549
• 关键词: Address; Air Pollution; Asbestos; Cardiometabolic Disease; Caring; Certification; Chemicals; Cholesterol; Chronic; Complex Mixtures; Data; Diabetes Mellitus; Disasters; Disease; Dust; Emergency Medical Technicians; Environmental Exposure; Environmental Risk Factor; Equipment; Event; Exposure to; Fogs; Funding; Future; Glucose; Health; Health Care Costs; Health Food; Healthcare; High Density Lipoprotein Cholesterol; High Density Lipoproteins; Home; Hour; Human; Incidence; Intervention; LDL Cholesterol Lipoproteins; Laboratories; Learning; Length; Link; London; Low-Density Lipoproteins; Malignant Neoplasms; Measures; Metals; Methods; Modeling; Modernization; Monitor; Myocardial Infarction; Noise; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Particulate; Physical Examination; Police; Policies; Pollution; Population; Positioning Attribute; Predisposition; Publishing; Questionnaires; Recovery; Research; Resolution; Respirators; Respiratory Disease; Retrospective cohort study; Risk Reduction; Role; Serum; Severities; Site; Smog; Source; Survivors; Temperature; Terrorism; Testing; Time; Vulnerable Populations; Wildfire; Work; World Health; cancer risk; cardiometabolic risk; cardiometabolism; climate change; climate instability; clinical center; cohort; data centers; disorder risk; fine particles; follow-up; food environment; innovation; insight; member; novel; pollutant; poor health outcome; programs; repository; respiratory; response; social vulnerability; spatiotemporal; survival outcome; walkability

After the 9/11/2001 terrorist attack on the World Trade Center (WTC), >100,000 residents, police, firemen, emergency medical technicians, and others were chronically exposed to an environmental toxic cloud of dust and chemicals for more than a year during the massive cleanup effort. Adequate respiratory protective equipment was not consistently available, so these exposures contributed to health consequences presenting years later. Understanding the impact of 9/11 on long-term cardiometabolic disease (CMD) risk is critical because federally funded healthcare is only provided to responders for diseases certified to be related to 9/11 exposure. Current evidence of WTC health effects is mostly limited to respiratory and cancer risk, while myocardial infarction (MI) and diabetes are not certified. This has vast implications for health care costs and accessibility of treatment. We propose a retrospective cohort study using the WTC Health Program (WTCHP) General Responder Cohort to identify WTC-related CMD risk. Mount Sinai is home to the WTCHP Data Center, a repository of all monitoring and treatment data from all five Clinical Centers of Excellence that longitudinally monitor responders involved in the 9/11 tragedy. The WTCHP has assessed more than 43,000 responders during 20 years of follow-up with physical examinations, laboratory tests, and exposure and health questionnaires. With this cohort we will innovatively address gaps in WTC-related CMD research; assess the effect of the 9/11 attack on diabetes and MI incidence, as well as glucose and total, HDL, and LDL cholesterol levels; and identify how this exposure interacts with subsequent environmental exposures. In Aim 1, we will estimate the association between WTC- related exposures and CMD. In Aim 2 we will assess the association between long-term exposure to fine particulate air pollution (PM2.5) chemical components and CMD. We have developed a novel spatiotemporal model that can identify PM2.5 components at very high spatial resolution, allowing us to identify mixtures that define effects. Unlike most current research, we will address the complexity of PM2.5 exposure as a mixture of chemical components rather than focusing on PM2.5 mass. In Aim 3, we will determine whether subsequent environmental exposures (i.e., air pollution, greenness, noise, walkability, food environment, social vulnerability, and temperature) interact with the effects of WTC-related exposures on CMD. We will assess whether WTC-related exposures among responders altered their susceptibility to subsequent air pollution exposure, setting up distinct cardiometabolic health trajectories. We will also identify beneficial environmental exposures that mitigate the cardiometabolic effect of WTC-related exposures. To our knowledge, this will be the first study to examine whether subsequent environmental exposures interact with WTC-related exposure effects on CMD. This research will leverage a rich cohort with 20 years of follow-up data to uncover the long- term trajectories of how environmental exposures contribute to CMD, revealing critical insights to inform future interventions and policies to protect human health from hazardous exposures.

2001 年 9 月 11 日世界贸易中心 (WTC) 发生恐怖袭击后，超过 100,000 名居民、警察、消防员、 紧急医疗技术人员和其他人长期暴露于环境有毒的粉尘云和 在大规模清理工作中，化学物质使用了一年多。足够的呼吸防护设备 并非始终可用，因此这些接触导致了数年后出现的健康后果。 了解 9/11 对长期心脏代谢疾病 (CMD) 风险的影响至关重要，因为联邦 受资助的医疗保健仅提供给经证实与 9/11 事件相关的疾病的响应者。当前的 世贸中心对健康影响的证据主要限于呼吸道和癌症风险，而心肌梗死 (MI) 和糖尿病未经认证。这对医疗保健费用和治疗的可及性产生巨大影响。我们 提议使用 WTC 健康计划 (WTCHP) 一般响应者队列进行一项回顾性队列研究 识别 WTC 相关的 CMD 风险。西奈山是 WTCHP 数据中心的所在地，该中心是所有监控的存储库 以及来自所有五个临床卓越中心的治疗数据，这些中心纵向监测参与的响应者 9/11 悲剧。 WTCHP 在 20 年的跟踪调查中评估了超过 43,000 名响应者 体格检查、实验室测试以及暴露和健康调查问卷。通过这个队列，我们​​将 创新地解决世贸中心相关 CMD 研究的空白；评估 9/11 袭击对糖尿病的影响 MI 发生率以及葡萄糖和总胆固醇、HDL 和 LDL 胆固醇水平；并确定这种暴露的方式 与随后的环境暴露相互作用。在目标 1 中，我们将估计 WTC- 相关暴露和 CMD。在目标 2 中，我们将评估长期接触罚款之间的关联 空气颗粒物污染（PM2.5）化学成分和CMD。我们开发了一种新颖的时空 可以以非常高的空间分辨率识别 PM2.5 成分的模型，使我们能够识别以下混合物： 定义效果。与当前大多数研究不同，我们将解决 PM2.5 暴露的复杂性，将其作为以下因素的混合体： 化学成分而不是关注 PM2.5 质量。在目标 3 中，我们将确定后续是否 环境暴露（即空气污染、绿色、噪音、步行性、食品环境、社会 脆弱性和温度）与 WTC 相关暴露对 CMD 的影响相互作用。我们将评估 响应者中与世贸中心相关的暴露是否改变了他们对随后空气污染的易感性 暴露，建立独特的心脏代谢健康轨迹。我们还将确定有益的环境 减轻 WTC 相关暴露对心脏代谢影响的暴露。据我们所知，这将是 第一项研究旨在检验后续环境暴露是否与世贸中心相关暴露相互作用 对 CMD 的影响。这项研究将利用拥有 20 年随访数据的丰富队列来揭示长期的 环境暴露如何影响 CMD 的术语轨迹，揭示了为未来提供信息的重要见解 保护人类健康免受危险暴露的干预措施和政策。