BACKGROUND: In October 2012, Hurricane Sandy struck the northeastern United States. There is evidence that environmental exposures experienced after Sandy could have caused or exacerbated lower respiratory symptoms (LRS). These exposures include mold, reconstruction-related respiratory irritants, and fumes. We studied the relationship between these Sandy-related inhalation exposures and post-Sandy LRS.
METHODS: In March 2013, World Trade Center Health Registry (Registry) enrollees who had completed a 2011-12 follow-up survey and who resided in the tri-state area (New York, New Jersey, and Connecticut) were invited to complete a survey about their experiences during and after Sandy. The overall response rate was 51.4% (n=4,558). The final analytic sample included 4,064 adult Registry enrollees. Three types of Sandy-related inhalational exposures were examined: 1) reconstruction exposure (removing water, removing mud/debris or “muck”, “tear out” work, or major repair at their or someone else’s homes that were damaged by Sandy); 2) exposure to mold or damp environments (for those who returned home after the hurricane, having a flooded home: seeing mold, or smelling mold at home; or being exposed to sewage, dirty or contaminated flood water, or visible mold); and 3) exposure to other respiratory irritants (i.e., debris, exhaust fumes from generators, diesel fuel or heating oil leaks or spills). LRS were defined as wheezing, persistent cough, or shortness of breath reported on >1 of the 30 days preceding survey completion (5-13 months after Sandy). Associations between LRS and Sandy exposures, controlling for socio-demographic factors, post-traumatic stress disorder, and previously reported LRS and asthma, were examined using multiple logistic regression.
RESULTS: Over one-third of participants (34.4%) reported post-Sandy LRS. We found a dose-response relationship between the number of types of Sandy-related exposures reported and post-Sandy LRS. Compared to those who reported no exposures, those who reported one type of exposure had twice the odds of having post-Sandy LRS (95% CI: 1.6-2.5), reporting two types had 2.4 the odds (95% CI: 1.9-3.2), while those who reported all three types of exposures had 2.7 the odds of having post-Sandy LRS (95% CI: 2.1-3.3). Each of the individual exposures was also independently associated with post-Sandy LRS, each having approximately twice the odds of having post-Sandy LRS.
CONCLUSIONS: This study provides evidence that post-hurricane clean-up and reconstruction exposures can increase the risk for LRS. Public health interventions should emphasize the importance of safe remediation practices and recommend use of personal protective equipment.