Subjective health legacy of the Chornobyl accident: a comparative study of 19-year olds in Kyiv

Abstract

Background: Since the Chornobyl accident in 1986, the physical health of exposed children in Ukraine has been monitored, but their perceived health has not been studied. This study examines health perceptions of Ukrainian adolescents exposed to radioactive fallout in utero or as infants, and the epidemiologic and Chornobyl-related influences on self-reported health.

Method: We assessed three groups of 19-year olds in Kyiv: 262 evacuees from contaminated areas near the plant; 261 classmate controls; and 325 population-based controls. The evacuees and classmates were previously assessed at age 11. Structured interviews were conducted with the adolescents and their mothers (N = 766), followed by general physical examinations (N = 722) and blood tests (N = 707). Proportional odds logistic regression and multi-group path analysis were the major statistical tests.

Results: The examination and blood test results were similar across groups except for a significantly elevated rate of thyroid enlargement found by palpation in evacuees (17.8%) compared former classmates (8.7%) and population-based controls (8.0%). In addition, four evacuees and one population control had had a thyroidectomy. Compared to controls, the evacuees rated their health the least positively and reported more medically diagnosed illnesses during the 5 years preceding the interview, particularly thyroid disease, migraine headache, and vascular dystony. The consistent risk factors (p < 0.001) for these subjective health reports were evacuee status, female gender, multiple hospitalizations, and health risk perception regarding Chornobyl. All three groups of mothers rated their children's health more negatively than the adolescents themselves, and maternal ratings were uniquely associated with the adolescents' health reports in the adjusted models. In the longitudinal evacuee and classmate subsamples, path analysis showed that mothers' health ratings when the children were age 11 predicted their later evaluations which in turn were associated with the adolescent self-reports.

Conclusion: The more negative self-evaluations of the evacuees were linked to a number of risk factors, including multiple hospitalizations, health risk perceptions, and epidemiologic risk factors. The increased rate of thyroid cancer and other diagnoses no doubt contributed to the evacuees' less positive subjective health. The strong effect of the mothers' perceptions argues in favor of developing risk communication programs for families rather than for mothers or adolescents as separate target groups.

Figure 1

Path analytic model for adolescent self-rated health in 240 evacuees and 234 classmates in Kyiv. The estimates shown are standardized estimates and all paths between evacuee and classmate groups have been constrained to be equal. E: Evacuees, C: Classmates. MODEL FIT: Chi-square 25.6, df = 16, p = 0.06; CFI 0.927; RMSEA 0.05. Indirect effects - E: 0.12, p < 0.001 C: 0.12, p < 0.001.

Figure 2

Path analytic model for adolescent reports of medical illnesses at age 19 in 226 evacuees and 220 classmates in Kyiv. The estimates shown are standardized estimates and all paths between evacuee and classmate groups have been constrained to be equal. E: Evacuees, C: Classmates. MODEL FIT: Chi-square 39.1, df = 15, p < 0.0001; CFI 0.89; RMSEA 0.08. Indirect effects - E: 0.12, p < 0.001 C: 0.16, p < 0.001.