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Khalifeh M, Goldfarb DG, Zeig-Owens R, Todd AC, Shapiro MZ, Carwile M, Dasaro CR, Li J, Yung J, Farfel MR, Brackbill RM, Cone JE, Qiao B, Schymura MJ, Prezant DJ, Hall C, Boffetta P. Cancer incidence in World Trade Center rescue and recovery workers by race and ethnicity. Am J Ind Med 2023; 66:1048-1055. [PMID: 37746817 DOI: 10.1002/ajim.23539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION It is unclear whether differences in health outcomes by racial and ethnic groups among World Trade Center (WTC) rescue and recovery workers reflect those of the population of New York State (NYS) or show distinct patterns. We assessed cancer incidence in WTC workers by self-reported race and ethnicity, and compared it to population figures for NYS. METHODS A total of 61,031 WTC workers enrolled between September 11, 2001 and January 10, 2012 were followed to December 31, 2015. To evaluate the association between race/ethnicity and cancer risk, Poisson regression analysis was used to estimate hazard ratios (HR) adjusted for WTC exposure, age, calendar year, sex and, for lung cancer, cigarette smoking. RESULTS In comparison to Whites, Black workers had a higher incidence of prostate cancer (HR = 1.99, 95% CI = 1.69-2.34) and multiple myeloma (HR = 3.57, 95% CI = 1.97-6.45), and a lower incidence of thyroid (HR = 0.41, 95% CI = 0.22-0.78) and colorectal cancer (HR = 0.57; 95% CI = 0.33-0.98). Hispanic workers had a higher incidence of liver cancer (HR = 4.03, 95% CI = 2.23-7.28). Compared with NYS population, White workers had significantly higher incidence of prostate cancer (HR = 1.26, 95% CI = 1.18-1.35) and thyroid cancer (HR = 1.80, 95% CI = 1.55-2.08), while Black workers had significantly higher incidence of prostate cancer (HR = 1.22, 95% CI = 1.05-1.40). CONCLUSION Cancer incidence in WTC workers generally reflects data from the NYS population, but some differences were identified that merit further investigation.
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Affiliation(s)
- Malak Khalifeh
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
| | - David G Goldfarb
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Fire Department of the City of New York, Brooklyn, New York, USA
| | - Rachel Zeig-Owens
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Andrew C Todd
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Moshe Z Shapiro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Madeline Carwile
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christopher R Dasaro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jiehui Li
- New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Janette Yung
- New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Mark R Farfel
- New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Robert M Brackbill
- New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - James E Cone
- New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Baozhen Qiao
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, New York, USA
| | - Maria J Schymura
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, New York, USA
| | - David J Prezant
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Charles Hall
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Li J, Hall CB, Yung J, Kehm RD, Zeig-Owens R, Singh A, Cone JE, Brackbill RM, Farfel MR, Qiao B, Schymura MJ, Shapiro MZ, Dasaro CR, Todd AC, Prezant DJ, Boffetta P. A 15-year follow-up study of mortality in a pooled cohort of World Trade Center rescue and recovery workers. Environ Res 2023; 219:115116. [PMID: 36549491 DOI: 10.1016/j.envres.2022.115116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/12/2022] [Accepted: 12/18/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Hazardous exposures from the World Trade Center (WTC) terrorist attacks have been linked to increased incidence of adverse health conditions, often associated with increased mortality. We assessed mortality in a pooled cohort of WTC rescue/recovery workers over 15 years of follow-up. MATERIALS AND METHODS We analyzed mortality through 2016 in a pooled and deduplicated cohort of WTC rescue/recovery workers from three WTC-exposed cohorts (N = 60,631): the Fire Department of the City of New York (FDNY); the WTC Health Registry (WTCHR); and the General Responder Cohort (GRC). Standardized mortality ratios (SMRs) were estimated to assess mortality vs. the US and NY state populations. Multivariable Cox proportional hazards models were used to examine associations of WTC exposures (date of first arrival, working on the WTC debris pile) with mortality risk. RESULTS There were 1912 deaths over 697,943.33 person-years of follow-up. The SMR for all-cause mortality was significantly lower-than-expected, both when using US (SMR 0.43, 95% confidence interval [CI] 0.42-0.45) and NYS (SMR 0.51, 95% CI 0.49-0.53) as reference populations. SMRs were not elevated for any of the 28 major causes of death. Arriving at the WTC site on 9/11-9/17/2001 vs. 9/18/2001-6/30/2002 was associated with 30-50% higher risk of all-cause, heart disease and smoking-related mortality in non-FDNY/non-GRC members. Conversely, arriving on 9/11/2001 vs. 9/18/2001-6/30/2002 was associated with 40% lower all-cause and smoking-related mortality risk in FDNY members. Working on vs. off the WTC pile was associated with an increased risk of all-cause mortality in non-FDNY/non-GRC members (adjusted hazard ratio [aHR] 1.25, 95% CI 1.04-1.50), and cancer-specific mortality in GRC members (aHR 1.39, 95% CI 1.05-1.84), but lower mortality risks were found in FDNY members. CONCLUSIONS We did not observe excess mortality among WTC rescue/recovery workers compared with general populations. However, significantly increased mortality risks among some sub-groups with high WTC exposure warrant further investigation.
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Affiliation(s)
- Jiehui Li
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, CN-6W, Long Island City, NY, 11101, United States
| | - Charles B Hall
- Albert Einstein College of Medicine, Department of Epidemiology and Population Health, 1300 Morris Park Ave, Bronx, NY, 10461, United States
| | - Janette Yung
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, CN-6W, Long Island City, NY, 11101, United States
| | - Rebecca D Kehm
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, CN-6W, Long Island City, NY, 11101, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, United States
| | - Rachel Zeig-Owens
- Albert Einstein College of Medicine, Department of Epidemiology and Population Health, 1300 Morris Park Ave, Bronx, NY, 10461, United States; Fire Department of the City of New York (FDNY), 9 Metrotech Center 5E-63-K, Brooklyn, NY, 11201, United States; Montefiore Medical Center, Department of Medicine, 111 E. 210th St., The Bronx, NY, 10467, United States
| | - Ankura Singh
- Fire Department of the City of New York (FDNY), 9 Metrotech Center 5E-63-K, Brooklyn, NY, 11201, United States; Montefiore Medical Center, Department of Medicine, 111 E. 210th St., The Bronx, NY, 10467, United States
| | - James E Cone
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, CN-6W, Long Island City, NY, 11101, United States
| | - Robert M Brackbill
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, CN-6W, Long Island City, NY, 11101, United States
| | - Mark R Farfel
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, CN-6W, Long Island City, NY, 11101, United States
| | - Baozhen Qiao
- New York State Department of Health, Bureau of Cancer Epidemiology, 150 Broadway, Albany, NY, 12204, United States
| | - Maria J Schymura
- New York State Department of Health, Bureau of Cancer Epidemiology, 150 Broadway, Albany, NY, 12204, United States
| | - Moshe Z Shapiro
- WTC Health Program General Responder Data Center, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One, Gustave L. Levy Place, Mail Stop 1057, New York, NY, 10029, United States
| | - Christopher R Dasaro
- WTC Health Program General Responder Data Center, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One, Gustave L. Levy Place, Mail Stop 1057, New York, NY, 10029, United States
| | - Andrew C Todd
- WTC Health Program General Responder Data Center, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One, Gustave L. Levy Place, Mail Stop 1057, New York, NY, 10029, United States
| | - David J Prezant
- Albert Einstein College of Medicine, Department of Epidemiology and Population Health, 1300 Morris Park Ave, Bronx, NY, 10461, United States; Fire Department of the City of New York (FDNY), 9 Metrotech Center 5E-63-K, Brooklyn, NY, 11201, United States; Montefiore Medical Center, Department of Medicine, 111 E. 210th St., The Bronx, NY, 10467, United States
| | - Paolo Boffetta
- Stony Brook University, Stony Brook Cancer Center, Lauterbur Dr., Stony Brook, NY, 11794, United States; University of Bologna, Department of Medical and Surgical Sciences, Via Zamboni, 33, 40126, Bologna, BO, Italy.
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Trivedi NU, Gargano LM, Brackbill RM, Jacobson MH. Posttraumatic stress disorder and functional impairment among World Trade Center Health Registry enrollees 14-15 years after the September 11, 2001, terrorist attacks. J Trauma Stress 2023; 36:44-58. [PMID: 36239980 DOI: 10.1002/jts.22887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/27/2022] [Accepted: 08/03/2022] [Indexed: 11/10/2022]
Abstract
The September 11, 2001, terrorist attacks on the World Trade Center (WTC) in New York City (9/11) had health-related consequences, including posttraumatic stress disorder (PTSD). PTSD is associated with functional impairment, which varies by symptom severity and other factors. This study aimed to identify predictors of functional impairment in individuals with low versus high PTSD symptom severity levels. WTC Health Registry enrollees exposed to 9/11 were surveyed four times between 2003 and 2015; cumulated data for individuals who endorsed at least one symptom on the PTSD Checklist-Civilian Version (PCL-C) at Wave 4 (2015-2016) were included (N = 30,287) and examined cross-sectionally. Individuals were classified based on PCL-C scores as having low/no (2-29) or high levels of PTSD symptom severity (≥ 44). Functional impairment was defined as subsequent difficulties in daily living. Among low/no PTSD severity participants, adjusted odds ratios (aORs) for the associations between functional impairment and poor self-rated health (vs. good), low social support (vs. high), and no physical activity (vs. active) were 1.23-1.92. In the same group, low versus high household income was associated with more functional impairment, aOR = 1.34, 95% CI [1.13, 1.59]. Among participants with high-level PTSD symptoms, women, aOR = 1.70, 95% CI [1.31, 2.20], and Hispanic enrollees, aOR = 1.76, 95% CI [1.31, 2.36], were more likely to report an absence of impairment. Self-rated health, social support, and physical activity emerged as important predictors of PTSD-related functional impairment across PTSD symptom severity levels, supporting clinical interventions targeting these factors.
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Affiliation(s)
- Niti U Trivedi
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, New York, USA.,Delfi Diagnostics, Inc., Baltimore, Maryland, USA
| | - Lisa M Gargano
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, New York, USA
| | - Robert M Brackbill
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, New York, USA
| | - Melanie H Jacobson
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, New York, USA.,Division of Environmental Pediatrics, Department of Pediatrics, New York University School of Medicine, New York, New York, USA
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Brackbill RM, Butturini E, Cone JE, Ahmadi A, Daniels RD, Farfel MR, Kubale T. Scientific Value of the Sub-Cohort of Children in the World Trade Center Health Registry. Int J Environ Res Public Health 2022; 19:12461. [PMID: 36231761 PMCID: PMC9564973 DOI: 10.3390/ijerph191912461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023]
Abstract
The World Trade Center Health Registry (WTCHR) was established in 2002 as a public health resource to monitor the health effects from the World Trade Center (WTC) disaster. We evaluated the representativeness of the WTC youth population (<18 years on 11 September 2001) by comparing the distributions of age, gender, race/ethnic groups, and income to 2000 census data for the matched geographic area, including distance from disaster. There were 2379 WTCHR enrolled children living in Lower Manhattan south of Canal Street on 11 September 2001, along with 752 enrolled students who attended school in Lower Manhattan but were not area residents. The WTCHR sub-group of children who were residents was similar to the geographically corresponding census population on age and sex. Black and Hispanic children are moderately overrepresented at 0.9% and 2.4% in the WTCHR compared to 0.8% and 1.7% in census population, respectively, while lower-income households are slightly under-represented, 28.8% in the WTCHR and 30.8% for the corresponding census information. Asian children appear underrepresented at 3.0% participation compared to 6.3% in the census. While the demographics of WTCHR youth are somewhat skewed, the gaps are within expected patterns of under-representation observed in other longitudinal cohorts and can be effectively addressed analytically or through targeted study design.
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Affiliation(s)
- Robert M. Brackbill
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 11101, USA
| | - Emma Butturini
- World Trade Center Health Program Division, National Institute for Occupational Safety and Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - James E. Cone
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 11101, USA
| | - Ayda Ahmadi
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 11101, USA
| | - Robert D. Daniels
- World Trade Center Health Program Division, National Institute for Occupational Safety and Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Mark R. Farfel
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 11101, USA
| | - Travis Kubale
- World Trade Center Health Program Division, National Institute for Occupational Safety and Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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Li J, Yung J, Qiao B, Takemoto E, Goldfarb DG, Zeig-Owens R, Cone JE, Brackbill RM, Farfel MR, Kahn AR, Schymura MJ, Shapiro MZ, Dasaro CR, Todd AC, Kristjansson D, Prezant DJ, Boffetta P, Hall CB. Cancer Incidence in World Trade Center Rescue and Recovery Workers: 14 Years of Follow-Up. J Natl Cancer Inst 2022; 114:210-219. [PMID: 34498043 PMCID: PMC8826586 DOI: 10.1093/jnci/djab165] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Statistically significantly increased cancer incidence has been reported from 3 cohorts of World Trade Center (WTC) disaster rescue and recovery workers. We pooled data across these cohorts to address ongoing public concerns regarding cancer risk 14 years after WTC exposure. METHODS From a combined deduplicated cohort of 69 102 WTC rescue and recovery workers, a sample of 57 402 workers enrolled before 2009 and followed through 2015 was studied. Invasive cancers diagnosed in 2002-2015 were identified from 13 state cancer registries. Standardized incidence ratios (SIRs) were used to assess cancer incidence. Adjusted hazard ratios (aHRs) were estimated from Cox regression to examine associations between WTC exposures and cancer risk. RESULTS Of the 3611 incident cancers identified, 3236 were reported as first-time primary (FP) cancers, with an accumulated 649 724 and 624 620 person-years of follow-up, respectively. Incidence for combined FP cancers was below expectation (SIR = 0.96, 95% confidence interval [CI] = 0.93 to 0.99). Statistically significantly elevated SIRs were observed for melanoma-skin (SIR = 1.43, 95% CI = 1.24 to 1.64), prostate (SIR = 1.19, 95% CI = 1.11 to 1.26), thyroid (SIR = 1.81, 95% CI = 1.57 to 2.09), and tonsil (SIR = 1.40, 95% CI = 1.00 to 1.91) cancer. Those arriving on September 11 had statistically significantly higher aHRs than those arriving after September 17, 2001, for prostate (aHR = 1.61, 95% CI = 1.33 to 1.95) and thyroid (aHR = 1.77, 95% CI = 1.11 to 2.81) cancers, with a statistically significant exposure-response trend for both. CONCLUSIONS In the largest cohort of 9/11 rescue and recovery workers ever studied, overall cancer incidence was lower than expected, and intensity of WTC exposure was associated with increased risk for specific cancer sites, demonstrating the value of long-term follow-up studies after environmental disasters.
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Affiliation(s)
- Jiehui Li
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY, USA
| | - Janette Yung
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY, USA
| | - Baozhen Qiao
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, NY, USA
| | - Erin Takemoto
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY, USA
| | - David G Goldfarb
- Fire Department of the City of New York (FDNY), Brooklyn, NY, USA
- Department of Medicine, Montefiore Medical Center, New York, NY, USA
| | - Rachel Zeig-Owens
- Fire Department of the City of New York (FDNY), Brooklyn, NY, USA
- Department of Medicine, Montefiore Medical Center, New York, NY, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - James E Cone
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY, USA
| | - Robert M Brackbill
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY, USA
| | - Mark R Farfel
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY, USA
| | - Amy R Kahn
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, NY, USA
| | - Maria J Schymura
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, NY, USA
| | - Moshe Z Shapiro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher R Dasaro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew C Todd
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dana Kristjansson
- Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, Oslo, Norway
| | - David J Prezant
- Fire Department of the City of New York (FDNY), Brooklyn, NY, USA
- Department of Medicine, Montefiore Medical Center, New York, NY, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Paolo Boffetta
- Medicine Department of Family, Population and Preventive Medicine Health Sciences, Stony Brook University, Stony Brook Cancer Center, Stony Brook, NY, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Charles B Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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Boffetta P, Goldfarb DG, Zeig-Owens R, Kristjansson D, Li J, Brackbill RM, Farfel MR, Cone JE, Yung J, Kahn AR, Qiao B, Schymura MJ, Webber MP, Prezant DJ, Dasaro CR, Todd AC, Hall CB. Temporal Aspects of the Association between Exposure to the World Trade Center Disaster and Risk of Cutaneous Melanoma. JID Innov 2022; 2:100063. [PMID: 35146479 PMCID: PMC8801528 DOI: 10.1016/j.xjidi.2021.100063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
Rescue/recovery workers who responded to the World Trade Center (WTC) attacks were exposed to known/suspected carcinogens. Studies have identified a trend toward an elevated risk of cutaneous melanoma in this population; however, few found significant increases. Furthermore, temporal aspects of the association have not been investigated. A total of 44,540 non-Hispanic White workers from the WTC Combined Rescue/Recovery Cohort were studied between March 12, 2002 and December 31, 2015. Cancer data were obtained through linkages with 13 state registries. Poisson regression was used to estimate hazard ratios and 95% confidence intervals using the New York State population as the reference; change points in hazard ratios were estimated using profile likelihood. We observed 247 incident cases of melanoma. No increase in incidence was detected during 2002-2004. From 2005 to 2015, the hazard ratio was 1.34 (95% confidence interval = 1.18-1.52). A dose‒response relationship was observed by arrival time at the WTC site. Risk was elevated just over 3 years after the attacks. Whereas WTC-related exposures to UVR or other agents might have contributed to this result, exposures other than those at the WTC site, enhanced medical surveillance, and lack of a control group with a similar proportion of rescue/recovery workers cannot be discounted. Our results support continued study of this population for melanoma.
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Affiliation(s)
- Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - David G. Goldfarb
- Department of Medicine, Montefiore Medical Center, New York, New York, USA
- Fire Department of the City of New York (FDNY), Brooklyn, New York, USA
- Department of Environmental, Occupational and Geospatial Health Sciences, City University of New York Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Rachel Zeig-Owens
- Department of Medicine, Montefiore Medical Center, New York, New York, USA
- Fire Department of the City of New York (FDNY), Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Dana Kristjansson
- Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, Oslo, Norway
- Center of Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jiehui Li
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Robert M. Brackbill
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Mark R. Farfel
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - James E. Cone
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Janette Yung
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Amy R. Kahn
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Baozhen Qiao
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Maria J. Schymura
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Mayris P. Webber
- Department of Medicine, Montefiore Medical Center, New York, New York, USA
- Fire Department of the City of New York (FDNY), Brooklyn, New York, USA
| | - David J. Prezant
- Department of Medicine, Montefiore Medical Center, New York, New York, USA
- Fire Department of the City of New York (FDNY), Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Christopher R. Dasaro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrew C. Todd
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Charles B. Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
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7
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Goldfarb DG, Colbeth HL, Skerker M, Webber MP, Prezant DJ, Dasaro CR, Todd AC, Kristjansson D, Li J, Brackbill RM, Farfel MR, Cone JE, Yung J, Kahn AR, Qiao B, Schymura MJ, Boffetta P, Hall CB, Zeig-Owens R. Impact of healthcare services on thyroid cancer incidence among World Trade Center-exposed rescue and recovery workers. Am J Ind Med 2021; 64:861-872. [PMID: 34275137 PMCID: PMC8796202 DOI: 10.1002/ajim.23277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND A recent study of World Trade Center (WTC)-exposed firefighters and emergency medical service workers demonstrated that elevated thyroid cancer incidence may be attributable to frequent medical testing, resulting in the identification of asymptomatic tumors. We expand on that study by comparing the incidence of thyroid cancer among three groups: WTC-exposed rescue/recovery workers enrolled in a New York State (NYS) WTC-medical monitoring and treatment program (MMTP); WTC-exposed rescue/recovery workers not enrolled in an MMTP (non-MMTP); and the NYS population. METHODS Person-time began on 9/12/2001 or at enrollment in a WTC cohort and ended at death or on 12/31/2015. Cancer data were obtained through linkages with 13 state cancer registries. We used Poisson regression to estimate rate ratios (RRs) and 95% confidence intervals (CIs) for MMTP and non-MMTP participants. NYS rates were used as the reference. To estimate potential changes over time in WTC-associated risk, change points in RRs were estimated using profile likelihood. RESULTS The thyroid cancer incidence rate among MMTP participants was more than twice that of NYS population rates (RR = 2.31; 95% CI = 2.00-2.68). Non-MMTP participants had a risk similar to NYS (RR = 0.96; 95% CI = 0.72-1.28). We observed no change points in the follow-up period. CONCLUSION Our findings support the hypothesis that no-cost screening (a benefit provided by WTC-MMTPs) is associated with elevated identification of thyroid cancer. Given the high survival rate for thyroid cancer, it is important to weigh the costs and benefits of treatment, as many of these cancers were asymptomatic and may have been detected incidentally.
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Affiliation(s)
- David G. Goldfarb
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, New York, USA
- Department of Environmental, Occupational and Geospatial Health Sciences, City University of New York Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Hilary L. Colbeth
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, New York, USA
| | - Molly Skerker
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, New York, USA
| | - Mayris P. Webber
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David J. Prezant
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Christopher R. Dasaro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrew C. Todd
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dana Kristjansson
- Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, Oslo, Norway
- Center of Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jiehui Li
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Robert M. Brackbill
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Mark R. Farfel
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - James E. Cone
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Janette Yung
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Amy R. Kahn
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, New York, USA
| | - Baozhen Qiao
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, New York, USA
| | - Maria J. Schymura
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, New York, USA
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Charles B. Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Rachel Zeig-Owens
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
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8
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Yu S, Alper HE, Nguyen A, Maqsood J, Brackbill RM. Stroke hospitalizations, posttraumatic stress disorder, and 9/11-related dust exposure: Results from the World Trade Center Health Registry. Am J Ind Med 2021; 64:827-836. [PMID: 34558721 DOI: 10.1002/ajim.23271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Few studies have examined the association between disaster-related factors and stroke by subtype or number. We investigated the association between 9/11-related posttraumatic stress disorder (PTSD), dust exposure, and stroke subtype as well as recurrent strokes. METHODS The study included 29,012 individuals enrolled in the World Trade Center Health Registry. Stroke cases were obtained by matching Registry enrollees to the New York State Department of Health's discharge records for inpatient visits between 2000 and 2016. Cox proportional hazards regression models were performed to examine the association between 9/11-related risk factors and stroke by subtype. Multinomial logistic regression models were conducted to assess the associations between the same risk factors and the number of stroke hospitalizations. RESULTS Having PTSD significantly increased the risk of developing ischemic and hemorrhagic stroke, with adjusted hazards ratios (AHRs) of 1.64 (95% confidence interval [CI]: 1.28-2.10) and 1.73 (95% CI: 1.10-2.71), respectively. The point estimate for dust cloud exposure, although not significant statistically, suggested an increased risk of ischemic stroke (AHR = 1.20, 95% CI: 0.96-1.50). PTSD was significantly associated with recurrent strokes with an adjusted odds ratio of 1.79 (95% CI: 1.09-2.95). CONCLUSIONS PTSD is a risk factor for both ischemic and hemorrhagic stroke and is associated with recurrent strokes. Dust exposure on 9/11 is a possible risk factor for ischemic stroke but not for hemorrhagic stroke, and was not associated with recurrent strokes. Our findings warrant additional research on stroke-morbidity and mortality associated with 9/11-related PTSD and dust exposure.
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Affiliation(s)
- Shengchao Yu
- New York City Department of Health and Mental Hygiene Long Island City New York USA
| | - Howard E. Alper
- New York City Department of Health and Mental Hygiene Long Island City New York USA
| | - Angela‐Maithy Nguyen
- Interdisciplinary Division, School of Public Health University of California‐Berkeley Berkeley California USA
| | - Junaid Maqsood
- New York City Department of Health and Mental Hygiene Long Island City New York USA
| | - Robert M. Brackbill
- New York City Department of Health and Mental Hygiene Long Island City New York USA
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9
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Goldfarb DG, Zeig-Owens R, Kristjansson D, Li J, Brackbill RM, Farfel MR, Cone JE, Yung J, Kahn AR, Qiao B, Schymura MJ, Webber MP, Dasaro CR, Shapiro M, Todd AC, Prezant DJ, Boffetta P, Hall CB. Temporal association of prostate cancer incidence with World Trade Center rescue/recovery work. Occup Environ Med 2021; 78:699-706. [PMID: 34507966 PMCID: PMC8458078 DOI: 10.1136/oemed-2021-107405] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/20/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The World Trade Center (WTC) attacks on 11 September 2001 created a hazardous environment with known and suspected carcinogens. Previous studies have identified an increased risk of prostate cancer in responder cohorts compared with the general male population. OBJECTIVES To estimate the length of time to prostate cancer among WTC rescue/recovery workers by determining specific time periods during which the risk was significantly elevated. METHODS Person-time accruals began 6 months after enrolment into a WTC cohort and ended at death or 12/31/2015. Cancer data were obtained through linkages with 13 state cancer registries. New York State was the comparison population. We used Poisson regression to estimate hazard ratios and 95% CIs; change points in rate ratios were estimated using profile likelihood. RESULTS The analytic cohort included 54 394 male rescue/recovery workers. We observed 1120 incident prostate cancer cases. During 2002-2006, no association with WTC exposure was detected. Beginning in 2007, a 24% increased risk (HR: 1.24, 95% CI 1.16 to 1.32) was observed among WTC rescue/recovery workers when compared with New York State. Comparing those who arrived earliest at the disaster site on the morning of 11 September 2001 or any time on 12 September 2001 to those who first arrived later, we observed a positive, monotonic, dose-response association in the early (2002-2006) and late (2007-2015) periods. CONCLUSIONS Risk of prostate cancer was significantly elevated beginning in 2007 in the WTC combined rescue/recovery cohort. While unique exposures at the disaster site might have contributed to the observed effect, screening practices including routine prostate specific antigen screening cannot be discounted.
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Affiliation(s)
- David G Goldfarb
- Department of Medicine, Division of Pulmonary Medicine, Montefiore Medical Center, Bronx, New York, USA
- Bureau of Health Services, World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York, USA
| | - Rachel Zeig-Owens
- Department of Medicine, Division of Pulmonary Medicine, Montefiore Medical Center, Bronx, New York, USA
- Bureau of Health Services, World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Division of Epidemiology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Dana Kristjansson
- Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, Oslo, Norway
- Center of Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jiehui Li
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Robert M Brackbill
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Mark R Farfel
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - James E Cone
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Janette Yung
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Amy R Kahn
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Baozhen Qiao
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Maria J Schymura
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Mayris P Webber
- Bureau of Health Services, World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Division of Epidemiology, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Epidemiology and Population Health, Division of Epidemiology, Montefiore Medical Center, Bronx, New York, USA
| | - Christopher R Dasaro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Moshe Shapiro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrew C Todd
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David J Prezant
- Department of Medicine, Division of Pulmonary Medicine, Montefiore Medical Center, Bronx, New York, USA
- Bureau of Health Services, World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Division of Epidemiology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Charles B Hall
- Department of Epidemiology & Population Health, Division of Biostatistics, Albert Einstein College of Medicine, Bronx, New York, USA
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10
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Goldfarb DG, Zeig‐Owens R, Kristjansson D, Li J, Brackbill RM, Farfel MR, Cone JE, Kahn AR, Qiao B, Schymura MJ, Webber MP, Dasaro CR, Lucchini RG, Todd AC, Prezant DJ, Hall CB, Boffetta P. Cancer survival among World Trade Center rescue and recovery workers: A collaborative cohort study. Am J Ind Med 2021; 64:815-826. [PMID: 34288025 PMCID: PMC8515734 DOI: 10.1002/ajim.23278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND World Trade Center (WTC)-exposed responders may be eligible to receive no-cost medical monitoring and treatment for certified conditions, including cancer. The survival of responders with cancer has not previously been investigated. METHODS This study compared the estimated relative survival of WTC-exposed responders who developed cancer while enrolled in two WTC medical monitoring and treatment programs in New York City (WTC-MMTP responders) and WTC-exposed responders not enrolled (WTC-non-MMTP responders) to non-responders from New York State (NYS-non-responders), all restricted to the 11-southernmost NYS counties, where most responders resided. Parametric survival models estimated cancer-specific and all-cause mortality. Follow-up ended at death or on December 31, 2016. RESULTS From January 1, 2005 to December 31, 2016, there were 2,037 cancer cases and 303 deaths (248 cancer-related deaths) among WTC-MMTP responders, 564 cancer cases, and 143 deaths (106 cancer-related deaths) among WTC-non-MMTP responders, and 574,075 cancer cases and 224,040 deaths (158,645 cancer-related deaths) among the NYS-non-responder population. Comparing WTC-MMTP responders with NYS-non-responders, the cancer-specific mortality hazard ratio (HR) was 0.72 (95% confidence interval [CI] = 0.64-0.82), and all-cause mortality HR was 0.64 (95% CI = 0.58-0.72). The cancer-specific HR was 0.94 (95% CI = 0.78-1.14), and all-cause mortality HR was 0.93 (95% CI = 0.79-1.10) comparing WTC-non-MMTP responders to the NYS-non-responder population. CONCLUSIONS WTC-MMTP responders had lower mortality compared with NYS-non-responders, after controlling for demographic factors and temporal trends. There may be survival benefits from no-out-of-pocket-cost medical care which could have important implications for healthcare policy, however, other occupational and socioeconomic factors could have contributed to some of the observed survival advantage.
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Affiliation(s)
- David G. Goldfarb
- Department of MedicineMontefiore Medical CenterNew YorkNew YorkUSA
- Fire Department of the City of New York (FDNY)BrooklynNew YorkUSA
- Department of Environmental, Occupational and Geospatial Health SciencesCity University of New York Graduate School of Public Health and Health PolicyNew YorkNew YorkUSA
| | - Rachel Zeig‐Owens
- Department of MedicineMontefiore Medical CenterNew YorkNew YorkUSA
- Fire Department of the City of New York (FDNY)BrooklynNew YorkUSA
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Dana Kristjansson
- Department of Hematology and OncologyIcahn School of Medicine at Mount Sinai, Tisch Cancer InstituteNew YorkNew YorkUSA
- Department of Genetics and BioinformaticsNorwegian Institute of Public HealthOsloNorway
- Center of Fertility and HealthNorwegian Institute of Public HealthOsloNorway
| | - Jiehui Li
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
| | - Robert M. Brackbill
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
| | - Mark R. Farfel
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
| | - James E. Cone
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
| | - Amy R. Kahn
- New York State Department of HealthBureau of Cancer EpidemiologyAlbanyNew YorkUSA
| | - Baozhen Qiao
- New York State Department of HealthBureau of Cancer EpidemiologyAlbanyNew YorkUSA
| | - Maria J. Schymura
- New York State Department of HealthBureau of Cancer EpidemiologyAlbanyNew YorkUSA
| | - Mayris P. Webber
- Fire Department of the City of New York (FDNY)BrooklynNew YorkUSA
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Christopher R. Dasaro
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Roberto G. Lucchini
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Andrew C. Todd
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - David J. Prezant
- Department of MedicineMontefiore Medical CenterNew YorkNew YorkUSA
- Fire Department of the City of New York (FDNY)BrooklynNew YorkUSA
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Charles B. Hall
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Paolo Boffetta
- Department of Hematology and OncologyIcahn School of Medicine at Mount Sinai, Tisch Cancer InstituteNew YorkNew YorkUSA
- Stony Brook Cancer CenterStony Brook UniversityStony BrookNew YorkUSA
- Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
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11
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Brackbill RM, Kahn AR, Li J, Zeig-Owens R, Goldfarb DG, Skerker M, Farfel MR, Cone JE, Yung J, Walker DJ, Solomon A, Qiao B, Schymura MJ, Dasaro CR, Kristjansson D, Webber MP, Lucchini RG, Todd AC, Prezant DJ, Boffetta P, Hall CB. Combining Three Cohorts of World Trade Center Rescue/Recovery Workers for Assessing Cancer Incidence and Mortality. Int J Environ Res Public Health 2021; 18:1386. [PMID: 33546187 PMCID: PMC7913216 DOI: 10.3390/ijerph18041386] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/30/2021] [Accepted: 01/31/2021] [Indexed: 02/02/2023]
Abstract
Three cohorts including the Fire Department of the City of New York (FDNY), the World Trade Center Health Registry (WTCHR), and the General Responder Cohort (GRC), each funded by the World Trade Center Health Program have reported associations between WTC-exposures and cancer. Results have generally been consistent with effect estimates for excess incidence for all cancers ranging from 6 to 14% above background rates. Pooling would increase sample size and de-duplicate cases between the cohorts. However, pooling required time consuming steps: obtaining Institutional Review Board (IRB) approvals and legal agreements from entities involved; establishing an honest broker for managing the data; de-duplicating the pooled cohort files; applying to State Cancer Registries (SCRs) for matched cancer cases; and finalizing analysis data files. Obtaining SCR data use agreements ranged from 6.5 to 114.5 weeks with six states requiring >20 weeks. Records from FDNY (n = 16,221), WTCHR (n = 29,372), and GRC (n = 33,427) were combined de-duplicated resulting in 69,102 unique individuals. Overall, 7894 cancer tumors were matched to the pooled cohort, increasing the number cancers by as much as 58% compared to previous analyses. Pooling resulted in a coherent resource for future research for studies on rare cancers and mortality, with more representative of occupations and WTC- exposure.
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Affiliation(s)
- Robert M. Brackbill
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (J.L.); (M.R.F.); (J.E.C.); (J.Y.); (D.J.W.); (A.S.)
| | - Amy R. Kahn
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, NY 12237, USA; (A.R.K.); (B.Q.); (M.J.S.)
| | - Jiehui Li
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (J.L.); (M.R.F.); (J.E.C.); (J.Y.); (D.J.W.); (A.S.)
| | - Rachel Zeig-Owens
- Fire Department of the City of New York (FDNY), Brooklyn, NY 11201, USA; (R.Z.-O.); (D.G.G.); (M.S.); (M.P.W.); (D.J.P.)
- Department of Medicine, Montefiore Medical Center, New York, NY 10467, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - David G. Goldfarb
- Fire Department of the City of New York (FDNY), Brooklyn, NY 11201, USA; (R.Z.-O.); (D.G.G.); (M.S.); (M.P.W.); (D.J.P.)
- Department of Medicine, Montefiore Medical Center, New York, NY 10467, USA
| | - Molly Skerker
- Fire Department of the City of New York (FDNY), Brooklyn, NY 11201, USA; (R.Z.-O.); (D.G.G.); (M.S.); (M.P.W.); (D.J.P.)
- Department of Medicine, Montefiore Medical Center, New York, NY 10467, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Mark R. Farfel
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (J.L.); (M.R.F.); (J.E.C.); (J.Y.); (D.J.W.); (A.S.)
| | - James E. Cone
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (J.L.); (M.R.F.); (J.E.C.); (J.Y.); (D.J.W.); (A.S.)
| | - Janette Yung
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (J.L.); (M.R.F.); (J.E.C.); (J.Y.); (D.J.W.); (A.S.)
| | - Deborah J. Walker
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (J.L.); (M.R.F.); (J.E.C.); (J.Y.); (D.J.W.); (A.S.)
| | - Adrienne Solomon
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (J.L.); (M.R.F.); (J.E.C.); (J.Y.); (D.J.W.); (A.S.)
| | - Baozhen Qiao
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, NY 12237, USA; (A.R.K.); (B.Q.); (M.J.S.)
| | - Maria J. Schymura
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, NY 12237, USA; (A.R.K.); (B.Q.); (M.J.S.)
| | - Christopher R. Dasaro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.R.D.); (R.G.L.); (A.C.T.)
| | - Dana Kristjansson
- Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, 0456 Oslo, Norway;
| | - Mayris P. Webber
- Fire Department of the City of New York (FDNY), Brooklyn, NY 11201, USA; (R.Z.-O.); (D.G.G.); (M.S.); (M.P.W.); (D.J.P.)
- Department of Medicine, Montefiore Medical Center, New York, NY 10467, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Roberto G. Lucchini
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.R.D.); (R.G.L.); (A.C.T.)
| | - Andrew C. Todd
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.R.D.); (R.G.L.); (A.C.T.)
| | - David J. Prezant
- Fire Department of the City of New York (FDNY), Brooklyn, NY 11201, USA; (R.Z.-O.); (D.G.G.); (M.S.); (M.P.W.); (D.J.P.)
- Department of Medicine, Montefiore Medical Center, New York, NY 10467, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY 11794, USA;
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Charles B. Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
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Pollari CD, Brite J, Brackbill RM, Gargano LM, Adams SW, Russo-Netzer P, Davidov J, Banyard V, Cone JE. World Trade Center Exposure and Posttraumatic Growth: Assessing Positive Psychological Change 15 Years after 9/11. Int J Environ Res Public Health 2020; 18:E104. [PMID: 33375729 PMCID: PMC7795403 DOI: 10.3390/ijerph18010104] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 12/11/2022]
Abstract
We evaluated the presence of posttraumatic growth (PTG) among survivors of the 9/11 terrorist attack and how indicators of psychosocial well-being, direct 9/11-related exposure, and posttraumatic stress symptoms (PTSS) relate to PTG. PTG was examined among 4934 participants using the Posttraumatic Growth Inventory (PTGI). A confirmatory factor analysis (CFA) was conducted to determine if the original factor structure of the PTGI fits our data and principal component analysis (PCA) to identify the appropriate factor structure. Multivariable linear regression models were used to examine the association between PTG and indicators of psychosocial well-being, 9/11-related exposure, and PTSS, controlling for covariates. CFA identified a two-factor structure of the PTGI as a better fit than the original five-factor model. Participants who experienced very high 9/11-related exposure level (ß = 7.72; 95% CI: 5.75-9.70), higher PTSS at waves 1 (ß = 0.13; 95% CI: 0.08-0.18) and 2 (ß = 0.09; 95% CI: 0.05-0.14), high social integration (ß = 5.71; 95% CI: 4.47, 6.96), greater social support (ß = 0.49; 95% CI: 0.37, 0.61), and higher self-efficacy (ß = 1.26; 95% CI: 1.04, 1.48) had higher PTGI scores. Our findings suggest PTG is present, 15 years following the 9/11 terrorist attack. Very high-level 9/11 exposure, PTSS, and indicators of psychosocial well-being were associated with PTG.
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Affiliation(s)
- Cristina D. Pollari
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY 11101, USA; (J.B.); (R.M.B.); (L.M.G.); (J.E.C.)
| | - Jennifer Brite
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY 11101, USA; (J.B.); (R.M.B.); (L.M.G.); (J.E.C.)
| | - Robert M. Brackbill
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY 11101, USA; (J.B.); (R.M.B.); (L.M.G.); (J.E.C.)
| | - Lisa M. Gargano
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY 11101, USA; (J.B.); (R.M.B.); (L.M.G.); (J.E.C.)
| | - Shane W. Adams
- Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York, NY 10019, USA;
- Department of Psychology, The Graduate Center, City University of New York, New York, NY 10016, USA
| | - Pninit Russo-Netzer
- Department of Counseling and Human Development, University of Haifa, Haifa 3498838, Israel; (P.R.-N.); (J.D.)
- School of Advanced Studies, Achva Academic College, Arugot 7980400, Israel
| | - Jonathan Davidov
- Department of Counseling and Human Development, University of Haifa, Haifa 3498838, Israel; (P.R.-N.); (J.D.)
| | - Victoria Banyard
- School of Social Work, Rutgers University, New Brunswick, NJ 08901, USA;
| | - James E. Cone
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY 11101, USA; (J.B.); (R.M.B.); (L.M.G.); (J.E.C.)
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13
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Giesinger I, Li J, Takemoto E, Brackbill RM, Cone JE, Qiao B, Farfel MR. Confirming mortality in a longitudinal exposure cohort: optimizing National Death Index search result processing. Ann Epidemiol 2020; 56:40-46. [PMID: 33393475 DOI: 10.1016/j.annepidem.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 09/14/2020] [Accepted: 10/20/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The National Death Index (NDI) is an important resource for mortality ascertainment. Methods selected to process NDI search results are rarely described in studies using linked data and can have an impact on resources and mortality ascertainment. We evaluate methods to process NDI search results among a 9/11-exposed cohort-the World Trade Center Health Registry (Registry). METHODS We describe three approaches to process search results (NDI-recommended cutoff points [NDIc]; National Program of Cancer Registries [NPCR] algorithm, and modified National Institute of Occupational Safety and Health algorithm [mNIOSH]). We calculate percent agreement, positive predictive value, sensitivity, specificity, and quantify the burden of manual review to compare the approaches. RESULTS Of 51,158 Registry enrollees submitted for linkage, 9449 enrollee-level and 17,909 record-level matches were identified. NPCR and mNIOSH were highly concordant (97.1%); more record pairs required manual review for mNIOSH (mNIOSH: 2.7% and NPCR: 1.8%). NDIc sensitivity was 82.9%, with differences observed by race and ethnicity (Asian: 74.4% and White: 86.1%). CONCLUSIONS NPCR algorithm minimized false matches and reduced the manual review burden. NDIc had nonrandom distribution of missed matches and low sensitivity. NDI search processing methods have important implications for resulting linked data; measures of linkage quality should be available to data users.
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Affiliation(s)
- Ingrid Giesinger
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY
| | - Jiehui Li
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY.
| | - Erin Takemoto
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY
| | - Robert M Brackbill
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY
| | - James E Cone
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY
| | - Baozhen Qiao
- New York State Department of Health, New York State Cancer Registry, Albany, NY
| | - Mark R Farfel
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY
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14
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Hamwey MK, Gargano LM, Friedman LG, Leon LF, Petrsoric LJ, Brackbill RM. Post-Traumatic Stress Disorder among Survivors of the September 11, 2001 World Trade Center Attacks: A Review of the Literature. Int J Environ Res Public Health 2020; 17:E4344. [PMID: 32560511 PMCID: PMC7344905 DOI: 10.3390/ijerph17124344] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 12/15/2022]
Abstract
Prior reviews of 9/11-related post-traumatic stress disorder (PTSD) have not focused on the civilian survivors most directly exposed to the attacks. Survivors include those individuals who were occupants of buildings in or near the World Trade Center (WTC) towers, those whose primary residence or workplace was in the vicinity, and persons who were on the street passing through the area. This review reports published information on the prevalence of and risk factors for PTSD, as well as comorbidities associated with PTSD among 9/11 survivors. Articles selected for inclusion met the following criteria: (1) full-length, original peer-reviewed empirical articles; (2) published in English from 2002-2019; (3) collected data from persons directly exposed; (4) adult populations; and (5) focused on non-rescue or recovery workers (i.e., survivors). Data were extracted with focus on study design, sample size, time frame of data collection post-9/11, PTSD assessment instrument, and PTSD prevalence, risk factors, and comorbidities. Our review identified the use of cross-sectional and longitudinal designs, finding multiple direct comorbidities with PTSD, as well as the prevalence and persistence of PTSD. Future research would benefit from incorporating more mixed methods designs, and exploring the mediating mechanisms and protective factors of the known associations of PTSD among the 9/11 survivor population.
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Affiliation(s)
| | | | | | | | | | - Robert M. Brackbill
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (M.K.H.); (L.M.G.); (L.G.F.); (L.F.L.); (L.J.P.)
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15
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Giesinger I, Li J, Takemoto E, Cone JE, Farfel MR, Brackbill RM. Association Between Posttraumatic Stress Disorder and Mortality Among Responders and Civilians Following the September 11, 2001, Disaster. JAMA Netw Open 2020; 3:e1920476. [PMID: 32022879 DOI: 10.1001/jamanetworkopen.2019.20476] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Posttraumatic stress disorder (PTSD) has been associated with increased mortality, primarily in studies of veterans. The World Trade Center Health Registry (Registry) provides a unique opportunity to study the association between PTSD and mortality among a population exposed to the World Trade Center attacks in New York, New York, on September 11, 2001 (9/11). OBJECTIVES To assess whether 9/11-related probable PTSD (PTSD) is associated with increased mortality risk, as well as whether this association differs when including repeated measures of PTSD over time vs a single baseline assessment. DESIGN, SETTING, AND PARTICIPANTS A longitudinal cohort study of 63 666 Registry enrollees (29 270 responders and 34 396 civilians) was conducted from September 5, 2003, to December 31, 2016, with PTSD assessments at baseline (wave 1: 2003-2004) and 3 follow-up time points (wave 2: 2006-2007, wave 3: 2011-2012, wave 4: 2015-2016). Data analyses were conducted from December 4, 2018, to May 20, 2019. EXPOSURES Posttraumatic stress disorder was defined using the 17-item PTSD Checklist-Specific (PCL-S) self-report measure (score ≥50) at each wave (waves 1-4). Baseline PTSD was defined using wave 1 PCL-S, and time-varying PTSD was defined using the PCL-S assessments from all 4 waves. MAIN OUTCOMES AND MEASURES Mortality outcomes were ascertained through National Death Index linkage from 2003 to 2016 and defined as all-cause, cardiovascular, and external-cause mortality. RESULTS Of 63 666 enrollees (38 883 men [61.1%]; mean [SD] age at 9/11, 40.4 [10.4] years), 6689 (10.8%) had PTSD at baseline (responders: 2702 [9.5%]; civilians: 3987 [12.0%]). Participants who were middle aged (2022 [12.5%]), female (3299 [13.8%]), non-Latino black (1295 [17.0%]), or Latino (1835 [22.2%]) were more likely to have PTSD. During follow-up, 2349 enrollees died (including 230 external-cause deaths and 487 cardiovascular deaths). Among all enrollees in time-varying analyses, PTSD was associated with all-cause, cardiovascular, and external-cause mortality, with adjusted hazard ratios (AHRs) of greater magnitude compared with analyses examining baseline PTSD. Among responders, time-varying PTSD was significantly associated with increased risk of all-cause (AHR, 1.91; 95% CI, 1.58-2.32), cardiovascular (AHR, 1.95; 95% CI, 1.25-3.04), and external-cause (AHR, 2.40; 95% CI, 1.47-3.91) mortality. Among civilians, time-varying PTSD was significantly associated with increased risk of all-cause (AHR, 1.54; 95% CI, 1.28-1.85), cardiovascular (AHR, 1.72; 95% CI, 1.15-2.58), and external-cause (AHR, 2.11; 95% CI, 1.06-4.19) mortality. CONCLUSIONS AND RELEVANCE The risk of mortality differed in examination of baseline PTSD vs repeated measures of PTSD over time, suggesting that longitudinal data should be used where possible. Comparable findings between responders and civilians suggest that 9/11-related PTSD is associated with an increased mortality risk.
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Affiliation(s)
- Ingrid Giesinger
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, New York
| | - Jiehui Li
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, New York
| | - Erin Takemoto
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, New York
| | - James E Cone
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, New York
| | - Mark R Farfel
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, New York
| | - Robert M Brackbill
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, New York
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16
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Schwartz RM, Rasul R, Gargano LM, Lieberman-Cribbin W, Brackbill RM, Taioli E. Examining Associations Between Hurricane Sandy Exposure and Posttraumatic Stress Disorder by Community of Residence. J Trauma Stress 2019; 32:677-687. [PMID: 31487410 DOI: 10.1002/jts.22445] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 05/31/2019] [Accepted: 06/01/2019] [Indexed: 11/10/2022]
Abstract
Exposure to 2012's Hurricane Sandy differed by community across New York City and nearby Long Island, and the differential impact of exposure on mental health concerns must be studied to enhance resilience in vulnerable communities. We assessed the association between self-reported Hurricane Sandy exposure and subsequent posttraumatic stress disorder (PTSD) symptoms, obtained through validated questionnaires completed by residents of lower Manhattan (n = 1,134), Queens/Long Island (LI)/Staten Island (SI; n = 622), and the Rockaways (n = 1,011); mean assessment times were 7, 14, and 32 months post-Sandy, respectively. The median number of hurricane exposures was similar for all communities; however, Rockaways residents had a higher proportion of likely PTSD symptoms (18.8%) compared to lower Manhattan (8.0%) and Queens/LI/SI residents (5.8%). Regarding likely PTSD, there was significant interaction between total hurricane exposure and community, p = .002, and flooding and community, p = .040. Number of hurricane exposures was associated with higher odds of likely PTSD in Queens/LI/SI, AOR = 1.61, 95% CI [1.34, 1.94]; lower Manhattan, AOR = 1.43, 95% CI [1.28, 1.59]; and the Rockaways, AOR = 1.25, 95% CI [1.16, 1.35]. Flooding was associated with increased odds of likely PTSD in the Rockaways, AOR = 1.65, 95% CI [1.01, 2.69]; and Queens/LI/SI, AOR = 3.29, 95% CI [1.08, 10.00]. This study emphasizes the differential impact of hurricane exposure on subsequent PTSD symptoms in three communities affected by Hurricane Sandy. Future preparedness and recovery efforts must understand community correlates of mental health concerns to promote resilience in vulnerable communities.
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Affiliation(s)
- Rebecca M Schwartz
- Department of Occupational Medicine, Epidemiology and Prevention, Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, USA.,Department of Population Health Science and Policy and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Center for Disaster Health, Trauma and Resilience, New York, New York, USA
| | - Rehana Rasul
- Center for Disaster Health, Trauma and Resilience, New York, New York, USA.,Biostatistics Unit, Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Lisa M Gargano
- New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Wil Lieberman-Cribbin
- Department of Population Health Science and Policy and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Center for Disaster Health, Trauma and Resilience, New York, New York, USA
| | - Robert M Brackbill
- New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Emanuela Taioli
- Department of Population Health Science and Policy and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Center for Disaster Health, Trauma and Resilience, New York, New York, USA
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17
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Brackbill RM, Alper HE, Frazier P, Gargano LM, Jacobson MH, Solomon A. An Assessment of Long-Term Physical and Emotional Quality of Life of Persons Injured on 9/11/2001. Int J Environ Res Public Health 2019; 16:E1054. [PMID: 30909548 PMCID: PMC6466210 DOI: 10.3390/ijerph16061054] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 12/15/2022]
Abstract
Fifteen years after the disaster, the World Trade Center Health Registry (Registry) conducted The Health and Quality of Life Survey (HQoL) assessing physical and mental health status among those who reported sustaining an injury on 11 September 2001 compared with non-injured persons. Summary scores derived from the Short Form-12 served as study outcomes. United States (US) population estimates on the Physical Component Score (PCS-12) and Mental Component Score (MCS-12) were compared with scores from the HQoL and were stratified by Post-traumatic Stress Disorder (PTSD) and injury status. Linear regression models were used to estimate the association between both injury severity and PTSD and PCS-12 and MCS-12 scores. Level of injury severity and PTSD history significantly predicted poorer physical health (mean PCS-12). There was no significant difference between injury severity level and mental health (mean MCS-12). Controlling for other factors, having PTSD symptoms after 9/11 predicted a nearly 10-point difference in mean MCS-12 compared with never having PTSD. Injury severity and PTSD showed additive effects on physical and mental health status. Injury on 9/11 and a PTSD history were each associated with long-term decrements in physical health status. Injury did not predict long-term decrements in one's mental health status. Although it is unknown whether physical wounds of the injury healed, our results suggest that traumatic injuries appear to have a lasting negative effect on perceived physical functioning.
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Affiliation(s)
- Robert M Brackbill
- World Trade Center Registry, New York Department of Health and Mental Hygiene, New York, NY 10013, USA.
| | - Howard E Alper
- World Trade Center Registry, New York Department of Health and Mental Hygiene, New York, NY 10013, USA.
| | - Patricia Frazier
- Department of Psychology, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Lisa M Gargano
- World Trade Center Registry, New York Department of Health and Mental Hygiene, New York, NY 10013, USA.
| | - Melanie H Jacobson
- World Trade Center Registry, New York Department of Health and Mental Hygiene, New York, NY 10013, USA.
| | - Adrienne Solomon
- World Trade Center Registry, New York Department of Health and Mental Hygiene, New York, NY 10013, USA.
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18
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Li J, Cone JE, Brackbill RM, Giesinger I, Yung J, Farfel MR. Pulmonary Fibrosis among World Trade Center Responders: Results from the WTC Health Registry Cohort. Int J Environ Res Public Health 2019; 16:ijerph16050825. [PMID: 30866415 PMCID: PMC6427469 DOI: 10.3390/ijerph16050825] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 01/11/2023]
Abstract
Dust created by the collapse of the World Trade Center (WTC) towers on 9/11 included metals and toxicants that have been linked to an increased risk of pulmonary fibrosis (PF) in the literature. Little has been reported on PF among WTC responders. This report used self-reported physician diagnosis of PF with an unknown sub-type to explore the association between levels of WTC dust exposure and PF. We included 19,300 WTC responders, enrolled in the WTC Health Registry in 2003–2004, who were followed for 11 years from 2004 to 2015. Exposure was defined primarily by intensity and duration of exposure to WTC dust/debris and work on the debris pile. Stratified Cox regression was used to assess the association. We observed 73 self-reported physician-diagnosed PF cases, with a PF incidence rate of 36.7/100,000 person-years. The adjusted hazard ratio (AHR) of PF was higher in those with a medium (AHR = 2.5, 95% CI = 1.1–5.8) and very high level of exposure (AHR = 4.5, 95% CI = 2.0–10.4), compared to those with low exposure. A test for exposure—response trend was statistically significant (Ptrend = 0.004). Future research on WTC dust exposure and PF would benefit from using data from multiple WTC Health Program responder cohorts for increased statistical power and clinically confirmed cases.
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Affiliation(s)
- Jiehui Li
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York City, NY 10013, USA.
| | - James E Cone
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York City, NY 10013, USA.
| | - Robert M Brackbill
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York City, NY 10013, USA.
| | - Ingrid Giesinger
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York City, NY 10013, USA.
| | - Janette Yung
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York City, NY 10013, USA.
| | - Mark R Farfel
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York City, NY 10013, USA.
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19
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Gargano LM, Li J, Millien L, Alper H, Brackbill RM. Exposure to multiple disasters: The long-term effect of Hurricane Sandy (October 29, 2012) on NYC survivors of the September 11, 2001 World Trade Center attack. Psychiatry Res 2019; 273:719-724. [PMID: 31207858 DOI: 10.1016/j.psychres.2019.01.090] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/28/2019] [Accepted: 01/28/2019] [Indexed: 11/28/2022]
Abstract
This study evaluated the impact of pre-Hurricane Sandy (Sandy) post-traumatic stress disorder (PTSD) trajectories on the relationship between Sandy exposures and post-Sandy 9/11-related PTSD among World Trade Center Health Registry (Registry) enrollees. The study population included 3,199 adult Registry enrollees who completed three surveys prior to Sandy in 2003-4, 2006-7, and 2011-12; a post-Hurricane Sandy survey (2013); and a follow-up survey in 2015-16. PTSD was assessed using the PTSD Checklist (PCL). Latent class growth analysis was used to identify groups of enrollees who shared a similar trajectory of change in PCL score in the time period prior to Sandy. We compared enrollees in each trajectory group to assess the impact of Sandy-related PTSD, Sandy exposures, and optimism on 9/11-related PTSD status post-Sandy (2015-16) using bivariate analyses and multivariable log-binomial regression. Sandy-related PTSD was the strongest predictor of subsequent 9/11-related PTSD. Lower optimism and higher Sandy exposure significantly predicted 9/11-related PTSD only in some trajectory groups. Hurricane Sandy may have exacerbated previously resolved symptoms of 9/11-related PTSD. This indicates a need after a disaster to assess and address mental health sequelae from previous traumatic exposures.
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Affiliation(s)
- Lisa M Gargano
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 10013, USA.
| | - Jiehui Li
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 10013, USA
| | - Lucie Millien
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 10013, USA
| | - Howard Alper
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 10013, USA
| | - Robert M Brackbill
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 10013, USA
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20
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Jacobson MH, Norman C, Sadler P, Petrsoric LJ, Brackbill RM. Characterizing Mental Health Treatment Utilization among Individuals Exposed to the 2001 World Trade Center Terrorist Attacks 14⁻15 Years Post-Disaster. Int J Environ Res Public Health 2019; 16:ijerph16040626. [PMID: 30791669 PMCID: PMC6406725 DOI: 10.3390/ijerph16040626] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/07/2019] [Accepted: 02/15/2019] [Indexed: 12/04/2022]
Abstract
Following the World Trade Center (WTC) attacks in New York City (NYC) on 11 September 2001 (9/11), thousands in NYC experienced significant stress reactions and disorders, presenting an immediate need for counseling and treatment. While other studies documented post-9/11 mental health treatment utilization, none have data more than two years post-disaster. We used data from 35,629 enrollees of the WTC Health Registry, a longitudinal cohort study of those exposed to the WTC attacks, to examine predictors of counseling after 9/11, the types of practitioners seen, and the perceived helpfulness of therapy up to 15 years post-disaster. Among enrollees, 37.7% reported receiving counseling at some time after 9/11. Predictors of seeking counseling included race/ethnicity, age at 9/11, education level, exposure to the WTC attacks, other traumatic experiences, mental health symptomology, and pre-9/11 counseling. Whites and Hispanics, those who were children on 9/11, and those with high levels of exposure to the WTC attacks sought counseling soonest after 9/11. Among those who sought counseling, Blacks, Asians, and those with lower education and income were less likely to see mental health specialists and more likely to see general practitioners or religious advisors. Finally, among those who sought recent counseling, women, Blacks, those aged ≥65 years, and those with very high WTC exposures were more likely to rate their recent counseling as very helpful. This study used data up to 15 years post-disaster to document mental health treatment utilization patterns, trends, and disparities that have implications for future preparedness plans and needs assessments.
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Affiliation(s)
- Melanie H Jacobson
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 10013, USA.
| | - Christina Norman
- Division of Mental Hygiene, New York City Department of Health and Mental Hygiene, Queens, NY 11101, USA.
| | - Pablo Sadler
- Division of Mental Hygiene, New York City Department of Health and Mental Hygiene, Queens, NY 11101, USA.
| | - Lysa J Petrsoric
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 10013, USA.
| | - Robert M Brackbill
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 10013, USA.
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21
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Jordan HT, Osahan S, Li J, Stein CR, Friedman SM, Brackbill RM, Cone JE, Gwynn C, Mok HK, Farfel MR. Persistent mental and physical health impact of exposure to the September 11, 2001 World Trade Center terrorist attacks. Environ Health 2019; 18:12. [PMID: 30755198 PMCID: PMC6373081 DOI: 10.1186/s12940-019-0449-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 01/17/2019] [Indexed: 05/29/2023]
Abstract
BACKGROUND Asthma, gastroesophageal reflux disease (GERD), posttraumatic stress disorder (PTSD) and depression have each been linked to exposure to the September 11, 2001 World Trade Center (WTC) terrorist attacks (9/11). We described the prevalence and patterns of these conditions and associated health-related quality of life (HRQOL) fifteen years after the attacks. METHODS We studied 36,897 participants in the WTC Health Registry, a cohort of exposed rescue/recovery workers and community members, who completed baseline (2003-2004) and follow-up (2015-16) questionnaires. Lower respiratory symptoms (LRS; cough, dyspnea, or wheeze), gastroesophageal reflux symptoms (GERS) and self-reported clinician-diagnosed asthma and GERD history were obtained from surveys. PTSD was defined as a score > 44 on the PTSD checklist, and depression as a score > 10 on the Patient Health Questionnaire (PHQ). Poor HRQOL was defined as reporting limited usual daily activities for > 14 days during the month preceding the survey. RESULTS In 2015-16, 47.8% of participants had ≥1 of the conditions studied. Among participants without pre-existing asthma, 15.4% reported asthma diagnosed after 9/11; of these, 76.5% had LRS at follow up. Among those without pre-9/11 GERD, 22.3% reported being diagnosed with GERD after 9/11; 72.2% had GERS at follow-up. The prevalence of PTSD was 14.2%, and of depression was 15.3%. HRQOL declined as the number of comorbidities increased, and was particularly low among participants with mental health conditions. Over one quarter of participants with PTSD or depression reported unmet need for mental health care in the preceding year. CONCLUSIONS Nearly half of participants reported having developed at least one of the physical or mental health conditions studied by 2015-2016; comorbidity among conditions was common. Poor HRQOL and unmet need for health were frequently reported, particularly among those with post-9/11 PTSD or depression. Comprehensive physical and mental health care are essential for survivors of complex environmental disasters, and continued efforts to connect 9/11-exposed persons to needed resources are critical.
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Affiliation(s)
- Hannah T Jordan
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, NY, USA.
- Present Address: Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, 42-09 28th St., CN-72B, Long Island City, Queens, NY, 11101, USA.
| | - Sukhminder Osahan
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Jiehui Li
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Cheryl R Stein
- Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at NYU Langone, One Park Avenue, room 7-314, New York, NY, USA
| | - Stephen M Friedman
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Robert M Brackbill
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - James E Cone
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Charon Gwynn
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Ho Ki Mok
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Mark R Farfel
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, NY, USA
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Adams SW, Bowler RM, Russell K, Brackbill RM, Li J, Cone JE. PTSD and comorbid depression: Social support and self-efficacy in World Trade Center tower survivors 14-15 years after 9/11. Psychol Trauma 2018; 11:156-164. [PMID: 30211599 DOI: 10.1037/tra0000404] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Following the World Trade Center (WTC) terrorist attack in New York City, prevalence rates of posttraumatic stress disorder (PTSD) and depression remain elevated. Although social support and self-efficacy have been associated with PTSD, little is known about their differential effect on PTSD and depressive comorbidity. METHOD WTC tower survivors (n = 1,304) were assessed at Wave 1 (2003-2004), Wave 2 (2006-2007), Wave 3 (2011-2012), and Wave 4 (2015-2016). RESULTS At Wave 4, 13.0% of participants had probable PTSD, a decrease from 16.5% at Wave 1. In addition, 4.1% (54) were identified as having PTSD alone, 6.8% (89) had depression alone, and 8.9% (116) had comorbid PTSD and depression. Of those with PTSD, 68.2% also had comorbid depression. WTC tower survivors with PTSD and comorbid depression reported greater PTSD symptom severity and were more likely to have had greater exposure to the events of 9/11 (adjusted odds ratio [aOR] = 1.14) and lower self-efficacy (aOR = 0.85) than those with depression alone. Less perceived social support predicted only depression and not PTSD, whereas less perceived self-efficacy equally predicted having PTSD or depression (aOR = 0.76). CONCLUSIONS Findings indicate that self-efficacy may be more important to the severity and chronicity of PTSD symptoms than social support. Multivariate comparisons suggest that PTSD with comorbid depression is a presentation of trauma-dependent psychopathologies, as opposed to depression alone following trauma, which was independent of trauma exposure and may be secondary to the traumatic event and posttraumatic response. Implications for assessment and treatment are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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23
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Hirst A, Miller-Archie SA, Welch AE, Li J, Brackbill RM. Post-9/11 drug- and alcohol- related hospitalizations among World Trade Center Health Registry enrollees, 2003-2010. Drug Alcohol Depend 2018; 187:55-60. [PMID: 29627406 DOI: 10.1016/j.drugalcdep.2018.01.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/25/2018] [Accepted: 01/30/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To describe patterns of drug- and alcohol-related hospitalizations among persons exposed to the 2001 World Trade Center (WTC) terrorist attacks and to assess whether 9/11-related exposures or post-9/11 post-traumatic stress disorder (PTSD) were associated with increased odds of hospitalization. METHODS Data for adult enrollees in the WTC Health Registry, a prospective cohort study, were linked to New York State (NYS) administrative hospitalization data to identify alcohol- and drug-related hospitalizations from enrollment to December 31, 2010. Logistic regression was used to analyze the associations between substance use-related hospitalization, 9/11-related exposure and PTSD. RESULTS Of 41,176 NYS resident enrollees, we identified 626 (1.5%) who had at least one alcohol- or drug-related hospitalization; 53.4% (n = 591) of these hospitalizations were for alcohol only diagnoses and 46.6% (n = 515) were drug-related. Witnessing ≥3 traumatic events on 9/11 was significantly associated with having a drug-related hospitalization (AOR 1.4, 95% CI = [1.1, 1.9]). PTSD was significantly associated with both having a drug-related hospitalization as well as an alcohol only-related hospitalization. (AOR 2.6, 95% CI = [2.0, 3.3], AOR 1.8, 95% CI = [1.4, 2.3], respectively). CONCLUSIONS Witnessing traumatic events and having PTSD were independently associated with substance use-related hospitalizations. Targeting people who witnessed traumatic events on 9/11 and/or who have PTSD for substance use- treatment could reduce alcohol and drug-related hospitalizations connected to 9/11.
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Affiliation(s)
- Andrew Hirst
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 125 Worth St. CN-6W, New York, NY 10013, United States
| | - Sara A Miller-Archie
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 125 Worth St. CN-6W, New York, NY 10013, United States.
| | - Alice E Welch
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 125 Worth St. CN-6W, New York, NY 10013, United States
| | - Jiehui Li
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 125 Worth St. CN-6W, New York, NY 10013, United States
| | - Robert M Brackbill
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 125 Worth St. CN-6W, New York, NY 10013, United States
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24
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Jordan HT, Stein CR, Li J, Cone JE, Stayner L, Hadler JL, Brackbill RM, Farfel MR. Mortality among rescue and recovery workers and community members exposed to the September 11, 2001 World Trade Center terrorist attacks, 2003-2014. Environ Res 2018; 163:270-279. [PMID: 29477875 DOI: 10.1016/j.envres.2018.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 01/05/2018] [Accepted: 01/09/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Multiple chronic health conditions have been associated with exposure to the September 11, 2001 World Trade Center (WTC) terrorist attacks (9/11). We assessed whether excess deaths occurred during 2003-2014 among persons directly exposed to 9/11, and examined associations of 9/11-related exposures with mortality risk. MATERIALS AND METHODS Deaths occurring in 2003-2014 among members of the World Trade Center Health Registry, a cohort of rescue/recovery workers and lower Manhattan community members who were exposed to 9/11, were identified via linkage to the National Death Index. Participants' overall levels of 9/11-related exposure were categorized as high, intermediate, or low. We calculated standardized mortality ratios (SMR) using New York City reference rates from 2003 to 2012. Proportional hazards were used to assess associations of 9/11-related exposures with mortality, accounting for age, sex, race/ethnicity and other potential confounders. RESULTS We identified 877 deaths among 29,280 rescue/recovery workers (3.0%) and 1694 deaths among 39,643 community members (4.3%) during 308,340 and 416,448 person-years of observation, respectively. The SMR for all causes of death was 0.69 [95% confidence interval (CI) 0.65-0.74] for rescue/recovery workers and 0.86 (95% CI 0.82-0.90) for community members. SMRs for diseases of the cardiovascular and respiratory systems were significantly lower than expected in both groups. SMRs for several other causes of death were significantly elevated, including suicide among rescue recovery workers (SMR 1.82, 95% CI 1.35-2.39), and brain malignancies (SMR 2.25, 95% CI 1.48-3.28) and non-Hodgkin's lymphoma (SMR 1.79, 95% CI 1.24-2.50) among community members. Compared to low exposure, both intermediate [adjusted hazard ratio (AHR) 1.36, 95% CI 1.10-1.67] and high (AHR 1.41, 95% CI 1.06-1.88) levels of 9/11-related exposure were significantly associated with all-cause mortality among rescue/recovery workers (p-value for trend 0.01). For community members, intermediate (AHR 1.13, 95% CI 1.01-1.27), but not high (AHR 1.14, 95% CI 0.94-1.39) exposure was significantly associated with all-cause mortality (p-value for trend 0.03). AHRs for associations of overall 9/11-related exposure with heart disease- and cancer-related mortality were similar in magnitude to those for all-cause mortality, but with 95% CIs crossing the null value. CONCLUSIONS Overall mortality was not elevated. Among specific causes of death that were significantly elevated, suicide among rescue/recovery workers is a plausible long-term consequence of 9/11 exposure, and is potentially preventable. Elevated mortality due to other causes, including non-Hodgkin's lymphoma and brain cancer, and small but statistically significant associations of 9/11-related exposures with all-cause mortality hazard warrant additional surveillance.
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Affiliation(s)
- Hannah T Jordan
- New York City Department of Health and Mental Hygiene, 125 Worth Street, New York, NY 10013, United States
| | - Cheryl R Stein
- New York City Department of Health and Mental Hygiene, 125 Worth Street, New York, NY 10013, United States
| | - Jiehui Li
- New York City Department of Health and Mental Hygiene, 125 Worth Street, New York, NY 10013, United States.
| | - James E Cone
- New York City Department of Health and Mental Hygiene, 125 Worth Street, New York, NY 10013, United States
| | - Leslie Stayner
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois, 1603 W. Taylor Street, Chicago, Illinois 60612, United States
| | - James L Hadler
- New York City Department of Health and Mental Hygiene, 125 Worth Street, New York, NY 10013, United States
| | - Robert M Brackbill
- New York City Department of Health and Mental Hygiene, 125 Worth Street, New York, NY 10013, United States
| | - Mark R Farfel
- New York City Department of Health and Mental Hygiene, 125 Worth Street, New York, NY 10013, United States
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25
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Abstract
Background Understanding Pre-Existing Posttraumatic Stress Disorder (PTSD) symptoms and risk of PTSD following Hurricane Sandy (Sandy) has important implications for PTSD screening of persons exposed to multiple traumas. This study assessed the association between Sandy exposure and a subset of PTSD symptoms related to re-experiencing trauma from the events of the September 11, 2001 (9/11). Methods We studied 4,220 respondents from a random 8,870 person sample of adult World Trade Center Health Registry enrollees who completed a post-Sandy survey between March 28 and November 7, 2013. The symptom cluster of re-experiencing 9/11 was defined using 3 out of 5 questions in the intrusion domain of the PTSD Checklist. Multivariable logistic regression, adjusting for socio-demographics, social support and any post-9/11 life threatening events prior to Sandy, was performed separately in those symptomatic and non-symptomatic of re-experiencing 9/11 prior to Sandy. Results A total of 688 enrollees (16.3%) reported re-experiencing 9/11 symptoms after Sandy (58.8% in those symptomatic prior to Sandy, and 8.7% in those non-symptomatic). A significant association between Sandy exposure and re-experiencing 9/11 was observed only among those non symptomatic prior to Sandy (adjusted odds ratio (AOR)=1.7, 95% confidence interval=1.2-2.3 for moderate Sandy exposure; AOR=2.8, 2.0-4.0 for high Sandy exposure). Conclusions Individuals with a history of trauma should be considered for early screening and counseling for mental health after a subsequent traumatic event, regardless of PTSD status, especially in 9/11 exposed populations.
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Affiliation(s)
- Jiehui Li
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, USA
| | - Howard E Alper
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, USA
| | - Lisa M Gargano
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, USA
| | - Carey B Maslow
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, USA
| | - Robert M Brackbill
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, USA
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26
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Gargano LM, Dechen T, Cone JE, Stellman SD, Brackbill RM. Psychological Distress in Parents and School-Functioning of Adolescents: Results from the World Trade Center Registry. J Urban Health 2017; 94:597-605. [PMID: 28321793 PMCID: PMC5610121 DOI: 10.1007/s11524-017-0143-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Poor school-functioning can be indicative of parent and adolescent mental health and adolescent behavior problems. This study examined 472 adolescents enrolled in the World Trade Center (WTC) Health Registry, with a two-step path analysis, using regression-based models, to unravel the relationships between parent and adolescent mental health, adolescent behavior problems, and adolescent unmet healthcare need (UHCN) on the outcome school-functioning. WTC exposure was associated with UHCN and parental mental health was a significant mediator. There was no evidence that family WTC exposure was associated with UHCN independent of its effect on parental mental health. For the second path, after accounting for the effects of adolescent mental health, behavioral problems, and UHCN, there remained a significant association between parental mental health and school-functioning. Interventions for poor school-functioning should have multiple components which address UHCN, mental health, and behavioral problems, as efforts to address any of these alone may not be sufficient.
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Affiliation(s)
- Lisa M Gargano
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, 7th Floor, Long Island City, NY, 11101, USA.
| | - Tenzin Dechen
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, 7th Floor, Long Island City, NY, 11101, USA
| | - James E Cone
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, 7th Floor, Long Island City, NY, 11101, USA
| | - Steven D Stellman
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, 7th Floor, Long Island City, NY, 11101, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Robert M Brackbill
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, 7th Floor, Long Island City, NY, 11101, USA
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27
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Miller-Archie SA, Jordan HT, Alper H, Wisnivesky JP, Cone JE, Friedman SM, Brackbill RM. Hospitalizations for asthma among adults exposed to the September 11, 2001 World Trade Center terrorist attack. J Asthma 2017; 55:354-363. [PMID: 28586254 DOI: 10.1080/02770903.2017.1337787] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE We described the patterns of asthma hospitalization among persons exposed to the 2001 World Trade Center (WTC) attacks, and assessed whether 9/11-related exposures or comorbidities, including posttraumatic stress disorder (PTSD) and gastroesophageal reflux symptoms (GERS), were associated with an increased rate of hospitalization. METHODS Data for adult enrollees in the WTC Health Registry, a prospective cohort study, with self-reported physician-diagnosed asthma who resided in New York State on 9/11 were linked to administrative hospitalization data to identify asthma hospitalizations during September 11, 2001-December 31, 2010. Multivariable zero-inflated Poisson regression was used to examine associations among 9/11 exposures, comorbid conditions, and asthma hospitalizations. RESULTS Of 11 471 enrollees with asthma, 406 (3.5%) had ≥1 asthma hospitalization during the study period (721 total hospitalizations). Among enrollees diagnosed before 9/11 (n = 6319), those with PTSD or GERS had over twice the rate of hospitalization (adjusted rate ratio (ARR) = 2.5, 95% CI = 1.4-4.1; ARR = 2.1, 95% CI = 1.3-3.2, respectively) compared to those without. This association was not statistically significant in enrollees diagnosed after 9/11. Compared to higher educational attainment, completing less than college was associated with an increased hospitalization rate among participants with both pre-9/11- and post-9/11-onset asthma (ARR = 1.9, 95% CI = 1.2-2.9; ARR = 2.6, 95% CI = 1.6-4.1, respectively). Sinus symptoms, exposure to the dust cloud, and having been a WTC responder were not associated with asthma hospitalization. CONCLUSIONS Among enrollees with pre-9/11 asthma, comorbid PTSD and GERS were associated with an increase in asthma hospitalizations. Management of these comorbidities may be an important factor in preventing hospitalization.
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Affiliation(s)
- Sara A Miller-Archie
- a World Trade Center Health Registry , New York City Department of Health and Mental Hygiene , New York , NY , USA
| | - Hannah T Jordan
- a World Trade Center Health Registry , New York City Department of Health and Mental Hygiene , New York , NY , USA
| | - Howard Alper
- a World Trade Center Health Registry , New York City Department of Health and Mental Hygiene , New York , NY , USA
| | | | - James E Cone
- a World Trade Center Health Registry , New York City Department of Health and Mental Hygiene , New York , NY , USA
| | - Stephen M Friedman
- a World Trade Center Health Registry , New York City Department of Health and Mental Hygiene , New York , NY , USA
| | - Robert M Brackbill
- a World Trade Center Health Registry , New York City Department of Health and Mental Hygiene , New York , NY , USA
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28
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Alper HE, Yu S, Stellman SD, Brackbill RM. Injury, intense dust exposure, and chronic disease among survivors of the World Trade Center terrorist attacks of September 11, 2001. Inj Epidemiol 2017. [PMID: 28626847 PMCID: PMC5511809 DOI: 10.1186/s40621-017-0115-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The World Trade Center attack of September 11, 2001 in New York City (9/11) exposed thousands of people to intense concentrations of hazardous materials that have resulted in reports of increased levels of asthma, heart disease, diabetes, and other chronic diseases along with psychological illnesses such as post-traumatic stress disorder (PTSD). Few studies have discriminated between health consequences of immediate (short-term or acute) intense exposures versus chronic residential or workplace exposures. Methods We used proportional hazards methods to determine adjusted hazard ratios (AHRs) for associations between several components of acute exposures (e.g., injury, immersion in the dust cloud) and four chronic disease outcomes: asthma, other non-neoplastic lung diseases, cardiovascular disease, and diabetes, in 8701 persons free of those conditions prior to exposure and who were physically present during or immediately after the World Trade Center attacks. Participants were followed prospectively up to 11 years post-9/11. Results Heart disease exhibited a dose-response association with sustaining injury (1 injury type: AHR =2.0, 95% CI (Confidence Interval) 1.1–3.6; 2 injury types: AHR = 3.1, 95% CI 1.2–7.9; 3 or more injury types: AHR = 6.8, 95% CI 2.0–22.6), while asthma and other lung diseases were both significantly associated with dust cloud exposure (AHR = 1.3, 95% CI 1.0–1.6). Diabetes was not associated with any of the predictors assessed in this study. Conclusion In this study we demonstrated that the acute exposures of injury and dust cloud that were sustained on 9/11/2001 had significant associations with later heart and respiratory diseases. Continued monitoring of 9/11 exposed persons’ health by medical providers is warranted for the foreseeable future.
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Affiliation(s)
- Howard E Alper
- New York City Department of Health and Mental Hygiene, 125 Worth Street, New York, 10013, USA
| | - Shengchao Yu
- New York City Department of Health and Mental Hygiene, 125 Worth Street, New York, 10013, USA
| | - Steven D Stellman
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
| | - Robert M Brackbill
- New York City Department of Health and Mental Hygiene, 125 Worth Street, New York, 10013, USA.
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29
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Boffetta P, Zeig-Owens R, Wallenstein S, Li J, Brackbill RM, Cone J, Farfel M, Holden W, Lucchini R, Webber MP, Prezant D, Stellman SD, Hall CB. Response to Soskolne [2017]. Am J Ind Med 2017; 60:512. [PMID: 28409859 DOI: 10.1002/ajim.22713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Paolo Boffetta
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rachel Zeig-Owens
- New York City Fire Department, New York, New York.,Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | | | - Jiehui Li
- New York City Department of Health and Mental Hygiene, New York, New York
| | - Robert M Brackbill
- New York City Department of Health and Mental Hygiene, New York, New York
| | - James Cone
- New York City Department of Health and Mental Hygiene, New York, New York
| | - Mark Farfel
- New York City Department of Health and Mental Hygiene, New York, New York
| | - William Holden
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - David Prezant
- New York City Fire Department, New York, New York.,Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Steven D Stellman
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Charles B Hall
- New York City Fire Department, New York, New York.,Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
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30
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Yu S, Alper HE, Nguyen AM, Brackbill RM, Turner L, Walker DJ, Maslow CB, Zweig KC. The effectiveness of a monetary incentive offer on survey response rates and response completeness in a longitudinal study. BMC Med Res Methodol 2017; 17:77. [PMID: 28446131 PMCID: PMC5406995 DOI: 10.1186/s12874-017-0353-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/20/2017] [Indexed: 11/10/2022] Open
Abstract
Background Achieving adequate response rates is an ongoing challenge for longitudinal studies. The World Trade Center Health Registry is a longitudinal health study that periodically surveys a cohort of ~71,000 people exposed to the 9/11 terrorist attacks in New York City. Since Wave 1, the Registry has conducted three follow-up surveys (Waves 2–4) every 3–4 years and utilized various strategies to increase survey participation. A promised monetary incentive was offered for the first time to survey non-respondents in the recent Wave 4 survey, conducted 13–14 years after 9/11. Methods We evaluated the effectiveness of a monetary incentive in improving the response rate five months after survey launch, and assessed whether or not response completeness was compromised due to incentive use. The study compared the likelihood of returning a survey for those who received an incentive offer to those who did not, using logistic regression models. Among those who returned surveys, we also examined whether those receiving an incentive notification had higher rate of response completeness than those who did not, using negative binomial regression models and logistic regression models. Results We found that a $10 monetary incentive offer was effective in increasing Wave 4 response rates. Specifically, the $10 incentive offer was useful in encouraging initially reluctant participants to respond to the survey. The likelihood of returning a survey increased by 30% for those who received an incentive offer (AOR = 1.3, 95% CI: 1.1, 1.4), and the incentive increased the number of returned surveys by 18%. Moreover, our results did not reveal any significant differences on response completeness between those who received an incentive offer and those who did not. Conclusions In the face of the growing challenge of maintaining a high response rate for the World Trade Center Health Registry follow-up surveys, this study showed the value of offering a monetary incentive as an additional refusal conversion strategy. Our findings also suggest that an incentive offer could be particularly useful near the end of data collection period when an immediate boost in response rate is needed.
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Affiliation(s)
- Shengchao Yu
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 125 Worth Street, 10th Floor, New York City, NY, 10013, USA.
| | - Howard E Alper
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 125 Worth Street, 10th Floor, New York City, NY, 10013, USA
| | - Angela-Maithy Nguyen
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 125 Worth Street, 10th Floor, New York City, NY, 10013, USA
| | - Robert M Brackbill
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 125 Worth Street, 10th Floor, New York City, NY, 10013, USA
| | - Lennon Turner
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 125 Worth Street, 10th Floor, New York City, NY, 10013, USA
| | - Deborah J Walker
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 125 Worth Street, 10th Floor, New York City, NY, 10013, USA
| | - Carey B Maslow
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 125 Worth Street, 10th Floor, New York City, NY, 10013, USA
| | - Kimberly C Zweig
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 125 Worth Street, 10th Floor, New York City, NY, 10013, USA
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31
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Abstract
The objectives of this study were to ascertain behavioral outcomes 10-11 years after 9/11 in adolescents ages 11-18 years (0-8 years old at the time of 9/11) enrolled in the World Trade Center Health Registry (Registry), and relate these outcomes to their 9/11-exposures and to parent health. Behavioral difficulties among adolescents were assessed using the adolescent-reported Strengths and Difficulties Questionnaire (SDQ). Parental post-traumatic stress disorder (PTSD) was assessed using a 9/11-specific PTSD Checklist-Civilian Version, a cut-off score of 44 or greater was considered probable PTSD. Multivariable logistic regression was used to estimate associations of 9/11-exposure and parental health with abnormal/borderline SDQ scores, adjusting for demographic variables that were significantly associated with the SDQ score in bivariate analyses. Of the 449 adolescents, 12.5% (n=56) had abnormal/borderline SDQ scores. In the multivariable model, adolescents with severe/ moderate 9/11-exposures were 2.4 times more likely to have abnormal/borderline SDQ scores compared to adolescents with mild 9/11-exposures (95% Confidence Interval (CI): 1.1-6.4). Adolescents who had a parent with 9/11-related PTSD and at least one comorbid chronic condition were 4.2 times more likely to have abnormal/borderline SDQ scores compared to adolescents with a parent who had no reported chronic health conditions. Adolescents whose parent reported 14 or more poor mental health days in the preceding 30 days were 3.4 times more likely to have abnormal/borderline SDQ scores (95% CI: 1.2-9.5) The finding that parents' health appears to influence adolescent behavior problems 10-11 years following a disaster may have implications for healthcare practitioners and disaster response planners.
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Affiliation(s)
- Lisa M. Gargano
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 10013
| | - Sean Locke
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 10013
| | - Robert M. Brackbill
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 10013
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32
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Abstract
Introduction: A number of studies published by the World Trade Center Health Registry (Registry) document the prevalence of injuries sustained by victims of the World Trade Center Disaster (WTCD) on 9/11. Injury occurrence during or in the immediate aftermath of this event has been shown to be a risk factor for long-term adverse physical and mental health status. More recent reports of ongoing physical health and mental health problems and overall poor quality of life among survivors led us to undertake this qualitative study to explore the long-term impact of having both disaster-related injuries and peri-event traumatic exposure on quality of life in disaster survivors. Methods: Semi-structured, in-depth individual telephone interviews were conducted with 33 Registry enrollees who reported being injured on 9/11/01. Topics included: extent and circumstance of the injury(ies), description of medical treatment for injury, current health and functional status, and lifestyle changes resulting from the WTCD. The interviews were recorded, transcribed, and inductively open-coded for thematic analysis. Results: Six themes emerged with respect to long term recovery and quality of life: concurrent experience of injury with exposure to peri-event traumatic exposure (e.g., witnessing death or destruction, perceived life threat, etc.); sub-optimal quality and timeliness of short- and long-term medical care for the injury reported and mental health care; poor ongoing health status, functional limitations, and disabilities; adverse impact on lifestyle; lack of social support; and adverse economic impact. Many study participants, especially those reporting more serious injuries, also reported self-imposed social isolation, an inability to participate in or take enjoyment from previously enjoyable leisure and social activities and greatly diminished overall quality of life. Discussion: This study provided unique insight into the long-term impact of disasters on survivors. Long after physical injuries have healed, some injured disaster survivors report having serious health and mental health problems, economic problems due to loss of livelihood, limited sources of social support, and profound social isolation. Strategies for addressing the long-term health problems of disaster survivors are needed in order to support recovery.
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Affiliation(s)
- Lisa M Gargano
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Division of Epidemiology, Long Island City, New York, USA
| | - Robyn R Gershon
- Philip R. Lee Institute for Health Policy Studies and Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California, USA
| | - Robert M Brackbill
- New York City Department of Health, World Trade Center Health Registry, New York, New York, USA
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Gargano LM, Nguyen A, DiGrande L, Brackbill RM. Mental health status of World Trade Center tower survivors compared to other survivors a decade after the September 11, 2001 terrorist attacks. Am J Ind Med 2016; 59:742-51. [PMID: 27582476 DOI: 10.1002/ajim.22636] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Studies of individuals directly exposed to the World Trade Center (WTC) terrorist attacks of September 11, 2001 have found increased risk for post-traumatic stress disorder (PTSD) and binge drinking (BD). No long-term studies have been conducted on one highly exposed group, WTC tower evacuees. METHODS The study sample included 7,695 adult civilians in the WTC Health Registry. Logistic regression was used to examine the odds of PTSD and BD in 1,946 towers evacuees compared to 5,749 others in nearby buildings or on the street. RESULTS WTC tower survivors were at increased risk for PTSD and BD compared to the others. Infrastructure and behavioral barriers experienced during evacuation were significantly associated with PTSD. CONCLUSIONS WTC tower evacuees are at increased risk for PTSD and BD. Understanding the effects of disaster-related evacuation barriers on the long-term mental health status of survivors can help in the planning of continuing post-disaster treatment. Am. J. Ind. Med. 59:742-751, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Lisa M. Gargano
- Division of Epidemiology; New York City Department of Health and Mental Hygiene; World Trade Center Health Registry; Queens New York
| | - Angela Nguyen
- Division of Epidemiology; New York City Department of Health and Mental Hygiene; World Trade Center Health Registry; Queens New York
| | - Laura DiGrande
- Department of Sociology and Anthropology; Farmingdale State College; State University of New York; Farmingdale New York
| | - Robert M. Brackbill
- Division of Epidemiology; New York City Department of Health and Mental Hygiene; World Trade Center Health Registry; Queens New York
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Yu S, Brackbill RM, Locke S, Stellman SD, Gargano LM. Impact of 9/11-related chronic conditions and PTSD comorbidity on early retirement and job loss among World Trade Center disaster rescue and recovery workers. Am J Ind Med 2016; 59:731-41. [PMID: 27582475 DOI: 10.1002/ajim.22640] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND The economic impact of the 9/11 terrorist attacks has rarely been studied. We examined the association between 9/11-related chronic health conditions with or without post-traumatic stress disorder (PTSD) and one important aspect of the economic impact, retirement, and job loss before age 60. METHODS A total of 7,662 workers who participated in the World Trade Center Health Registry surveys were studied. Logistic regression models examined the association of 9/11-related health and labor force exit. RESULTS Workers with chronic conditions were more likely to experience early retirement and job loss, and the association was stronger in the presence of PTSD comorbidity: the odds ratios for reporting early retirement or job loss were increased considerably when chronic conditions were comorbid with PTSD. CONCLUSIONS Disaster-related health burden directly impacts premature labor force exit and income. Future evaluation of disaster outcome should include its long-term impact on labor force. Am. J. Ind. Med. 59:731-741, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Shengchao Yu
- New York City Department of Health and Mental Hygiene; Long Island City New York
| | - Robert M. Brackbill
- New York City Department of Health and Mental Hygiene; Long Island City New York
| | - Sean Locke
- New York City Department of Health and Mental Hygiene; Long Island City New York
| | - Steven D. Stellman
- Department of Epidemiology; Mailman School of Public Health; Columbia University; New York New York
| | - Lisa M. Gargano
- New York City Department of Health and Mental Hygiene; Long Island City New York
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Li J, Brackbill RM, Liao TS, Qiao B, Cone JE, Farfel MR, Hadler JL, Kahn AR, Konty KJ, Stayner LT, Stellman SD. Ten-year cancer incidence in rescue/recovery workers and civilians exposed to the September 11, 2001 terrorist attacks on the World Trade Center. Am J Ind Med 2016; 59:709-21. [PMID: 27582473 DOI: 10.1002/ajim.22638] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cancer incidence in exposed rescue/recovery workers (RRWs) and civilians (non-RRWs) was previously reported through 2008. METHODS We studied occurrence of first primary cancer among World Trade Center Health Registry enrollees through 2011 using adjusted standardized incidence ratios (SIRs), and the WTC-exposure-cancer association, using Cox proportional hazards models. RESULTS All-cancer SIR was 1.11 (95% confidence interval (CI) 1.03-1.20) in RRWs, and 1.08 (95% CI 1.02-1.15) in non-RRWs. Prostate cancer and skin melanoma were significantly elevated in both populations. Thyroid cancer was significantly elevated only in RRWs while breast cancer and non-Hodgkin's lymphoma were significantly elevated only in non-RRWs. There was a significant exposure dose-response for bladder cancer among RRWs, and for skin melanoma among non-RRWs. CONCLUSIONS We observed excesses of total and specific cancers in both populations, although the strength of the evidence for causal relationships to WTC exposures is somewhat limited. Continued monitoring of this population is indicated. Am. J. Ind. Med. 59:709-721, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jiehui Li
- World Trade Center Health Registry; New York City Department of Health and Mental Hygiene; Long Island City New York
| | - Robert M. Brackbill
- World Trade Center Health Registry; New York City Department of Health and Mental Hygiene; Long Island City New York
| | - Tim S. Liao
- World Trade Center Health Registry; New York City Department of Health and Mental Hygiene; Long Island City New York
| | - Baozhen Qiao
- Bureau of Cancer Epidemiology; New York State Department of Health; Albany New York
| | - James E. Cone
- World Trade Center Health Registry; New York City Department of Health and Mental Hygiene; Long Island City New York
| | - Mark R. Farfel
- World Trade Center Health Registry; New York City Department of Health and Mental Hygiene; Long Island City New York
| | - James L. Hadler
- World Trade Center Health Registry; New York City Department of Health and Mental Hygiene; Long Island City New York
| | - Amy R. Kahn
- Bureau of Cancer Epidemiology; New York State Department of Health; Albany New York
| | - Kevin J. Konty
- World Trade Center Health Registry; New York City Department of Health and Mental Hygiene; Long Island City New York
| | - Leslie T. Stayner
- Division of Epidemiology and Biostatistics; University of Illinois; Chicago Illinois
| | - Steven D. Stellman
- World Trade Center Health Registry; New York City Department of Health and Mental Hygiene; Long Island City New York
- Department of Epidemiology; Mailman School of Public Health; Columbia University; New York New York
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Li J, Brackbill RM, Jordan HT, Cone JE, Farfel MR, Stellman SD. Effect of asthma and PTSD on persistence and onset of gastroesophageal reflux symptoms among adults exposed to the September 11, 2001, terrorist attacks. Am J Ind Med 2016; 59:805-14. [PMID: 27582483 DOI: 10.1002/ajim.22644] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Little is known about the direction of causality among asthma, posttraumatic stress disorder (PTSD), and onset of gastroesophageal reflux symptoms (GERS) after exposure to the 9/11/2001 World Trade Center (WTC) disaster. METHODS Using data from the WTC Health Registry, we investigated the effects of early diagnosed post-9/11 asthma and PTSD on the late onset and persistence of GERS using log-binomial regression, and examined whether PTSD mediated the asthma-GERS association using structural equation modeling. RESULTS Of 29,406 enrollees, 23% reported GERS at follow-up in 2011-2012. Early post-9/11 asthma and PTSD were each independently associated with both the persistence of GERS that was present at baseline and the development of GERS in persons without a prior history. PTSD mediated the association between early post-9/11 asthma and late-onset GERS. CONCLUSIONS Clinicians should assess patients with post-9/11 GERS for comorbid asthma and PTSD, and plan medical care for these conditions in an integrated fashion. Am. J. Ind. Med. 59:805-814, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jiehui Li
- New York City Department of Health and Mental Hygiene; New York New York
| | | | - Hannah T. Jordan
- New York City Department of Health and Mental Hygiene; New York New York
| | - James E. Cone
- New York City Department of Health and Mental Hygiene; New York New York
| | - Mark R. Farfel
- New York City Department of Health and Mental Hygiene; New York New York
| | - Steven D. Stellman
- New York City Department of Health and Mental Hygiene; New York New York
- Department of Epidemiology; Mailman School of Public Health; Columbia University; New York New York
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Maslow CB, Caramanica K, Li J, Stellman SD, Brackbill RM. Reproductive Outcomes Following Maternal Exposure to the Events of September 11, 2001, at the World Trade Center, in New York City. Am J Public Health 2016; 106:1796-803. [PMID: 27552273 DOI: 10.2105/ajph.2016.303303] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To estimate associations between exposure to the events of September 11, 2001, (9/11) and low birth weight (LBW), preterm delivery (PD), and small size for gestational age (SGA). METHODS We matched birth certificates filed in New York City for singleton births between 9/11 and the end of 2010 to 9/11-related exposure data provided by mothers who were World Trade Center Health Registry enrollees. Generalized estimating equations estimated associations between exposures and LBW, PD, and SGA. RESULTS Among 3360 births, 5.8% were LBW, 6.5% were PD, and 9% were SGA. Having incurred at least 2 of 4 exposures, having performed rescue or recovery work, and probable 9/11-related posttraumatic stress disorder 2 to 3 years after 9/11 were associated with PD and LBW during the early study period. CONCLUSIONS Disasters on the magnitude of 9/11 may exert effects on reproductive outcomes for several years. Women who are pregnant during and after a disaster should be closely monitored for physical and psychological sequelae. PUBLIC HEALTH IMPLICATIONS In utero and maternal disaster exposure may affect birth outcomes. Researchers studying effects of individual disasters should identify commonalities that may inform postdisaster responses to minimize disaster-related adverse birth outcomes.
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Affiliation(s)
- Carey B Maslow
- Carey B. Maslow, Kimberly Caramanica, Jiehui Li, Steven D. Stellman, and Robert M. Brackbill are with the World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY. Steven D. Stellman is also with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Kimberly Caramanica
- Carey B. Maslow, Kimberly Caramanica, Jiehui Li, Steven D. Stellman, and Robert M. Brackbill are with the World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY. Steven D. Stellman is also with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Jiehui Li
- Carey B. Maslow, Kimberly Caramanica, Jiehui Li, Steven D. Stellman, and Robert M. Brackbill are with the World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY. Steven D. Stellman is also with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Steven D Stellman
- Carey B. Maslow, Kimberly Caramanica, Jiehui Li, Steven D. Stellman, and Robert M. Brackbill are with the World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY. Steven D. Stellman is also with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Robert M Brackbill
- Carey B. Maslow, Kimberly Caramanica, Jiehui Li, Steven D. Stellman, and Robert M. Brackbill are with the World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY. Steven D. Stellman is also with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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Friedman SM, Farfel MR, Maslow C, Jordan HT, Li J, Alper H, Cone JE, Stellman SD, Brackbill RM. Risk factors for and consequences of persistent lower respiratory symptoms among World Trade Center Health Registrants 10 years after the disaster. Occup Environ Med 2016; 73:676-84. [PMID: 27449135 DOI: 10.1136/oemed-2015-103512] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 06/19/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The prevalence of persistent lower respiratory symptoms (LRS) among rescue/recovery workers, local area workers, residents and passers-by in the World Trade Center Health Registry (WTCHR) was analysed to identify associated factors and to measure its effect on quality of life (QoL) 10 years after 9/11/2001. METHODS This cross-sectional study included 18 913 adults who completed 3 WTCHR surveys (2003-2004 (Wave 1 (W1)), 2006-2007 (Wave 2 (W2)) and 2011-2012 (Wave 3 (W3)). LRS were defined as self-reported cough, wheeze, dyspnoea or inhaler use in the 30 days before survey. The prevalence of three LRS outcomes: LRS at W1; LRS at W1 and W2; and LRS at W1, W2 and W3 (persistent LRS) was compared with no LRS on WTC exposure and probable mental health conditions determined by standard screening tests. Diminished physical and mental health QoL measures were examined as potential LRS outcomes, using multivariable logistic and Poisson regression. RESULTS Of the 4 outcomes, persistent LRS was reported by 14.7%. Adjusted ORs for disaster exposure, probable post-traumatic stress disorder (PTSD) at W2, lacking college education and obesity were incrementally higher moving from LRS at W1, LRS at W1 and W2 to persistent LRS. Half of those with persistent LRS were comorbid for probable PTSD, depression or generalised anxiety disorder. Enrollees with persistent LRS were 3 times more likely to report poor physical health and ∼ 50% more likely to report poor mental health than the no LRS group. CONCLUSIONS LRS, accompanied by mental health conditions and decreased QoL, have persisted for at least 10 years after 9/11/2001. Affected adults require continuing surveillance and treatment.
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Affiliation(s)
- Stephen M Friedman
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Mark R Farfel
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Carey Maslow
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Hannah T Jordan
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Jiehui Li
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Howard Alper
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - James E Cone
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Steven D Stellman
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Robert M Brackbill
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
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Welch AE, Caramanica K, Maslow CB, Brackbill RM, Stellman SD, Farfel MR. Trajectories of PTSD Among Lower Manhattan Residents and Area Workers Following the 2001 World Trade Center Disaster, 2003-2012. J Trauma Stress 2016; 29:158-66. [PMID: 26954702 DOI: 10.1002/jts.22090] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 02/01/2016] [Accepted: 02/04/2016] [Indexed: 11/06/2022]
Abstract
Group-based trajectory modeling was used to explore empirical trajectories of symptoms of posttraumatic stress disorder (PTSD) among 17,062 adult area residents/workers (nonrescue/recovery workers) enrolled in the World Trade Center (WTC) Health Registry using 3 administrations of the PTSD Checklist (PCL) over 9 years of observation. Six trajectories described PTSD over time: low-stable (48.9%), moderate-stable (28.3%), moderate-increasing (8.2%), high-stable (6.0%), high-decreasing (6.6 %), and very high-stable (2.0%). To examine factors associated with improving or worsening PTSD symptoms, groups with similar intercepts, but different trajectories were compared using bivariate analyses and logistic regression. The adjusted odds of being in the moderate-increasing relative to the moderate-stable group were significantly greater among enrollees reporting low social integration (OR = 2.18), WTC exposures (range = 1.34 to 1.53), job loss related to the September 11, 2001 disaster (OR = 1.41), or unmet mental health need/treatment (OR = 4.37). The odds of being in the high-stable relative to the high-decreasing group were significantly greater among enrollees reporting low social integration (OR = 2.23), WTC exposures (range = 1.39 to 1.45), or unmet mental health need/treatment (OR = 3.42). The influence of severe exposures, scarce personal/financial resources, and treatment barriers on PTSD trajectories suggest a need for early and ongoing PTSD screening postdisaster.
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Affiliation(s)
- Alice E Welch
- New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Kimberly Caramanica
- New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Carey B Maslow
- New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Robert M Brackbill
- New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Steven D Stellman
- New York City Department of Health and Mental Hygiene, Queens, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Mark R Farfel
- New York City Department of Health and Mental Hygiene, Queens, New York, USA
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Maslow CB, Caramanica K, Welch AE, Stellman SD, Brackbill RM, Farfel MR. Trajectories of Scores on a Screening Instrument for PTSD Among World Trade Center Rescue, Recovery, and Clean-Up Workers. J Trauma Stress 2015; 28:198-205. [PMID: 25990986 DOI: 10.1002/jts.22011] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The longitudinal course of posttraumatic stress disorder (PTSD) over 8-9 years was examined among 16,488 rescue and recovery workers who responded to the events of September 11, 2001 (9/11) at the World Trade Center (WTC; New York, NY), and were enrolled in the World Trade Center Health Registry. Latent class growth analysis identified 5 groups of rescue and recovery workers with similar score trajectories at 3 administrations of the PTSD Checklist (PCL): low-stable (53.3%), moderate- stable (28.7%), moderate-increasing (6.4%), high-decreasing (7.7%), and high-stable (4.0%). Relative to the low-stable group, membership in higher risk groups was associated with 9/11-related exposures including duration of WTC work, with adjusted odds ratios ranging from 1.3 to 2.0, witnessing of horrific events (range = 1.3 to 2.1), being injured (range = 1.4 to 2.3), perceiving threat to life or safety (range = 2.2 to 5.2), bereavement (range = 1.6 to 4.8), and job loss due to 9/11 (range = 2.4 to 15.8). Within groups, higher PCL scores were associated with adverse social circumstances including lower social support, with B coefficients ranging from 0.2 to 0.6, divorce, separation, or widowhood (range = 0.4-0.7), and unemployment (range = 0.4-0.5). Given baseline, exposure-related, and contextual influences that affect divergent PTSD trajectories, screening for both PTSD and adverse circumstances should occur immediately, and at regular intervals postdisaster.
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Affiliation(s)
- Carey B Maslow
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Kimberly Caramanica
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Alice E Welch
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Steven D Stellman
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Robert M Brackbill
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Mark R Farfel
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
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Jordan HT, Stellman SD, Reibman J, Farfel MR, Brackbill RM, Friedman SM, Li J, Cone JE. Factors associated with poor control of 9/11-related asthma 10-11 years after the 2001 World Trade Center terrorist attacks. J Asthma 2015; 52:630-7. [PMID: 25539137 PMCID: PMC4776729 DOI: 10.3109/02770903.2014.999083] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objective: To identify key factors associated with poor asthma control among adults in the World Trade Center (WTC) Health Registry, a longitudinal study of rescue/recovery workers and community members who were directly exposed to the 2001 WTC terrorist attacks and their aftermath. Methods: We studied incident asthma diagnosed by a physician from 12 September 2001 through 31 December 2003 among participants aged ≥18 on 11 September 2001, as reported on an enrollment (2003–2004) or follow-up questionnaire. Based on modified National Asthma Education and Prevention Program criteria, asthma was considered controlled, poorly-controlled, or very poorly-controlled at the time of a 2011–2012 follow-up questionnaire. Probable post-traumatic stress disorder, depression, and generalized anxiety disorder were defined using validated scales. Self-reported gastroesophageal reflux symptoms (GERS) and obstructive sleep apnea (OSA) were obtained from questionnaire responses. Multinomial logistic regression was used to examine factors associated with poor or very poor asthma control. Results: Among 2445 participants, 33.7% had poorly-controlled symptoms and 34.6% had very poorly-controlled symptoms in 2011–2012. Accounting for factors including age, education, body mass index, and smoking, there was a dose–response relationship between the number of mental health conditions and poorer asthma control. Participants with three mental health conditions had five times the odds of poor control and 13 times the odds of very poor control compared to participants without mental health comorbidities. GERS and OSA were significantly associated with poor or very poor control. Conclusions: Rates of poor asthma control were very high in this group with post-9/11 diagnosed asthma. Comprehensive care of 9/11-related asthma should include management of mental and physical health comorbidities.
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Affiliation(s)
- Hannah T Jordan
- a World Trade Center Health Registry , New York City Department of Health and Mental Hygiene , Queens , NY , USA
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Caramanica K, Brackbill RM, Stellman SD, Farfel MR. Posttraumatic Stress Disorder after Hurricane Sandy among Persons Exposed to the 9/11 Disaster. Int J Emerg Ment Health 2015; 17:356-362. [PMID: 25960693 PMCID: PMC4424196 DOI: 10.4172/1522-4821.1000173] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Traumatic exposure during a hurricane is associated with adverse mental health conditions post-event. The World Trade Center Health Registry provided a sampling pool for a rapid survey of persons directly affected by Hurricane Sandy in the New York City (NYC) metropolitan area in late October 2012. This study evaluated the relationship between Sandy experiences and Sandy-related posttraumatic stress disorder (PTSD) among individuals previously exposed to the September 11, 2001 (9/11) disaster. METHODS A total of 4,558 surveys were completed from April 10-November 7, 2013. After exclusions for missing data, the final sample included 2,214 (53.5%) respondents from FEMA-defined inundation zones and 1,923 (46.5%) from non-inundation zones. Sandy exposures included witnessing terrible events, Sandy-related injury, fearing for own life or safety of others, evacuation, living in a home that was flooded or damaged, property loss, and financial loss. Sandy-related PTSD was defined as a score of ≥44 on a Sandy-specific PTSD Checklist. RESULTS PTSD prevalence was higher in the inundation zones (11.3%) and lower in the non-inundation zones (4.4%). The highest prevalence of Sandy-related PTSD was among individuals in the inundation zone who sustained an injury (31.2%), reported a history of 9/11-related PTSD (28.8%), or had low social support prior to the event (28.6%). In the inundation zones, significantly elevated adjusted odds of Sandy-related PTSD were observed among persons with a prior history of 9/11-related PTSD, low social support, and those who experienced a greater number of Sandy traumatic events. CONCLUSIONS Sandy-related stress symptoms indicative of PTSD affected a significant proportion of persons who lived in flooded areas of the NYC metropolitan area. Prior 9/11-related PTSD increased the likelihood of Sandy-related PTSD, while social support was protective. Public health preparation for events similar to Sandy should incorporate outreach and linkages to care for persons with prior disaster-related trauma.
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Affiliation(s)
| | | | - Steven D Stellman
- New York City Department of Health and Mental Hygiene, USA ; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Mark R Farfel
- New York City Department of Health and Mental Hygiene, USA
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Yu S, Brackbill RM, Stellman SD, Ghuman S, Farfel MR. Evaluation of non-response bias in a cohort study of World Trade Center terrorist attack survivors. BMC Res Notes 2015; 8:42. [PMID: 25889176 PMCID: PMC4409729 DOI: 10.1186/s13104-015-0994-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 01/23/2015] [Indexed: 11/10/2022] Open
Abstract
Background Few longitudinal studies of disaster cohorts have assessed both non-response bias in prevalence estimates of health outcomes and in the estimates of associations between health outcomes and disaster exposures. We examined the factors associated with non-response and the possible non-response bias in prevalence estimates and association estimates in a longitudinal study of World Trade Center (WTC) terrorist attack survivors. Methods In 2003–04, 71,434 enrollees completed the WTC Health Registry wave 1 health survey. This study is limited to 67,670 adults who were eligible for both wave 2 and wave 3 surveys in 2006–07 and 2011–12. We first compared the characteristics between wave 3 participants (wave 3 drop-ins and three-wave participants) and non-participants (wave 3 drop-outs and wave 1 only participants). We then examined potential non-response bias in prevalence estimates and in exposure-outcome association estimates by comparing one-time non-participants (wave 3 drop-ins and drop-outs) at the two follow-up surveys with three-wave participants. Results Compared to wave 3 participants, non-participants were younger, more likely to be male, non-White, non-self enrolled, non-rescue or recovery worker, have lower household income, and less than post-graduate education. Enrollees’ wave 1 health status had little association with their wave 3 participation. None of the disaster exposure measures measured at wave 1 was associated with wave 3 non-participation. Wave 3 drop-outs and drop-ins (those who participated in only one of the two follow-up surveys) reported somewhat poorer health outcomes than the three-wave participants. For example, compared to three-wave participants, wave 3 drop-outs had a 1.4 times higher odds of reporting poor or fair health at wave 2 (95% CI 1.3-1.4). However, the associations between disaster exposures and health outcomes were not different significantly among wave 3 drop-outs/drop-ins as compared to three-wave participants. Conclusion Our results show that, despite a downward bias in prevalence estimates of health outcomes, attrition from the WTC Health Registry follow-up studies does not lead to serious bias in associations between 9/11 disaster exposures and key health outcomes. These findings provide insight into the impact of non-response on associations between disaster exposures and health outcomes reported in longitudinal studies.
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Affiliation(s)
- Shengchao Yu
- New York City Department of Health and Mental Hygiene, Long Island City, NY, USA.
| | - Robert M Brackbill
- New York City Department of Health and Mental Hygiene, Long Island City, NY, USA.
| | - Steven D Stellman
- New York City Department of Health and Mental Hygiene, Long Island City, NY, USA. .,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Sharon Ghuman
- New York City Department of Health and Mental Hygiene, Long Island City, NY, USA.
| | - Mark R Farfel
- New York City Department of Health and Mental Hygiene, Long Island City, NY, USA.
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Caramanica K, Brackbill RM, Liao T, Stellman SD. Comorbidity of 9/11-related PTSD and depression in the World Trade Center Health Registry 10-11 years postdisaster. J Trauma Stress 2014; 27:680-8. [PMID: 25470556 DOI: 10.1002/jts.21972] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Many studies report elevated prevalence of posttraumatic stress disorder (PTSD) and depression among persons exposed to the September 11, 2001 (9/11) disaster compared to those unexposed; few have evaluated long-term PTSD with comorbid depression. We examined prevalence and risk factors for probable PTSD, probable depression, and both conditions 10-11 years post-9/11 among 29,486 World Trade Center Health Registry enrollees who completed surveys at Wave 1 (2003-2004), Wave 2 (2006-2007), and Wave 3 (2011-2012). Enrollees reporting physician diagnosed pre-9/11 PTSD or depression were excluded. PTSD was defined as scoring ≥ 44 on the PTSD Checklist and depression as scoring ≥ 10 on the 8-item Patient Health Questionnaire. We examined 4 groups: comorbid PTSD and depression, PTSD only, depression only, and neither. Among enrollees, 15.2% reported symptoms indicative of PTSD at Wave 3, 14.9% of depression, and 10.1% of both. Comorbid PTSD and depression was associated with high 9/11 exposures, low social integration, health-related unemployment, and experiencing ≥ 1 traumatic life event post-9/11. Comorbid persons experienced poorer outcomes on all PTSD-related impairment measures, life satisfaction, overall health, and unmet mental health care need compared to those with only a single condition. These findings highlight the importance of ongoing screening and treatment for both conditions, particularly among those at risk for mental health comorbidity.
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Affiliation(s)
- Kimberly Caramanica
- New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
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Brackbill RM, Caramanica K, Maliniak M, Stellman SD, Fairclough MA, Farfel MR, Turner L, Maslow CB, Moy AJ, Wu D, Yu S, Welch AE, Cone JE, Walker DJ. Nonfatal injuries 1 week after hurricane sandy--New York city metropolitan area, October 2012. MMWR Morb Mortal Wkly Rep 2014; 63:950-4. [PMID: 25340912 PMCID: PMC5779470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
On October 29, 2012, Hurricane Sandy (Sandy) made landfall in densely populated areas of New York, New Jersey, and Connecticut. Flooding affected 51 square miles (132 square kilometers) of New York City (NYC) and resulted in 43 deaths, many caused by drowning in the home, along with numerous storm-related injuries. Thousands of those affected were survivors of the World Trade Center (WTC) disaster of September 11, 2001 (9/11) who had previously enrolled in the WTC Health Registry (Registry) cohort study. To assess Sandy-related injuries and associated risk factors among those who lived in Hurricane Sandy-flooded areas and elsewhere, the NYC Department of Health and Mental Hygiene surveyed 8,870 WTC survivors, who had provided physical and mental health updates 8 to 16 months before Sandy. Approximately 10% of the respondents in flooded areas reported injuries in the first week after Sandy; nearly 75% of those had more than one injury. Injuries occurred during evacuation and clean-up/repair of damaged or destroyed homes. Hurricane preparation and precautionary messages emphasizing potential for injury hazards during both evacuation and clean-up or repair of damaged residences might help mitigate the occurrence and severity of injury after a hurricane.
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Affiliation(s)
- Robert M. Brackbill
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York,Corresponding author: Robert Brackbill, , 347-396-2882
| | - Kimberly Caramanica
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York
| | - Maret Maliniak
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York,School of Public Health, Emory University, Atlanta, Georgia
| | - Steven D. Stellman
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Monique A. Fairclough
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York
| | - Mark R. Farfel
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York
| | - Lennon Turner
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York
| | - Carey B. Maslow
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York
| | - Amanda J. Moy
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York
| | - David Wu
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York
| | - Shengchao Yu
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York
| | - Alice E. Welch
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York
| | - James E. Cone
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York
| | - Deborah J. Walker
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York
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Miller-Archie SA, Jordan HT, Ruff RR, Chamany S, Cone JE, Brackbill RM, Kong J, Ortega F, Stellman SD. Posttraumatic stress disorder and new-onset diabetes among adult survivors of the World Trade Center disaster. Prev Med 2014; 66:34-8. [PMID: 24879890 DOI: 10.1016/j.ypmed.2014.05.016] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 05/12/2014] [Accepted: 05/19/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore the temporal relationship between 9/11-related posttraumatic stress disorder (PTSD) and new-onset diabetes in World Trade Center (WTC) survivors up to 11 years after the attack in 2001. METHODS Three waves of surveys (conducted from 2003 to 2012) from the WTC Health Registry cohort collected data on physical and mental health status, sociodemographic characteristics, and 9/11-related exposures. Diabetes was defined as self-reported, physician-diagnosed diabetes reported after enrollment. After excluding prevalent cases, there were 36,899 eligible adult enrollees. Logistic regression and generalized multilevel growth models were used to assess the association between PTSD measured at enrollment and subsequent diabetes. RESULTS We identified 2143 cases of diabetes. After adjustment, we observed a significant association between PTSD and diabetes in the logistic model [adjusted odds ratio (AOR) 1.28, 95% confidence interval (CI) 1.14-1.44]. Results from the growth model were similar (AOR 1.37, 95% CI 1.23-1.52). CONCLUSION This exploratory study found that PTSD, a common 9/11-related health outcome, was a risk factor for self-reported diabetes. Clinicians treating survivors of both the WTC attacks and other disasters should be aware that diabetes may be a long-term consequence.
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Affiliation(s)
- Sara A Miller-Archie
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA.
| | - Hannah T Jordan
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA
| | - Ryan R Ruff
- Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA
| | - Shadi Chamany
- Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA
| | - James E Cone
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA
| | - Robert M Brackbill
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA
| | - Joanne Kong
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA
| | - Felix Ortega
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA
| | - Steven D Stellman
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA
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Ghuman SJ, Brackbill RM, Stellman SD, Farfel MR, Cone JE. Unmet mental health care need 10-11 years after the 9/11 terrorist attacks: 2011-2012 results from the World Trade Center Health Registry. BMC Public Health 2014; 14:491. [PMID: 24885506 PMCID: PMC4053282 DOI: 10.1186/1471-2458-14-491] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 04/29/2014] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND There is little current information about the unmet mental health care need (UMHCN) and reasons for it among those exposed to the World Trade Center (WTC) terrorist attacks. The purpose of this study was to assess the level of UMHCN among symptomatic individuals enrolled in the WTC Health Registry (WTCHR) in 2011-2012, and to analyze the relationship between UMHCN due to attitudinal, cost, and access factors and mental health symptom severity, mental health care utilization, health insurance availability, and social support. METHODS The WTCHR is a prospective cohort study of individuals with reported exposure to the 2001 WTC attacks. This study used data from 9,803 adults who completed the 2003-2004 (Wave 1) and 2011-2012 (Wave 3) surveys and had posttraumatic stress disorder (PTSD) or depression in 2011-2012. We estimated logistic regression models relating perceived attitudinal, cost and access barriers to symptom severity, health care utilization, a lack of health insurance, and social support after adjusting for sociodemographic characteristics. RESULTS Slightly more than one-third (34.2%) of study participants reported an UMHCN. Symptom severity was a strong predictor of UMHCN due to attitudinal and perceived cost and access reasons. Attitudinal UMHCN was common among those not using mental health services, particularly those with relatively severe mental health symptoms. Cost-related UMHCN was significantly associated with a lack of health insurance but not service usage. Access-related barriers were significantly more common among those who did not use any mental health services. A higher level of social support served as an important buffer against cost and access UMHCN. CONCLUSIONS A significant proportion of individuals exposed to the WTC attacks with depression or PTSD 10 years later reported an UMHCN, and individuals with more severe and disabling conditions, those who lacked health insurance, and those with low levels of social support were particularly vulnerable.
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Affiliation(s)
- Sharon J Ghuman
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA.
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Brackbill RM, Cone JE, Farfel MR, Stellman SD. Chronic physical health consequences of being injured during the terrorist attacks on World Trade Center on September 11, 2001. Am J Epidemiol 2014; 179:1076-85. [PMID: 24561992 DOI: 10.1093/aje/kwu022] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Few studies have focused on injuries from the World Trade Center disaster on September 11, 2001. Severe injury has health consequences, including an increased mortality risk 10 years after injury and the risk of mental health problems, such as posttraumatic stress disorder (PTSD). The World Trade Center Health Registry identified 14,087 persons with none of a selected group of preexisting chronic conditions before 2002 who were present during and soon after the World Trade Center attacks, 1,980 of whom reported sustaining 1 or more types of injury (e.g., a broken bone or burn). Survey data obtained during 2003-2004 and 2006-2007 were used to assess the odds of reporting a diagnosis of chronic conditions (heart disease, respiratory disease, diabetes, cancer) up to 5-6 years after the attacks. Number of injury types and probable PTSD were significantly associated with having any chronic conditions diagnosed in 2002-2007. Persons with multiple injuries and PTSD had a 3-fold higher risk of heart disease than did those with no injury and no PTSD, and persons with multiple injuries and with no PTSD had a 2-fold higher risk of respiratory diseases. The present study shows that injured persons with or without comorbid PTSD have a higher risk of developing chronic diseases. Clinicians should be aware of the heightened risk of chronic heart and respiratory conditions among injured persons.
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Friedman SM, Farfel MR, Maslow CB, Cone JE, Brackbill RM, Stellman SD. Comorbid persistent lower respiratory symptoms and posttraumatic stress disorder 5-6 years post-9/11 in responders enrolled in the World Trade Center Health Registry. Am J Ind Med 2013; 56:1251-61. [PMID: 23794365 DOI: 10.1002/ajim.22217] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Co-occurrence of lower respiratory symptoms (LRS) and posttraumatic stress disorder (PTSD) has been increasingly recognized among responders and survivors of the World Trade Center (WTC) disaster. Information is limited on the degree which comorbidity intensifies symptoms and compromises quality of life across exposed groups. METHODS Among responders who completed the first and second Registry surveys, measures of respiratory illness, psychological distress, and diminished quality of life were compared between responders comorbid for LRS and PTSD and responders with only LRS or PTSD. RESULTS Of 14,388 responders, 40% of those with LRS and 57% of those with PTSD were comorbid. When demographic and WTC exposure-related factors were controlled, comorbid responders compared to those with LRS alone were twice as likely to have frequent dyspnea and to have sought care for dyspnea. Compared to responders with PTSD alone, comorbid responders were 2.1 times more likely to report intense re-experiencing of the disaster, 2.5 times more likely to express feelings of significant non-specific psychological distress, and 1.4 times more likely to have received mental health care. Comorbid responders were approximately three times more likely to report only fair or poor general health and more than twice as likely to report being unable to perform usual activities for ≥14 of 30 days before interview. CONCLUSIONS Outcomes in comorbid responders were similar to or more severe than in comorbid survivors. Health care and disaster relief providers must suspect comorbid illness when evaluating responders' respiratory or mental illnesses and consider treatment for both.
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Affiliation(s)
- Stephen M. Friedman
- Division of Epidemiology, New York City Department of Health and Mental Hygiene; World Trade Center Health Registry; Long Island City; New York
| | - Mark R. Farfel
- Division of Epidemiology, New York City Department of Health and Mental Hygiene; World Trade Center Health Registry; Long Island City; New York
| | - Carey B. Maslow
- Division of Epidemiology, New York City Department of Health and Mental Hygiene; World Trade Center Health Registry; Long Island City; New York
| | - James E. Cone
- Division of Epidemiology, New York City Department of Health and Mental Hygiene; World Trade Center Health Registry; Long Island City; New York
| | - Robert M. Brackbill
- Division of Epidemiology, New York City Department of Health and Mental Hygiene; World Trade Center Health Registry; Long Island City; New York
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Jordan HT, Stellman SD, Morabia A, Miller-Archie SA, Alper H, Laskaris Z, Brackbill RM, Cone JE. Cardiovascular disease hospitalizations in relation to exposure to the September 11, 2001 World Trade Center disaster and posttraumatic stress disorder. J Am Heart Assoc 2013; 2:e000431. [PMID: 24157650 PMCID: PMC3835258 DOI: 10.1161/jaha.113.000431] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background A cohort study found that 9/11‐related environmental exposures and posttraumatic stress disorder increased self‐reported cardiovascular disease risk. We attempted to replicate these findings using objectively defined cardiovascular disease hospitalizations in the same cohort. Methods and Results Data for adult World Trade Center Health Registry enrollees residing in New York State on enrollment and no cardiovascular disease history (n=46 346) were linked to a New York State hospital discharge–reporting system. Follow‐up began at Registry enrollment (2003–2004) and ended at the first cerebrovascular or heart disease (HD) hospitalization, death, or December 31, 2010, whichever was earliest. We used proportional hazards models to estimate adjusted hazard ratios (AHRs) for HD (n=1151) and cerebrovascular disease (n=284) hospitalization during 302 742 person‐years of observation (mean follow‐up, 6.5 years per person), accounting for other factors including age, race/ethnicity, smoking, and diabetes. An elevated risk of HD hospitalization was observed among women (AHR 1.32, 95% CI 1.01 to 1.71) but not men (AHR 1.16, 95% CI 0.97 to 1.40) with posttraumatic stress disorder at enrollment. A high overall level of World Trade Center rescue and recovery–related exposure was associated with an elevated HD hospitalization risk in men (AHR 1.82, 95% CI 1.06 to 3.13; P for trend=0.05), but findings in women were inconclusive (AHR 3.29, 95% CI 0.85 to 12.69; P for trend=0.09). Similar associations were observed specifically with coronary artery disease hospitalization. Posttraumatic stress disorder increased the cerebrovascular disease hospitalization risk in men but not in women. Conclusions 9/11‐related exposures and posttraumatic stress disorder appeared to increase the risk of subsequent hospitalization for HD and cerebrovascular disease. This is consistent with findings based on self‐reported outcomes.
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Affiliation(s)
- Hannah T Jordan
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Queens, NY
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