Hospitalizations for asthma among adults exposed to the September 11, 2001 World Trade Center terrorist attack. (3rd April 2018)

• Record Type: Journal Article
• Authors: Miller-Archie, Sara A.; Jordan, Hannah T.; Alper, Howard; Wisnivesky, Juan P.; Cone, James E.; Friedman, Stephen M.; Brackbill, Robert M.
• Is Part Of: Journal of asthma. Volume 55:Number 4(2018)
• Page Start: 354
• Page End: 363
• Publication Date: 2018-04-03
• Subjects: Asthma hospitalization -- cohort study -- comorbidity -- gastroesophageal reflux -- posttraumatic stress disorder -- World Trade Center; Asthma -- Periodicals; 616.238005
• DOI: 10.1080/02770903.2017.1337787
• Languages: English
• ISSNs: 0277-0903

Abstract

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.