The effect of world trade center exposure on the timing of diagnoses of obstructive airway disease, chronic rhinosinusitis, and gastroesophageal reflux disease

Xiaoxue Liu, Jennifer Yip, Rachel Zeig-Owens, Jessica Weakley, Mayris P. Webber, Theresa M. Schwartz, David J. Prezant, Michael D. Weiden, Charles B. Hall

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objectives: In a cohort of rescue/recovery workers exposed to the dust that resulted from the collapse of the World Trade Center (WTC), we assessed how a diagnosis of obstructive airways disease (OAD) affected the likelihood of a subsequent diagnosis of chronic rhinosinusitis (CRS) or gastroesophageal reflux disease (GERD). We also assessed whether OAD acted as a mediator of the association between exposure to the WTC rescue/recovery effort and CRS and GERD diagnoses. Methods: In this prospective cohort study, we analyzed Fire Department of the City of New York physician diagnoses of OAD, CRS, and GERD that were first documented between September 11, 2001, and September 10, 2011, among 8,968 WTC-exposed firefighters. We used piecewise exponential survival models to evaluate whether OAD was a risk factor for either CRS or GERD and to assess OAD as a possible mediator. Results: An OAD diagnosis significantly increased the risks for subsequent CRS [relative rate (RR), 4.24; 95% CI, 3.78-4.76] and GERD (RR, 3.21; 95% CI, 2.93-3.52) diagnoses. Further, 21% of the WTC exposure effect (high vs. low intensity) on GERD and 13% of the effect (high vs. low intensity) on CRS were mediated by a prior OAD diagnosis. Conclusion: Individuals with an OAD diagnosis had elevated risks for subsequent diagnoses of CRS or GERD. Part of the effect of WTC exposure on CRS and GERD diagnoses is mediated by prior diagnoses of OAD; this mediation effect of OAD may reflect biological pathways or healthcare utilization practices.

Original languageEnglish (US)
Article number2
JournalFrontiers in Public Health
Volume5
Issue numberFEB
DOIs
StatePublished - Feb 8 2017

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Gastroesophageal Reflux
Chronic Obstructive Pulmonary Disease
Firefighters
Dust
Cohort Studies
Prospective Studies
Delivery of Health Care
Physicians

Keywords

  • 9/11
  • Aerodigestive
  • Firefighters
  • Obstructive airways disease
  • Piecewise survival model

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

The effect of world trade center exposure on the timing of diagnoses of obstructive airway disease, chronic rhinosinusitis, and gastroesophageal reflux disease. / Liu, Xiaoxue; Yip, Jennifer; Zeig-Owens, Rachel; Weakley, Jessica; Webber, Mayris P.; Schwartz, Theresa M.; Prezant, David J.; Weiden, Michael D.; Hall, Charles B.

In: Frontiers in Public Health, Vol. 5, No. FEB, 2, 08.02.2017.

Research output: Contribution to journalArticle

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abstract = "Objectives: In a cohort of rescue/recovery workers exposed to the dust that resulted from the collapse of the World Trade Center (WTC), we assessed how a diagnosis of obstructive airways disease (OAD) affected the likelihood of a subsequent diagnosis of chronic rhinosinusitis (CRS) or gastroesophageal reflux disease (GERD). We also assessed whether OAD acted as a mediator of the association between exposure to the WTC rescue/recovery effort and CRS and GERD diagnoses. Methods: In this prospective cohort study, we analyzed Fire Department of the City of New York physician diagnoses of OAD, CRS, and GERD that were first documented between September 11, 2001, and September 10, 2011, among 8,968 WTC-exposed firefighters. We used piecewise exponential survival models to evaluate whether OAD was a risk factor for either CRS or GERD and to assess OAD as a possible mediator. Results: An OAD diagnosis significantly increased the risks for subsequent CRS [relative rate (RR), 4.24; 95{\%} CI, 3.78-4.76] and GERD (RR, 3.21; 95{\%} CI, 2.93-3.52) diagnoses. Further, 21{\%} of the WTC exposure effect (high vs. low intensity) on GERD and 13{\%} of the effect (high vs. low intensity) on CRS were mediated by a prior OAD diagnosis. Conclusion: Individuals with an OAD diagnosis had elevated risks for subsequent diagnoses of CRS or GERD. Part of the effect of WTC exposure on CRS and GERD diagnoses is mediated by prior diagnoses of OAD; this mediation effect of OAD may reflect biological pathways or healthcare utilization practices.",
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author = "Xiaoxue Liu and Jennifer Yip and Rachel Zeig-Owens and Jessica Weakley and Webber, {Mayris P.} and Schwartz, {Theresa M.} and Prezant, {David J.} and Weiden, {Michael D.} and Hall, {Charles B.}",
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AU - Liu, Xiaoxue

AU - Yip, Jennifer

AU - Zeig-Owens, Rachel

AU - Weakley, Jessica

AU - Webber, Mayris P.

AU - Schwartz, Theresa M.

AU - Prezant, David J.

AU - Weiden, Michael D.

AU - Hall, Charles B.

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N2 - Objectives: In a cohort of rescue/recovery workers exposed to the dust that resulted from the collapse of the World Trade Center (WTC), we assessed how a diagnosis of obstructive airways disease (OAD) affected the likelihood of a subsequent diagnosis of chronic rhinosinusitis (CRS) or gastroesophageal reflux disease (GERD). We also assessed whether OAD acted as a mediator of the association between exposure to the WTC rescue/recovery effort and CRS and GERD diagnoses. Methods: In this prospective cohort study, we analyzed Fire Department of the City of New York physician diagnoses of OAD, CRS, and GERD that were first documented between September 11, 2001, and September 10, 2011, among 8,968 WTC-exposed firefighters. We used piecewise exponential survival models to evaluate whether OAD was a risk factor for either CRS or GERD and to assess OAD as a possible mediator. Results: An OAD diagnosis significantly increased the risks for subsequent CRS [relative rate (RR), 4.24; 95% CI, 3.78-4.76] and GERD (RR, 3.21; 95% CI, 2.93-3.52) diagnoses. Further, 21% of the WTC exposure effect (high vs. low intensity) on GERD and 13% of the effect (high vs. low intensity) on CRS were mediated by a prior OAD diagnosis. Conclusion: Individuals with an OAD diagnosis had elevated risks for subsequent diagnoses of CRS or GERD. Part of the effect of WTC exposure on CRS and GERD diagnoses is mediated by prior diagnoses of OAD; this mediation effect of OAD may reflect biological pathways or healthcare utilization practices.

AB - Objectives: In a cohort of rescue/recovery workers exposed to the dust that resulted from the collapse of the World Trade Center (WTC), we assessed how a diagnosis of obstructive airways disease (OAD) affected the likelihood of a subsequent diagnosis of chronic rhinosinusitis (CRS) or gastroesophageal reflux disease (GERD). We also assessed whether OAD acted as a mediator of the association between exposure to the WTC rescue/recovery effort and CRS and GERD diagnoses. Methods: In this prospective cohort study, we analyzed Fire Department of the City of New York physician diagnoses of OAD, CRS, and GERD that were first documented between September 11, 2001, and September 10, 2011, among 8,968 WTC-exposed firefighters. We used piecewise exponential survival models to evaluate whether OAD was a risk factor for either CRS or GERD and to assess OAD as a possible mediator. Results: An OAD diagnosis significantly increased the risks for subsequent CRS [relative rate (RR), 4.24; 95% CI, 3.78-4.76] and GERD (RR, 3.21; 95% CI, 2.93-3.52) diagnoses. Further, 21% of the WTC exposure effect (high vs. low intensity) on GERD and 13% of the effect (high vs. low intensity) on CRS were mediated by a prior OAD diagnosis. Conclusion: Individuals with an OAD diagnosis had elevated risks for subsequent diagnoses of CRS or GERD. Part of the effect of WTC exposure on CRS and GERD diagnoses is mediated by prior diagnoses of OAD; this mediation effect of OAD may reflect biological pathways or healthcare utilization practices.

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