The upper respiratory pyramid: Early factors and later treatment utilization in World Trade Center exposed firefighters

Justin K. Niles, Mayris P. Webber, Xiaoxue Liu, Rachel Zeig-Owens, Charles B. Hall, Hillel W. Cohen, Michelle S. Glaser, Jessica Weakley, Theresa M. Schwartz, Michael D. Weiden, Anna Nolan, Thomas K. Aldrich, Lara Glass, Kerry J. Kelly, David J. Prezant

Research output: Contribution to journalArticle

8 Scopus citations


Background: We investigated early post 9/11 factors that could predict rhinosinusitis healthcare utilization costs up to 11 years later in 8,079 World Trade Center-exposed rescue/recovery workers. Methods: We used bivariate and multivariate analytic techniques to investigate utilization outcomes; we also used a pyramid framework to describe rhinosinusitis healthcare groups at early (by 9/11/2005) and late (by 9/11/2012) time points. Results: Multivariate models showed that pre-9/11/2005 chronic rhinosinusitis diagnoses and nasal symptoms predicted final year healthcare utilization outcomes more than a decade after WTC exposure. The relative proportion of workers on each pyramid level changed significantly during the study period. Conclusions: Diagnoses of chronic rhinosinusitis within 4 years of a major inhalation event only partially explain future healthcare utilization. Exposure intensity, early symptoms and other factors must also be considered when anticipating future healthcare needs. Am. J. Ind. Med. 57:857-865, 2014.

Original languageEnglish (US)
Pages (from-to)857-865
Number of pages9
JournalAmerican Journal of Industrial Medicine
Issue number8
Publication statusPublished - Aug 2014



  • Chronic rhinosinusitis
  • Firefighters
  • Sinus symptoms
  • Treatment outcomes
  • World trade center

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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