Hospitalizations for asthma among adults exposed to the September 11, 2001 World Trade Center terrorist attack

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.

Hospitalizations among World Trade Center Health Registry Enrollees Who Were under 18 Years of Age on 9/11, 2001–2016

“…We found that demographic characteristics, themselves proxies for structural racism, known to be risk factors for either self-reported disease and/or hospitalization for physical health conditions of interest, such as asthma, GERDS, cardiovascular disease, including race/ethnicity and socioeconomic status, were significantly associated with hospitalization for a 9/11-related physical health condition [ 33 , 34 , 35 ]. Our findings align with previous 9/11 research showing that both minority children and adults and those from low SES backgrounds were at higher risk of asthma [ 2 , 3 , 23 ]. In addition, a previous study found that children from lower income households were more likely to have uncontrolled asthma [ 4 ], which could lead to ED visits.…”

“…Numerous studies among adults and children exposed to 9/11 identified a relationship between dust exposure and asthma [ 2 , 3 , 4 , 30 , 31 ]. However, a study among 9/11-exposed adults did not find an association between asthma hospitalization and dust cloud [ 23 ]. Previous research on self-reported asthma control among 9/11-exposed adults and children found that dust cloud exposure was not associated with the level of asthma control [ 4 , 32 ].…”

“…ICD-10 codes were only available for one year of the matching and thus were not used. For 9/11-related physical health hospitalizations, conditions that had previously been assessed as associated with 9/11-exposure in adults by either self-report or hospitalization records were examined [ 21 , 22 , 23 , 24 , 25 , 26 ]. The conditions were asthma (ICD-9 code 493.xx) as the discharge diagnosis or as a hospitalization with another respiratory condition listed as the principal discharge diagnosis [ 23 ], gastro-esophageal reflux disease (GERDS) (ICD-9 code 530.81, 530.10, 530.11, 530.19, and 530.3) [ 25 , 26 , 27 ], and cardiovascular diseases (ICD-9 codes, 401–405, 410–414, 427, 428, 430–438) [ 22 ].…”

“…For 9/11-related physical health hospitalizations, conditions that had previously been assessed as associated with 9/11-exposure in adults by either self-report or hospitalization records were examined [ 21 , 22 , 23 , 24 , 25 , 26 ]. The conditions were asthma (ICD-9 code 493.xx) as the discharge diagnosis or as a hospitalization with another respiratory condition listed as the principal discharge diagnosis [ 23 ], gastro-esophageal reflux disease (GERDS) (ICD-9 code 530.81, 530.10, 530.11, 530.19, and 530.3) [ 25 , 26 , 27 ], and cardiovascular diseases (ICD-9 codes, 401–405, 410–414, 427, 428, 430–438) [ 22 ]. Due to the small number of enrollees with hospitalizations for these conditions (asthma, n = 172; GERDS, n = 38; cardiovascular diseases, n = 53), they were combined into one variable indicating ≥1 hospitalization for 9/11-related physical health condition variable.…”

Association Between Socioeconomic Status and Asthma-Related Emergency Department Visits Among World Trade Center Rescue and Recovery Workers and Survivors

“…This analysis builds on previous work on this topic by using additional data through 2016 and also formally testing whether barriers to care mediate the association between SES and asthma hospitalizations. 4 It is also the first study, to our knowledge, to explicitly examine these pathways in a disaster-exposed population with elevated rates of respiratory illness. 9 their health conditions before and after 9/11.…”