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Cardiovascular disease hospitalizations in relation to exposure to the September 11, 2001 World Trade Center disaster and posttraumatic stress disorder.

Authors
Jordan-HT; Stellman-SD; Morabia-A; Miller-Archie-SA; Alper-H; Laskaris-Z; Brackbill-RM; Cone-JE
Source
J Am Heart Assoc 2013 Oct; 2(5):e000431
NIOSHTIC No.
20043353
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.
Keywords
Environmental-exposure; Exposure-levels; Risk-factors; Stress; Epidemiology; Cardiovascular-disease; Cardiovascular-system-disorders; Cardiovascular-system-disease; Cerebrovascular-system-disorders; Cerebrovascular-system; Hazards; Statistical-analysis; Humans; Men; Women; Author Keywords: 9/11 World Trade Center disaster; cardiovascular diseases; epidemiology; risk factors; stress
Contact
Hannah T. Jordan, MD, MPH, World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, 7th floor, Long Island City, NY 11101
CODEN
JAHABZ
Publication Date
20131001
Document Type
Journal Article
Email Address
hjordan1@health.nyc.gov
Funding Type
Cooperative Agreement
Fiscal Year
2014
NTIS Accession No.
NTIS Price
Identifying No.
Cooperative-Agreement-Number-U50-OH-009739; M112013
Issue of Publication
5
ISSN
2047-9980
Source Name
Journal of the American Heart Association
State
NY
Performing Organization
New York City Health/Mental Hygiene
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