NIOSHTIC-2 Publications Search

Gastroesophageal reflux symptoms and comorbid asthma and posttraumatic stress disorder following the 9/11 terrorist attacks on World Trade Center in New York City.

Li J; Brackbill RM; Stellman SD; Farfel MR; Miller-Archie SA; Friedman S; Walker DJ; Thorpe LE; Cone J
Am J Gastroenterol 2011 Nov; 106(11):1933-1941
OBJECTIVES: Excess gastroesophageal reflux disease (GERD) was reported in several populations exposed to the September 11 2001 (9/11) terrorist attacks on the World Trade Center (WTC). We examined new onset gastroesophageal reflux symptoms (GERS) since 9/11 and persisting up to 5-6 years in relation to 9/11-related exposures among the WTC Health Registry enrollees, and potential associations with comorbid asthma and posttraumatic stress disorder (PTSD). METHODS: This is a retrospective analysis of 37,118 adult enrollees (i.e., rescue/recovery workers, local residents, area workers, and passersby in lower Manhattan on 9/11) who reported no pre-9/11 GERS and who participated in two Registry surveys 2-3 and 5-6 years after 9/11. Post-9/11 GERS (new onset since 9/11) reported at first survey, and persistent GERS (post-9/11 GERS reported at both surveys) were analyzed using log-binomial regression. RESULTS: Cumulative incidence was 20 percent for post-9/11 GERS and 13 percent for persistent GERS. Persistent GERS occurred more often among those with comorbid PTSD (24 percent), asthma (13 percent), or both (36 percent) compared with neither of the comorbid conditions (8 percent). Among enrollees with neither asthma nor PTSD, the adjusted risk ratio (aRR) for persistent GERS was elevated among: workers arriving at the WTC pile on 9/11 (aRR = 1.6; 95 percent confidence interval (CI) 1.3 - 2.1) or working at the WTC site greater than 90 days (aRR = 1.6; 1.4 - 2.0); residents exposed to the intense dust cloud on 9/11 (aRR = 1.5; 1.0 - 2.3), or who did not evacuate their homes (aRR = 1.7; 1.2 - 2.3); and area workers exposed to the intense dust cloud (aRR = 1.5; 1.2 - 1.8). CONCLUSIONS: Disaster-related environmental exposures may contribute to the development of GERS. GERS may be accentuated in the presence of asthma or PTSD.
Emergency-responders; Emergency-response; Employee-health; Rescue-workers; Stress; Respiratory-system-disorders; Job-stress; Mental-stress; Psychological-disorders; Bronchial-asthma; Psychological-stress; Health-surveys; Surveillance-programs; Medical-monitoring; Medical-surveys; Statistical-analysis; Environmental-exposure; Dust-exposure; Dusts; Stomach-disorders; Membrane-dysfunction; Epidemiology; Risk-analysis; Risk-factors; Morbidity-rates
Jiehui Li, MBBS, MSc, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA
Publication Date
Document Type
Journal Article
Email Address
Funding Type
Cooperative Agreement
Fiscal Year
Identifying No.
Cooperative-Agreement-Number-U50-OH-009739; B09282011
Issue of Publication
Source Name
American Journal of Gastroenterology
Performing Organization
New York City Health/Mental Hygiene
Page last reviewed: May 11, 2023
Content source: National Institute for Occupational Safety and Health Education and Information Division