Gastroesophageal reflux symptoms and comorbid asthma and posttraumatic stress disorder following the 9/11 terrorist attacks on world trade center in New York City

Jiehui Li, Robert M. Brackbill, Steven D. Stellman, Mark R. Farfel, Sara A. Miller-Archie, Stephen Friedman, Deborah J. Walker, Lorna Thorpe, James Cone

Research output: Contribution to journalArticle

Abstract

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% for post-9/11 GERS and 13% for persistent GERS. Persistent GERS occurred more often among those with comorbid PTSD (24%), asthma (13%), or both (36%) compared with neither of the comorbid conditions (8%). 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% confidence interval (CI) 1.3-2.1) or working at the WTC site >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.

Original languageEnglish (US)
Pages (from-to)1933-1941
Number of pages9
JournalAmerican Journal of Gastroenterology
Volume106
Issue number11
DOIs
StatePublished - Nov 2011

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Post-Traumatic Stress Disorders
Gastroesophageal Reflux
Asthma
Odds Ratio
Dust
Registries
September 11 Terrorist Attacks
Environmental Exposure
Disasters
Confidence Intervals

ASJC Scopus subject areas

  • Gastroenterology

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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, Jiehui; Brackbill, Robert M.; Stellman, Steven D.; Farfel, Mark R.; Miller-Archie, Sara A.; Friedman, Stephen; Walker, Deborah J.; Thorpe, Lorna; Cone, James.

In: American Journal of Gastroenterology, Vol. 106, No. 11, 11.2011, p. 1933-1941.

Research output: Contribution to journalArticle

Li, Jiehui ; Brackbill, Robert M. ; Stellman, Steven D. ; Farfel, Mark R. ; Miller-Archie, Sara A. ; Friedman, Stephen ; Walker, Deborah J. ; Thorpe, Lorna ; Cone, James. / Gastroesophageal reflux symptoms and comorbid asthma and posttraumatic stress disorder following the 9/11 terrorist attacks on world trade center in New York City. In: American Journal of Gastroenterology. 2011 ; Vol. 106, No. 11. pp. 1933-1941.
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abstract = "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{\%} for post-9/11 GERS and 13{\%} for persistent GERS. Persistent GERS occurred more often among those with comorbid PTSD (24{\%}), asthma (13{\%}), or both (36{\%}) compared with neither of the comorbid conditions (8{\%}). 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{\%} confidence interval (CI) 1.3-2.1) or working at the WTC site >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.",
author = "Jiehui Li and Brackbill, {Robert M.} and Stellman, {Steven D.} and Farfel, {Mark R.} and Miller-Archie, {Sara A.} and Stephen Friedman and Walker, {Deborah J.} and Lorna Thorpe and James Cone",
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T1 - Gastroesophageal reflux symptoms and comorbid asthma and posttraumatic stress disorder following the 9/11 terrorist attacks on world trade center in New York City

AU - Li, Jiehui

AU - Brackbill, Robert M.

AU - Stellman, Steven D.

AU - Farfel, Mark R.

AU - Miller-Archie, Sara A.

AU - Friedman, Stephen

AU - Walker, Deborah J.

AU - Thorpe, Lorna

AU - Cone, James

PY - 2011/11

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N2 - 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% for post-9/11 GERS and 13% for persistent GERS. Persistent GERS occurred more often among those with comorbid PTSD (24%), asthma (13%), or both (36%) compared with neither of the comorbid conditions (8%). 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% confidence interval (CI) 1.3-2.1) or working at the WTC site >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.

AB - 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% for post-9/11 GERS and 13% for persistent GERS. Persistent GERS occurred more often among those with comorbid PTSD (24%), asthma (13%), or both (36%) compared with neither of the comorbid conditions (8%). 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% confidence interval (CI) 1.3-2.1) or working at the WTC site >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.

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