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/… Show more
“…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.…”
Section: Discussionsupporting
confidence: 92%
“…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 ].…”
Section: Discussionmentioning
confidence: 99%
“…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 ].…”
Section: Methodsmentioning
confidence: 99%
“…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.…”
Much of the literature on hospitalizations post-September 11, 2001 (9/11) focuses on adults but little is known about post-9/11 hospitalizations among children. Data for World Trade Center Health Registry enrollees who were under 18-years old on 9/11 were linked to New York State hospitalization data to identify hospitalizations from enrollment (2003–2004) to December 31, 2016. Logistic regression was used to analyze factors associated with hospitalization. Of the 3151 enrollees under age 18 on 9/11, 243 (7.7%) had at least one 9/11-related physical health hospitalization and 279 (8.9%) had at least one 9/11-related mental health hospitalization. Individuals of non-White race, those living in New York City Housing Authority housing, those exposed to the dust cloud on 9/11, and those with probable 9/11-related PTSD symptoms were more likely to be hospitalized for a 9/11-related physical health condition. Older age and having probable 9/11-related PTSD symptoms at baseline were associated with being hospitalized for a 9/11-related mental health condition. Dust cloud exposure on 9/11 and PTSD symptoms were associated with hospitalizations among those exposed to 9/11 as children. Racial minorities and children living in public housing were at greater risk of hospitalization. Continued monitoring of this population and understanding the interplay of socioeconomic factors and disaster exposure will be important to understanding the long-term effects of 9/11.
“…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.…”
Section: Discussionsupporting
confidence: 92%
“…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 ].…”
Section: Discussionmentioning
confidence: 99%
“…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 ].…”
Section: Methodsmentioning
confidence: 99%
“…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.…”
Much of the literature on hospitalizations post-September 11, 2001 (9/11) focuses on adults but little is known about post-9/11 hospitalizations among children. Data for World Trade Center Health Registry enrollees who were under 18-years old on 9/11 were linked to New York State hospitalization data to identify hospitalizations from enrollment (2003–2004) to December 31, 2016. Logistic regression was used to analyze factors associated with hospitalization. Of the 3151 enrollees under age 18 on 9/11, 243 (7.7%) had at least one 9/11-related physical health hospitalization and 279 (8.9%) had at least one 9/11-related mental health hospitalization. Individuals of non-White race, those living in New York City Housing Authority housing, those exposed to the dust cloud on 9/11, and those with probable 9/11-related PTSD symptoms were more likely to be hospitalized for a 9/11-related physical health condition. Older age and having probable 9/11-related PTSD symptoms at baseline were associated with being hospitalized for a 9/11-related mental health condition. Dust cloud exposure on 9/11 and PTSD symptoms were associated with hospitalizations among those exposed to 9/11 as children. Racial minorities and children living in public housing were at greater risk of hospitalization. Continued monitoring of this population and understanding the interplay of socioeconomic factors and disaster exposure will be important to understanding the long-term effects of 9/11.
“…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.…”
IMPORTANCE Although the association between poor economic or social standing and health is well established, few studies have attempted to examine the mediational pathways that produce adverse outcomes in disadvantaged populations. OBJECTIVE To determine whether barriers to care mediate the association between socioeconomic status (SES) and asthma-related emergency department (ED) visits.
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