Change in Asthma Is Associated with Change in PTSD in World Trade Center Health Registrants, 2011 to 2016
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source
2.2. Analytic Sample
2.3. Change in Asthma Control
2.4. Predictors of Change in Asthma Control
2.5. Statistical Analysis
2.6. Participants vs. Non-Participants in W4
3. Results
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Significant Change | Reference |
---|---|---|
ACT | Increase or decrease of 3 points or more | Remain within 2 points |
Income level | Increase or decrease of one or more levels | No change |
Smoking | Started smoking or quit smoking | No change |
GERS frequency in last 12 months | Increase to two or more times a week or decrease to less than two times a week | Not crossing the ≥twice a week frequency threshold |
BMI relative change | Increase or decrease of 5% or more | Remain within less than 5% |
Social support | Increase or decrease of 2 levels or more | Remain within 1 level |
PTSD-17 | Increase or decrease of 10 points or more | Remain within 9 points |
PHQ-8 | Increase or decrease of 5 points or more | Remain within 4 points |
Physical health QoL | Increase or decrease of 10 days or more | Remain within 9 days |
Increase or decrease of days to cross the 14 days/month threshold | Not crossing the 14 days/month threshold | |
Mental health QoL | Increase or decrease of 10 days or more | Remain within 9 days |
Increase or decrease of days to cross the 14 days/month threshold | Not crossing the 14 days/month threshold |
Measurement at Wave 1 | Overall | Distribution by ACT Change from W3 to W4 | Chi-Square * | |||||
---|---|---|---|---|---|---|---|---|
Decrease by ≥ 3 | Within +/−3 | Increase by ≥ 3 | ||||||
Number | Number | Percent | Number | Percent | Number | Percent | ||
Age group 11 September | ||||||||
18–34 | 645 | 170 | 26.4 | 345 | 53.5 | 130 | 20.2 | |
35–39 | 508 | 171 | 33.7 | 259 | 51.0 | 78 | 15.4 | |
40–49 | 1026 | 341 | 33.2 | 538 | 52.4 | 147 | 14.3 | |
50- | 617 | 202 | 32.7 | 326 | 52.8 | 89 | 14.4 | |
Total | 2796 | 884 | 31.6 | 1468 | 52.5 | 444 | 15.9 | p = 0.0071 * |
Sex | ||||||||
Male | 1650 | 557 | 33.8 | 875 | 53.0 | 218 | 13.2 | |
Female | 1146 | 327 | 28.5 | 593 | 51.7 | 226 | 19.7 | |
Total | 2796 | 884 | 31.6 | 1468 | 52.5 | 444 | 15.9 | p < 0.0001 |
Race/ethnicity | ||||||||
White, non-Hispanic | 1880 | 574 | 30.5 | 1019 | 54.2 | 287 | 15.3 | |
Black non-Hispanic, Hispanic, Asian, other | 916 | 310 | 33.8 | 449 | 49.0 | 157 | 17.1 | |
Total | 2796 | 884 | 31.6 | 1468 | 52.5 | 444 | 15.9 | p = 0.0360 |
Education | ||||||||
High school or less | 672 | 245 | 36.5 | 323 | 48.1 | 104 | 15.5 | |
Some college | 822 | 287 | 34.9 | 394 | 47.9 | 141 | 17.2 | |
College and higher | 1287 | 347 | 27.0 | 741 | 57.6 | 199 | 15.5 | |
Total | 2781 | 879 | 31.6 | 1458 | 52.4 | 444 | 16.0 | p < 0.0001 |
11 September exposure category | ||||||||
RR worker | 1623 | 553 | 34.1 | 831 | 51.2 | 239 | 14.7 | |
Others | 1173 | 331 | 28.2 | 637 | 0.0 | 205 | 17.5 | |
Total | 2796 | 239 | 8.5 | 1468 | 52.5 | 444 | 15.9 | p = 0.0026 |
Dust cloud exposure on 11 September | ||||||||
Yes | 1502 | 535 | 35.6 | 855 | 56.9 | 277 | 18.4 | |
No | 995 | 345 | 34.7 | 612 | 61.5 | 166 | 16.7 | |
Total | 2497 | 880 | 35.2 | 1467 | 58.8 | 443 | 17.7 | p = 0.2085 |
Distribution by ACT change | ||||||||
Measurement at W3 | Overall | Decrease by ≥ 3 | Within +/−3 | Increase by ≥ 3 | ||||
Income level | ||||||||
≤25,000 | 327 | 111 | 13.1 | 156 | 11.1 | 60 | 14.2 | |
25,000–50,000 | 434 | 145 | 17.1 | 226 | 16.1 | 63 | 14.9 | |
50,001–75,000 | 482 | 161 | 19.0 | 231 | 16.4 | 90 | 21.2 | |
75,001–150,000 | 1039 | 341 | 40.2 | 542 | 38.6 | 156 | 36.8 | |
>150,000 | 396 | 91 | 10.7 | 250 | 17.8 | 55 | 13.0 | |
2678 | 849 | 1405 | 424 | p = 0.0003 | ||||
Smoking history | Decrease by ≥ 3 | Within +/−3 | Increase by ≥ 3 | |||||
Currently smoking | 258 | 94 | 36.4 | 118 | 45.7 | 46 | 17.8 | |
Previously but not currently smoking | 972 | 296 | 30.5 | 527 | 54.2 | 149 | 15.3 | |
Never smoked | 1378 | 432 | 31.3 | 731 | 53.0 | 215 | 15.6 | |
Total | 2608 | 822 | 31.5 | 1376 | 52.8 | 410 | 15.7 | p = 0.1989 |
Poor health care accessibility | ||||||||
Yes | 594 | 188 | 31.6 | 283 | 47.6 | 123 | 20.7 | |
No | 2176 | 685 | 31.5 | 1172 | 53.9 | 319 | 14.7 | |
Total | 2770 | 873 | 31.5 | 1455 | 52.5 | 442 | 16.0 | p = 0.0009 |
Body mass index | ||||||||
Underweight/normal | 591 | 166 | 28.1 | 331 | 56.0 | 94 | 15.9 | |
Overweight | 1007 | 310 | 30.8 | 539 | 53.5 | 158 | 15.7 | |
Obese | 1146 | 393 | 34.3 | 573 | 50.0 | 180 | 15.7 | |
Total | 2744 | 869 | 31.7 | 1443 | 52.6 | 432 | 15.7 | p = 0.0884 |
GERS frequency | ||||||||
≤Once/week | 2013 | 623 | 30.9 | 1093 | 54.3 | 297 | 14.8 | |
>Once/week | 769 | 255 | 33.2 | 370 | 48.1 | 144 | 18.7 | |
Total | 2782 | 878 | 31.6 | 1463 | 52.6 | 441 | 15.9 | p = 0.0054 |
History of obstructive sleep apnea | ||||||||
Yes | 805 | 283 | 35.2 | 395 | 49.1 | 127 | 15.8 | |
No | 1856 | 558 | 30.1 | 1001 | 53.9 | 297 | 16.0 | |
Total | 2661 | 841 | 31.6 | 1396 | 52.5 | 424 | 15.9 | p = 0.0279 |
Social support level | ||||||||
Low | 573 | 189 | 33.0 | 297 | 51.8 | 87 | 15.2 | |
Medium | 1005 | 307 | 30.5 | 535 | 53.2 | 163 | 16.2 | |
High | 1146 | 363 | 31.7 | 601 | 52.4 | 182 | 15.9 | p = 0.8953 |
Total | 2724 | 859 | 31.5 | 1433 | 52.6 | 432 | 15.9 | |
PCL-17 | ||||||||
≥44 | 901 | 305 | 33.9 | 418 | 46.4 | 182 | 20.2 | |
<44 | 1745 | 531 | 30.4 | 983 | 56.3 | 244 | 14.0 | |
Total | 2646 | 836 | 31.6 | 1401 | 52.9 | 426 | 16.1 | p < 0.0001 |
PHQ-8 | ||||||||
≥10 | 819 | 268 | 32.7 | 389 | 47.5 | 162 | 19.8 | p = 0.0001 |
<10 | 1861 | 578 | 31.1 | 1022 | 54.9 | 261 | 14.0 | |
Total | 2680 | 846 | 31.6 | 1411 | 52.6 | 423 | 15.8 | |
ACT level at W3 | ||||||||
Controlled | 1440 | 485 | 33.7 | 862 | 59.9 | 93 | 6.5 | |
Poorly controlled | 652 | 251 | 38.5 | 254 | 39.0 | 147 | 22.5 | |
Very poorly controlled | 704 | 148 | 21.0 | 352 | 50.0 | 204 | 29.0 | |
2796 | 884 | 31.6 | 1468 | 52.5 | 444 | 15.9 | p < 0.0001 |
Risk Factor Change, W3 to W4 | Overall | Distribution of ACT Change from W3 to W4 | Chi-Square * | |||||
---|---|---|---|---|---|---|---|---|
Decrease by ≥ 3 | Within +/− 3 | Increase by ≥3 | ||||||
Number | Number | Percent | Number | Percent | Number | Percent | ||
Income level | ||||||||
no change | 1383 | 443 | 32.0 | 729 | 52.7 | 211 | 15.3 | |
Decreased | 320 | 114 | 35.6 | 165 | 51.6 | 41 | 12.8 | |
Increased | 604 | 187 | 31.0 | 316 | 52.3 | 101 | 16.7 | |
Total | 2307 | 744 | 32.2 | 1210 | 52.4 | 353 | 15.3 | p = 0.4593 |
Smoking | ||||||||
no change | 2047 | 646 | 31.6 | 1094 | 53.4 | 307 | 15.0 | |
started smoking | 32 | 12 | 37.5 | 16 | 50.0 | 4 | 12.5 | |
stopped smoking | 66 | 23 | 34.8 | 30 | 45.5 | 13 | 19.7 | |
Total | 2145 | 681 | 31.7 | 1140 | 53.1 | 324 | 15.1 | p = 0.6508 |
BMI | ||||||||
5% < change < −5% | 1406 | 434 | 30.9 | 758 | 53.9 | 214 | 15.2 | |
increased by ≥ 5% | 591 | 206 | 34.9 | 299 | 50.6 | 86 | 14.6 | |
decreased by ≥ 5% | 422 | 124 | 29.4 | 225 | 53.3 | 73 | 17.3 | |
Total | 2419 | 764 | 31.6 | 1282 | 53.0 | 373 | 15.4 | p = 0.2827 |
GERS frequency | ||||||||
remained the same | 1950 | 597 | 30.6 | 1058 | 54.3 | 295 | 15.1 | |
increased to ≥ twice a week | 323 | 134 | 41.5 | 147 | 45.5 | 42 | 13.0 | |
decreased to < twice a week | 198 | 52 | 26.3 | 101 | 51.0 | 45 | 22.7 | |
Total | 2471 | 783 | 31.7 | 1306 | 52.9 | 382 | 15.5 | p < 0.0001 |
Social support level | 0.0 | |||||||
within 2 levels | 2112 | 665 | 31.5 | 1125 | 53.3 | 322 | 15.2 | |
worsened by ≥ 2 levels | 102 | 39 | 38.2 | 42 | 41.2 | 21 | 20.6 | |
improved by ≥ 2 levels | 125 | 36 | 28.8 | 68 | 54.4 | 21 | 16.8 | |
Total | 2356 | 740 | 31.6 | 1235 | 52.8 | 364 | 15.6 | p = 0.1706 |
PCL-17 score | ||||||||
within 10 | 1600 | 492 | 30.8 | 880 | 55.0 | 228 | 14.3 | |
worsened by ≥ 10 | 426 | 120 | 28.2 | 201 | 47.2 | 105 | 24.6 | |
improved by ≥ 10 | 230 | 103 | 44.8 | 102 | 44.3 | 25 | 10.9 | |
Total | 2256 | 715 | 31.7 | 1183 | 52.4 | 358 | 15.9 | p < 0.0001 |
PHQ-8 score | ||||||||
within 10 | 1693 | 532 | 31.4 | 912 | 53.9 | 249 | 14.7 | |
worsened by ≥ 5 | 342 | 92 | 26.9 | 171 | 50.0 | 79 | 23.1 | |
improved by ≥ 5 | 253 | 105 | 41.5 | 118 | 46.6 | 30 | 11.9 | |
Total | 2288 | 729 | 31.9 | 1201 | 52.5 | 358 | 15.6 | p < 0.0001 |
Multivariable Model: Change in ACT Score of ≥ 3 Points = Change from W3 to W4 in PCL ≥ 10, GERS, and BMI, Adjusting for Age Group at 9/11, Gender, Race/Ethnicity, Education, Exposure to the Disaster, Dust Cloud, Healthcare Accessibility, Smoking, History of Obstructive Sleep Apnea, and Asthma Control Level at W3, n = 1861 | |||||
---|---|---|---|---|---|
Bivariate Analysis | Adjusted Analysis | ||||
Change in ACT Score | Change in ACT Score | ||||
Number | Worsened by ≥ 3 vs. No Change | Improved by ≥ 3 vs. No Change | Worsened by ≥ 3 vs. No Change | Improved by ≥ 3 vs. No Change | |
Measurement at W1 | |||||
Age group on 11 September | |||||
18–34 | 645 | ref | ref | ref | Ref |
35–39 | 508 | 1.34 (1.03, 1.75) | 0.80 (0.58, 1.11) | 1.45 (1.03, 2.04) | 0.63 (0.41, (0.98) |
40–49 | 1026 | 1.29 (1.02, 1.62) | 0.73 (0.55, 0.95) | 1.41 (1.04, 1.90) | 0.59 (0.41, 0.86) |
50– | 617 | 1.26 (0.98, 1.62) | 0.72 (0.53, 0.99) | 1.61 (1.14, 2.26) | 0.62 (0.40, 0.95) |
total | 2796 | ||||
Sex | |||||
male | 1650 | ref | ref | ref | Ref |
female | 1146 | 0.87 (0.73, 1.03) | 1.53 (1.24, 1.89) | 0.98 (0.75, 1.26) | 1.66 (1.18, 2.33) |
total | 2796 | ||||
Race/ethnicity | |||||
White, non-Hispanic | 1880 | ref | ref | ref | Ref |
Black non-Hispanic, Hispanic, Asian, other | 916 | 1.23 (1.03, 1.46) | 1.24 (0.99, 1.55) | 1.08 (0.84, 1.38) | 0.73 (0.52, 1.01) |
total | 2796 | ||||
Education | |||||
high school or less | 672 | ref | ref | 0.94 (0.70, 1.26) | 0.69 (0.44, 1.04) |
some college | 822 | 0.96 (0.72, 1.20) | 1.11 (0.83, 1.49) | ref | Ref |
college and higher | 1287 | 0.62 (0.50, 0.76) | 0.83 (0.64, 1.09) | 0.65 (0.51, 0.84) | 0.95 (0.68, 1.34) |
total | 2781 | ||||
9/11 exposure category | |||||
RR worker | 1623 | ref | ref | ref | Ref |
others | 1173 | 0.78 (0.66, 0.93) | 1.12 (0.90, 1.39) | 0.71 (0.55, 0.93) | 1.07 (0.75, 1.51) |
total | 2796 | ||||
Dust cloud exposure | |||||
light | 1123 | ref | ref | ref | Ref |
heavy | 1667 | 1.11 (0.94, 1.32) | 1.19 (0.96, 1.49) | 1.15 (0.92, 1.44) | 1.00 (0.74, 1.36) |
2790 | |||||
Measurement at W3 | |||||
Poor health care accessibility | |||||
no | 2176 | ref | ref | ref | Ref |
yes | 594 | 1.13 (0.91, 1.39) | 1.59 (1.24, 2.03) | 1.16 (0.871.53) | 1.25 (0.89, 1.76) |
total | 2770 | ||||
Smoking | |||||
never smoker | 1378 | ref | ref | ref | Ref |
current smoker | 258 | 1.34 (0.995, 1.80) | 1.34 (0.92, 1.94) | 0.85 (0.67, 1.08) | 0.89 (0.65, 1.21 |
former smoker | 972 | 0.93 (0.77, 1.13) | 0.98 (0.77, 1.26) | 1.18 (0.80, 1.73) | 1.28 (0.78, 2.10) |
total | 2608 | ||||
History of Obstructive sleep apnea | |||||
no | 1856 | ref | ref | ref | Ref |
yes | 805 | 1.27 (1.05, 1.52) | 1.07 (0.84, 1.36) | 1.32 (1.03, 1.70) | 0.86 (0.62, 1.21) |
total | 2661 | ||||
Asthma control test level at W3 | |||||
controlled | 1440 | ref | ref | ref | Ref |
poorly controlled | 652 | 1.74 (1.42, 2.14) | 5.24 (3.90, 7.05) | 1.55 (1.19, 2.03) | 7.22 (4.91, 10.63) |
very poorly controlled | 704 | 0.76 (0.61, 0.95) | 5.38 (4.08, 7.08) | 0.52 (0.38, 0.71) | 7.93 (5.37, 11.72) |
total | 2796 | ||||
Change from W3 to W4 | |||||
Income level | |||||
no change | 1383 | ref | ref | ||
worsened | 320 | 1.11 (0.85, 1.45) | 0.85 (0.58, 1.24) | ||
improved | 604 | 0.96 (0.77, 1.19) | 1.09 (0.83, 1.43) | ||
2307 | |||||
GERS frequency change category | |||||
Remained the same | 1950 | ref | ref | ref | ref |
Increased to ≥ twice a week | 323 | 1.60 (1.24, 2.07) | 1.02 (0.70, 1.46) | 1.70 (1.25, 2.31) | 0.86 (0.54, 1.36) |
Decreased to < twice a week | 198 | 0.91 (0.63, 1.30) | 1.58 (1.09, 2.30) | 0.84 (0,55, 1.29) | 1.21 (0.77, 1.95) |
total | 2471 | ||||
BMI change from W3 to W4 | |||||
5% < change < -5% | 1406 | ref | ref | ref | Ref |
increased by ≥ 5% | 591 | 1.21 (0.98, 1.50) | 1.03 (0.77, 1.37) | 1.28 (0.98, 1.66) | 0.95 (0.66, 1.36) |
decreased by ≥ 5% | 422 | 0.96 (0.75, 1.23) | 1.15 (0.85, 1.56) | 1.02 (0.76, 1.38) | 1.19 (0.82, 1.73) |
total | 2419 | ||||
Social support change from W3 to W4 | |||||
no change | 1463 | ref | ref | ref | ref |
worsened by ≥ 1 level | 390 | 1.25 (0.98, 1.60) | 1.11 (0.80, 1.54) | 1.24 (0.93, 1.66) | 0.85 (0.56, 1.27) |
improved by ≥ 1 level | 498 | 0.95 (0.75, 1.20) | 1.13 (0.85, 1.51) | 1.04 (0.79, 1.38) | 1.08 (0.76, 1.54) |
total | 2351 | ||||
PCL-17 score change from W3 to W4 | |||||
within 10 | 1600 | ref | ref | ref | ref |
worsened by ≥ 10 | 230 | 1.85 (1.37, 2.49) | 0.97 (0.61, 1.54) | 1.77 (1.26, 2.50) | 0.64 (0.37, 1.11) |
improved by ≥ 10 | 426 | 1.08 (0.84, 1.39) | 2.00 (1.52, 2.65) | 1.00 (0.75, 1.35) | 1.42 (1.01, 1.99) |
total | 2256 | ||||
Multivariable model: Change in ACT score of ≥ 3 points = Change from W3 to W4 in PHQ ≥ 5, GERS, and BMI, adjusting for age group at 9/11, gender, race/ethnicity, education, exposure to the disaster, dust cloud, healthcare accessibility, smoking, history of obstructive sleep apnea, and asthma control level at W3, n = 1842 | |||||
PHQ-8 score change from W3 to W4 | |||||
within 5 | 1693 | ref | ref | ref | ref |
worsened by ≥ 5 | 253 | 1.53 (1.15, 2.03) | 0.93 (0.61, 1.42) | 1.34 (0.96, 1.86) | 0.68 (0.41, 1.12) |
improved by ≥ 5 | 342 | 0.92 (0.70, 1.21) | 1.69 (1.25, 2.29) | 0.96 (0.70, 1.33) | 1.23 (0.85, 1.78) |
total | 2288 |
Model: Change in Days ≥10 of Poor Physical or Mental Health = Change in ACT Score (≥3), Change in PCL-17 (≥10), Change in BMI (≥5 Percent), Change in GERS Category; ACT Score, Obstructive Sleep Apnea, and Smoking at W3, and Sex, Age, Race/Ethnicity, and Education | ||||
Days of good physical health | ||||
n = 1914 | worsened by ≥10 | improved by ≥10 | ||
ACT worsened W3 to W4 ≥ 3 | 1.97 (1.48, 2.62) * | 0.95 (0.66, 1.33) | ||
ACT improved W3 to W4 ≥ 3 | 0.80 (0.51, 1.26) | 1.38 (0.96, 1.98) | ||
Days of good mental health | Removing PCL-17, n = 2083 | |||
n = 1903 | worsened by ≥10 | improved by ≥10 | worsened by ≥10 | improved by ≥10 |
ACT worsened W3 to W4 ≥ 3 | 1.23 (0.89, 1.71) | 0.92 (0.67, 1.26) | 1.44 (1.07, 1.96) * | 0.88 (0.66, 1.17) |
ACT improved W3 to W4 ≥ 3 | 1.00 (0.63, 1.59) | 0.98 (0.67, 1.43) | 0.86 (0.56, 1.33) | 1.05 (0.72, 1.49) |
Analysis Using 14-day Cutoff (Sensitivity Analysis to Demonstrate That Effects Are Similar to ≥ 10 Day Change) | ||||
Model: Change to ≥14 Days of Poor Physical or Mental Health = Change in ACT Score (≥3), Change in PCL-17 (≥10), Change in BMI (≥5 percent), Change in GERS Category; ACT Score, Obstructive Sleep Apnea, and Smoking at W3, and Sex, Age, Race/Ethnicity, and Education | ||||
Days of good physical health | ||||
n = 1914 | worsened to ≥14 | improved to <14 | ||
ACT worsened W3 to W4 ≥ 3 | 1.91 (1.37, 2.67)* | 0.94 (0.62, 1.43) | ||
ACT improved W3 to W4 ≥ 3 | 0.79 (0.46, 1.37) | 1.47 (0.94, 2.29) | ||
Days of good mental health | Removing PCL-17 n = 2083 | |||
n = 1903 | worsened to ≥14 | improved to <14 | worsened to ≥14 | improved to <14 |
ACT worsened W3 to W4 ≥ 3 | 1.18 (0.78, 1.78) | 1.00 (0.67, 1.48) | 1.44 (0.98, 2.10) | 0.84 (0.58, 1.21) |
ACT improved W3 to W4 ≥ 3 | 1.10 (0.62, 1.95) | 1.26 (0.81, 1.98) | 0.90 (0.53, 1.55) | 1.31 (0.87, 1.96) |
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Friedman, S.M.; Alper, H.; de la Hoz, R.E.; Osahan, S.; Farfel, M.R.; Cone, J. Change in Asthma Is Associated with Change in PTSD in World Trade Center Health Registrants, 2011 to 2016. Int. J. Environ. Res. Public Health 2022, 19, 7795. https://doi.org/10.3390/ijerph19137795
Friedman SM, Alper H, de la Hoz RE, Osahan S, Farfel MR, Cone J. Change in Asthma Is Associated with Change in PTSD in World Trade Center Health Registrants, 2011 to 2016. International Journal of Environmental Research and Public Health. 2022; 19(13):7795. https://doi.org/10.3390/ijerph19137795
Chicago/Turabian StyleFriedman, Stephen M., Howard Alper, Rafael E. de la Hoz, Sukhminder Osahan, Mark R. Farfel, and James Cone. 2022. "Change in Asthma Is Associated with Change in PTSD in World Trade Center Health Registrants, 2011 to 2016" International Journal of Environmental Research and Public Health 19, no. 13: 7795. https://doi.org/10.3390/ijerph19137795