title: Comorbid trends in World Trade Center cough syndrome and probable posttraumatic stress disorder in firefighters.
abstract: BACKGROUND
  We describe the relationship between World Trade Center (WTC) cough syndrome symptoms, pulmonary function, and symptoms consistent with probable posttraumatic stress disorder (PTSD) in WTC-exposed firefighters in the first year post-September 11, 2001 (baseline), and 3 to 4 years later (follow-up).
  
  
  METHODS
  Five thousand three hundred sixty-three firefighters completed pulmonary function tests (PFTs) and questionnaires at both times. Relationships among WTC cough syndrome, probable PTSD, and PFTs were analyzed using simple and multivariable models. We also examined the effects of cofactors, including WTC exposure.
  
  
  RESULTS
  WTC cough syndrome was found in 1,561 firefighters (29.1%) at baseline and 1,186 (22.1%) at follow-up, including 559 with delayed onset (present only at follow-up). Probable PTSD was found in 458 firefighters (8.5%) at baseline and 548 (10.2%) at follow-up, including 343 with delayed onset. Baseline PTSD symptom counts and probable PTSD were associated with WTC cough syndrome at baseline, at follow-up, and in those with delayed-onset WTC cough syndrome. Similarly, WTC cough syndrome symptom counts and WTC cough syndrome at baseline were associated with probable PTSD at baseline, at follow-up, and in those with delayed-onset probable PTSD. WTC arrival time and work duration were cofactors of both outcomes. A small but consistent association existed between pulmonary function and WTC cough syndrome, but none with PTSD.
  
  
  CONCLUSIONS
  The study showed a moderate association between WTC cough syndrome and probable PTSD. The presence of one contributed to the likelihood of the other, even after adjustment for shared cofactors such as WTC exposure.
authors.affiliation: Montefiore Medical Center, Bronx; Fire Department of the City of New York, Bureau of Health Services, Brooklyn, NY.
authors.forename: Justin K
authors.initials: JK
authors.lastname: Niles
authors.affiliation: Montefiore Medical Center, Bronx; Fire Department of the City of New York, Bureau of Health Services, Brooklyn, NY. Electronic address: webberm@fdny.nyc.gov.
authors.forename: Mayris P
authors.initials: MP
authors.lastname: Webber
authors.affiliation: Fire Department of the City of New York, Bureau of Health Services, Brooklyn, NY.
authors.forename: Jackson
authors.initials: J
authors.lastname: Gustave
authors.affiliation: Albert Einstein College of Medicine, Bronx.
authors.forename: Hillel W
authors.initials: HW
authors.lastname: Cohen
authors.affiliation: Montefiore Medical Center, Bronx.
authors.forename: Rachel
authors.initials: R
authors.lastname: Zeig-Owens
authors.affiliation: Fire Department of the City of New York, Bureau of Health Services, Brooklyn, NY.
authors.forename: Kerry J
authors.initials: KJ
authors.lastname: Kelly
authors.affiliation: Fire Department of the City of New York, Bureau of Health Services, Brooklyn, NY.
authors.forename: Lara
authors.initials: L
authors.lastname: Glass
authors.affiliation: Montefiore Medical Center, Bronx; Fire Department of the City of New York, Bureau of Health Services, Brooklyn, NY.
authors.forename: David J
authors.initials: DJ
authors.lastname: Prezant
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D003371:Cough / Q000453:epidemiology* / Q000209:etiology*; D003430:Cross-Sectional Studies; D005260:Female; D061388:Firefighters; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D016273:Occupational Exposure / Q000009:adverse effects*; D012044:Regression Analysis; D012129:Respiratory Function Tests; D012307:Risk Factors; D047851:September 11 Terrorist Attacks; D018709:Statistics, Nonparametric; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000209:etiology*; D011795:Surveys and Questionnaires; D013577:Syndrome