title: Posttraumatic stress disorder and new-onset diabetes among adult survivors of the World Trade Center disaster.
abstract: OBJECTIVE
  To explore the temporal relationship between 9/11-related posttraumatic stress disorder (PTSD) and new-onset diabetes in World Trade Center (WTC) survivors up to 11 years after the attack in 2001.
  
  
  METHODS
  Three waves of surveys (conducted from 2003 to 2012) from the WTC Health Registry cohort collected data on physical and mental health status, sociodemographic characteristics, and 9/11-related exposures. Diabetes was defined as self-reported, physician-diagnosed diabetes reported after enrollment. After excluding prevalent cases, there were 36,899 eligible adult enrollees. Logistic regression and generalized multilevel growth models were used to assess the association between PTSD measured at enrollment and subsequent diabetes.
  
  
  RESULTS
  We identified 2143 cases of diabetes. After adjustment, we observed a significant association between PTSD and diabetes in the logistic model [adjusted odds ratio (AOR) 1.28, 95% confidence interval (CI) 1.14-1.44]. Results from the growth model were similar (AOR 1.37, 95% CI 1.23-1.52).
  
  
  CONCLUSIONS
  This exploratory study found that PTSD, a common 9/11-related health outcome, was a risk factor for self-reported diabetes. Clinicians treating survivors of both the WTC attacks and other disasters should be aware that diabetes may be a long-term consequence.
authors.affiliation: World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA. Electronic address: smille12@health.nyc.gov.
authors.forename: Sara A
authors.initials: SA
authors.lastname: Miller-Archie
authors.affiliation: World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA.
authors.forename: Hannah T
authors.initials: HT
authors.lastname: Jordan
authors.affiliation: Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA.
authors.forename: Ryan R
authors.initials: RR
authors.lastname: Ruff
authors.affiliation: Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA.
authors.forename: Shadi
authors.initials: S
authors.lastname: Chamany
authors.affiliation: World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Cone
authors.affiliation: World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Brackbill
authors.affiliation: World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA.
authors.forename: Joanne
authors.initials: J
authors.lastname: Kong
authors.affiliation: World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA.
authors.forename: Felix
authors.initials: F
authors.lastname: Ortega
authors.affiliation: World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Stellman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D016017:Odds Ratio; D012042:Registries; D012307:Risk Factors; D047851:September 11 Terrorist Attacks / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000150:complications*; D017741:Survivors / Q000523:psychology*; D055815:Young Adult
keywords: Diabetes; Disaster registry; Posttraumatic stress disorder; Prospective cohort; World Trade Center