title: The upper respiratory pyramid: early factors and later treatment utilization in World Trade Center exposed firefighters.
abstract: BACKGROUND
  We investigated early post 9/11 factors that could predict rhinosinusitis healthcare utilization costs up to 11 years later in 8,079 World Trade Center-exposed rescue/recovery workers.
  
  
  METHODS
  We used bivariate and multivariate analytic techniques to investigate utilization outcomes; we also used a pyramid framework to describe rhinosinusitis healthcare groups at early (by 9/11/2005) and late (by 9/11/2012) time points.
  
  
  RESULTS
  Multivariate models showed that pre-9/11/2005 chronic rhinosinusitis diagnoses and nasal symptoms predicted final year healthcare utilization outcomes more than a decade after WTC exposure. The relative proportion of workers on each pyramid level changed significantly during the study period.
  
  
  CONCLUSIONS
  Diagnoses of chronic rhinosinusitis within 4 years of a major inhalation event only partially explain future healthcare utilization. Exposure intensity, early symptoms and other factors must also be considered when anticipating future healthcare needs.
authors.affiliation: Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York.
authors.forename: Justin K
authors.initials: JK
authors.lastname: Niles
authors.forename: Mayris P
authors.initials: MP
authors.lastname: Webber
authors.forename: Xiaoxue
authors.initials: X
authors.lastname: Liu
authors.forename: Rachel
authors.initials: R
authors.lastname: Zeig-Owens
authors.forename: Charles B
authors.initials: CB
authors.lastname: Hall
authors.forename: Hillel W
authors.initials: HW
authors.lastname: Cohen
authors.forename: Michelle S
authors.initials: MS
authors.lastname: Glaser
authors.forename: Jessica
authors.initials: J
authors.lastname: Weakley
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Schwartz
authors.forename: Michael D
authors.initials: MD
authors.lastname: Weiden
authors.forename: Anna
authors.initials: A
authors.lastname: Nolan
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Aldrich
authors.forename: Lara
authors.initials: L
authors.lastname: Glass
authors.forename: Kerry J
authors.initials: KJ
authors.lastname: Kelly
authors.forename: David J
authors.initials: DJ
authors.lastname: Prezant
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002908:Chronic Disease; D016527:Drug Costs / Q000706:statistics & numerical data; D061388:Firefighters; D005544:Forecasting; D006296:Health Services / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006685:Hoarseness / Q000209:etiology; D006801:Humans; D019570:Inhalation Exposure; D007828:Laryngoscopy / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction / Q000209:etiology; D020380:Needs Assessment; D009519:New York City; D016273:Occupational Exposure / Q000009:adverse effects*; D010036:Otolaryngology / Q000706:statistics & numerical data; D013517:Otorhinolaryngologic Surgical Procedures / Q000706:statistics & numerical data; D010612:Pharyngitis / Q000209:etiology; D018635:Rescue Work; D012220:Rhinitis / Q000150:complications / Q000191:economics / Q000628:therapy; D047851:September 11 Terrorist Attacks; D012852:Sinusitis / Q000150:complications / Q000191:economics / Q000628:therapy; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: chronic rhinosinusitis; firefighters; sinus symptoms; treatment outcomes; world trade center