title: Estimating the time interval between exposure to the World Trade Center disaster and incident diagnoses of obstructive airway disease.
abstract: Respiratory disorders are associated with occupational and environmental exposures. The latency period between exposure and disease onset remains uncertain. The World Trade Center (WTC) disaster presents a unique opportunity to describe the latency period for obstructive airway disease (OAD) diagnoses. This prospective cohort study of New York City firefighters compared the timing and incidence of physician-diagnosed OAD relative to WTC exposure. Exposure was categorized by WTC arrival time as high (on the morning of September 11, 2001), moderate (after noon on September 11, 2001, or on September 12, 2001), or low (during September 13-24, 2001). We modeled relative rates and 95% confidence intervals of OAD incidence by exposure over the first 5 years after September 11, 2001, estimating the times of change in the relative rate with change point models. We observed a change point at 15 months after September 11, 2001. Before 15 months, the relative rate for the high- versus low-exposure group was 3.96 (95% confidence interval: 2.51, 6.26) and thereafter, it was 1.76 (95% confidence interval: 1.26, 2.46). Incident OAD was associated with WTC exposure for at least 5 years after September 11, 2001. There were higher rates of new-onset OAD among the high-exposure group during the first 15 months and, to a lesser extent, throughout follow-up. This difference in relative rate by exposure occurred despite full and free access to health care for all WTC-exposed firefighters, demonstrating the persistence of WTC-associated OAD risk.
authors: Michelle S
authors: MS
authors: Glaser
authors: Mayris P
authors: MP
authors: Webber
authors: Rachel
authors: R
authors: Zeig-Owens
authors: Jessica
authors: J
authors: Weakley
authors: Xiaoxue
authors: X
authors: Liu
authors: Fen
authors: F
authors: Ye
authors: Hillel W
authors: HW
authors: Cohen
authors: Thomas K
authors: TK
authors: Aldrich
authors: Kerry J
authors: KJ
authors: Kelly
authors: Anna
authors: A
authors: Nolan
authors: Michael D
authors: MD
authors: Weiden
authors: David J
authors: DJ
authors: Prezant
authors: Charles B
authors: CB
authors: Hall
mesh_terms: D000328:Adult; D061388:Firefighters / Q000706:statistics & numerical data*; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D016273:Occupational Exposure / Q000009:adverse effects* / Q000032:analysis; D047851:September 11 Terrorist Attacks; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: World Trade Center; change point model; latency; obstructive airway disease; occupational exposure; rescue/recovery workers