title: Risk factors for and consequences of persistent lower respiratory symptoms among World Trade Center Health Registrants 10 years after the disaster.
abstract: OBJECTIVE
  The prevalence of persistent lower respiratory symptoms (LRS) among rescue/recovery workers, local area workers, residents and passers-by in the World Trade Center Health Registry (WTCHR) was analysed to identify associated factors and to measure its effect on quality of life (QoL) 10 years after 9/11/2001.
  
  
  METHODS
  This cross-sectional study included 18 913 adults who completed 3 WTCHR surveys (2003-2004 (Wave 1 (W1)), 2006-2007 (Wave 2 (W2)) and 2011-2012 (Wave 3 (W3)). LRS were defined as self-reported cough, wheeze, dyspnoea or inhaler use in the 30 days before survey. The prevalence of three LRS outcomes: LRS at W1; LRS at W1 and W2; and LRS at W1, W2 and W3 (persistent LRS) was compared with no LRS on WTC exposure and probable mental health conditions determined by standard screening tests. Diminished physical and mental health QoL measures were examined as potential LRS outcomes, using multivariable logistic and Poisson regression.
  
  
  RESULTS
  Of the 4 outcomes, persistent LRS was reported by 14.7%. Adjusted ORs for disaster exposure, probable post-traumatic stress disorder (PTSD) at W2, lacking college education and obesity were incrementally higher moving from LRS at W1, LRS at W1 and W2 to persistent LRS. Half of those with persistent LRS were comorbid for probable PTSD, depression or generalised anxiety disorder. Enrollees with persistent LRS were 3 times more likely to report poor physical health and ∼ 50% more likely to report poor mental health than the no LRS group.
  
  
  CONCLUSIONS
  LRS, accompanied by mental health conditions and decreased QoL, have persisted for at least 10 years after 9/11/2001. Affected adults require continuing surveillance and treatment.
authors.affiliation: New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Friedman
authors.affiliation: New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Farfel
authors.affiliation: New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA.
authors.forename: Carey
authors.initials: C
authors.lastname: Maslow
authors.affiliation: New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA.
authors.forename: Hannah T
authors.initials: HT
authors.lastname: Jordan
authors.affiliation: New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA.
authors.forename: Jiehui
authors.initials: J
authors.lastname: Li
authors.affiliation: New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Alper
authors.affiliation: New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Cone
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Stellman
authors.affiliation: New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Brackbill
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001249:Asthma / Q000453:epidemiology; D003371:Cough / Q000453:epidemiology / Q000209:etiology*; D003430:Cross-Sectional Studies; D004190:Disasters; D004417:Dyspnea / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000209:etiology; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D009519:New York City / Q000453:epidemiology; D009784:Occupational Diseases / Q000453:epidemiology / Q000209:etiology*; D011788:Quality of Life / Q000523:psychology*; D012042:Registries; D012044:Regression Analysis; D018635:Rescue Work; D012135:Respiratory Sounds; D012137:Respiratory System; D012307:Risk Factors; D047851:September 11 Terrorist Attacks / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology*; D055815:Young Adult