title: Effect of asthma and PTSD on persistence and onset of gastroesophageal reflux symptoms among adults exposed to the September 11, 2001, terrorist attacks.
abstract: Little is known about the direction of causality among asthma, posttraumatic stress disorder (PTSD), and onset of gastroesophageal reflux symptoms (GERS) after exposure to the 9/11/2001 World Trade Center (WTC) disaster.
  
  
  
  Using data from the WTC Health Registry, we investigated the effects of early diagnosed post-9/11 asthma and PTSD on the late onset and persistence of GERS using log-binomial regression, and examined whether PTSD mediated the asthma-GERS association using structural equation modeling.
  
  
  
  Of 29,406 enrollees, 23% reported GERS at follow-up in 2011-2012. Early post-9/11 asthma and PTSD were each independently associated with both the persistence of GERS that was present at baseline and the development of GERS in persons without a prior history. PTSD mediated the association between early post-9/11 asthma and late-onset GERS.
  
  
  
  Clinicians should assess patients with post-9/11 GERS for comorbid asthma and PTSD, and plan medical care for these conditions in an integrated fashion. Am. J. Ind. Med. 59:805-814, 2016. © 2016 Wiley Periodicals, Inc.
authors: New York City Department of Health and Mental Hygiene, New York, New York.
authors: Jiehui
authors: J
authors: Li
authors: New York City Department of Health and Mental Hygiene, New York, New York.
authors: Robert M
authors: RM
authors: Brackbill
authors: New York City Department of Health and Mental Hygiene, New York, New York.
authors: Hannah T
authors: HT
authors: Jordan
authors: New York City Department of Health and Mental Hygiene, New York, New York.
authors: James E
authors: JE
authors: Cone
authors: New York City Department of Health and Mental Hygiene, New York, New York.
authors: Mark R
authors: MR
authors: Farfel
authors: New York City Department of Health and Mental Hygiene, New York, New York.|Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
authors: Steven D
authors: SD
authors: Stellman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001249:Asthma / Q000150:complications / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D009784:Occupational Diseases / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D012042:Registries; D018635:Rescue Work / Q000706:statistics & numerical data*; D047851:September 11 Terrorist Attacks; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000453:epidemiology*; D013997:Time Factors; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: PTSD; World Trade Center; asthma; gastroesophageal reflux; terrorist attacks