TY - JOUR
T1 - Standardized morbidity ratios of four chronic health conditions among World Trade Center responders
T2 - Comparison to the National Health Interview Survey
AU - Kim, Hyun
AU - Kriebel, David
AU - Liu, Bian
AU - Baron, Sherrry
AU - Mongin, Steven
AU - Baidwan, Navneet K.
AU - Moline, Jacqueline M.
N1 - Publisher Copyright:
© 2018 Wiley Periodicals, Inc.
PY - 2018/5
Y1 - 2018/5
N2 - Purpose: We conducted external comparisons for the prevalence of asthma, hypertension, diabetes, and cancer among World Trade Center (WTC) general responders using the National Health Interview Survey (NHIS) as the reference, along with internal comparisons for the incidence of asthma. Methods: Standardized Morbidity Ratios (SMRs) were calculated for the prevalence of the health conditions, and risk ratios (RRs) for asthma incidence. Results: Relative to the NHIS, asthma prevalence was in excess in responders over the study years (age-adjusted SMRs = 1.3-2.8). Hypertension prevalence began to exceed expected from 2006 while diabetes was lower than expected. An upward trend towards excess cancer prevalence was observed. Internal comparisons showed elevated asthma incidence among protective service and utility workers compared to construction workers; while those who arrived at the WTC site in the morning of 9/11 had a lower asthma risk than those who arrived in the afternoon. Conclusions: The use of NHIS data as a reference population demonstrates and reconfirms several important patterns of excess risk in WTC responders. External comparisons are an alternative for disaster cohorts without an established comparison group.
AB - Purpose: We conducted external comparisons for the prevalence of asthma, hypertension, diabetes, and cancer among World Trade Center (WTC) general responders using the National Health Interview Survey (NHIS) as the reference, along with internal comparisons for the incidence of asthma. Methods: Standardized Morbidity Ratios (SMRs) were calculated for the prevalence of the health conditions, and risk ratios (RRs) for asthma incidence. Results: Relative to the NHIS, asthma prevalence was in excess in responders over the study years (age-adjusted SMRs = 1.3-2.8). Hypertension prevalence began to exceed expected from 2006 while diabetes was lower than expected. An upward trend towards excess cancer prevalence was observed. Internal comparisons showed elevated asthma incidence among protective service and utility workers compared to construction workers; while those who arrived at the WTC site in the morning of 9/11 had a lower asthma risk than those who arrived in the afternoon. Conclusions: The use of NHIS data as a reference population demonstrates and reconfirms several important patterns of excess risk in WTC responders. External comparisons are an alternative for disaster cohorts without an established comparison group.
KW - World Trade Center responders
KW - chronic diseases
KW - national health interview survey
KW - standardized morbidity ratios
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U2 - 10.1002/ajim.22825
DO - 10.1002/ajim.22825
M3 - Article
C2 - 29508426
AN - SCOPUS:85043297650
SN - 0271-3586
VL - 61
SP - 413
EP - 421
JO - American Journal of Industrial Medicine
JF - American Journal of Industrial Medicine
IS - 5
ER -