与 2001 年 9 月 11 日世界贸易中心灾难和创伤后应激障碍相关的心血管疾病住院治疗。
Cardiovascular disease hospitalizations in relation to exposure to the September 11, 2001 World Trade Center disaster and posttraumatic stress disorder.
机构信息
World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Queens, NY.
出版信息
J Am Heart Assoc. 2013 Oct 24;2(5):e000431. doi: 10.1161/JAHA.113.000431.
BACKGROUND
A cohort study found that 9/11-related environmental exposures and posttraumatic stress disorder increased self-reported cardiovascular disease risk. We attempted to replicate these findings using objectively defined cardiovascular disease hospitalizations in the same cohort.
METHODS AND RESULTS
Data for adult World Trade Center Health Registry enrollees residing in New York State on enrollment and no cardiovascular disease history (n = 46,346) were linked to a New York State hospital discharge-reporting system. Follow-up began at Registry enrollment (2003-2004) and ended at the first cerebrovascular or heart disease (HD) hospitalization, death, or December 31, 2010, whichever was earliest. We used proportional hazards models to estimate adjusted hazard ratios (AHRs) for HD (n = 1151) and cerebrovascular disease (n = 284) hospitalization during 302,742 person-years of observation (mean follow-up, 6.5 years per person), accounting for other factors including age, race/ethnicity, smoking, and diabetes. An elevated risk of HD hospitalization was observed among women (AHR 1.32, 95% CI 1.01 to 1.71) but not men (AHR 1.16, 95% CI 0.97 to 1.40) with posttraumatic stress disorder at enrollment. A high overall level of World Trade Center rescue and recovery-related exposure was associated with an elevated HD hospitalization risk in men (AHR 1.82, 95% CI 1.06 to 3.13; P for trend = 0.05), but findings in women were inconclusive (AHR 3.29, 95% CI 0.85 to 12.69; P for trend = 0.09). Similar associations were observed specifically with coronary artery disease hospitalization. Posttraumatic stress disorder increased the cerebrovascular disease hospitalization risk in men but not in women.
CONCLUSIONS
9/11-related exposures and posttraumatic stress disorder appeared to increase the risk of subsequent hospitalization for HD and cerebrovascular disease. This is consistent with findings based on self-reported outcomes.
背景
一项队列研究发现，9/11 相关环境暴露和创伤后应激障碍会增加自我报告的心血管疾病风险。我们试图在同一队列中使用客观定义的心血管疾病住院数据来复制这些发现。
方法和结果
数据来自居住在纽约州的成年世界贸易中心健康登记处参与者（n=46346），他们在登记时没有心血管疾病史。随访从登记（2003-2004 年）开始，以首次脑血管或心脏病（HD）住院、死亡或 2010 年 12 月 31 日（以最早者为准）结束。我们使用比例风险模型来估计调整后的危险比（AHR），用于在 302742 人年的观察期（平均随访时间为每人 6.5 年）内发生的 HD（n=1151）和脑血管疾病（n=284）住院治疗，同时考虑了其他因素，包括年龄、种族/族裔、吸烟和糖尿病。在登记时有创伤后应激障碍的女性（AHR 1.32，95%CI 1.01 至 1.71），而男性（AHR 1.16，95%CI 0.97 至 1.40）则观察到 HD 住院风险升高。在世贸中心救援和恢复相关暴露水平较高的情况下，男性的 HD 住院风险升高（AHR 1.82，95%CI 1.06 至 3.13；P 趋势=0.05），但女性的结果不确定（AHR 3.29，95%CI 0.85 至 12.69；P 趋势=0.09）。与冠状动脉疾病住院相关的关联也类似。创伤后应激障碍增加了男性而非女性的脑血管疾病住院风险。
结论
9/11 相关暴露和创伤后应激障碍似乎会增加随后发生 HD 和脑血管疾病住院的风险。这与基于自我报告结果的发现一致。
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