New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 30-30 47th Ave, Long Island City, NY, 11101, USA.
New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 30-30 47th Ave, Long Island City, NY, 11101, USA; Department of Epidemiology, Columbia University, Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA.
Drug Alcohol Depend. 2021 Apr 1;221:108656. doi: 10.1016/j.drugalcdep.2021.108656. Epub 2021 Feb 26.
We examined both the impact of 9/11-related exposures and repeated assessments of post-traumatic stress disorder (PTSD) on the risk of alcohol-related hospitalizations (ARH) among individuals exposed to the World Trade Center (WTC) disaster.
9/11-related exposures (witnessing traumatic events, physical injuries, or both) were measured at baseline and PTSD symptoms were assessed at four time points (2003-2016) using the PTSD Checklist-17 among 53,174 enrollees in the WTC Health Registry. ICD-9-CM and ICD-10-CM codes were used to identify ARHs (2003-2016) through linked administrative data. For the effect of 9/11-related exposures on ARH, Cox proportional-hazards regression estimated hazard ratios (HR) and 95 % confidence intervals (CI); for time-varying PTSD, extended Cox proportional-hazards regression was used. Models were adjusted fora priori confounders and stratified by enrollee group (uniformed rescue and recovery worker (RRW), non-uniformed RRW, and community members). Person-time was calculated from baseline or 9/12/2001 to the earliest of ARH, withdrawal, death, or end of follow-up (12/31/2016).
Across all 9/11-related exposures, community members and non-uniformed RRWs were at increased risk of ARHs; uniformed RRWs were not. In adjusted models, PTSD was associated with an increased risk of hospitalization across all groups [HR, (95 % CI): uniformed RRWs: 2.6, (1.9, 3.6); non-uniformed RRWs: 2.1, (1.7, 2.7); and community members: 2.6, (2.1, 3.2)].
Among certain enrollee groups, 9/11-related exposures are associated with an increased risk of ARH and that PTSD is strongly associated with ARHs among all enrollee groups. Findings may assist the clinical audience in improving screening and treatment.
我们研究了 9·11 相关暴露以及创伤后应激障碍（PTSD）的反复评估对暴露于世界贸易中心（WTC）灾难的个体发生酒精相关住院治疗（ARH）的风险的影响。
在 WTC 健康登记处的 53174 名参与者中，在基线时测量了与 9·11 相关的暴露（目睹创伤性事件、身体伤害或两者兼有），并使用 PTSD 清单-17 在 2003-2016 年的四个时间点评估 PTSD 症状。使用 ICD-9-CM 和 ICD-10-CM 代码通过链接的行政数据识别 ARH（2003-2016）。对于 9·11 相关暴露对 ARH 的影响，Cox 比例风险回归估计风险比（HR）和 95%置信区间（CI）；对于时变 PTSD，使用扩展 Cox 比例风险回归。模型根据预先确定的混杂因素和参与者群体（制服救援和恢复工人（RRW）、非制服 RRW 和社区成员）进行调整。自基线或 2001 年 9 月 12 日起计算人员时间，至 ARH、退出、死亡或随访结束（2016 年 12 月 31 日）的最早时间。
在所有与 9·11 相关的暴露中，社区成员和非制服 RRW 发生 ARH 的风险增加；制服 RRW 则不然。在调整后的模型中，PTSD 与所有组的住院风险增加相关[HR，（95%CI）：制服 RRW：2.6，（1.9，3.6）；非制服 RRW：2.1，（1.7，2.7）；社区成员：2.6，（2.1，3.2）]。
在某些参与者群体中，与 9·11 相关的暴露与 ARH 的风险增加相关，而 PTSD 与所有参与者群体的 ARH 密切相关。研究结果可能有助于临床医生改善筛查和治疗。
