Steven Stellman - Cardiovascular disease hospitalizations in relation to exposure to the September 11, 2001 World Trade Center disaster and posttraumatic stress disorder

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      Jordan, H. T., Stellman, S. D., Morabia, A., Miller-Archie, S.   A., Alper, H., Laskaris, Z., Brackbill, R. M., Cone, J. E.   2 (5) e000431-

      Abstract: 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.

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