Asthma following the 2001 World Trade Center attack - reply

Details

• Personal Author:
  Brackbill RM ; Hadler JL ; Thorpe LE
• Description:
  The limitations in our study that Dr Miller notes are common to any study in which participation is voluntary and health conditions are self-reported. The most serious are selective self-reporting among exposed persons and oversurveillance by local physicians; both limitations were discussed in the article and in previous studies from our group. While these potential biases undoubtedly exist, we believe they do not fully explain our main conclusions. We observed strong associations between asthma and intense dust cloud exposure in all groups, regardless of how they were recruited into the registry, whether by prior identification through lists or by self-identification. Significant exposure-response relationships were observed for exposure metrics unique to each group (length of time worked, amount of dust in the home or office), including among nonoccupationally exposed groups not being closely followed in other World Trade Center special studies. Furthermore, we had previously reported that respiratory protection was associated with a lower risk of asthma among workers on the pile. We do not agree that extrapolation from asthma rates in our study to the 409 000 estimated exposed persons is inappropriate. It is true that some of the most highly exposed and larger groups (eg, firefighters and police) contributed to a higher prevalence of September 11-related asthma among self-identified World Trade Center Health Registry enrollees. However, prevalence was elevated in self- as well as listidentified enrollees, and our estimation methods for burden of asthma in the full population of 409 000 exposed persons took these differential prevalence levels into account. Miller is correct that we may have underestimated the background rate of asthma in urban areas, including New York City, using national data from the mid-1990s. Nonetheless, we obtained a rate of 1.3% for the 3-year period 2004- 2006 among persons without implicated September 11- related exposures and without respiratory symptoms at the time of enrollment in the registry, a rate markedly lower than the 4.7% rate in persons with respiratory symptoms at the time of their enrollment. The comparison with national data was to demonstrate that the 1.3% 3-year rate is within the crude range of what might be expected as a background rate in the absence of the World Trade Center attack. [Description provided by NIOSH]
• Subjects:
  Asthma Asthma, Occupational Dust Lung Men Occupational Health Respiratory System Respiratory Tract Diseases Risk Assessment Risk Factors Safety Women

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• Keywords:
  Bronchial-asthma Dust-exposure Dust-particles Dusts Exposure-levels Humans Pulmonary-function Pulmonary-system Pulmonary-system-disorders Respiration Respiratory-rate Respiratory-system-disorders Risk-factors

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• ISSN:
  0098-7484
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Journal Article
• Place as Subject:
  Georgia ; New York ; OSHA Region 2 ; OSHA Region 4
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  302
• Issue:
  21
• NIOSHTIC Number:
  nn:20046620
• Citation:
  JAMA 2009 Dec; 302(21):2319-2320
• Contact Point Address:
  Lorna E. Thorpe, PhD, New York City Department of Health and Mental Hygiene, New York, New York
• Email:
  lthorpe@health.nyc.gov
• Federal Fiscal Year:
  2010
• Performing Organization:
  New York City Health/Mental Hygiene
• Peer Reviewed:
  False
• Start Date:
  20030430
• Source Full Name:
  Journal of the American Medical Association
• End Date:
  20090429
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:3dfc83766dd47914de319189affe5ee595789dbb76d0e9761c64042a5a74361d99d900c9431986d53168eb75963b6a5080a64329afdb902eb4493d966f82e041
• Download URL:
  https://stacks.cdc.gov/view/cdc/201622/cdc_201622_DS1.pdf
• File Type:
  [PDF - 49.61 KB ]