Blood eosinophils and World Trade Center exposure predict surgery in chronic rhinosinusitis: a 13.5-year longitudinal study

Details

• Personal Author:
  Aldrich TK ; Cohen HW ; Hall CB ; Kwon S ; Nolan A ; Prezant D ; Putman B ; Schwartz T ; Weakley J ; Webber MP ; Weiden WD ; Zeig-Owens R
• Description:
  Background: The World Trade Center (WTC) collapse generated caustic airborne particulates causing chronic rhinosinusitis CCRS) in exposed fire department of New York (FDNY) firefighters. Surgery occurred when patients' symptoms remained uncontrolled despite medical management. Methods: We assessed predictors of CRS-surgery in 8,227 fire fighters with WTC-exposure between 9/11/2001 (9/ 11) and 9/25/2001, including WTC-site arrival time, months of rescue/recovery work, and blood eosinophil concentration between 9/ 11 and 3/10/2003 using Cox proportional hazard models. Results: Between 9/ 11 and 3/ 10/ 2015 CRS and CRS-surgery rates were 3-4 and 0-47 cases per 100 person years, respectively. Medically managed CRS (CRS no-surgery) was associated with arriving at the WTC site 9/11 or 9/12/2001, hazard ratio (HR) 1.33 (95% confidence interval (CI) 1.11 to 1.44; P<0.001). Surprisingly, compared with one month of work at the WTC site, >6 months work duration was protective (HR 0.83 Cl 0.74-0.93 P<0.001). CRS no-surgery was not significantly associated with blood eosinophils in the cohort's top quartile, (cells /ml 1.090.99· 1.19 p=0.08). CRS-surgery patients had higher blood eosinophil concentration than the study cohort (median 184 cells/ml interquartile range (lQR) 116 to 285 vs.160 cells/ml IQR 106 to 240; P <0·001 ), lncreased CRS-surgery risk was associated with blood eosinophils >240 cells/ml, HR 1..50 (95% Cl 1.24 to 1.81; P <0·001); arriving at the site 9/11 or 9/12/2001, HR 1.45 (95% CI 1.05 to 2.01: P=0.02); and working >6 months at the WTC-site. HR 1.48 (95% CI 1.14 to 1.93: P<0-01). There was a significant synergistic interaction between earlier arrival time and working 6 or more months at the site (P=0.034). Conclusions: In WTC-exposed FDNY firefighters, the risk profile of patients with medically managed CRS differs from the profile of those who received CRS surgery. Blood eosinophil >240 cells/ml identified a vulnerable group with higher risk for irritant-associated CRS-surgery, particularly in those with both intense acute and prolonged chronic irritant exposures. [Description provided by NIOSH]
• Subjects:
  Air Pollutants, Occupational Blood Emergency Responders Firefighters Occupational Health Particulate Matter Safety September 11 Terrorist Attacks
• Keywords:
  Airborne Particles Airborne Particulates Fire Fighters Hazards Rescue Workers Statistical Analysis Surgery World Trade Center WTC
• ISSN:
  1073-449X
• Document Type:
  Text
• Funding:
  Cooperative Agreement ; Contract
• Genre:
  Abstract or Summary
• Place as Subject:
  California ; New York ; OSHA Region 2 ; OSHA Region 9
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  193
• NIOSHTIC Number:
  nn:20048429
• Citation:
  Am J Respir Crit Care Med 2016 May; 193(Abstract Issue):A5443
• Contact Point Address:
  Michael D. Weiden, NYU School of Medicine, New York, NY
• Email:
  weidem01@nyumc.org
• Federal Fiscal Year:
  2016
• Performing Organization:
  New York University School of Medicine
• Peer Reviewed:
  False
• Start Date:
  20140701
• Source Full Name:
  American Journal of Respiratory and Critical Care Medicine
• Supplement:
  Abstract Issue
• End Date:
  20170630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:c6c4048aa0c6983334c95f009c836b29ee90ab3ca7b991854447547a01ed99441ba4b4c98ee604be21165ed8852d919ccfb89dfd9889e9678715a65feb0d6d44
• Download URL:
  https://stacks.cdc.gov/view/cdc/203184/cdc_203184_DS1.pdf
• File Type:
  [PDF - 18.10 KB ]