Aerodigestive Disease Overlap: Defining the Cohort for an Observational Non-Invasive Biomarker Study in World Trade Center Exposed First Responders

Details

• Personal Author:
  Grunig G ; Javed U ; Kwon S ; Li Y ; Liu M ; Nolan A ; Podury S ; Prezant D ; Schwartz T ; Veerappan A ; Zeig-Owens R
• Description:
  RATIONALE: World Trade Center particulate matter (WTC-PM) exposure is associated with airway hyperreactivity (AHR), gastroesophageal reflux disease (GERD) and Barrett's Esophagus (BE). WTC-exposed firefighters with obstructive airways disease had a three times higher risk of developing GERD. GERD is a well-known independent risk factor in the development of the metaplastic changes of BE which can lead to adenocarcinoma. Our earlier pilot findings have shown that short-acting beta agonists (SABA) usage was significantly increased in participants with GERD. To understand the aerodigestive disease overlap we designed Biomarkers of Airway Disease, Barrett's and Underdiagnosed Reflux Noninvasively (BAD-BURN). We will validate biomarkers of GERD and BE in a randomly selected subcohort, and phenotype subgroups with aerodigestive disease to identify noninvasive biomarkers of under-diagnosis/treatment efficacy to inform future biologically plausible therapies to improve care. METHODS: Fire Department of New York City-Electronic Medical Record (FDNY-EMR) on N=14,976 WTC-exposed and initially enrolled in the WTC Health Program, Figure 1, was reviewed for GERD/BE diagnoses. AHR was defined by either a methacholine challenge (PC20<16 mg/mL) or a positive bronchodilator response. The following inclusion criteria was applied: i. currently enrolled in WTC-HP; ii. Consented; iii. Normal Pre 9/11 FEV1 iv. Reliable NHANES data. A random 20% of the baseline cohort (N=898) was obtained as a subcohort for nested case cohort studies, Figure 1. Of the randomly selected subcohort of 20% (N=898), N=868 subjects were available for further study. Clinicaltrials.gov Identifier: NCT05216133. RESULTS: We identified subjects with GERD/ Barrett's (N=468), BE (N=89), AHR (N=43), AHR/GERD aerodigestive overlap population of (N=31), and non-GERD/AHR (N=327) in WTC-exposed first responders. Smoking was not associated with increased risk of GERD (p=0.377). Arrival time was associated with GERD (Pearson Chi-square, p=0.025). Furthermore, use of short acting beta agonists (SABA) was associated with GERD and Barrett's (Pearson Chi square, p<0.001 and 0.003 respectively). CONCLUSIONS: We identified a potential subcohort of individuals for recruiting into BADBURN. Previously identified biomarkers to differentiate GERD and AHR populations will be validated and the subset of cohort with pulmonary disease and GERD will be phenotyped. Representative cohort will be contacted for recruitment into the BADBURN study to investigate non-invasive biomarkers of GERD and Barrett's, such as exhaled biomarkers and serum OMICs. [Description provided by NIOSH]
• Subjects:
  Biomarkers Cohort Studies Emergency Responders Occupational Health Safety September 11 Terrorist Attacks
• Keywords:
  Cohort Studies First Responders Gastroesophageal Reflux Disease GERD World Trade Center WTC
• ISSN:
  1073-449X
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Abstract or Summary
• Place as Subject:
  New York ; OSHA Region 2
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  207
• NIOSHTIC Number:
  nn:20070826
• Citation:
  Am J Respir Crit Care Med 2023 May; 207(Abstract Issue):A1841
• Email:
  urooj.javed@nyulangone.org
• Federal Fiscal Year:
  2023
• Performing Organization:
  New York University School of Medicine
• Peer Reviewed:
  False
• Start Date:
  20210701
• Source Full Name:
  American Journal of Respiratory and Critical Care Medicine
• Supplement:
  Abstract Issue
• End Date:
  20260630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:b4bab3dbab23497995b0a84e2efae8a8b4e3e4c6415e242de3c815744e49a2d828bb57b9531b932b9e16364df977fb7cbe670b5ceef65aca89562f64ca29122a
• Download URL:
  https://stacks.cdc.gov/view/cdc/208975/cdc_208975_DS1.pdf
• File Type:
  [PDF - 93.82 KB ]