Association of COVID-19 Severity with Comorbidities: Results from the World Trade Center Health Registry

Details

• Personal Author:
  Yung, Janette ; Kehm, Rebecca D. ; Li, Jiehui ; Cone, James E.
• Description:
  The impact of physical health conditions on coronavirus disease of 2019 (COVID-19) severity in World Trade Center disaster-exposed populations remains understudied. We examined the association of type, number and diagnosis time of pre-existing health conditions with COVID-19 severity, using the WTC Health Registry (WTCHR). We analyzed 3568 WTCHR enrollees with self-reported severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a 2021 follow-up survey. COVID-19 severity was measured by self-reported symptom duration (<2, 2-4, and >4 weeks) and hospitalization (hospitalized versus not). Pre-existing gastroesophageal reflux disease (GERD), respiratory conditions, cardiovascular conditions, and diabetes were self-reported and categorized into four groups (no diagnosis, post-9/11, pre-9/11, and undefinable). We used multinomial logistic regression and binary logistic regression to analyze the association of comorbidities with COVID-19 symptom duration and hospitalization, respectively, adjusting for post-traumatic stress disorder and demographic factors. Analysis was also conducted separately by enrollee type: rescue and recovery workers (RRW) vs. community members (non-RRW). Having all four health conditions post-9/11 was associated with longer symptom duration after SARS-CoV-2 infection (>4 weeks) among RRW (AOR: 2.66, 95% CI: 1.03-6.87). Reporting a post-9/11 respiratory condition was associated with an increased risk of being hospitalized among RRW and an increased risk of longer symptom duration (>4 weeks) among non-RRW. While post-9/11 diabetes was associated with an increased risk of longer symptom duration among RRW, post-9/11 GERD and pre-9/11 cardiovascular conditions were associated with an increased risk of longer symptom duration and being hospitalized among non-RRW, respectively. The impact of certain health conditions on COVID-19 severity varied across enrollee types and time of diagnosis. Given the lasting health impacts of 9/11-related exposures, targeted medical surveillance and proactive healthcare interventions are critical for mitigating the risk of severe COVID-19 illness in this population.
• Subjects:
  Chronic Disease Comorbidity COVID-19 September 11 Terrorist Attacks
• Keywords:
  Author Keywords: COVID-19 Severity; Hospitalization; World Trade Center Disaster; Pre-existing Physical Health Condition World Trade Center; WTC; COVID-19; Disaster Recovery; Health Programs; SARS-CoV-2; Rescue Workers; Gastroesophageal Reflux Disease; GERD; Medical Monitoring;
• ISSN:
  1660-4601
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Journal Article
• Place as Subject:
  New York ; New York City Region [OSHA]
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  WTCHP - World Trade Center Health Program
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  15 pdf pages
• Volume:
  23
• NIOSHTIC Number:
  nn:20071150
• Citation:
  Int J Environ Res Public Health 2026 Jan; 23(1):10
• Email:
  jcone@health.nyc.gov
• Federal Fiscal Year:
  2026
• Performing Organization:
  New York City Health/Mental Hygiene
• Peer Reviewed:
  True
• Start Date:
  20090430
• Source Full Name:
  International Journal of Environmental Research and Public Health
• End Date:
  20260630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:0ac3de0b01412f413dc9daa6ed159f702e99e43663ec2583ea7612331f8617b70525c178ad7b336042e35723268476b6ec3686847d0299c1896c4ad66226d0bf
• Download URL:
  https://stacks.cdc.gov/view/cdc/257917/cdc_257917_DS1.pdf
• File Type:
  [PDF - 828.18 KB ]