The Relationship between 9/11 Exposure, Systemic Autoimmune Disease, and Post-Traumatic Stress Disorder: A Mediational Analysis

Jennifer Brite, Sara A. Miller-Archie and James Cone
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Jennifer Brite: New York City Department of Health and Mental Hygiene, New York, NY 11101, USA
Sara A. Miller-Archie: New York City Department of Health and Mental Hygiene, New York, NY 11101, USA
James Cone: New York City Department of Health and Mental Hygiene, New York, NY 11101, USA

IJERPH, 2022, vol. 19, issue 11, 1-9

Abstract: The relationship between 9/11 exposure, systemic autoimmune disease (SAD) and mental health remains poorly understood. This report builds on a prior analysis of World Trade Center Health Registry data to determine whether 9/11 exposure is associated with higher risk of SAD, and if so, whether post-traumatic stress disorder (PTSD) is a mediating factor and whether the association varies by responder/community member status. The final analytic sample comprised 41,656 enrollees with 123 cases of SAD diagnosed post 9/11 through November 2017. SAD diagnosis was ascertained from survey responses and confirmed by medical record review or physician survey. Logistic regression models were constructed to determine the relationship between 9/11 exposure and PTSD and SAD. Causal mediation analysis was used to determine the mediational effect of PTSD. Each analysis was stratified by 9/11 responder/community member status. Rheumatoid arthritis ( n = 75) was the most frequent SAD, followed by Sjögren’s syndrome ( n = 23), systemic lupus erythematosus ( n = 20), myositis ( n = 9), mixed connective tissue disease ( n = 7), and scleroderma ( n = 4). In the pooled cohort, those with 9/11-related PTSD had 1.85 times the odds (95% CI: 1.21–2.78) of SAD. Among responders, those with dust cloud exposure had almost twice the odds of SAD, while among community members, those with 9/11-related PTSD had 2.5 times the odds of SAD (95% CI: 1.39, 4.39). PTSD was not a significant mediator. Although emerging evidence suggests 9/11 exposure may be associated with SAD, more research is needed, particularly using pooled data sources from other 9/11-exposed cohorts, to fully characterize this relationship.

Keywords: systemic autoimmune disease; mediation analysis; post-traumatic stress disorder (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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