摘要：Objectives. We have described the epidemiology of co-occurring lower respiratory symptoms (LRS) and probable posttraumatic stress disorder (PTSD) 5 to 6 years after exposure to the 9/11 disaster. Methods. We analyzed residents, office workers, and passersby (n = 16 363) in the World Trade Center Health Registry. Using multivariable logistic regression, we examined patterns of reported respiratory symptoms, treatment sought for symptoms, diagnosed respiratory conditions, mental health comorbidities, quality of life, and unmet health care needs in relation to comorbidity. Results. Among individuals with either LRS or PTSD, 24.6% had both conditions. The odds of comorbidity was significantly higher among those with more severe 9/11 exposures. Independent of 9/11 exposures, participants with LRS had 4 times the odds of those without it of meeting criteria for PTSD, and those with PTSD had 4 times the odds of those without it of meeting criteria for LRS. Participants with comorbidity had worse quality of life and more unmet mental health care needs than did all other outcome groups. Conclusions. Respiratory and mental illness are closely linked in individuals exposed to 9/11 and should be considered jointly in public health outreach and treatment programs. Respiratory illness 1–9 and posttraumatic stress disorder (PTSD) 6,7,9–12 are 2 of the most commonly reported health outcomes related to the September 11, 2001 terrorist attacks on the New York City World Trade Center (WTC). Only recently, however, have studies addressed their co-occurrence among 9/11 disaster–exposed individuals. 13 Comorbidity is increasingly seen as the norm rather than the exception in primary care settings 14 and can significantly affect diagnosis, treatment, and prognosis of a given disease, 15 including respiratory illness. 16–20 Co-occurring physical illness may also affect the diagnosis, treatment, and prognosis of PTSD. Therefore, understanding the epidemiology of co-occurring respiratory illness and PTSD can have important implications for ongoing public health outreach and treatment efforts aimed at individuals exposed to the 9/11 disaster as well as individuals in the general population with respiratory or mental illness. The burden of co-occurring respiratory illness and PTSD among individuals directly exposed to the 9/11 disaster is likely to be high because of shared 9/11-related risk factors 6 and because of the close, reciprocal association between PTSD and physical health. Individuals with PTSD are at greater risk for long-term physical illness 20–30 partly because of lifestyle and health behaviors associated with PTSD and partly because of physiological dysregulation linked to PTSD. 30 The latter might also underlie the well-documented association between PTSD and somatization. 31 Because symptoms can arise from interacting physical and psychological factors, a single, causative disease might not be found, 15 highlighting the importance of examining comorbid conditions and symptomatology in 9/11-exposed individuals. In this study we have described the prevalence, risk factors, and severity of illness associated with co-occurring lower respiratory symptoms (LRS) and probable PTSD 5 to 6 years after the 9/11 disaster among lower Manhattan residents, area workers, and passersby enrolled in the World Trade Center Health Registry. To better understand the burden of undiagnosed illness, we focused on symptoms. We hypothesized that severe dust cloud exposure and returning to homes or workplaces with dust or damage from the disaster would be associated with co-occurring LRS and PTSD. We also hypothesized that (1) independent of these risk factors LRS and PTSD would be risk factors for each other, (2) individuals with LRS who had comorbid PTSD would have worse respiratory illness and a higher prevalence of diagnosed asthma than would those with LRS alone, (3) those with PTSD who had co-occurring LRS would report more PTSD symptoms and have greater odds of comorbid mental health conditions than would those with PTSD alone, and (4) co-occurring LRS and PTSD would be associated with worse health-related quality of life (QOL) and more unmet health care needs after controlling for diagnosed respiratory and mental health conditions.
