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

• Published in: International journal of environmental research and public health 2022-05, Vol.19 (11), p.6514
• Main Authors: Brite, Jennifer, Miller-Archie, Sara A, Cone, James
• Format: Article
• Language: English
• Subjects: Arthritis; Autoimmune diseases; Chronic conditions; Connective tissue diseases; Disease; Dust; Ethnicity; Exposure; Family income; Medical records; Mental disorders; Mental health; Mixed connective tissue disease; Myositis; Post traumatic stress disorder; Psychological stress; Regression analysis; Rheumatoid arthritis; Scleroderma; September 11 terrorist attacks-2001; Sjogren's syndrome; Systemic lupus erythematosus
• ISSN: 1660-4601; 1661-7827; 1660-4601
• DOI: 10.3390/ijerph19116514

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 ( = 75) was the most frequent SAD, followed by Sjögren's syndrome ( = 23), systemic lupus erythematosus ( = 20), myositis ( = 9), mixed connective tissue disease ( = 7), and scleroderma ( = 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.