The upper respiratory pyramid: early factors and later treatment utilization in World Trade Center exposed firefighters

Am J Ind Med. 2014 Aug;57(8):857-65. doi: 10.1002/ajim.22326. Epub 2014 Jun 4.

Abstract

Background: We investigated early post 9/11 factors that could predict rhinosinusitis healthcare utilization costs up to 11 years later in 8,079 World Trade Center-exposed rescue/recovery workers.

Methods: We used bivariate and multivariate analytic techniques to investigate utilization outcomes; we also used a pyramid framework to describe rhinosinusitis healthcare groups at early (by 9/11/2005) and late (by 9/11/2012) time points.

Results: Multivariate models showed that pre-9/11/2005 chronic rhinosinusitis diagnoses and nasal symptoms predicted final year healthcare utilization outcomes more than a decade after WTC exposure. The relative proportion of workers on each pyramid level changed significantly during the study period.

Conclusions: Diagnoses of chronic rhinosinusitis within 4 years of a major inhalation event only partially explain future healthcare utilization. Exposure intensity, early symptoms and other factors must also be considered when anticipating future healthcare needs.

Keywords: chronic rhinosinusitis; firefighters; sinus symptoms; treatment outcomes; world trade center.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Analysis of Variance
  • Chronic Disease
  • Drug Costs / statistics & numerical data
  • Firefighters*
  • Forecasting
  • Health Services / statistics & numerical data*
  • Health Services Needs and Demand / statistics & numerical data*
  • Hoarseness / etiology
  • Humans
  • Inhalation Exposure
  • Laryngoscopy / statistics & numerical data
  • Male
  • Middle Aged
  • Nasal Obstruction / etiology
  • Needs Assessment
  • New York City
  • Occupational Exposure / adverse effects*
  • Otolaryngology / statistics & numerical data
  • Otorhinolaryngologic Surgical Procedures / statistics & numerical data
  • Pharyngitis / etiology
  • Rescue Work*
  • Rhinitis* / complications
  • Rhinitis* / economics
  • Rhinitis* / therapy
  • September 11 Terrorist Attacks
  • Sinusitis* / complications
  • Sinusitis* / economics
  • Sinusitis* / therapy
  • Surveys and Questionnaires
  • Time Factors