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The upper respiratory pyramid: Early factors and later treatment utilization in World Trade Center exposed firefighters
Author(s) -
Niles Justin K.,
Webber Mayris P.,
Liu Xiaoxue,
ZeigOwens Rachel,
Hall Charles B.,
Cohen Hillel W.,
Glaser Michelle S.,
Weakley Jessica,
Schwartz Theresa M.,
Weiden Michael D.,
Nolan Anna,
Aldrich Thomas K.,
Glass Lara,
Kelly Kerry J.,
Prezant David J.
Publication year - 2014
Publication title -
american journal of industrial medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.7
H-Index - 104
eISSN - 1097-0274
pISSN - 0271-3586
DOI - 10.1002/ajim.22326
Subject(s) - medicine , world trade center , respiratory system , center (category theory) , emergency medicine , pyramid (geometry) , environmental health , archaeology , terrorism , history , chemistry , physics , optics , crystallography
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. Am. J. Ind. Med. 57:857–865, 2014. © 2014 Wiley Periodicals, Inc.