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Risk of Stroke Among Survivors of the September 11, 2001, World Trade Center Disaster

Yu, Shengchao PhD, MA; Alper, Howard E. PhD; Nguyen, Angela-Maithy MPH; Brackbill, Robert M. PhD, MPH

Journal of Occupational and Environmental Medicine: August 2018 - Volume 60 - Issue 8 - p e371–e376
doi: 10.1097/JOM.0000000000001361

Objective: The aim of this study was to investigate the association between 9/11-related posttraumatic stress disorder (PTSD), dust cloud exposure, and subsequent development of stroke among 42,527 enrollees in the World Trade Center (WTC) Health Registry.

Methods: Using four waves of longitudinal data from the WTC Health Registry surveys, we employed Cox proportional hazards regression models to assess the associations.

Results: Incidence of stroke was higher among those with PTSD or intense dust cloud exposure than those without, and it was even higher for those who had experienced both. In fully adjusted models, participants with PTSD had an increased risk of developing stroke [adjusted hazards ratio (AHR) 1.69, 95% confidence interval (95% CI) 1.42 to 2.02], as did those with intense dust exposure (AHR 1.29, 95% CI 1.09 to 1.53).

Conclusion: We found that individuals with 9/11-related PTSD and/or intense dust exposure may have an increased risk of developing stroke.

New York City Department of Health and Mental Hygiene, New York City, New York.

Address correspondence to: Shengchao Yu, PhD, MA, World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 125 Worth Street, 10th Floor, New York City, NY 10013 (

This work was supported by Cooperative Agreement (Number 5U50/OH009739) from the Centers for Disease Control and Prevention (CDC) - the National Institute for Occupational Safety and Health (NIOSH); and from the Agency for Toxic Substances and Disease Registry (ATSDR) (U50/ATU272750) of the CDC, which included support from CDC- the National Center for Environmental Health (NCEH) and the New York City Department of Health and Mental Hygiene (NYC DOHMH). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NIOSH-CDC.

The authors have no conflicts of interest.

Copyright © 2018 by the American College of Occupational and Environmental Medicine