Asthma among World Trade Center First Responders: A Qualitative Synthesis and Bias Assessment
Abstract
:1. Introduction
2. Methods
3. Results
3.1. Study Populations and Key Findings from the Five Studies Included in This Review
3.2. Selection Bias
3.3. Differential Surveillance Bias
3.4. Exposure and Outcome Misclassification
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
Appendix A
References
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World Trade Center (WTC) Cohort | |||||
---|---|---|---|---|---|
General Responders | Fire Department of New York (FDNY) | WTC Health Registry | |||
Reference | Wisnivesky et al., 2011 [19] | Kim et al., 2012 [20] | Webber et al., 2011 [18] | Wheeler et al., 2007 [16] | Brackbill et al., 2009 [17] |
Study population | Search, rescue, recovery, cleanup workers and volunteers except FDNY employees | Firefighters and emergency medical service (EMS) workers of FDNY | Search, rescue, recovery, cleanup workers and volunteers, including FDNY employees | ||
Participants, no. | 27,449 | 20,834 | 10,943 | 25,748 | 19,788 |
Inclusion period | Participated between 07/16/2002 and 09/11/2010 | Participated between 07/16/2002 and 12/31/2007 | Hired before 07/25/2002 | Completed Wave 1 (2003–2004) | Completed both Wave 1 and Wave 2 (2006–2007) |
Cohort type | Open cohort since 7/16/2002 | Closed cohort limit to exposed to WTC | Closed cohort | ||
Follow-up frequency | Every 12–18 months | Every 12–18 months | Four Waves with unfixed period between Waves | ||
Study design for the analysis | Longitudinal | Repeated cross-sectional | Longitudinal | Retrospective cohort | Retrospective cohort |
Asthma ascertainment | Self-reported physician diagnosed asthma | ||||
Verification with medical chart | No | No | Yes | No | No |
Comparison group | Internal comparison | External comparison with NHIS | Internal comparison | Internal comparison | Internal comparison |
Type of measure | Cumulative incidence | Prevalence/Incidence | |||
Measure of association | Cumulative incidence ratio | Standardized Morbidity Ratio | Odds Ratio | ||
Exposure variables | |||||
Arrival on the site | Day/Time | Day | Day/location | ||
Duration | Months at the site | Days at the site | Days at the site | ||
In the dust cloud on 9/11 | Yes/No | Intense/some/no | |||
Work on the pile | Yes/No | Ever/never | Yes/No on 9/11 | ||
Use respiratory protection | Initial date and amount delay of masks and respirators use | ||||
Other exposure variable | Days in the cloud and/or on the pile | WTC responder versus general population |
Key Component for Bias Evaluation |
---|
Study design |
Exposure measurement |
Outcome measurement |
Measured association |
Lag period |
Control selection bias (no-controls and no-exposed) |
Self-selection bias/response bias |
Loss to follow-up |
Differential surveillance/diagnosis/referral |
Recall bias/reporting bias |
Interviewer bias |
Healthy worker effects |
Overmatching |
Ecologic exposure misclassification |
Differential (systematic)/ non-differential (random) misclassification |
Magnitude and direction |
Probable unmeasured confounders |
Reference | Exposure Variable | Asthma Variable * | Population ** | Contrast | Effect Estimate *** | 95% CI † |
---|---|---|---|---|---|---|
Kim et al., 2012 [20] | Being a WTC responder | Self-reported | GRC—male | Responder vs. U.S. population | SMR = 2.4 | 2.2–2.5 |
Self-reported | GRC—female | SMR = 2.2 | 2.0–2.5 | |||
Webber et al., 2011 [18] | Time of arrival at WTC site | Self-reported | FDNY | a.m. 9/11 vs. 9/14 or later | OR = 3.3 | 2.4–4.8 |
Clinically confirmed | FDNY | OR = 1.4 | 1.0–2.1 | |||
Wheeler et al., 2007 [16] | Self-reported | WTCHR | 9/11 vs. 1/1/2002 or later | OR = 1.8 †† | 1.2–2.7 | |
Duration on site | Self-reported | WTCHR | > 90 days vs. 1–7 days | OR = 1.7 †† | 1.4–2.1 | |
Worked in dust cloud | Self-reported | WTCHR | ever/never | OR = 1.3 †† | 1.1–1.5 | |
Brackbill et al., 2009 [17] | Self-reported | WTCHR | “intense” dust cloud vs. no | OR = 1.5 †† | 1.4–1.7 | |
Wheeler et al., 2007 [16] | Worked on pile | Self-reported | WTCHR | ever/never | OR = 1.3 †† | 1.1–1.5 |
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Kim, H.; Baidwan, N.K.; Kriebel, D.; Cifuentes, M.; Baron, S. Asthma among World Trade Center First Responders: A Qualitative Synthesis and Bias Assessment. Int. J. Environ. Res. Public Health 2018, 15, 1053. https://doi.org/10.3390/ijerph15061053
Kim H, Baidwan NK, Kriebel D, Cifuentes M, Baron S. Asthma among World Trade Center First Responders: A Qualitative Synthesis and Bias Assessment. International Journal of Environmental Research and Public Health. 2018; 15(6):1053. https://doi.org/10.3390/ijerph15061053
Chicago/Turabian StyleKim, Hyun, Navneet Kaur Baidwan, David Kriebel, Manuel Cifuentes, and Sherry Baron. 2018. "Asthma among World Trade Center First Responders: A Qualitative Synthesis and Bias Assessment" International Journal of Environmental Research and Public Health 15, no. 6: 1053. https://doi.org/10.3390/ijerph15061053