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Relationship of Self-Reported Asthma Severity and Urgent Health Care Utilization to Psychological Sequelae of the September 11, 2001 Terrorist Attacks on the World Trade Center Among New York City Area Residents

From Center for Urban Epidemiologic Studies, New York Academy of Medicine, 1216 Fifth Avenue, New York City, NY 10029.

Address correspondence and reprint requests to Sandro Galea, MD, DrPH, Center for Urban Epidemiologic Studies Room 556, New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029-5283. E-mail: sgalea{at}nyam.org

OBJECTIVE: Posttraumatic psychological stress may be associated with increases in somatic illness, including asthma, but the impact of the psychological sequelae of the September 11, 2001 terrorist attacks on physical illness has not been well documented. The authors assessed the relationship between the psychological sequelae of the attacks and asthma symptom severity and the utilization of urgent health care services for asthma since September 11.

MATERIALS AND METHODS: The authors performed a random digit dial telephone survey of adults in the New York City (NYC) metropolitan area 6 to 9 months after September 11, 2001. Two thousand seven hundred fifty-five demographically representative adults including 364 asthmatics were recruited. The authors assessed self-reported asthma symptom severity, emergency room (ER) visits, and unscheduled physician office visits for asthma since September 11.

RESULTS: After adjustment for asthma measures before September 11, demographics, and event exposure in multivariate models posttraumatic stress disorder (PTSD) were a significant predictor of self-reported moderate-to-severe asthma symptoms (OR = 3.4; CI = 1.2–9.4), seeking care for asthma at an ER since September 11 (OR = 6.6; CI = 1.6–28.0), and unscheduled physician visits for asthma since September 11 (OR = 3.6; CI = 1.1–11.5). The number of PTSD symptoms was also significantly related to moderate-to-severe asthma symptoms and unscheduled physician visits since September 11. Neither a panic attack on September 11 nor depression since September 11 was an independent predictor of asthma severity or utilization in multivariate models after September 11.

CONCLUSIONS: PTSD related to the September 11 terrorist attacks contributed to symptom severity and the utilization of urgent health care services among asthmatics in the NYC metropolitan area.

Key Words: asthma, • disaster, • mental health, • posttraumatic stress.

Abbreviations: NYC = New York City;; PTSD = posttraumatic stress disorder;; WTC = World Trade Center;; RDD = random digit dial;; ER = emergency room.

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