For how long is WTC exposure associated with chronic rhinosinusitis

描述(由申请人提供)：在世贸中心(WTC)灾难现场工作的不良短期和中期呼吸影响已在纽约市消防局(FDNY)、急救人员和其他人员中得到广泛记录。我们的FDNY团队首先报告了WTC咳嗽综合征，证明了9/11事件后与工作相关的暴露增加了空气消化症状的风险长达九年，并表明医生诊断的呼吸系统疾病的患病率，无论是自报的还是FDNY医生诊断的，在灾难现场工作七到九年后仍然居高不下。然而，与数百篇关于WTC相关下呼吸道疾病的出版物相比，我们发现只有5篇同行评议的出版物专注于上呼吸道障碍，特别是慢性鼻-鼻窦炎(CRS)。在目前与美国国家职业安全与健康研究所的一项合作协议中，我们一直在使用创新的统计方法-带有变化点的参数生存模型-来检查WTC暴露与新发的阻塞性呼吸道疾病之间的关系在9/11事件后的第一个十年中是否稳定，或者观察到的关联是否随着时间的推移而减弱。我们的初步结果证实，至少在暴露后的头五年内，暴露反应/疾病累积发病率的梯度是持续的。我们现在建议扩展这一方法来解决CRS发生率的类似问题，CRS是与暴露于WTC救援/恢复工作相关的另一种常见的呼吸系统疾病，目的是确定在暴露于FDNY的消防员中观察到暴露反应梯度的时间长度。

DESCRIPTION (provided by applicant): Adverse short- and medium-term respiratory effects of work at the World Trade Center (WTC) disaster site have been widely documented in Fire Department of the City of New York (FDNY) first responders and others. Our FDNY team first reported WTC cough syndrome, demonstrated that work-related exposures to the disaster site increased the odds of aerodigestive symptoms up to nine years post-9/11, and showed that the prevalence of physician-diagnosed respiratory conditions, both self-reported and FDNY-physician diagnosed, remained elevated seven to nine years after working at the site. However, in contrast to hundreds of publications about WTC-related lower respiratory conditions, we found only 5 peer-reviewed publications that focused on upper airway disturbance, specifically chronic rhinosinusitis (CRS). In a current cooperative agreement with the National Institute of Occupational Safety and Health, we have been using innovative statistical methods - parametric survival models with change points - to examine whether the relationship between WTC-exposure and new onset obstructive airway disease was stable over the first post-9/11 decade or whether the observed association attenuated over time. Our preliminary results confirm the persistence of the exposure response/gradient for the cumulative incidence of disease for at least the first five years after exposure. We now propose to extend this methodology to address a similar question in CRS incidence, another common respiratory condition associated with exposure to the WTC rescue/recovery effort, with the goal of determining the length of time that exposure response gradients are observed among exposed FDNY firefighters.