OBJECTIVE Autoimmune disease is an emerging condition among persons exposed to the September 11, 2001 attack on the World Trade Center (WTC). Components of the dust cloud resulting from the collapse of the WTC have been associated with development of a systemic autoimmune disease, as has posttraumatic stress disorder (PTSD). We undertook this study to determine whether dust exposure and PTSD were associated with an increased risk of systemic autoimmune disease in a 9/11-exposed cohort. METHODS Among 43,133 WTC Health Registry enrollees, 2,786 self-reported having a post-9/11 systemic autoimmune disease. We obtained informed consent to review medical records to validate systemic autoimmune disease diagnoses for 1,041 enrollees. Diagnoses of systemic autoimmune diseases were confirmed by classification criteria, rheumatologist diagnosis, or having been prescribed systemic autoimmune disease medication. Controls were enrollees who denied having an autoimmune disease diagnosis (n = 37,017). We used multivariable log-binomial regression to examine the association between multiple 9/11 exposures and risk of post-9/11 systemic autoimmune disease, stratifying by responders (rescue, recovery, and clean-up workers) and community members (e.g., residents, area workers). RESULTS We identified 118 persons with systemic autoimmune disease. Rheumatoid arthritis was most frequent (n = 71), followed by Sjӧgren's syndrome (n = 22), systemic lupus erythematosus (n = 20), myositis (n = 9), mixed connective tissue disease (n = 7), and scleroderma (n = 4). Among 9/11 responders, those with intense dust cloud exposure had almost twice the risk of systemic autoimmune disease (adjusted risk ratio 1.86 [95% confidence interval 1.02-3.40]). Community members with PTSD had a nearly 3-fold increased risk of systemic autoimmune disease. CONCLUSION Intense dust cloud exposure among responders and PTSD among community members were associated with a statistically significant increased risk of new-onset systemic autoimmune disease. Clinicians treating 9/11 survivors should be aware of the potential increased risk of systemic autoimmune disease in this population.

中文翻译：

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暴露于2001年9月11日恐怖袭击的成年人中的全身性自身免疫性疾病。

目的自身免疫性疾病是在2001年9月11日遭受世界贸易中心（WTC）袭击的人群中正在出现的一种新型疾病。WTC崩溃所产生的尘埃云的成分与全身性自身免疫性疾病的发展相关，创伤后应激障碍（PTSD）也是如此。我们进行了这项研究，以确定在9/11暴露人群中，粉尘暴露和PTSD是否与全身性自身免疫性疾病风险增加相关。方法在43133名WTC健康注册登记者中，有2786名自我报告患有9/11后全身性自身免疫性疾病。我们获得了知情同意书，以审查医疗记录，以验证1,041名入选者的全身性自身免疫性疾病诊断。通过分类标准，风湿病学诊断，或已开具全身性自身免疫性疾病药物。对照组是拒绝进行自身免疫性疾病诊断的受试者（n = 37,017）。我们使用多变量对数二项式回归分析了多重9/11暴露与9/11后系统性自身免疫疾病风险之间的关联，并按响应者（救援人员，恢复人员和清洁工人）和社区成员（例如居民）进行了分层。 ，区域工作人员）。结果我们确定了118例系统性自身免疫性疾病患者。类风湿关节炎是最常见的（n = 71），其次是Sjngren综合征（n = 22），系统性红斑狼疮（n = 20），肌炎（n = 9），混合性结缔组织病（n = 7）和硬皮病（ n = 4）。在9/11响应者中，接触大量粉尘云的人患全身自身免疫疾病的风险几乎是其两倍（调整后的风险比1.86 [95％置信区间1.02-3.40]）。患有PTSD的社区成员患全身性自身免疫疾病的风险增加了近3倍。结论应答者之间强烈的尘埃云和社区成员中的PTSD与新发系统性自身免疫疾病的风险显着增加相关。治疗9/11幸存者的临床医生应意识到该人群中系统性自身免疫疾病的潜在风险增加。结论应答者之间强烈的尘埃云和社区成员中的PTSD与新发系统性自身免疫疾病的风险显着增加相关。治疗9/11幸存者的临床医生应意识到该人群中系统性自身免疫疾病的潜在风险增加。结论应答者之间强烈的尘埃云和社区成员中的PTSD与新发系统性自身免疫疾病的风险显着增加相关。治疗9/11幸存者的临床医生应意识到该人群中系统性自身免疫疾病的潜在风险增加。