Abstract
BackgroundThe World Trade Center (WTC) attacks on September 11, 2001 (9/11) resulted in over 2700 fatalities and thousands injured. Injury on 9/11 has been identified as a risk factor for physical and mental health conditions, but the reasons for this are not well understood. In a population exposed to 9/11 and since followed, an in-depth study on the impacts of injury on 9/11 was conducted to identify factors that contribute to long-term functional issues. This report sought to examine factors influencing participation, participant recall of injury status over time, and determinants of injury severity.MethodsEnrollees from the World Trade Center Health Registry who completed all surveys between 2003 and 2016 and initially reported being injured (N = 2699) as well as a sample of non-injured (N = 2598) were considered to be eligible for the Health and Quality of Life 15 Years after 9/11 (HQoL) Study. Predictors of study non-participation and inconsistent recall of injury over time (i.e., discrepant reports) were identified through fitting log binomial models.ResultsParticipation rates were high overall (76.1%) and did not vary by initially reported injury status, although younger (vs. older), non-White (vs. White), and less educated (vs. more educated) enrollees were less likely to participate in the HQoL Study. Discrepant reporting of 9/11 injury status was much more common among enrollees who initially reported being injured on 9/11 (49.6%) compared with those who did not (7.3%). However, those who incurred more severe injuries on 9/11 were less likely to have discrepant reporting over time compared with those with more minor injuries (broken bone vs. sprain: risk ratio = 0.33, 95% Confidence Interval: 0.19, 0.57). Among those who consistently reported that they were injured on 9/11, most injuries occurred as a result of descending down stairs (31.5%) or by tripping and falling (19.9%); although being hit by a falling object was most often associated with high severity injuries (63.2%) compared with other modes of injury.ConclusionsThese findings highlight the methodological issues involved in conducting a study on the long-term impact of injury more than a decade after the initial incident and may be relevant to future investigators. Factors affecting participation rates, such as demographic characteristics, and those related to discrepant reporting over time, such as injury severity, may affect both the internal and external validity of studies examining the long-term impact of injury.
Highlights
The impacts on health from physical injuries sustained from natural or human-made disasters are complex due to the simultaneous experience of psychological trauma, stress, and physical wounds
We identified predictors of discrepant reports by comparing frequencies across strata of injury on 9/11 status as reported at Wave 1, sociodemographic characteristics, World Trade Center (WTC)-related exposures, and posttraumatic stress disorder (PTSD) history and by fitting log binomial models controlling for these factors
Study participation Among those who completed the questionnaire, 62.3% completed it online and 37.7% on paper. Among those initially invited to participate by a paper mailing (9.3%), 99% completed it on paper and 1% completed it online. Among those initially invited by an e-mail invitation with a link to the online questionnaire, 68.2% completed it online, and 31.8% completed it on paper, either by calling to request a paper copy or completing one after it arrived at their home during the later stages of recruitment
Summary
The impacts on health from physical injuries sustained from natural or human-made disasters are complex due to the simultaneous experience of psychological trauma, stress, and physical wounds. A recent qualitative study examining the experiences of people who were injured on 9/11 documented a major diminution of quality of life as represented by physical and functional impairments, economic difficulties, and social isolation (Gargano et al 2016). Motivated by these observations, an in-depth study on the long-term impacts of injury on 9/ 11 was conducted in order to identify factors that contribute to long-term functional issues and provide guidance for ameliorating these outcomes through intervention. This report sought to examine factors influencing participation, participant recall of injury status over time, and determinants of injury severity
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