Self-reported chronic rhinosinusitis diagnoses and symptoms in World Trade Center-exposed and non-World Trade Center-exposed United States firefighters

Background: Greater World Trade Center (WTC) exposure levels have been associated with chronic rhinosinusitis (CRS) diagnoses and symptoms. We aimed to determine whether self-reported CRS is elevated in WTC-exposed Fire Department of the City of New York (FDNY) firefighters when compared with non-WTC-exposed/non-FDNY firefighters and with the general population. Methods: The study included male WTC-exposed (N = 7840) and non-WTC-exposed (N = 2771) firefighters who were employed on 9/11/2001 and later completed a health survey. Self-reported CRS diagnoses and symptoms were evaluated. Multivariable logistic regression analyses estimated the odds of self-reported ever CRS diagnosis and current symptoms in WTC-exposed vs. non-WTC-exposed firefighters. Additional analyses compared self- reported current CRS diagnoses in firefighters vs. American males. Models were adjusted for demographics, smoking, and BMI. Results: Fifty-one percent of WTC-exposed firefighters reported ever having a CRS diagnosis vs. 20 % of non-WTCexposed firefighters (adjusted-OR = 3.84, 95 % CI = 3.44-4.28). WTC-exposure was also associated with specific rhinosinusitis symptoms, including nasal/sinus congestion (adjusted-OR = 1.17, 95 % CI = 1.06-1.29), nose irritation (adjusted-OR = 1.48, 95 % CI = 1.24-1.76), and sinus pain/pressure (adjusted-OR = 1.42, 95 % CI = 1.26-1.60). Both WTC-exposed (adjusted-OR = 3.84, 95 % CI = 3.46-4.27) and non-WTC-exposed firefighters (adjusted-OR = 1.97, 95 % CI = 1.71-2.27) were more likely to report a current CRS diagnosis than similar adult males. Conclusions: WTC-exposure was associated with self-reported CRS diagnoses and symptoms in firefighters. Higher CRS diagnosis prevalence in the WTC-exposed cohort could be a result of exposure to irritants present at the WTC site, and may also be explained, in part, by the enhanced surveillance and healthcare WTC-exposed firefighters receive via the WTC Health Program. Elevated levels of CRS in firefighters overall could be due to routine, nonWTC-related firefighting exposures.