{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T07:32:49Z","timestamp":1788593569768,"version":"build-2803163510"},"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T00:00:00Z","timestamp":1764806400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000125","name":"National Institute for Occupational Safety and Health","doi-asserted-by":"publisher","award":["U01 OH012473"],"award-info":[{"award-number":["U01 OH012473"]}],"id":[{"id":"10.13039\/100000125","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000125","name":"National Institute for Occupational Safety and Health","doi-asserted-by":"publisher","award":["U01 OH012068"],"award-info":[{"award-number":["U01 OH012068"]}],"id":[{"id":"10.13039\/100000125","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000125","name":"National Institute for Occupational Safety and Health","doi-asserted-by":"publisher","award":["R21 OH012786"],"award-info":[{"award-number":["R21 OH012786"]}],"id":[{"id":"10.13039\/100000125","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>During and after the 9\/11 rescue and recovery efforts, World Trade Center (WTC) responders were exposed to environmental hazards that may accelerate aging and increase frailty. This study examines the relationship between polypharmacy and frailty among WTC responders to inform strategies that mitigate medication-related risks in high-risk, aging populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We included WTC responders aged 50 and older who attended at least one clinical monitoring visit at WTC Health Program between 2017\u20132019. Frailty was assessed using the WTC-specific Clinical Frailty Index, and associations with polypharmacy (concurrent use of 5 or more medications) and fall-risk increasing drugs (FRIDs) use were evaluated through multivariable logistic regression models adjusting for demographic, employment, health, and WTC exposure data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 6,966 WTC responders, 55% met the criteria for polypharmacy and 7.6% used FRIDs. Frailty was independently associated with both polypharmacy (OR 1.15, p\u2009&lt;\u20090.001) and FRID use (OR 1.11, p\u2009&lt;\u20090.001). Older age (OR 1.08, p\u2009&lt;\u20090.001), obesity (OR 1.92, p\u2009&lt;\u20090.001 for BMI\u2009\u2265\u200930), protective service occupations (OR 1.30, p\u2009=\u20090.002), and chronic conditions such as gastroesophageal reflux disease (OR 1.71, p\u2009&lt;\u20090.001), obstructive airway disease (OR 2.24, p\u2009&lt;\u20090.001), and upper respiratory disease (OR 1.85, p\u2009&lt;\u20090.001) were associated with higher odds of polypharmacy. In contrast, male sex (OR 0.81, p\u2009=\u20090.018) and construction occupations (OR 0.73, p\u2009=\u20090.001) were associated with lower odds of polypharmacy. Female sex (OR 1.64, p\u2009&lt;\u20090.001), smoking (current: OR 1.55, p\u2009=\u20090.013; former: OR 1.30, p\u2009=\u20090.014), and mental health conditions such as anxiety (OR 1.66, p\u2009=\u20090.004), depression (OR 2.85, p\u2009&lt;\u20090.001), and post-traumatic stress disorder (OR 1.72, p\u2009&lt;\u20090.001) were associated with higher odds of FRID use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We found a high prevalence of polypharmacy and FRID use among aging WTC responders, with frailty significantly associated with both. Our findings underscore the need to optimize medication management for aging WTC responders, which may impact their healthy aging.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0337391","type":"journal-article","created":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T18:47:27Z","timestamp":1764874047000},"page":"e0337391","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Polypharmacy and frailty among aging World Trade Center responders"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4711-741X","authenticated-orcid":true,"given":"Chinmayi","family":"Venkatram","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fred","family":"Ko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghalib","family":"Bello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Sabra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3405-5184","authenticated-orcid":true,"given":"Hannah M.","family":"Thompson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Thanik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Colicino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto G.","family":"Lucchini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Crane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2190-1575","authenticated-orcid":true,"given":"Susan L.","family":"Teitelbaum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine A.","family":"Ornstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William W.","family":"Hung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,12,4]]},"reference":[{"key":"pone.0337391.ref001"},{"issue":"4","key":"pone.0337391.ref002","first-page":"1","article-title":"World Trade Center Health Program - 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