{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T03:16:06Z","timestamp":1762053366645,"version":"build-2065373602"},"reference-count":40,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2022,5,27]],"date-time":"2022-05-27T00:00:00Z","timestamp":1653609600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute for Occupational Safety and Health (NIOSH)","award":["2U50\/OH009739","5U50\/OH009739","U50\/ATU272750"],"award-info":[{"award-number":["2U50\/OH009739","5U50\/OH009739","U50\/ATU272750"]}]},{"DOI":"10.13039\/100005220","name":"Agency for Toxic Substances and Disease Registry (ATSDR)","doi-asserted-by":"publisher","award":["2U50\/OH009739","5U50\/OH009739","U50\/ATU272750"],"award-info":[{"award-number":["2U50\/OH009739","5U50\/OH009739","U50\/ATU272750"]}],"id":[{"id":"10.13039\/100005220","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The relationship between 9\/11 exposure, systemic autoimmune disease (SAD) and mental health remains poorly understood. This report builds on a prior analysis of World Trade Center Health Registry data to determine whether 9\/11 exposure is associated with higher risk of SAD, and if so, whether post-traumatic stress disorder (PTSD) is a mediating factor and whether the association varies by responder\/community member status. The final analytic sample comprised 41,656 enrollees with 123 cases of SAD diagnosed post 9\/11 through November 2017. SAD diagnosis was ascertained from survey responses and confirmed by medical record review or physician survey. Logistic regression models were constructed to determine the relationship between 9\/11 exposure and PTSD and SAD. Causal mediation analysis was used to determine the mediational effect of PTSD. Each analysis was stratified by 9\/11 responder\/community member status. Rheumatoid arthritis (n = 75) was the most frequent SAD, followed by Sj\u00f6gren\u2019s syndrome (n = 23), systemic lupus erythematosus (n = 20), myositis (n = 9), mixed connective tissue disease (n = 7), and scleroderma (n = 4). In the pooled cohort, those with 9\/11-related PTSD had 1.85 times the odds (95% CI: 1.21\u20132.78) of SAD. Among responders, those with dust cloud exposure had almost twice the odds of SAD, while among community members, those with 9\/11-related PTSD had 2.5 times the odds of SAD (95% CI: 1.39, 4.39). PTSD was not a significant mediator. Although emerging evidence suggests 9\/11 exposure may be associated with SAD, more research is needed, particularly using pooled data sources from other 9\/11-exposed cohorts, to fully characterize this relationship.<\/jats:p>","DOI":"10.3390\/ijerph19116514","type":"journal-article","created":{"date-parts":[[2022,5,27]],"date-time":"2022-05-27T07:05:07Z","timestamp":1653635107000},"page":"6514","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The Relationship between 9\/11 Exposure, Systemic Autoimmune Disease, and Post-Traumatic Stress Disorder: A Mediational Analysis"],"prefix":"10.3390","volume":"19","author":[{"given":"Jennifer","family":"Brite","sequence":"first","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, New York, NY 11101, USA"},{"name":"School of Health Sciences and Professional Programs, York College, The City University of New York (CUNY), New York, NY 11451, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara A.","family":"Miller-Archie","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, New York, NY 11101, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Cone","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, New York, NY 11101, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,5,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"151","DOI":"10.12691\/ijcd-3-4-8","article-title":"The world incidence and prevalence of autoimmune diseases is increasing","volume":"3","author":"Lerner","year":"2015","journal-title":"Int. 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