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. 2025 Dec 4;20(12):e0337391.
doi: 10.1371/journal.pone.0337391. eCollection 2025.

Polypharmacy and frailty among aging World Trade Center responders

Chinmayi Venkatram  1 , Fred Ko  2   3 , Ghalib Bello  4 , Ahmad Sabra  5 , Hannah M Thompson  4 , Erin Thanik  4 , Elena Colicino  4 , Roberto G Lucchini  6 , Michael Crane  4 , Susan L Teitelbaum  4 , Katherine A Ornstein  7 , William W Hung  2   3
Affiliations

Polypharmacy and frailty among aging World Trade Center responders

Chinmayi Venkatram et al. PLoS One. .

Abstract

Background: 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.

Methods: We included WTC responders aged 50 and older who attended at least one clinical monitoring visit at WTC Health Program between 2017-2019. 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.

Results: 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 < 0.001) and FRID use (OR 1.11, p < 0.001). Older age (OR 1.08, p < 0.001), obesity (OR 1.92, p < 0.001 for BMI ≥ 30), protective service occupations (OR 1.30, p = 0.002), and chronic conditions such as gastroesophageal reflux disease (OR 1.71, p < 0.001), obstructive airway disease (OR 2.24, p < 0.001), and upper respiratory disease (OR 1.85, p < 0.001) were associated with higher odds of polypharmacy. In contrast, male sex (OR 0.81, p = 0.018) and construction occupations (OR 0.73, p = 0.001) were associated with lower odds of polypharmacy. Female sex (OR 1.64, p < 0.001), smoking (current: OR 1.55, p = 0.013; former: OR 1.30, p = 0.014), and mental health conditions such as anxiety (OR 1.66, p = 0.004), depression (OR 2.85, p < 0.001), and post-traumatic stress disorder (OR 1.72, p < 0.001) were associated with higher odds of FRID use.

Conclusions: 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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of participant inclusion and exclusion for the analytic sample.
Fig 2
Fig 2. This forest plot displays the results of a multivariable logistic regression analysis of factors associated with polypharmacy in the WTC Responder Cohort.
Odds ratios and corresponding 95% confidence intervals are shown for each factor.
Fig 3
Fig 3. This forest plot presents the multivariable logistic regression analysis of factors associated with FRID use in the WTC Responder Cohort.
Odds ratios and their corresponding 95% confidence intervals are shown for each factor.
See this image and copyright information in PMC

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