TY - JOUR
T1 - A 15-year follow-up study of mortality in a pooled cohort of World Trade Center rescue and recovery workers
AU - Li, Jiehui
AU - Hall, Charles B.
AU - Yung, Janette
AU - Kehm, Rebecca D.
AU - Zeig-Owens, Rachel
AU - Singh, Ankura
AU - Cone, James E.
AU - Brackbill, Robert M.
AU - Farfel, Mark R.
AU - Qiao, Baozhen
AU - Schymura, Maria J.
AU - Shapiro, Moshe Z.
AU - Dasaro, Christopher R.
AU - Todd, Andrew C.
AU - Prezant, David J.
AU - Boffetta, Paolo
N1 - Funding Information:
This is a longitudinal cohort study. We used data from the combined cohort, which includes workers and volunteers from three WTC-exposed cohorts based in NYC who were involved in rescue, response, recovery, clean-up and related activities after the 9/11 attacks (Brackbill et al., 2021). The sources of the combined cohort included the FDNY cohort (n = 16,221), GRC (n = 33,427), and WTCHR (n = 29,372) (Brackbill et al., 2021). The FDNY cohort consists of FDNY Responders (i.e., active or retired WTC-exposed firefighters and EMS workers) who have received routine monitoring, treatment, and medical examinations since September 11, 2001 via FDNY's WTC medical monitoring and treatment program (WTC-MMTP), an extension of the pre-existing occupational health service (Yip et al., 2016). The GRC cohort consists of WTC General Responders of the WTC Worker Monitoring Program (also a WTC-MMTP) that was established at the Icahn School of Medicine at Mount Sinai in July 2002 to provide comprehensive medical monitoring examinations. GRC members include police officers from New York City Police Department (NYPD), construction and communications workers, other workers, and volunteers who engaged in WTC rescue, recovery, and cleanup efforts (Savitz et al., 2008; Dasaro et al., 2017). The WTCHR was established in July 2002 as a collaborative effort between the NYC Department of Health and Mental Hygiene and the Agency for Toxic Substances and Disease Registry (ATSDR) to track and evaluate short- and long-term physical and mental health of people directly exposed to the WTC disaster (Farfel et al., 2008; Azofeifa et al., 2021) through periodical surveys. The WTCHR is not a WTC-MMTP and provides neither clinical treatments nor medical examinations. The 29,372 workers (e.g., firefighters, police, construction workers, etc. and volunteers) who were enrolled into WTCHR in 2003–2004 were involved in WTC rescue, recovery and/or cleanup efforts (Farfel et al., 2008). Following the Zagroga Act that was signed into law in January 2011, the Center for Disease Control and Prevention (CDC) WTC Health Program was created in July 2011, the three cohorts have been supported by the CDC WTC Health Program since then. The processes of pooling and deduplication of the three individual cohorts into one combined cohort of 69,102 responders has been described in detail elsewhere (Brackbill et al., 2021). In brief, the membership and deduplication of individuals in the combined cohort was categorized using the following hierarchical criteria: (a) member of FDNY regardless of membership in GRC or WTCHR (FDNY members); (b) member of GRC regardless of enrollment in the WTCHR, but not a member of FDNY (GRC members); (c) remaining member of the WTCHR, not in the GRC nor the FDNY (non-FDNY/non-GRC members) (Brackbill et al., 2021). Each cohort developed and administered its own questionnaire to capture data on sociodemographic factors and level of WTC exposures at enrollment.This work was supported by the National Institute for Occupational Safety and Health at the Centers for Disease Control and Prevention, United States (cooperative agreements U01OH011315, U01 OH011932, U01 OH011681, U01 OH011931, U01 OH011480, and U50/OH009739; and contracts 200-2011-39378, 200-2017-93325, and 200-2017-93326). This work was also supported by the Agency for Toxic Substances and Disease Registry at the Centers for Disease Control and Prevention, United States (cooperative agreement U50/ATU272750); by the National Cancer Institute/National Institutes of Health (grant number P30 CA013330); by the New York City Department of Health and Mental Hygiene, New York State, United Status; and by the New York State Department of Health, United Statess. Additionally, this work was supported in part by cooperative agreement (6NU58DP006309) awarded to the New York State Department of Health by the Centers for Disease Control and Prevention and by the National Cancer Institute, United States, Contract (75N91018D00005, Task Order 75N91018F00001).This study was approved by the Institutional Review Boards (IRB) of the Albert Einstein College of Medicine, United States; New York City Department of Health and Mental Hygiene, New York State, United States; FDNY and New York State Department of Health, United States. IRBs of Icahn School of Medicine at Mount Sinai and Stony Brook University, United States, granted exemptions.
Funding Information:
This work was supported by the National Institute for Occupational Safety and Health at the Centers for Disease Control and Prevention, United States (cooperative agreements U01OH011315 , U01 OH011932 , U01 OH011681 , U01 OH011931 , U01 OH011480 , and U50/OH009739 ; and contracts 200-2011-39378 , 200-2017-93325 , and 200-2017-93326 ). This work was also supported by the Agency for Toxic Substances and Disease Registry at the Centers for Disease Control and Prevention, United States (cooperative agreement U50/ATU272750 ); by the National Cancer Institute / National Institutes of Health (grant number P30 CA013330 ); by the New York City Department of Health and Mental Hygiene, New York State, United Status ; and by the New York State Department of Health, United Statess . Additionally, this work was supported in part by cooperative agreement ( 6NU58DP006309 ) awarded to the New York State Department of Health by the Centers for Disease Control and Prevention and by the National Cancer Institute, United States, Contract ( 75N91018D00005 , Task Order 75N91018F00001 ).
Publisher Copyright:
© 2022
PY - 2023/2/15
Y1 - 2023/2/15
N2 - Introduction: Hazardous exposures from the World Trade Center (WTC) terrorist attacks have been linked to increased incidence of adverse health conditions, often associated with increased mortality. We assessed mortality in a pooled cohort of WTC rescue/recovery workers over 15 years of follow-up. Materials and methods: We analyzed mortality through 2016 in a pooled and deduplicated cohort of WTC rescue/recovery workers from three WTC-exposed cohorts (N = 60,631): the Fire Department of the City of New York (FDNY); the WTC Health Registry (WTCHR); and the General Responder Cohort (GRC). Standardized mortality ratios (SMRs) were estimated to assess mortality vs. the US and NY state populations. Multivariable Cox proportional hazards models were used to examine associations of WTC exposures (date of first arrival, working on the WTC debris pile) with mortality risk. Results: There were 1912 deaths over 697,943.33 person-years of follow-up. The SMR for all-cause mortality was significantly lower-than-expected, both when using US (SMR 0.43, 95% confidence interval [CI] 0.42–0.45) and NYS (SMR 0.51, 95% CI 0.49–0.53) as reference populations. SMRs were not elevated for any of the 28 major causes of death. Arriving at the WTC site on 9/11-9/17/2001 vs. 9/18/2001-6/30/2002 was associated with 30–50% higher risk of all-cause, heart disease and smoking-related mortality in non-FDNY/non-GRC members. Conversely, arriving on 9/11/2001 vs. 9/18/2001-6/30/2002 was associated with 40% lower all-cause and smoking-related mortality risk in FDNY members. Working on vs. off the WTC pile was associated with an increased risk of all-cause mortality in non-FDNY/non-GRC members (adjusted hazard ratio [aHR] 1.25, 95% CI 1.04–1.50), and cancer-specific mortality in GRC members (aHR 1.39, 95% CI 1.05–1.84), but lower mortality risks were found in FDNY members. Conclusions: We did not observe excess mortality among WTC rescue/recovery workers compared with general populations. However, significantly increased mortality risks among some sub-groups with high WTC exposure warrant further investigation.
AB - Introduction: Hazardous exposures from the World Trade Center (WTC) terrorist attacks have been linked to increased incidence of adverse health conditions, often associated with increased mortality. We assessed mortality in a pooled cohort of WTC rescue/recovery workers over 15 years of follow-up. Materials and methods: We analyzed mortality through 2016 in a pooled and deduplicated cohort of WTC rescue/recovery workers from three WTC-exposed cohorts (N = 60,631): the Fire Department of the City of New York (FDNY); the WTC Health Registry (WTCHR); and the General Responder Cohort (GRC). Standardized mortality ratios (SMRs) were estimated to assess mortality vs. the US and NY state populations. Multivariable Cox proportional hazards models were used to examine associations of WTC exposures (date of first arrival, working on the WTC debris pile) with mortality risk. Results: There were 1912 deaths over 697,943.33 person-years of follow-up. The SMR for all-cause mortality was significantly lower-than-expected, both when using US (SMR 0.43, 95% confidence interval [CI] 0.42–0.45) and NYS (SMR 0.51, 95% CI 0.49–0.53) as reference populations. SMRs were not elevated for any of the 28 major causes of death. Arriving at the WTC site on 9/11-9/17/2001 vs. 9/18/2001-6/30/2002 was associated with 30–50% higher risk of all-cause, heart disease and smoking-related mortality in non-FDNY/non-GRC members. Conversely, arriving on 9/11/2001 vs. 9/18/2001-6/30/2002 was associated with 40% lower all-cause and smoking-related mortality risk in FDNY members. Working on vs. off the WTC pile was associated with an increased risk of all-cause mortality in non-FDNY/non-GRC members (adjusted hazard ratio [aHR] 1.25, 95% CI 1.04–1.50), and cancer-specific mortality in GRC members (aHR 1.39, 95% CI 1.05–1.84), but lower mortality risks were found in FDNY members. Conclusions: We did not observe excess mortality among WTC rescue/recovery workers compared with general populations. However, significantly increased mortality risks among some sub-groups with high WTC exposure warrant further investigation.
KW - 9/11
KW - Cause of death
KW - Mortality
KW - Rescue and recovery workers
KW - Terrorist attacks
KW - World Trade Center (WTC)
UR - http://www.scopus.com/inward/record.url?scp=85144745161&partnerID=8YFLogxK
U2 - 10.1016/j.envres.2022.115116
DO - 10.1016/j.envres.2022.115116
M3 - Article
C2 - 36549491
AN - SCOPUS:85144745161
SN - 0013-9351
VL - 219
JO - Environmental Research
JF - Environmental Research
M1 - 115116
ER -