This study will comprehensively describe the overall physical, mental, and socioeconomic impact of the World Trade Center (WTC) disaster on responders, as well as identify the linkage between socioeconomic sequelae (SES) and health among WTC responders. Results from this study have the potential to make a significant public health impact through the identification of new diseases and high-risk groups within the WTC cohort, and aid future development of new guidelines for the implementation of an occupational health surveillance system for disasters, which is essential for disaster preparedness.
Overall health status of WTC responders was evaluated by comparing prevalence of five major health outcomes to the general population surveyed by the National Health Interview Survey (NHIS). Potential associations between new onset of asthma and WTC exposures were investigated, especially the protective effect of respirator use during rescue and recovery activities.
A total of 26,796 responders who participated in the WTC Health Program (WTCHP) from 2002-2010 were included in the analysis. Standardized Morbidity Ratios (SMR) were calculated after adjusting for age and occupation, separately, and stratified by gender. Self-reported life-time prevalence of each outcome was used for SMR. Internal comparison was conducted for asthma incidence. Incidence Rate Ratios (IRR) were estimated using the generalized estimating equations with robust Poisson family and log link.
SMR for asthma was the only outcome showing an elevated rate compared to the general population. From the internal comparison, protective service (IRR=1.31 (1.12-1.54)) and utility workers (IRR=1.39 (1.11-1.73) had a higher risk of experiencing asthma compared to construction workers. Responders who arrived at the site on 9/11 not in the dust cloud (IRR=0.81 (0.71-0.93)) or later had a lower risk of getting asthma than those who arrived on 9/11 in the dust cloud. Notably, responders who used a full/half-face respirator on 9/11-9/18 had a significantly lower risk (IRR=0.70 (0.60-0.82) than when none was worn.
We confirmed that asthma was the main health problem among WTC responders, though we did not observe an increased risk of the other four health outcomes. We also found a clear protective effect of using a respirator on asthma incidence. This is an important finding not only for future disaster preparedness but also for protecting general workers from their daily occupational exposures.
Asthma was highly prevalent among WTC responders while other health outcomes were not. Significant protective effect for asthma and rheumatoid arthritis was observed among those who used a respirator while working at WTC sites
Bian Liu, PhD, Assistant professor; Francine Smith, MPH, Program coordinator; Sherry Baron, MD, MS, Professor; David Kriebel, ScD, Professor; Jacqueline Moline, MD MS, Chair
Kim H, Baron S, Baidwan N.K, Schwartz A, Moline J. 2017. New Onset of Asthma and Job Status Change among World Trade Center Responders and Workers. American Journal of Industrial Medicine.
Liu B, Tarigan LH, Bromet EJ, Kim H. 2014. World Trade Center Disaster Exposure-Related Probable Posttraumatic Stress Disorder among Responders and Civilians: A Meta-Analysis. PLoS ONE 9(7): e101491.
Kim H, Kriebel D, Liu B, et al. 2018. Standardized morbidity ratios of four chronic health conditions among World Trade Center responders: Comparison to the national health interview survey. Am J Ind Med. 61(5): 359–448.
