Nested case-control study of selected systemic autoimmune diseases in World Trade Center rescue/recovery workers

Details

• Personal Author:
  Berman J ; Glaser MS ; Hall C ; Jaber N ; Kelly K ; Loupasakis K ; Moir W ; Prezant DJ ; Qayyum B ; Webber MP ; Zeig-Owens R
• Description:
  Objective: To test the a priori hypothesis that acute (arrival time at the World Trade Center site) and chronic (months of World Trade Center-related work) exposures were associated with risk of new onset systemic autoimmune diseases. Methods: We performed a nested case-control study by individually matching each rheumatologist-confirmed case diagnosed between 9/12/2001 and 9/11/2013 (n=59) to 4 randomly selected controls (n=236) that were matched for year of hire (+/-1 year), gender, race and work assignment (firefighter or Emergency Medical Service). Rheumatologists were blinded to exposure status. Conditional odds ratios (COR) and 95% confidence intervals (95% CI) were derived from exact conditional logistic models. Results: Rheumatoid arthritis (37%) was the most common autoimmune diagnosis, followed by spondyloarthritis (22%), inflammatory myositis (14%), systemic lupus ethythematosus (12%), systemic sclerosis (5%), Sjögrens syndrome (5%), antiphospholipid syndrome (3%) and granulomatosis with polyangiitis (Wegener's) (2%). The COR of autoimmune disease increased by 13% for each additional month worked at the site (95% CI 1.02-1.26) and was independent of the association between high acute exposure (working during the morning of 9/11/2001) and disease outcome, which was elevated, but not statistically significant (COR 1.85 95% CI 0.86-3.89). Conclusion: Prolonged work at the WTC site, independent of acute exposure, was an important predictor of post-9/11 systemic autoimmune diseases. The World Trade Center Health Program should expand surveillance efforts for those with extended exposures as early detection can facilitate early treatment, which has been shown to minimize organ damage and improve quality of life. [Description provided by NIOSH]
• Subjects:
  Diagnosis Emergency Responders Environmental Exposure Environmental Monitoring Firefighters Hazardous Substances Health Care Facilities Workforce And Services Immune System Occupational Exposure Occupational Health Risk Assessment Safety

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• Keywords:
  Acute-exposure Autoimmunity Chronic-exposure Clinical-diagnosis Diseases Emergency-responders Environmental-exposure Exposure-assessment Fire-fighters Hazardous-waste-cleanup Immune-reaction Immune-system Immune-system-disorders Medical-monitoring Medical-treatment Rescue-workers Rheumatoid-disorders Risk-analysis Surveillance-programs

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• ISSN:
  2326-5191
• Document Type:
  Text
• Funding:
  Cooperative Agreement ; Contract
• Genre:
  Journal Article
• Place as Subject:
  New York ; OSHA Region 2
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  67
• Issue:
  5
• NIOSHTIC Number:
  nn:20045943
• Citation:
  Arthritis Rheumatol 2015 May; 67(5):1369-1376
• Contact Point Address:
  Mayris P. Webber, FDNY Headquarters, 9 Metrotech Center, 5E63K, Brooklyn, NY 11201
• Email:
  webberm@fdny.nyc.gov
• Federal Fiscal Year:
  2015
• Performing Organization:
  Albert Einstein College of Medicine, New York
• Peer Reviewed:
  True
• Start Date:
  20130701
• Source Full Name:
  Arthritis and Rheumatology
• End Date:
  20150630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:70ce2ce65c6147aa20e9a4514694dd58d038b5e5f745c62b1a02177cc7024bfe2c453a87b08e451f09eb91da66277d8fae26082e00d3356936d5e306e298fb35
• Download URL:
  https://stacks.cdc.gov/view/cdc/201157/cdc_201157_DS1.pdf
• File Type:
  [PDF - 91.23 KB ]