Sarcoidosis and World Trade Center disaster - authors' response

Details

• Personal Author:
  Cone, James E. ; Jordan HT ; Osahan SS ; Stellman SD
• Description:
  Our nested case-control study found a strong relationship between performing rescue/recovery work on the 9/11 dust and debris pile and post-9/11 sarcoidosis but did not detect such a relationship between dust cloud exposure and post-9/11 sarcoidosis. We may have lacked sufficient statistical power to detect the latter relationship. It is also possible that the more intense 9/11- related exposures experienced by rescue and recovery workers as compared with others in our study enabled us to detect a relationship in the former group but not in the latter. We found a relationship between 9/11-related exposures and sarcoidosis diagnosed several years after 9/11. Nevertheless, we could not determine when the disease process was initiated for the individuals in our study, only the year when the illness came to medical attention and was definitively diagnosed. It is plausible that some of the cases, particularly those that were diagnosed incidentally, had begun years before. As we did not have access to pre-9/11 chest radiographs or other medical records, and because the exposure-disease interval for sarcoidosis is unknown, it is not possible to confirm this. It is not clear how the exposure-disease interval for post-9/11 sarcoidosis, which is likely of an environmental etiology, compares with the exposure-disease interval for infectious granulomatous diseases. Table 2 of our report shows the year of diagnosis for the cases in our study. These data cannot be used to compute incidence rates, which we could not calculate because we did not have a systematic way of identifying all cases in our study population. We do not believe that any conclusions about trends in incidence over time can be drawn from our data. The World Trade Center Health Registry conducts periodic health surveys but is not a clinical surveillance program. It is true that many of our enrollees may participate in such surveillance programs at other institutions, and, therefore, that our population may receive, on average, more screening chest radiographs compared with the general public. Nevertheless, both cases and controls in our study are likely to have received this heightened degree of medical attention, so detection bias is unlikely to explain the strong exposure-disease relationship we reported. [Description provided by NIOSH]
• Subjects:
  Case Reports Cells, Cultured Demography Emergencies Emergency Responders Environmental Monitoring Eye Immune System Lung Occupational Exposure Occupational Health Respiratory System Risk Assessment Risk Factors Safety Sense Organs Skin

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• Keywords:
  Biological-effects Biological-monitoring Biopsy Case-studies Cell-alteration Cell-cultures Cell-damage Cell-function Corticosteroids Demographic-characteristics Disease-incidence Emergency-responders Emergency-response Employee-exposure Employee-health Exposure-assessment Eyes Immune-reaction Immune-system Immune-system-disorders Lymph-nodes Organs Rescue-workers Risk-analysis Risk-factors Tissue-disorders

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• ISSN:
  1076-2752
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• 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
• Pages in Document:
  2-3
• Volume:
  54
• Issue:
  1
• NIOSHTIC Number:
  nn:20047480
• Citation:
  J Occup Environ Med 2012 Jan; 54(1):2-3
• Contact Point Address:
  Hannah T. Jordan, MD, World Trade Center Health Registry New York City Department of Health and Mental Hygiene New York, NY
• Federal Fiscal Year:
  2012
• Performing Organization:
  New York City Health/Mental Hygiene
• Peer Reviewed:
  True
• Start Date:
  20090430
• Source Full Name:
  Journal of Occupational and Environmental Medicine
• End Date:
  20260630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:b6bbe76df1b55d469bf525354f5aac9b59c786f31c617f07a8c5992f7d7e951a83751c4aed39c30080f2e79c99585573a3ef6385201d5c619c9eb57b2872ad35
• Download URL:
  https://stacks.cdc.gov/view/cdc/202536/cdc_202536_DS1.pdf
• File Type:
  [PDF - 153.88 KB ]