Mortality After the 9/11 Terrorist Attacks Among World Trade Center Health Registry Enrollees with Cancer

Details

• Personal Author:
  Cone, James E. ; Farfel MR ; Kehm RD ; Li J ; Qiao B ; Takemoto E ; Yung J
• Description:
  Background: While several studies have reported the association between 9/11 exposure and cancer risk, cancer survival has not been well studied in the World Trade Center (WTC) exposed population. We examined associations of 9/11-related exposures with mortality in WTC Health Registry enrollees diagnosed with cancer before and after 9/11/2001. Patients and methods: This is a longitudinal cohort study of 5061 enrollees with a first-ever primary invasive cancer diagnosis between 1995 and 2015 and followed through 2016. Based on the timing of first cancer diagnosis, pre-9/11 (n = 634) and post-9/11 (n = 4427) cancer groups were examined separately. 9/11-related exposures included witnessing traumatic events, injury on 9/11, and 9/11-related post-traumatic stress disorder (PTSD). Associations of exposures with all-cause mortality were examined using Cox proportional hazards regression. In the post-9/11 group, cancer-specific mortality was evaluated by enrollee group (WTC rescue/recovery workers vs. non-workers) using Fine and Gray's proportional sub-distribution hazard models, adjusting for baseline covariates, tumor characteristics, and treatment. Results: In the pre-9/11 group, 9/11-related exposures were not associated with all-cause mortality. In the post-9/11 group, increased risk of all-cause mortality was associated with PTSD (adjusted HR = 1.35; 95% CI = 1.11-1.65), but not with injury or witnessing traumatic events. Cancer-specific mortality was not statistically significantly associated with 9/11-related exposures. In rescue/recovery workers, increased non-cancer mortality risk was associated with PTSD (aHR = 2.13, 95% CI = 1.13-4.00) and witnessing ≥3 traumatic events (aHR = 2.00, 95% CI = 1.13-3.55). Conclusions: We did not observe associations between 9/11-related exposures and cancer-specific mortality. Similar to findings in the non-cancer WTC exposed population, PTSD was associated with increased risk of all-cause mortality in cancer patients. [Description provided by NIOSH]
• Subjects:
  Cohort Studies Mental Health Mortality Neoplasms Nervous System Occupational Health Safety September 11 Terrorist Attacks Stress Disorders, Post-Traumatic
• Keywords:
  Author Keywords: 9/11-disaster Cancer Cohort Studies Mental Health Mortality Mortality Rates Post-traumatic Stress Disorder PTSD Quality Of Life Trauma Traumatic Incident Stress World Trade Center WTC

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• ISSN:
  2045-7634
• 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
• Volume:
  12
• Issue:
  2
• NIOSHTIC Number:
  nn:20066052
• Citation:
  Cancer Med 2023 Jan; 12(2):1829-1840
• Contact Point Address:
  Jiehui Li, New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, Box CN-6W, Long Island City, New York 11101
• Email:
  jli3@health.nyc.gov
• Federal Fiscal Year:
  2023
• Performing Organization:
  New York City Health/Mental Hygiene
• Peer Reviewed:
  True
• Start Date:
  20090430
• Source Full Name:
  Cancer Medicine
• End Date:
  20260630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:df13ec8d5049b8103a4a8f6b3405704e5a5944241beb4465f286aa9d515b5f8464ed1adeeda711e0d70bdce5d6daefe63db2010c361aecdd6bb7e4a8e4d10b32
• Download URL:
  https://stacks.cdc.gov/view/cdc/209133/cdc_209133_DS1.pdf
• File Type:
  [PDF - 259.30 KB ]