Mortality Among WTC Rescue and Recovery Workers

Details

• Personal Author:
  Boffetta P ; Hall CB
• Description:
  Introduction: Hazardous exposures from the World Trade Center (WTC) terrorist attacks have been linked to increased 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, and we compared mortality of law enforcement officers (LEO) among WTC workers to a comparable external cohort. A similar comparison was conducted for firefighters. 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. In the analysis of LEO, follow-up began on 9/11/2001 and ended at the earlier of death date or 12/31/2016 for the WTC cohort, and ranged from 2000-2018 for the Buffalo cohort. The study population comprised 11,313 WTC- and 1,533 non-WTC LEO. We restricted our analysis to those who were aged between the ages of 40 and 79 years. Mortality relative rates (RRs) were estimated for the WTC cohort compared to the Buffalo cohort using Poisson regression models for grouped data, with adjustment for gender, age group, race, and five-year calendar period. Results: There were 1,912 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 to 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. In the analysis of LEO, 127 deaths were observed in the WTC cohort and 274 in the Buffalo cohort. The adjusted all-cause mortality RR for WTC vs. Buffalo was 0.77, 95%CI: 0.57-1.04, and the respiratory disease-specific mortality RR was 0.29, 95%CI: 0.09-0.95. Mortality rates for other causes of death did not differ between the two cohorts. 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 warrants further investigation. Our study found a lower mortality in WTC LEO compared to non-WTC LEO, which was significantly different for respiratory diseases. Similar results were observed in the comparison of WTC-exposed and WTC-unexposed firefighters. These results suggest that WTC-specific health program contributed to lower or higher mortality among LEO in the WTC cohort. [Description provided by NIOSH]
• Subjects:
  Cohort Studies Emergency Responders Firefighters Law Enforcement Occupational Health Safety September 11 Terrorist Attacks
• Keywords:
  Cohort Studies Disaster Recovery Fire Fighters Law Enforcement Workers Mortality Studies Rescue Workers World Trade Center WTC
• Series:
  Grant Final Reports
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Final Cooperative Agreement Report
• Place as Subject:
  New York ; OSHA Region 2
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OEP - Office of Extramural Programs
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-51
• NIOSHTIC Number:
  nn:20069596
• Citation:
  Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, U01-OH-012235, 2023 Nov; :1-51
• Contact Point Address:
  Paolo Boffetta, Stony Brook University, Cancer Center, MART building, level 7, Room 0844, Stony Brook, NY 11794
• Email:
  paolo.boffetta@stonybrookmedicine.edu
• Federal Fiscal Year:
  2024
• Performing Organization:
  State University New York Stony Brook
• Peer Reviewed:
  False
• Start Date:
  20200821
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20210630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:3eb32cc384645110257530d96a3228d0166ddaed7a2ad22e5851a1fcfe050b1a19f4596c335e5fd49b23045eb5bd07f3e95aa08c8df4381af5a9bb4396d97a6b
• Download URL:
  https://stacks.cdc.gov/view/cdc/219245/cdc_219245_DS1.pdf
• File Type:
  [PDF - 633.95 KB ]