Non-Invasive Liver Fibrosis Scores and Mortality in a Cohort of World Trade Center Rescue/Recovery Workers

Details

• Journal Article:
  BMJ Open Gastroenterology
• Personal Author:
  Singh, Ankura ; Zeig-Owens, Rachel ; Icitovic, Nikolina ; Goldfarb, David G. ; Hall, Charles B. ; Choi, Jaeun ; Dasaro, Christopher R. ; Garrity, Victoria ; Todd, Andrew C. ; Prezant, David J.
• Description:
  Objectives: Higher liver fibrosis scores have been associated with all-cause and liver disease-related mortality. We investigated whether liver fibrosis scores were associated with all-cause, liver disease-related and non-liver disease-related mortality and liver cancer incidence in an occupational cohort. Methods: The study included 43 870 Combined World Trade Center Rescue/Recovery Worker Cohort members who had blood drawn between 11/9/2001-31/12/2020. Aspartate aminotransferase to platelet ratio index (APRI), fibrosis-4 score (FIB-4), and non-alcoholic fatty liver disease fibrosis score (NFS) were calculated and categorised as low, intermediate or high scores per established cut-offs. Deaths and liver cancers were identified via National Death Index records and state cancer registries. Cox proportional hazards regression models estimated HRs and 95% CIs for each outcome in those with intermediate and high versus low fibrosis scores. Results: By 31/12/2020, 1996 deaths, 81 liver disease-related deaths and 36 incident liver cancers occurred. Participants with intermediate or high APRI (HR=1.73, 95% CI 1.50 to 1.99 and HR=7.23, 95% CI 5.63 to 9.29), FIB-4 (HR=1.18, 95% CI 1.05 to 1.34 and HR=3.96, 95% CI 3.22 to 4.85) or NFS (HR=1.61, 95% CI 1.43 to 1.81 and HR=4.73, 95% CI 3.78 to 5.93) had increased risks of all-cause mortality vs those with low scores, controlling for potential confounders. Those with intermediate/high scores also had increased liver disease- and non-liver disease-related mortality. High APRI, FIB-4 and NFS, and intermediate APRI and NFS were associated with liver cancer. Conclusions: Intermediate and high liver fibrosis scores predicted all-cause, liver disease-related and non-liver disease-related mortality, and high scores predicted liver cancer, in this population. Liver fibrosis scores may identify those at greater risk for poor health outcomes, even in a healthy occupational cohort.
• Subjects:
  Emergency Responders Liver Neoplasms Occupational Health Safety September 11 Terrorist Attacks
• Keywords:
  World Trade Center; WTC; Rescue workers; Emergency responders; Cohort studies; Liver disease; Fibrosis; Liver cancer; Cancer rates; Mortality rates; Epidemiology; Blood samples
• Source:
  BMJ Open Gastroenterol 2025 Nov; 12(1):e001889
• ISSN:
  2054-4774
• Document Type:
  Text
• Funding:
  Cooperative Agreement ; Contract
• Genre:
  Journal Article
• Place as Subject:
  New York ; New York City Region [OSHA]
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  10 pdf pages
• Volume:
  12
• NIOSHTIC Number:
  nn:20071526
• Contact Point Address:
  Rachel Zeig-Owens, Fire Department of the City of New York, Brooklyn, New York, USA
• Email:
  Rachel.Zeig-Owens@fdny.nyc.gov
• Federal Fiscal Year:
  2026
• Performing Organization:
  Albert Einstein College of Medicine, Inc., Bronx, New York
• Peer Reviewed:
  True
• Start Date:
  20160901
• End Date:
  20200831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:879ff5e113ac59d18117a1ad4dd4992fc8d5a651368e661d34789ff0e6b5db2ae85e92c17257cfcea4cd96f3ca779188ce640424e17ad25db54af46ba4db1dc4
• Download URL:
  https://stacks.cdc.gov/view/cdc/259122/cdc_259122_DS1.pdf
• File Type:
  [PDF - 624.25 KB ]