Continuing Toll on 9/11 Responders Evident 15 Years Later

Marcia Frellick

September 06, 2016

After the September 11, 2001, attacks on the World Trade Center (WTC), the Fire Department of the City of New York (FDNY) started a medical monitoring and treatment program and established a data center to document long-term health outcomes among the 16,000 firefighters and Emergency Medical Service workers exposed in the attacks and the recovery effort.

Through comparisons of medical information before and after the attacks, questionnaires, and examination of research, a team led by Jennifer Yip, MPH, from the Department of Medicine at Montefiore Medical Center in the Bronx, New York, and the Bureau of Health Services with the Fire Department of the City of New York in Brooklyn, has drawn conclusions about which responders were most affected and by what diseases and complications.

Results were published in the September 11 issue of the American Journal of Industrial Medicine.

Among the findings are that symptoms or diagnoses of respiratory health conditions were rare in the group before 9/11, but by 2015, almost half (47.2%) of the FDNY-WTC rescue/recovery group had at least one of the following diagnoses: obstructive airway disease, chronic rhinosinusitis (CRS), or gastroesophageal reflux disease (GERD).

"Most of those who experienced an unprecedented decline in lung function shortly after 9/11 continue to show either lack of recovery or only a partial recovery up to 14 years later," the authors write.

Overall, those who arrived on the scene in the morning of the attacks, as opposed to the afternoon or following days or weeks, had the worst physical and mental outcomes, according to the study.

Outcome trends included increases in the following:

  • GERD: Before 9/11, only 5.2% of FDNY firefighters reported GERD symptoms (acid reflux, sore throat, chest burning/tightness, and difficulty swallowing). In the first year after 9/11, 41% reported GERD symptoms, of which sore throat was the most prevalent, at 61%. In 2015, the prevalence of physician-diagnosed GERD was 28%.

  • Lower respiratory distress: More than half (53%) of the rescue/recovery responders reported cough immediately after the attacks. The next most common respiratory symptoms were shortness of breath (38%) and wheezing (33%). In 2015, physician-diagnosed obstructive airway disease occurred in 24% of participants, with asthma the most common diagnosis (19%).

  • CRS: Pre-9/11, 4.4% of FDNY firefighters reported frequent rhinosinusitis. From the first post-9/11 year to 14 years post-9/11, CRS symptoms consistently affected about 40% of the FDNY-WTC rescue/recovery workers. Examination of medical records showed the prevalence of diagnosed CRS increased from 11% in 2005 to 30% in 2015.

  • Cancer: Seven years after 9/11, FDNY-WTC-exposed firefighters had a 10% higher overall cancer incidence rate (standardized incidence ratio [SIR], 1.10; 95% confidence interval [CI], 0.98 - 1.25) than the general US male population. Rates were higher for some specific cancers among WTC-exposed firefighters compared with among the general US male population, particularly prostate (SIR, 1.49; 95% CI, 1.20 - 1.85) and thyroid (SIR, 3.07; 95% CI, 1.86 - 5.08). Thyroid and prostate cancer rates remained elevated when compared with a group of career firefighters from Chicago, Philadelphia, and San Francisco, but overall cancer rates were similar when compared with firefighters from those cities.

  • Sarcoidosis: In the first 14 years after 9/11, 75 FDNY-WTC rescue and recovery workers were diagnosed with new incident sarcoidosis. Before 9/11, all had normal chest X-rays and normal spirometry and had no symptoms. "This post-9/11 sarcoidosis rate of ~22/100,000 was considerably higher than the average pre-9/11 incidence rate of ~15/100,000," the authors write.

  • Alcohol/tobacco use: In post-9/11 questionnaires, 15% of the FDNY WTC rescue/recovery workers said they were current smokers, and 29% said they increased tobacco use after the attacks. A third (34%) of the 14,228 people who completed a post-9/11 mental health questionnaire said they had increased alcohol use.

  • Depression: High prevalence of probable depression ranges from 20% in year 6 to 16% in year 14, and is highest among those who arrived on the scene earliest.

Retirement rates show some of the overall effect of the attacks: In the first 4 years after 9/11, more than 3000 FDNY responders retired, which is more than twice the number who retired 4 years before.

"The increase in retirement was attributed to challenges associated with work at the WTC including grief, physical injuries, respiratory health conditions, and psychological distress," the authors write.

The health program and the data center will continue to monitor effects of the attacks on respiratory illnesses as well as cancer, autoimmune, and cardiovascular diseases in later years.

"Analyses on mortality rates and later-emerging conditions with longer follow-up time may yield increased case accrual and account for latency periods," the authors write.

Free treatment for WTC-related health conditions are offered to all active and retired FDNY rescue/recovery workers who were exposed.

This project was funded by the National Institute for Occupational Safety and Health. The authors have disclosed no relevant financial relationships.

Am J Ind Med. 2016;59:731-741. Abstract

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