Abstract
The World Trade Center (WTC) disaster exposed the responders to several hazards. Three cohorts i.e., the Fire Department of New York (FDNY), the General Responder Cohort (GRC), and the WTC Health Registry (WTCHR) surveyed the exposed responder population. We searched Pubmed and Web of Science for literature on a well-published association between the WTC exposures and asthma, focusing on new-onset self-reported physician-diagnosed asthma. The resulting five articles were qualitatively assessed for potential biases. These papers were independently reviewed by the co-authors, and conclusions were derived after discussions. While, the cohorts had well-defined eligibility criteria, they lacked information about the entire exposed population. We conclude that selection and surveillance biases may have occurred in the GRC and WTCHR cohorts, but were likely to have been minimal in the FDNY cohort. Health care benefits available to responders may have increased the reporting of both exposure and outcome in the former, and decreased outcome reporting in the FDNY cohort. Irrespective of the biases, the studies showed similar findings, confirming the association between WTC exposure and self-reported physician-diagnosed asthma among responders. This suggests that health data gathered under great duress and for purposes other than epidemiology can yield sound conclusions. Potential biases can, however, be minimized by having validated survey instruments and worker registries in place before events occur.
Highlights
First responders, clean-up workers, and volunteers involved in rescue and recovery following the attack on the World Trade Center (WTC) on 11 September 2001 suffered from extreme hazardous physical, chemical and emotional conditions [1,2]
It is likely that there were biases in the WTC studies of asthma incidence when defined as self-reported physician diagnosed, but on balance the observed associations across all five studies were similar in direction and strength, suggesting that biases were either modest in effect or worked in different directions with little net effect
While it is possible that biases similar in intensity and direction could explain this, these findings need to be combined with a larger discussion regarding causality
Summary
Clean-up workers, and volunteers involved in rescue and recovery following the attack on the World Trade Center (WTC) on 11 September 2001 suffered from extreme hazardous physical, chemical and emotional conditions [1,2]. After 9/11, local clinicians and researchers began to screen responders, workers and volunteers (hereafter called “responders”) for health effects via separate but coordinated initiatives. These were: the Fire Department of New York (FDNY) that created a program to screen firefighters and emergency medical service (EMS) workers employed by the FDNY [3,4]; and the New York/New Jersey World Trade Center Clinical Center Consortium (hereafter called the General Responder Cohort (GRC)) established to monitor workers and volunteers who performed search, rescue and recovery (excluding FDNY firefighters/EMS) [5]. Public Health 2018, 15, 1053; doi:10.3390/ijerph15061053 www.mdpi.com/journal/ijerph
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