Abstract
The World Trade Center (WTC) attacks on 9/11/2001 have consistently been associated with elevated rates of physical and mental health morbidities, while evidence about mortality has been limited. We examined mortality between 9/12/2001 and 12/31/2017 among 15,431 WTC-exposed Fire Department of the City of New York (FDNY) firefighters and emergency medical service providers (EMS), specifically assessing associations between intensity of WTC-exposure and mortality risk. Standardized mortality ratios (SMR) and 95% confidence intervals (CI) compared FDNY cohort mortality with the US general population using life table analysis. Deaths were identified via linkage to the National Death Index. Cox proportional hazards regression models were used to identify associations between intensity of WTC-exposure and mortality, accounting for age, sex, race/ethnicity, smoking history, and other relevant confounders. We identified 546 deaths and a lower than expected all-cause mortality rate (SMR = 0.22; 95% CI, 0.20–0.24). No cause-specific SMRs were meaningfully elevated. Mortality hazard ratios showed no association or linear trend with level of WTC-exposure. Our results provide evidence of the healthy worker effect, despite exposure to the World Trade Center. More follow-up time may be needed to assess the full impact of WTC-exposure on mortality in this occupational population.
Highlights
The collapse of the World Trade Center (WTC) buildings after the September 11, 2001 terrorist attacks exposed Fire Department of the City of New York (FDNY) rescue/recovery workers to caustic dust and products of combustion [1]
Rescue/recovery workers who were actively employed by FDNY for less than 18-months were excluded (n = 47) to ensure that all included participants were actively employed as a firefighter or emergency medical service providers (EMS) after completing training [4]
The lack of differences between Standardized mortality ratios (SMR) stratified by race, work assignment, and WTC-exposure level suggest that the overall study findings are robust
Summary
The collapse of the World Trade Center (WTC) buildings after the September 11, 2001 terrorist attacks exposed Fire Department of the City of New York (FDNY) rescue/recovery workers to caustic dust and products of combustion [1]. The disaster’s intense dust cloud contained a huge variety of irritants, including partially combusted and/or pulverized wood, paper, and jet fuel; construction materials including asbestos, glass, silica, fiberglass, and concrete; complex organic chemicals; lead and other metals [1,2]. Several physical and mental health conditions were linked to. 9/11/2001-related exposures, such as high rates of airway injury including excessive loss of lung. Res. Public Health 2020, 17, 6266; doi:10.3390/ijerph17176266 www.mdpi.com/journal/ijerph
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