Abstract
Dust created by the collapse of the World Trade Center (WTC) towers on 9/11 included metals and toxicants that have been linked to an increased risk of pulmonary fibrosis (PF) in the literature. Little has been reported on PF among WTC responders. This report used self-reported physician diagnosis of PF with an unknown sub-type to explore the association between levels of WTC dust exposure and PF. We included 19,300 WTC responders, enrolled in the WTC Health Registry in 2003–2004, who were followed for 11 years from 2004 to 2015. Exposure was defined primarily by intensity and duration of exposure to WTC dust/debris and work on the debris pile. Stratified Cox regression was used to assess the association. We observed 73 self-reported physician-diagnosed PF cases, with a PF incidence rate of 36.7/100,000 person-years. The adjusted hazard ratio (AHR) of PF was higher in those with a medium (AHR = 2.5, 95% CI = 1.1–5.8) and very high level of exposure (AHR = 4.5, 95% CI = 2.0–10.4), compared to those with low exposure. A test for exposure—response trend was statistically significant (Ptrend = 0.004). Future research on WTC dust exposure and PF would benefit from using data from multiple WTC Health Program responder cohorts for increased statistical power and clinically confirmed cases.
Highlights
The collapse of the World Trade Center (WTC) towers resulting from the terrorist attack on 11September 2001 (9/11) produced a dense cloud of dust and debris that spread widely and contained toxic substances including heavy metals, silica, asbestos fibers, and wood dust [1,2].WTC responders were potentially highly exposed as a result of performing rescue and recovery work on the WTC site including searching for remains, firefighting and debris removal work that continued through June 2002 [3]
Using self-reported survey data on pulmonary fibrosis (PF) from the World Trade Center Health Registry [20], we investigated the incidence of PF and assessed the association between WTC dust exposure and PF in a large longitudinal cohort of WTC responders during an 11-year median follow-up period
We focused our study sample on WTC responders, who presumably experienced more intense dust exposure than those not involved with rescue/recovery
Summary
WTC responders were potentially highly exposed as a result of performing rescue and recovery work on the WTC site including searching for remains, firefighting and debris removal work that continued through June 2002 [3]. Of those involved in the rescue/recovery activities, nearly half were directly exposed to the dust cloud (blackout conditions) on 9/11 [3]. A small number of cases of pulmonary fibrosis (PF) among WTC responders were reported in the first eight years following 9/11 [4,10,11]
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