World Trade Center Disaster Research Articles

Firefighters and COVID-19: An Occupational Health Perspective.

Firefighters and COVID-19: An Occupational Health Perspective.

Assembling the Career Firefighter Health Study cohort: A methods overview.

Studies of World Trade Center (WTC)-exposed rescue/recovery workers report the increased occurrence of health conditions after work at the WTC disaster site. However, the extent to which these associations are due to WTC exposure is unclear, in part due to the lack of suitable comparison groups. Accordingly, we identified a previously assembled National Institute for Occupational Safety and Health (NIOSH) cohort of career firefighters from three US cities (n = 29,992). Here, we document the challenges in establishing this non-WTC-exposed firefighter cohort for the goal of tracking and comparing cancer and chronic health conditions in WTC-exposed and non-WTC-exposed firefighters. Follow-up process included institutional review board applications, data use agreements, state cancer registry linkages and vital status determination for the NIOSH firefighter cohort. After completion of these steps, we undertook outreach to the three original city fire departments and union officials, before contact tracing and direct recruitment of 14,566 living firefighters to complete a confidential health survey. We staggered recruitment efforts by the city, using letters, postcards, emails, videos, and telephone outreach. Participants who completed the survey received $10. A total of 4962 of 14,566 alive firefighters responded to the baseline survey (34.1% response rate). Respondents were older and more likely to be non-Hispanic white than nonrespondents. We provide an overview of the process for the first survey to collect information on physical and mental health conditions among US firefighters. The data collected will have an important impact on studies of WTC rescue/recovery work, firefighting, and related health conditions.

Trajectories of psychological distress among individuals exposed to the 9/11 World Trade Center disaster.

Individuals present in lower Manhattan during the 9/11 World Trade Center (WTC) disaster suffered from significant physical and psychological trauma. Studies of longitudinal psychological distress among those exposed to trauma have been limited to relatively short durations of follow-up among smaller samples. The current study longitudinally assessed heterogeneity in trajectories of psychological distress among WTC Health Registry enrollees - a prospective cohort health study of responders, students, employees, passersby, and residents in the affected area (N = 30 839) - throughout a 15-year period following the WTC disaster. Rescue/recovery status and exposure to traumatic events of 9/11, as well as sociodemographic factors and health status, were assessed as risk factors for trajectories of psychological distress. Five psychological distress trajectory groups were found: none-stable, low-stable, moderate-increasing, moderate-decreasing, and high-stable. Of the study sample, 78.2% were classified as belonging to the none-stable or low-stable groups. Female sex, being younger at the time of 9/11, lower education and income were associated with a higher probability of being in a greater distress trajectory group relative to the none-stable group. Greater exposure to traumatic events of 9/11 was associated with a higher probability of a greater distress trajectory, and community members (passerby, residents, and employees) were more likely to be in greater distress trajectory groups - especially in the moderate-increasing [odds ratios (OR) 2.31 (1.97-2.72)] and high-stable groups [OR 2.37 (1.81-3.09)] - compared to the none-stable group. The current study illustrated the heterogeneity in psychological distress trajectories following the 9/11 WTC disaster, and identified potential avenues for intervention in future disasters.

Exposure to mass disaster and probable panic disorder among children in New York City

While both direct and indirect exposure to mass trauma are increasing in the United States, relatively little is known about the potential link between mass trauma and risk of panic disorder early in life. It is also unclear whether history of prior individual trauma increases risk of panic disorder even further among those with exposure to mass trauma. The current study investigated the association between exposure to a mass trauma event (the World Trade Center (WTC) attack) and risk of panic disorder among children, how panic disorder varies by exposure severity and sociodemographic characteristics, and whether there is an interaction between individual and mass trauma exposure in the risk of panic disorder. Data were from an epidemiologic study of probable mental disorders among New York City schoolchildren exposed to the WTC terrorist attack. Severe (adjusted odds ratio [AOR] = 2.0 (1.1, 3.7)) exposure to the WTC disaster was associated with increased odds of probable panic disorder, relative to mild exposure. The prevalence of panic disorder increased with higher level of WTC exposure among all sociodemographic strata. Prior individual trauma exposure was associated with increased odds of panic disorder (AOR = 2.4 (1.6, 3.5)), but there was no evidence of interaction between prior individual trauma exposure and exposure to the WTC disaster. Preventive measures to address the widespread nature of mass disaster exposure at increasingly earlier ages and via media could mitigate the potential impact on mental health.

Association between post-traumatic stress disorder and alcohol-related hospitalizations among World Trade Center Health Registry enrollees

BackgroundWe examined both the impact of 9/11-related exposures and repeated assessments of post-traumatic stress disorder (PTSD) on the risk of alcohol-related hospitalizations (ARH) among individuals exposed to the World Trade Center (WTC) disaster. Methods9/11-related exposures (witnessing traumatic events, physical injuries, or both) were measured at baseline and PTSD symptoms were assessed at four time points (2003–2016) using the PTSD Checklist-17 among 53,174 enrollees in the WTC Health Registry. ICD-9-CM and ICD-10-CM codes were used to identify ARHs (2003–2016) through linked administrative data. For the effect of 9/11-related exposures on ARH, Cox proportional-hazards regression estimated hazard ratios (HR) and 95 % confidence intervals (CI); for time-varying PTSD, extended Cox proportional-hazards regression was used. Models were adjusted fora priori confounders and stratified by enrollee group (uniformed rescue and recovery worker (RRW), non-uniformed RRW, and community members). Person-time was calculated from baseline or 9/12/2001 to the earliest of ARH, withdrawal, death, or end of follow-up (12/31/2016). ResultsAcross all 9/11-related exposures, community members and non-uniformed RRWs were at increased risk of ARHs; uniformed RRWs were not. In adjusted models, PTSD was associated with an increased risk of hospitalization across all groups [HR, (95 % CI): uniformed RRWs: 2.6, (1.9, 3.6); non-uniformed RRWs: 2.1, (1.7, 2.7); and community members: 2.6, (2.1, 3.2)]. ConclusionsAmong certain enrollee groups, 9/11-related exposures are associated with an increased risk of ARH and that PTSD is strongly associated with ARHs among all enrollee groups. Findings may assist the clinical audience in improving screening and treatment.

Initial Whole-Genome Sequencing of Plasma Cell Neoplasms in First Responders and Recovery Workers Exposed to the World Trade Center Attack of September 11, 2001.

The World Trade Center (WTC) attack of September 11, 2001 created an unprecedented environmental exposure to known and suspected carcinogens. High incidence of multiple myeloma and precursor conditions has been reported among first responders to the WTC disaster. To expand on our prior screening studies, and to characterize the genomic impact of the exposure to known and potential carcinogens in the WTC debris, we were motivated to perform whole-genome sequencing (WGS) of WTC first responders and recovery workers who developed a plasma cell disorder after the attack. We performed WGS of nine CD138-positive bone marrow mononuclear samples from patients who were diagnosed with plasma cell disorders after the WTC disaster. No significant differences were observed in comparing the post-WTC driver and mutational signature landscapes with 110 previously published WGSs from 56 patients with multiple myeloma and the CoMMpass WGS cohort (n = 752). Leveraging constant activity of the single-base substitution mutational signatures 1 and 5 over time, we estimated that tumor-initiating chromosomal gains were windowed to both pre- and post-WTC exposure. Although limitations in sample size preclude any definitive conclusions, our findings suggest that the observed increased incidence of plasma cell neoplasms in this population is due to complex and heterogeneous effects of the WTC exposure that may have initiated or contributed to progression of malignancy.

Single-cell transcriptomics analysis of mild cognitive impairment in World Trade Center disaster responders.

IntroductionRecent research has found that World Trade Center (WTC) responders in their mid‐50s have an elevated prevalence of mild cognitive impairment (MCI) that is associated with neural degeneration and subcortical thinning. This article extends our understanding of the molecular complexity of MCI through gene expression profiling of blood.MethodsThe transcriptomics of 40 male WTC responders were profiled across two cohorts (discovery: nine MCI and nine controls; replication: 11 MCI and 11 controls) using CITE‐Seq at single‐cell resolution in blood.ResultsComparing the transcriptomic signatures across seven major cell subpopulations, the largest differences were observed in monocytes in which 226 genes were differentially expressed. Pathway analysis on the genes unique to monocytes identified processes associated with cerebral immune response.DiscussionOur findings suggested monocytes may constitute a key cell type to target in blood‐based biomarker studies for early detection of risk of MCI and development of new interventions.

Proteomic analysis of cognitive impairment in responders traumatized by the World Trade Center disaster

AbstractBackgroundWTC responders, particularly those with long‐term PTSD, have an increased incidence of mild cognitive impairment (MCI), a prognostic marker of later dementia. In this study, we used proteomics to interrogate the interaction between PTSD and MCI in a cohort of disaster responders.MethodThe sample included 181 responders to the World Trade Center (WTC) disaster, including 73 with probable PTSD, 61 with MCI, and 81 WTC traumatized controls with neither condition. 34 responders had comorbid PTSD and MCI. PTSD was measured with the Posttraumatic Stress Disorder Checklist (PCL; cut‐point >44). MCI was defined according to NIA‐AA criteria using the Montreal Cognitive Assessment (MoCA; cut‐point <23). In total, we profiled 282 proteins with known involvement in relevant biological processes using the Olink Proseek Multiplex Platform. Specifically, we focused on markers of neurodevelopmental processes, cellular regulation, immunological function, cardiovascular disease, inflammatory processes, neurological diseases. Differential expression analysis was conducted to identify protein biomarkers of PTSD, MCI, and co‐occurring PTSD/MCI.ResultsIn total, 46 unique proteins were identified from the combined list of PTSD and MCI associated proteins. Thirty‐seven proteins were differentially expressed in PTSD versus exposed controls at p < 0.05; nine were significant after correcting for multiple comparisons using the false discovery rate (FDR < 0.1). Twenty‐five proteins were differentially expressed in MCI versus exposed controls (p < 0.05); 6 attained an FDR < 0.1. After controlling for PTSD, effect size directions for these 25 MCI‐related proteins were unchanged; 13 remained significant at p < 0.05.ConclusionThe current study identified several novel protein biomarkers for PTSD and MCI, which were associated with disease burden characterized by co‐occurrence of the phenotypes. Results indicated that half of the proteins associated with PTSD, and vice versa proteins associated with MCI were found in comorbid PTSD and MCI. The results suggest that identification of protein biomarkers might be useful in development of a plasma‐based assay for early detection of MCI in traumatized patients, especially those showing signs of MCI.

Initial Whole Genome Sequencing of Plasma Cell Neoplasms in First Responders and Recovery Workers Exposed to the World Trade Center Attack of September 11, 2001

Initial Whole Genome Sequencing of Plasma Cell Neoplasms in First Responders and Recovery Workers Exposed to the World Trade Center Attack of September 11, 2001

The Role of Chemical Mixtures and Stress in World Trade Center-Related Birth Outcomes

Background: Fetal growth has been shown to be influenced by both maternal stress and exposure to environmental contaminants, including persistent organic pollutants. The terrorist attacks on the World Trade Center (WTC) on September 11, 2001 were a catastrophic disaster and resulted in the release of thousands of tons of chemicals as well as long-lasting psychological stress amongst both responders and New York City residents. Methods: Prenatal demoralization and exposure to persistent organic pollutants (including polybrominated diphenyl ethers, polychlorinated biphenyls, dioxins and perfluoroalkyl substances) were measured in 110 participants from a Columbia University birth cohort designed to study the effects of WTC exposures on pregnancy outcomes and development. Principal component analyses were conducted to characterize the mixture of exposure to the four groups of chemicals. Demoralization was measured using the PERI-D scale, a non-specific measure of psychological stress. We evaluated the associations between proximity to the WTC disaster with chemical exposure principal components and demoralization. We then evaluated the effect these variables had on previously reported associations between proximity to the WTC disaster and birth outcomes in this study population to understand their individual roles in the observed associations. We also evaluated the interactive effects of the chemical principal components and demoralization with birth outcomes. Results: The principal component reflecting higher dioxin exposure (PC4) was associated with proximity to the WTC disaster but there was no association for demoralization. Previously reported significant reductions in birth weight and birth length associated with living <2 miles from the WTC disaster were attenuated and no longer significant after adjusting for PC4. There were no significant interactions between principal components and demoralization with birth outcomes. Conclusions: Our findings suggest chemical exposures, specifically dioxins, explain some but not all of the previously observed associations between proximity to the WTC disaster and adverse birth outcomes.

Polygenic prediction of PTSD trajectories in 9/11 responders.

Genetics hold promise of predicting long-term post-traumatic stress disorder (PTSD) outcomes following trauma. The aim of the current study was to test whether six hypothesized polygenic risk scores (PRSs) developed to capture genetic vulnerability to psychiatric conditions prospectively predict PTSD onset, severity, and 18-year course after trauma exposure. Participants were 1490 responders to the World Trade Center (WTC) disaster (mean age at 9/11 = 38.81 years, s.d. = 8.20; 93.5% male; 23.8% lifetime WTC-related PTSD diagnosis). Prospective longitudinal data on WTC-related PTSD symptoms were obtained from electronic medical records and modelled as PTSD trajectories using growth mixture model analysis. Independent regression models tested whether six hypothesized psychiatric PRSs (PTSD-PRS, Re-experiencing-PRS, Generalized Anxiety-PRS, Schizophrenia-PRS, Depression-PRS, and Neuroticism-PRS) are predictive of WTC-PTSD outcomes: lifetime diagnoses, average symptom severity, and 18-year symptom trajectory. All analyses were adjusted for population stratification, 9/11 exposure severity, and multiple testing. Depression-PRS predicted PTSD diagnostic status (OR 1.37, CI 1.17-1.61, adjusted p = 0.001). All PRSs, except PTSD-PRS, significantly predicted average PTSD symptoms (β = 0.06-0.10, adjusted p < 0.05). Re-experiencing-PRS, Generalized Anxiety-PRS and Schizophrenia-PRS predicted the high severity PTSD trajectory class (ORs 1.21-1.28, adjusted p < 0.05). Finally, PRSs prediction was independent of 9/11 exposure severity and jointly accounted for 3.7 times more variance in PTSD symptoms than the exposure severity. Psychiatric PRSs prospectively predicted WTC-related PTSD lifetime diagnosis, average symptom severity, and 18-year trajectory in responders to 9/11 disaster. Jointly, PRSs were more predictive of subsequent PTSD than the exposure severity. In the future, PRSs may help identify at-risk responders who might benefit from targeted prevention approaches.

Reconfiguración mundial: fracturas globales y cambios geo/económico/político/estratégicos

This investigation starts from the premise, according to which, we are witnessing a change of epoch that began with a transition stage, which begins with the fall of the Berlin wall and ends in 2001 with the collapse of the World Trade Center . The objective is to problematize and analyze the instability that characterizes this period of global transition and reconfiguration, in which global fractures have occurred that have given rise to geopolitical and geoeconomic changes. It makes use of the qualitative methodology, specifically, the documentary review and the hermeneutic analysis, while, it consists of a historical and conjuncture analysis. While, from a theoretical point of view, it is an interdisciplinary study, which uses structuralist and transnationalist theories to carry out the analysis

Mortality among Fire Department of the City of New York Rescue and Recovery Workers Exposed to the World Trade Center Disaster, 2001-2017.

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.

Staying connected under fire: Effects of individual roles and organizational specialization on the robustness of emergency-phase communication networks

Communication network connectivity is central to organizational performance, but maintaining connectivity can be difficult during periods of disruption. During the World Trade Center (WTC) disaster of September 11th, 2001, both emergency response-specialized organizations and organizations without such specialization forcibly adapted to a radically altered environment. Their dynamic communication networks necessarily entailed trade-offs between competing demands for efficiency and robustness to disruption. Of particular importance is whether organizations concentrated activity within a small number of “hub” nodes, and whether those with existing coordinative roles were critical to maintaining connectivity. We examine these questions by analyzing seventeen organizational communication networks in the WTC disaster. We find that organizations maintain connectivity through relatively small numbers of coordinators, but the realization of institutionalized coordinative roles depends upon organizational context. Further, we find distinct patterns of robustness, with the removal of key players leading to mass isolation in specialist networks versus a gradual pattern of failure in non-specialist networks. These results suggest that organizations responding to disruptions within their usual domain of operations will be more likely to retain institutionalized roles when building emergent networks, although this increases the network's fragility in the event of the loss of one of those coordinators. Organizations responding to novel threats may reconfigure more radically, limiting vulnerability to the loss of institutionalized—but not emergent—coordinators.

Genome-Wide DNA Methylation Profiles in Community Members Exposed to the World Trade Center Disaster

The primary goal of this pilot study was to assess feasibility of studies among local community members to address the hypothesis that complex exposures to the World Trade Center (WTC) dust and fumes resulted in long-term epigenetic changes. We enrolled 18 WTC-exposed cancer-free women from the WTC Environmental Health Center (WTC EHC) who agreed to donate blood samples during their standard clinical visits. As a reference WTC unexposed group, we randomly selected 24 age-matched cancer-free women from an existing prospective cohort who donated blood samples before 11 September 2001. The global DNA methylation analyses were performed using Illumina Infinium MethylationEpic arrays. Statistical analyses were performed using R Bioconductor package. Functional genomic analyses were done by mapping the top 5000 differentially expressed CpG sites to the Kyoto Encyclopedia of Genes and Genomes (KEGG) Pathway database. Among cancer-free subjects, we observed substantial methylation differences between WTC-exposed and unexposed women. The top 15 differentially methylated gene probes included BCAS2, OSGIN1, BMI1, EEF1A2, SPTBN5, CHD8, CDCA7L, AIDA, DDN, SNORD45C, ZFAND6, ARHGEF7, UBXN8, USF1, and USP12. Several cancer-related pathways were enriched in the WTC-exposed subjects, including endocytosis, mitogen-activated protein kinase (MAPK), viral carcinogenesis, as well as Ras-associated protein-1 (Rap1) and mammalian target of rapamycin (mTOR) signaling. The study provides preliminary data on substantial differences in DNA methylation between WTC-exposed and unexposed populations that require validation in further studies.

Change in binge drinking behavior after Hurricane Sandy among persons exposed to the 9/11 World Trade Center disaster.

The objective of this study was to examine changes in drinking behavior after Hurricane Sandy among 3199 World Trade Center Health Registry (Registry) enrollees before (2011-12) and after Hurricane Sandy (2015-16). A composite Sandy exposure scale (none, low, medium and high) included Sandy traumatic experiences, financial and other factors. Probable Sandy-related posttraumatic stress disorder (PTSD) was defined as scoring ≥44 on PTSD Checklist, and binge drinking as consuming ≥5 alcoholic drinks for men or ≥4 for women on one occasion in the past 30days. Some of the enrollees reported binge drinking post Sandy as new binge drinkers (4.7%) or consistent binge drinkers pre- and post-Sandy (19%). Compared with non-binge drinkers pre- and post-Sandy (66.9%), the adjusted odds ratios (aOR) for being new binge drinkers and consistent binge drinkers among high Sandy exposure enrollees were 2.1 (95%CI 1.1-4.1) and 2.5 (95%CI: 1.7-3.6), respectively. High Sandy traumatic experience alone was associated with consistent binge drinking (aOR: 1.9, 95%CI: 1.4-2.6). Among enrollees without 9/11 PTSD, those with Sandy PTSD were more likely to become new binge drinkers (aOR: 4.4, 95%CI: 1.4-13.9), while Sandy PTSD was not associated with any binge drinking behavior changes among those with 9/11 PTSD. Sandy exposure, Sandy traumatic experience, and Sandy PTSD were all associated with higher binge drinking intensity. Future natural disaster response should plan for treatment to address alcohol use and PTSD simultaneously.

Association of low FVC spirometric pattern with WTC occupational exposures

BackgroundA reduced forced vital capacity without obstruction (low FVC) is the predominant spirometric abnormality reported in workers and volunteers exposed to dust, gases, and fumes at the World Trade Center (WTC) disaster site in 2001–2002. While low FVC has been associated with obesity and metabolic syndrome, its association with WTC occupational exposures has not been demonstrated. We estimated the prevalence of this abnormality and examined its association with WTC exposure level. MethodsLongitudinal study of the relation between arrival at the WTC site within 48 h and FVC below the lower limit of normal (FVC < LLN, with normal FEV1/FVC ratio) at any time in 10,284 workers with at least two spirometries between 2002 and 2018. Logistic regression and linear mixed models were used for the multivariable analyses. ResultsThe prevalence of low FVC increased from 17.0% (95% CI 15.4%, 18.5%) in June 2003, to 26.4% (95% CI 24.8%, 28.1%) in June 2018, and exceeded at both times that of obstruction. The rate of FVC decline was −43.7 ml/year during the study period. In a multivariable analysis adjusting for obesity, metabolic syndrome indicators, and other factors, early arrival at the WTC disaster site was significantly associated with low FVC, but only among men (ORadj = 1.29, 95% CI 1.17, 1.43). Longitudinal FVC rate of decline did not differ by WTC site arrival time. ConclusionsAmong WTC workers, the prevalence of low FVC increased over a 16-year period. Early arrival to the WTC disaster site was significantly associated with low FVC in males.

Allergy and Lung Injury Among Rescue Workers Exposed to the World Trade Center Disaster Assessed 17 Years After Exposure to Ground Zero.

Investigate the following in rescue and cleanup workers exposed to the World Trade Center (WTC) disaster 17 years post-fallout: (1) allergic hypersensitivity; (2) spirometry; (3) impulse oscillometry; and (4) the reversibility of airway hyperresponsiveness and distal airways narrowing pre- and post-bronchodilator. In subjects (n = 54) referred to our clinic from the WTC Health Program for management of allergy-immunology services, environmental allergy testing, impulse oscillometry (IOS), and spirometry results were retrospectively reviewed to determine the long-term impact of exposure to the WTC fallout. Rescue and cleanup workers exposed to the WTC fallout had a high incidence of allergic hypersensitivity and had evidence of permanent small airways dysfunction characterized by distal airways narrowing and airway hyperresponsiveness. Following exposure to the WTC disaster, the patients in our cohort developed allergic hypersensitivity and severe lung injury with only partial reversibility.

Post-traumatic stress disorder and the association with overweight, obesity, and weight change among individuals exposed to the World Trade Center disaster, 2003–2016

Among Veterans, post-traumatic stress disorder (PTSD) has been shown to be associated with obesity and accelerated weight gain. Less is known among the general population. We sought to determine the impact of PTSD on body mass index (BMI) and weight change among individuals with exposure to the World Trade Center (WTC) disaster. We examined individuals from the WTC Health Registry. PTSD symptoms were assessed on multiple surveys (Waves 1-4) using the PTSD Checklist-Specific. Three categories of post-9/11 PTSD were derived: no, intermittent, and persistent. We examined two outcomes: (1) Wave 3 BMI (normal, overweight, and obese) and (2) weight change between Waves 3 and 4. We used multivariable logistic regression to assess the association between PTSD and BMI (N = 34 958) and generalized estimating equations to assess the impact of PTSD on weight change (N = 26 532). Sex- and age-stratified analyses were adjusted for a priori confounders. At Wave 3, the observed prevalence of obesity was highest among the persistent (39.5%) and intermittent PTSD (36.6%) groups, compared to the no PTSD group (29.3%). In adjusted models, persistent and intermittent PTSD were consistently associated with a higher odds of obesity. Weight gain was similar across all groups, but those with persistent and intermittent PTSD had higher estimated group-specific mean weights across time. Our findings that those with a history of PTSD post-9/11 were more likely to have obesity is consistent with existing literature. These findings reaffirm the need for an interdisciplinary focus on physical and mental health to improve health outcomes.

Systemic Autoimmune Disease Among Adults Exposed to the September 11, 2001 Terrorist Attack.

ObjectiveAutoimmune disease is an emerging condition among persons exposed to the September 11, 2001 attack on the World Trade Center (WTC). Components of the dust cloud resulting from the collapse of the WTC have been associated with development of a systemic autoimmune disease, as has posttraumatic stress disorder (PTSD). We undertook this study to determine whether dust exposure and PTSD were associated with an increased risk of systemic autoimmune disease in a 9/11‐exposed cohort.MethodsAmong 43,133 WTC Health Registry enrollees, 2,786 self‐reported having a post‐9/11 systemic autoimmune disease. We obtained informed consent to review medical records to validate systemic autoimmune disease diagnoses for 1,041 enrollees. Diagnoses of systemic autoimmune diseases were confirmed by classification criteria, rheumatologist diagnosis, or having been prescribed systemic autoimmune disease medication. Controls were enrollees who denied having an autoimmune disease diagnosis (n = 37,017). We used multivariable log‐binomial regression to examine the association between multiple 9/11 exposures and risk of post‐9/11 systemic autoimmune disease, stratifying by responders (rescue, recovery, and clean‐up workers) and community members (e.g., residents, area workers).ResultsWe identified 118 persons with systemic autoimmune disease. Rheumatoid arthritis was most frequent (n = 71), followed by Sjӧgren's syndrome (n = 22), systemic lupus erythematosus (n = 20), myositis (n = 9), mixed connective tissue disease (n = 7), and scleroderma (n = 4). Among 9/11 responders, those with intense dust cloud exposure had almost twice the risk of systemic autoimmune disease (adjusted risk ratio 1.86 [95% confidence interval 1.02–3.40]). Community members with PTSD had a nearly 3‐fold increased risk of systemic autoimmune disease.ConclusionIntense dust cloud exposure among responders and PTSD among community members were associated with a statistically significant increased risk of new‐onset systemic autoimmune disease. Clinicians treating 9/11 survivors should be aware of the potential increased risk of systemic autoimmune disease in this population.