Conducting a study to assess the long-term impacts of injury after 9/11: participation, recall, and description

Effects of 9/11-related injury on retirement patterns among World Trade Center Health Registry enrollees

BACKGROUND

Many survivors of the 9/11/2001 terrorist attacks in New York City sustained injuries. The aim of this study was to understand how 9/11-related injuries affected retirement patterns of World Trade Center Health Registry enrollees.

METHODS

The study included enrollees who participated in the 2017 Health & Quality of Life Survey, focused on 9/11-related injuries and quality of life, and the 2017-2018 Health & Employment Survey, focused on retirement and employment (N = 3535). Using Cox proportional hazards and logistic regression modeling, we calculated the risk of retiring at earlier ages and the odds of retirees working again, controlling for relevant covariates.

RESULTS

Results showed that 9/11-related injuries did affect retirement patterns. Injured enrollees were at greater risk of retiring at younger age compared to non-injured enrollees. Compared to more severely injured retirees, non-injured and less severely injured retirees were significantly more likely to work again postretirement. Our results suggested that being injured on 9/11 was associated with retirement, meaning that if the injury had not occurred, the individual may have continued working longer.

CONCLUSIONS

The need to retire earlier than planned could be addressed with employer and societal changes. Employers should consider making accommodations for those impacted by 9/11 a priority, as it is imperative for those who were injured on 9/11 to have the ability to work to support their physical, mental, and financial well-being.

Injury Severity and Psychological Distress Sustained in the Aftermath of the Attacks of 11 September 2001 Predict Somatic Symptoms in World Trade Center Health Registry Enrollees Sixteen Years Later

The World Trade Center attacks of 11 September 2001 (9/11) have been associated with the subsequent development of chronic diseases. Few studies have investigated the burden of somatic symptoms on attack victims, or the association of such symptoms with exposure to the 9/11 attacks. World Trade Center Health Registry (Registry) enrollees who were present south of Chambers Street during or immediately after the 9/11 attacks and who provided consistent answers regarding injury sustained on 9/11 were followed prospectively for up to 16 years post-9/11/01. We employed linear regression to evaluate the associations between injury severity, psychological distress and somatic symptoms in 2322 persons who completed all four Registry surveys and a subsequent Health and Quality of Life survey. Twenty-one percent of subjects had a “very high” burden of somatic symptoms, greater than in populations not exposed to a disaster. Somatic symptoms exhibited a dose-response association separately with injury severity and psychological distress trajectories. Victims of the 9/11 attacks suffer from a substantial burden of somatic symptoms which are associated with physical and psychological consequences of exposure to the attacks. Physical and mental health professionals need to work together when treating those exposed to complex disasters such as 9/11.

Comparing life satisfaction and functioning 15 years after September 11, 2001 among survivors with and without injuries: a mixed-method study

PURPOSE

This study compares life satisfaction and limited activity days among 9/11 survivors with and without physical injuries using quantitative and qualitative approaches.

METHODS

The study population included World Trade Center Health Registry enrollees who reported being injured on 9/11 in 2003-2004 and a sample of non-injured enrollees who participated in a cross-sectional substudy. We used multivariable logistic regression to examine differences in life satisfaction and number of limited activity days in the last 30 days between those with and without injuries. The free-response section of the survey was analyzed qualitatively to compare themes of those with and without injuries.

RESULTS

The final sample consisted of 2821 adult enrollees. Compared to those who were not injured, those who were injured on 9/11 were more likely to report being unsatisfied with their life (adjusted odds ratio (AOR): 1.5, 95% confidence intervals (CI) 1.1-2.0) and have 14 or more limited activity days in the last 30 days (AOR: 1.4, 95% CI 1.0-1.9). Among those who were injured, being partially or completely prevented from working increased the odds of being unsatisfied with life and having 14 or more limited activity days. In qualitative analysis, the emotional trauma experienced from 9/11 was a major and common theme, regardless of injury status. Those with injuries were more likely to express anger/lack of recognition/appreciation, describe substance use/abuse, and have financial/health care access issues.

CONCLUSIONS

More than 15 years after 9/11, those who were injured continue to be impacted, reporting lower life satisfaction and more functional impairment.

An Assessment of Long-Term Physical and Emotional Quality of Life of Persons Injured on 9/11/2001

Fifteen years after the disaster, the World Trade Center Health Registry (Registry) conducted The Health and Quality of Life Survey (HQoL) assessing physical and mental health status among those who reported sustaining an injury on 11 September 2001 compared with non-injured persons. Summary scores derived from the Short Form-12 served as study outcomes. United States (US) population estimates on the Physical Component Score (PCS-12) and Mental Component Score (MCS-12) were compared with scores from the HQoL and were stratified by Post-traumatic Stress Disorder (PTSD) and injury status. Linear regression models were used to estimate the association between both injury severity and PTSD and PCS-12 and MCS-12 scores. Level of injury severity and PTSD history significantly predicted poorer physical health (mean PCS-12). There was no significant difference between injury severity level and mental health (mean MCS-12). Controlling for other factors, having PTSD symptoms after 9/11 predicted a nearly 10-point difference in mean MCS-12 compared with never having PTSD. Injury severity and PTSD showed additive effects on physical and mental health status. Injury on 9/11 and a PTSD history were each associated with long-term decrements in physical health status. Injury did not predict long-term decrements in one's mental health status. Although it is unknown whether physical wounds of the injury healed, our results suggest that traumatic injuries appear to have a lasting negative effect on perceived physical functioning.