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Almashat S, McDiarmid M. Toxic chemical exposures among civilians in armed conflicts: the need for research equity, justice, and accountability. Inhal Toxicol 2024; 36:304-313. [PMID: 38060421 DOI: 10.1080/08958378.2023.2286325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/17/2023] [Indexed: 07/22/2024]
Abstract
OBJECTIVE Armed conflicts result in the release of toxic chemicals into the surrounding environment and civilians are commonly exposed to these toxicants. This paper reviews the evidence on civilian exposure to toxic chemicals, including but not limited to inhaled toxic substances, in post-World War II armed conflicts, and proposes a framework for the implementation of long-term surveillance programs for these populations. MATERIALS AND METHODS Four databases of peer-reviewed health articles were searched for all English-language articles with a primary focus on toxic chemical exposures among civilians in armed conflicts since World War II. The review was supplemented substantially by the gray literature. RESULTS In the 66 articles that met the inclusion criteria, the authors categorized the chemical toxicants to which civilians have been exposed in modern armed conflicts as ubiquitous (e.g. smoke, dust, and munitions components present in all conflicts) or particular agents (e.g. specific chemical agents used in a few conflicts). While most studies focused on particular agents, the vast majority of civilians are in fact exposed to ubiquitous agents both in the acute conflict phase and through persistent environmental exposures after the cessation of hostilities. DISCUSSION/CONCLUSION There is a dearth of research concerning civilian exposures to toxic chemicals during armed conflicts. In line with principles of equity, justice, and accountability, robust research and surveillance programs are urgently needed to document exposures and provide ongoing assessments and any necessary treatment for these long-ignored populations, most of whom live in the Global South.
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Affiliation(s)
- Sammy Almashat
- Division of Occupational and Environmental Medicine, University of MD School of Medicine, Baltimore, MD, USA
| | - Melissa McDiarmid
- Division of Occupational and Environmental Medicine, University of MD School of Medicine, Baltimore, MD, USA
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Chen Y, Gutierrez V, Morris L, Marti JL. Diagnostic Scrutiny and Patterns of Elevated Cancer Risk: Uncovering Overdiagnosis Through Standardized Incidence Ratios. Cureus 2023; 15:e42439. [PMID: 37637595 PMCID: PMC10447997 DOI: 10.7759/cureus.42439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Certain medical diagnoses and environmental or occupational exposures may be associated with elevated risk of cancer diagnosis, either through causal mechanisms or via increased detection of a subclinical reservoir through increased diagnostic scrutiny (overdiagnosis). The present study aimed to investigate the distribution of elevated cancer risks associated with different diagnoses and exposures. A systematic literature search was conducted to identify studies published in the last 30 years that examined the standardized incidence ratio (SIR) associated with exposures and risk factors. Meta-SIRs for each cancer type were calculated. The distribution of elevated cancer risks was then compared between cancer types previously reported to be susceptible to overdiagnosis and those that have not been associated with overdiagnosis. The review of 108 studies identified four patterns: SIR generally elevated for 1) only overdiagnosis-susceptible cancer types, 2) both overdiagnosed and non-overdiagnosed cancer types, 3) select cancers in accordance with risk factor or exposure, and 4) SIRs that did not exhibit a distinct increase in any cancer type. The distribution of elevated cancer risks may serve as a signature of whether the underlying risk factor or exposure is a carcinogenic process or a mechanism of increased diagnostic scrutiny uncovering clinically occult diseases. The identification of increased cancer risk should be viewed with caution, and analyzing the pattern of elevated cancer risk distribution can potentially reveal conditions that appear to be cancer risk factors but are in fact the result of exposure to medical surveillance or other healthcare activities that lead to the detection of indolent tumors.
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Affiliation(s)
- Yunchan Chen
- Department of Surgery, Weill Cornell Medicine, New York, USA
| | | | - Luc Morris
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Jennifer L Marti
- Division of Breast Surgical Oncology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, USA
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Lowe SM, Haugen PT, Rosen R, Werth AS. World Trade Center psychological exposures and trauma related disorders: PTSD and adjustment disorders. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2023:1-6. [PMID: 36927280 DOI: 10.1080/19338244.2023.2188153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The relationship between exposure to the World Trade Center (WTC) disaster and elevated rates of trauma related psychiatric illnesses in 9/11 responders and survivors has been well documented. This paper is part of a series to promote the practice of evidence-based medicine when managing persons with WTC-related conditions and focuses on "Trauma and Stressor Related Disorders," a diagnostic category that includes posttraumatic stress disorder (PTSD) and adjustment disorder. It offers background on 9/11-related trauma exposure, a summary of research findings from this cohort, and is followed by brief diagnostic and treatment information from selected clinical practice guidelines.
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Affiliation(s)
- Sandra M Lowe
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- World Trade Center Health Program, Icahn School of Medicine at Mount Sinai Clinical Center of Excellence, New York, NY, USA
| | - Peter T Haugen
- NYU Grossman School of Medicine World Trade Center Health Program Clinical Center of Excellence, New York, NY, USA
- Department of Psychiatry, NYU Grossman School of Medicine, New York, New York, USA
| | - Rebecca Rosen
- NYU Grossman School of Medicine, New York, NY, USA
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY, USA
| | - Aditi S Werth
- NYU Grossman School of Medicine World Trade Center Health Program Clinical Center of Excellence, New York, NY, USA
- Department of Psychiatry, NYU Grossman School of Medicine, New York, New York, USA
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Calvert GM, Lilly G, Cochran J. The World Trade Center Health Program: Cancer screening and cancer care best practices. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2023; 78:222-228. [PMID: 36908247 PMCID: PMC10773562 DOI: 10.1080/19338244.2023.2188152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
The events of September 11, 2001 (9/11) exposed nearly a half million persons to many carcinogenic chemicals and dusts, as well as psychological and physical stressors. Subsequent epidemiologic studies of 9/11-exposed persons have suggested elevated risks for some cancers, e.g., prostate cancer, thyroid cancer, and melanoma. To detect cancer at an early stage, the US Preventive Services Task Force recommends screening certain asymptomatic persons for lung, colorectal, cervical and breast cancer, but not for other cancers. High quality cancer diagnosis and treatment guidelines are available from the National Comprehensive Cancer Network and the National Cancer Institute. For enrolled members, the WTC Health Program provides coverage for cancer screening and diagnosis, and covers medically necessary treatment costs for all types of cancer, assuming 9/11-exposure and minimum latency requirements are met, and a Program-affiliated physician attests that 9/11 exposures were substantially likely to have been a significant factor in aggravating, contributing to, or causing the enrolled WTC member's cancer.
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Affiliation(s)
- Geoffrey M. Calvert
- World Trade Center Health Program, National Institute for
Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention
(CDC), Cincinnati, OH, USA
| | - Gerald Lilly
- World Trade Center Health Program, National Institute for
Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention
(CDC), Cincinnati, OH, USA
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Li J, Hall CB, Yung J, Kehm RD, Zeig-Owens R, Singh A, Cone JE, Brackbill RM, Farfel MR, Qiao B, Schymura MJ, Shapiro MZ, Dasaro CR, Todd AC, Prezant DJ, Boffetta P. A 15-year follow-up study of mortality in a pooled cohort of World Trade Center rescue and recovery workers. ENVIRONMENTAL RESEARCH 2023; 219:115116. [PMID: 36549491 DOI: 10.1016/j.envres.2022.115116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/12/2022] [Accepted: 12/18/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Hazardous exposures from the World Trade Center (WTC) terrorist attacks have been linked to increased incidence of adverse health conditions, often associated with increased mortality. We assessed mortality in a pooled cohort of WTC rescue/recovery workers over 15 years of follow-up. MATERIALS AND METHODS We analyzed mortality through 2016 in a pooled and deduplicated cohort of WTC rescue/recovery workers from three WTC-exposed cohorts (N = 60,631): the Fire Department of the City of New York (FDNY); the WTC Health Registry (WTCHR); and the General Responder Cohort (GRC). Standardized mortality ratios (SMRs) were estimated to assess mortality vs. the US and NY state populations. Multivariable Cox proportional hazards models were used to examine associations of WTC exposures (date of first arrival, working on the WTC debris pile) with mortality risk. RESULTS There were 1912 deaths over 697,943.33 person-years of follow-up. The SMR for all-cause mortality was significantly lower-than-expected, both when using US (SMR 0.43, 95% confidence interval [CI] 0.42-0.45) and NYS (SMR 0.51, 95% CI 0.49-0.53) as reference populations. SMRs were not elevated for any of the 28 major causes of death. Arriving at the WTC site on 9/11-9/17/2001 vs. 9/18/2001-6/30/2002 was associated with 30-50% higher risk of all-cause, heart disease and smoking-related mortality in non-FDNY/non-GRC members. Conversely, arriving on 9/11/2001 vs. 9/18/2001-6/30/2002 was associated with 40% lower all-cause and smoking-related mortality risk in FDNY members. Working on vs. off the WTC pile was associated with an increased risk of all-cause mortality in non-FDNY/non-GRC members (adjusted hazard ratio [aHR] 1.25, 95% CI 1.04-1.50), and cancer-specific mortality in GRC members (aHR 1.39, 95% CI 1.05-1.84), but lower mortality risks were found in FDNY members. CONCLUSIONS We did not observe excess mortality among WTC rescue/recovery workers compared with general populations. However, significantly increased mortality risks among some sub-groups with high WTC exposure warrant further investigation.
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Affiliation(s)
- Jiehui Li
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, CN-6W, Long Island City, NY, 11101, United States
| | - Charles B Hall
- Albert Einstein College of Medicine, Department of Epidemiology and Population Health, 1300 Morris Park Ave, Bronx, NY, 10461, United States
| | - Janette Yung
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, CN-6W, Long Island City, NY, 11101, United States
| | - Rebecca D Kehm
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, CN-6W, Long Island City, NY, 11101, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, United States
| | - Rachel Zeig-Owens
- Albert Einstein College of Medicine, Department of Epidemiology and Population Health, 1300 Morris Park Ave, Bronx, NY, 10461, United States; Fire Department of the City of New York (FDNY), 9 Metrotech Center 5E-63-K, Brooklyn, NY, 11201, United States; Montefiore Medical Center, Department of Medicine, 111 E. 210th St., The Bronx, NY, 10467, United States
| | - Ankura Singh
- Fire Department of the City of New York (FDNY), 9 Metrotech Center 5E-63-K, Brooklyn, NY, 11201, United States; Montefiore Medical Center, Department of Medicine, 111 E. 210th St., The Bronx, NY, 10467, United States
| | - James E Cone
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, CN-6W, Long Island City, NY, 11101, United States
| | - Robert M Brackbill
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, CN-6W, Long Island City, NY, 11101, United States
| | - Mark R Farfel
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, CN-6W, Long Island City, NY, 11101, United States
| | - Baozhen Qiao
- New York State Department of Health, Bureau of Cancer Epidemiology, 150 Broadway, Albany, NY, 12204, United States
| | - Maria J Schymura
- New York State Department of Health, Bureau of Cancer Epidemiology, 150 Broadway, Albany, NY, 12204, United States
| | - Moshe Z Shapiro
- WTC Health Program General Responder Data Center, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One, Gustave L. Levy Place, Mail Stop 1057, New York, NY, 10029, United States
| | - Christopher R Dasaro
- WTC Health Program General Responder Data Center, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One, Gustave L. Levy Place, Mail Stop 1057, New York, NY, 10029, United States
| | - Andrew C Todd
- WTC Health Program General Responder Data Center, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One, Gustave L. Levy Place, Mail Stop 1057, New York, NY, 10029, United States
| | - David J Prezant
- Albert Einstein College of Medicine, Department of Epidemiology and Population Health, 1300 Morris Park Ave, Bronx, NY, 10461, United States; Fire Department of the City of New York (FDNY), 9 Metrotech Center 5E-63-K, Brooklyn, NY, 11201, United States; Montefiore Medical Center, Department of Medicine, 111 E. 210th St., The Bronx, NY, 10467, United States
| | - Paolo Boffetta
- Stony Brook University, Stony Brook Cancer Center, Lauterbur Dr., Stony Brook, NY, 11794, United States; University of Bologna, Department of Medical and Surgical Sciences, Via Zamboni, 33, 40126, Bologna, BO, Italy.
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Iban-Arias R, Trageser KJ, Yang EJ, Griggs E, Radu A, Naughton S, Al Rahim M, Tatsunori O, Raval U, Palmieri J, Huang Z, Chen LC, Pasinetti GM. Exposure to World Trade Center Dust Exacerbates Cognitive Impairment and Evokes a Central and Peripheral Pro-Inflammatory Transcriptional Profile in an Animal Model of Alzheimer's Disease. J Alzheimers Dis 2023; 91:779-794. [PMID: 36502334 PMCID: PMC9912736 DOI: 10.3233/jad-221046] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The terrorist attacks on September 11, 2001, on the World Trade Center (WTC) led to intense fires and a massive dense cloud of toxic gases and suspended pulverized debris. In the subsequent years, following the attack and cleanup efforts, a cluster of chronic health conditions emerged among First Responders (FR) who were at Ground Zero for prolonged periods and were repeatedly exposed to high levels of WTC particulate matter (WTCPM). Among those are neurological complications which may increase the risk for the development of Alzheimer's disease (AD) later in life. OBJECTIVE We hypothesize that WTCPM dust exposure affects the immune cross-talking between the periphery and central nervous systems that may induce brain permeability ultimately promoting AD-type phenotype. METHODS 5XFAD and wild-type mice were intranasally administered with WTCPM dust collected at Ground Zero within 72 h after the attacks. Y-maze assay and novel object recognition behavioral tests were performed for working memory deficits and learning and recognition memory, respectively. Transcriptomic analysis in the blood and hippocampus was performed and confirmed by RT qPCR. RESULTS Mice exposed to WTCPM dust exhibited a significant impairment in spatial and recognition short and long-term memory. Furthermore, the transcriptomic analysis in the hippocampal formation and blood revealed significant changes in genes related to immune-inflammatory responses, and blood-brain barrier disruption. CONCLUSION These studies suggest a putative peripheral-brain immune inflammatory cross-talking that may potentiate cognitive decline, identifying for the first time key steps which may be therapeutically targetable in future studies in WTC FR.
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Affiliation(s)
- Ruth Iban-Arias
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kyle J. Trageser
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eun-Jeong Yang
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elizabeth Griggs
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aurelian Radu
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sean Naughton
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Md Al Rahim
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Oguchi Tatsunori
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Urdhva Raval
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua Palmieri
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zerlina Huang
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lung-Chi Chen
- Department of Environmental Medicine, NYU Langone School of Medicine, New York, NY, USA
| | - Giulio Maria Pasinetti
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Geriatrics Research, Education and Clinical Center, JJ Peters VA Medical Center, Bronx, NY, USA,Correspondence to: Giulio Maria Pasinetti, MD, PhD, Department of Neurology, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, Box 1137, New York, NY 10029, USA. Tel.: +1 212 241 7938; Fax: +1 212 876 9042; E-mail:
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7
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Calvert GM, Anderson K, Cochran J, Cone JE, Harrison DJ, Haugen PT, Lilly G, Lowe SM, Luft BJ, Moline JM, Reibman J, Rosen R, Udasin IG, Werth AS. The World Trade Center Health Program: an introduction to best practices. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2022; 78:199-205. [PMID: 36533439 PMCID: PMC10277307 DOI: 10.1080/19338244.2022.2156975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
More than 20 years have elapsed since the September 11, 2001 (9/11) terrorist attacks on the World Trade Center (WTC), Pentagon and at Shanksville, PA. Many persons continue to suffer a variety of physical and mental health conditions following their exposures to a mixture of incompletely characterized toxicants and psychological stressors at the terrorist attack sites. Primary care and specialized clinicians should ask patients who may have been present at any of the 9/11 sites about their 9/11 exposures, especially patients with cancer, respiratory symptoms, chronic rhinosinusitis, gastroesophageal reflux disease, psychiatric symptoms, and substance use disorders. Clinicians, especially those in the NY metropolitan area, should know how to evaluate, diagnose, and treat patients with conditions that could be associated with exposure to the 9/11 attacks and its aftermath. As such, this issue of Archives contains a series of updates to clinical best practices relevant to medical conditions whose treatment is covered by the WTC Health Program. This first paper in the 14-part series describes the purpose of this series, defines the WTC Health Program and its beneficiaries, and explains how relevant Clinical Practice Guidelines were identified. This paper also reminds readers that because physical and mental health conditions are often intertwined, a coordinated approach to care usually works best and referral to health centers affiliated with the WTC Health Program may be necessary, since all such Centers offer multidisciplinary care.
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Affiliation(s)
- Geoffrey M. Calvert
- World Trade Center Health Program, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Cincinnati, OH, USA
| | - Kristi Anderson
- World Trade Center Health Program, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Cincinnati, OH, USA
| | | | - James E. Cone
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, NY, USA
| | - Denise J. Harrison
- NYU Grossman School of Medicine, World Trade Center Health Program Clinical Center of Excellence, New York, NY, USA
| | - Peter T. Haugen
- NYU Grossman School of Medicine, World Trade Center Health Program Clinical Center of Excellence, New York, NY, USA
- Department of Psychiatry, New York University Grossman School of Medicine, New York, New York, USA
| | - Gerald Lilly
- World Trade Center Health Program, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Cincinnati, OH, USA
| | - Sandra M. Lowe
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai Clinical Center of Excellence, World Trade Center Health Program, New York, NY, USA
| | - Benjamin J. Luft
- Department of Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Jacqueline M. Moline
- Department of Occupational Medicine, Epidemiology and Prevention, World Trade Center Health Program Clinical Center of Excellence, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Joan Reibman
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY, USA
- Department of Medicine and Environmental Medicine, Division of Pulmonary Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Rebecca Rosen
- Department of Psychiatry, New York University Grossman School of Medicine, New York, New York, USA
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY, USA
| | - Iris G. Udasin
- World Trade Center Health Program Clinical Center of Excellence, Environmental and Occupational Health Sciences Institute, Rutgers University Biomedical Sciences, Piscataway, NJ, USA
| | - Aditi S. Werth
- NYU Grossman School of Medicine, World Trade Center Health Program Clinical Center of Excellence, New York, NY, USA
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Brackbill RM, Butturini E, Cone JE, Ahmadi A, Daniels RD, Farfel MR, Kubale T. Scientific Value of the Sub-Cohort of Children in the World Trade Center Health Registry. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12461. [PMID: 36231761 PMCID: PMC9564973 DOI: 10.3390/ijerph191912461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023]
Abstract
The World Trade Center Health Registry (WTCHR) was established in 2002 as a public health resource to monitor the health effects from the World Trade Center (WTC) disaster. We evaluated the representativeness of the WTC youth population (<18 years on 11 September 2001) by comparing the distributions of age, gender, race/ethnic groups, and income to 2000 census data for the matched geographic area, including distance from disaster. There were 2379 WTCHR enrolled children living in Lower Manhattan south of Canal Street on 11 September 2001, along with 752 enrolled students who attended school in Lower Manhattan but were not area residents. The WTCHR sub-group of children who were residents was similar to the geographically corresponding census population on age and sex. Black and Hispanic children are moderately overrepresented at 0.9% and 2.4% in the WTCHR compared to 0.8% and 1.7% in census population, respectively, while lower-income households are slightly under-represented, 28.8% in the WTCHR and 30.8% for the corresponding census information. Asian children appear underrepresented at 3.0% participation compared to 6.3% in the census. While the demographics of WTCHR youth are somewhat skewed, the gaps are within expected patterns of under-representation observed in other longitudinal cohorts and can be effectively addressed analytically or through targeted study design.
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Affiliation(s)
- Robert M. Brackbill
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 11101, USA
| | - Emma Butturini
- World Trade Center Health Program Division, National Institute for Occupational Safety and Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - James E. Cone
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 11101, USA
| | - Ayda Ahmadi
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 11101, USA
| | - Robert D. Daniels
- World Trade Center Health Program Division, National Institute for Occupational Safety and Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Mark R. Farfel
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 11101, USA
| | - Travis Kubale
- World Trade Center Health Program Division, National Institute for Occupational Safety and Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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9
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Kehm RD, Li J, Takemoto E, Yung J, Qiao B, Farfel MR, Cone JE. Mortality after the 9/11 terrorist attacks among world trade center health registry enrollees with cancer. Cancer Med 2022; 12:1829-1840. [PMID: 36107389 PMCID: PMC9883583 DOI: 10.1002/cam4.4992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/27/2022] [Accepted: 06/10/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND While several studies have reported the association between 9/11 exposure and cancer risk, cancer survival has not been well studied in the World Trade Center (WTC) exposed population. We examined associations of 9/11-related exposures with mortality in WTC Health Registry enrollees diagnosed with cancer before and after 9/11/2001. PATIENTS AND METHODS This is a longitudinal cohort study of 5061 enrollees with a first-ever primary invasive cancer diagnosis between 1995 and 2015 and followed through 2016. Based on the timing of first cancer diagnosis, pre-9/11 (n = 634) and post-9/11 (n = 4427) cancer groups were examined separately. 9/11-related exposures included witnessing traumatic events, injury on 9/11, and 9/11-related post-traumatic stress disorder (PTSD). Associations of exposures with all-cause mortality were examined using Cox proportional hazards regression. In the post-9/11 group, cancer-specific mortality was evaluated by enrollee group (WTC rescue/recovery workers vs. non-workers) using Fine and Gray's proportional sub-distribution hazard models, adjusting for baseline covariates, tumor characteristics, and treatment. RESULTS In the pre-9/11 group, 9/11-related exposures were not associated with all-cause mortality. In the post-9/11 group, increased risk of all-cause mortality was associated with PTSD (adjusted HR = 1.35; 95% CI = 1.11-1.65), but not with injury or witnessing traumatic events. Cancer-specific mortality was not statistically significantly associated with 9/11-related exposures. In rescue/recovery workers, increased non-cancer mortality risk was associated with PTSD (aHR = 2.13, 95% CI = 1.13-4.00) and witnessing ≥3 traumatic events (aHR = 2.00, 95% CI = 1.13-3.55). CONCLUSIONS We did not observe associations between 9/11-related exposures and cancer-specific mortality. Similar to findings in the non-cancer WTC exposed population, PTSD was associated with increased risk of all-cause mortality in cancer patients.
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Affiliation(s)
- Rebecca D. Kehm
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA,Department of EpidemiologyMailman School of Public Health, Columbia UniversityNew York CityNew YorkUSA
| | - Jiehui Li
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
| | - Erin Takemoto
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
| | - Janette Yung
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
| | - Baozhen Qiao
- New York State Department of HealthBureau of Cancer EpidemiologyAlbanyNew YorkUSA
| | - Mark R. Farfel
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
| | - James E. Cone
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
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10
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Exposure to the World Trade Center disaster and test performance among New York City public school students over time, 1998–2003. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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11
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Mears MJ, Aslaner DM, Barson CT, Cohen MD, Gorr MW, Wold LE. Health effects following exposure to dust from the World Trade Center disaster: An update. Life Sci 2022; 289:120147. [PMID: 34785191 PMCID: PMC8791014 DOI: 10.1016/j.lfs.2021.120147] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/22/2021] [Accepted: 11/08/2021] [Indexed: 01/17/2023]
Abstract
Exposure to dust, smoke, and fumes containing volatile chemicals and particulate matter (PM) from the World Trade Center (WTC) towers' collapse impacted thousands of citizens and first responders (FR; firefighters, medicals staff, police officers) of New York City. Surviving FR and recovery workers are increasingly prone to age-related diseases that their prior WTC dust exposures might expedite or make worse. This review provides an overview of published WTC studies concerning FR/recovery workers' exposure and causal mechanisms of age-related disease susceptibility, specifically those involving the cardiopulmonary and neurological systems. This review also highlights the recent findings of the major health effects of cardiovascular, pulmonary, and neurological health sequelae from WTC dust exposure. To better treat those that risked their lives during and after the disaster of September 11, 2001, the deleterious mechanisms that WTC dust exposure exerted and continue to exert on the heart, lungs, and brain of FR must be better understood.
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Affiliation(s)
- Matthew J. Mears
- College of Nursing, The Ohio State University, Columbus, OH, United States of America
| | - David M. Aslaner
- College of Nursing, The Ohio State University, Columbus, OH, United States of America
| | - Chad T. Barson
- College of Nursing, The Ohio State University, Columbus, OH, United States of America
| | - Mitchell D. Cohen
- Department of Environmental Medicine, New York University School of Medicine, New York, NY, United States of America
| | - Matthew W. Gorr
- College of Nursing, The Ohio State University, Columbus, OH, United States of America,Dorothy M. Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, United States of America,Correspondence to: M. W. Gorr, 617 Dorothy M. Davis Heart and Lung Research Institute, 473 W. 12th Avenue, Columbus, OH 43210, United States of America. (M.W. Gorr)
| | - Loren E. Wold
- College of Nursing, The Ohio State University, Columbus, OH, United States of America,Dorothy M. Davis Heart and Lung Research Institute and Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, United States of America,Correspondence to: L. E. Wold, 603 Dorothy M. Davis Heart and Lung Research Institute, 473 W. 12th Avenue, Columbus, OH 43210, United States of America. (L.E. Wold)
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Daniels RD, Kubale TL, Reissman DB, Howard J. The World Trade Center Health Program: Twenty years of health effects research. Am J Ind Med 2021; 64:797-802. [PMID: 34558722 PMCID: PMC9631716 DOI: 10.1002/ajim.23273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 11/14/2022]
Abstract
It has been 20 years since the devastating terrorist attacks on September 11, 2001. Thousands were injured or killed during the attacks and many more are at risk of adverse health stemming from physical, psychological, and emotional stressors born out of the attacks. Private, federal, state, and local resources were gathered soon after the attacks to address impacts to the community, including the health and well-being of both responders and survivors. Many of these efforts are now largely consolidated under the federally mandated World Trade Center (WTC) Health Program. This program provides medical monitoring and treatment of qualifying conditions among the 9/11-exposed population and supports related physical and mental health research. In this commentary, we describe the WTC Health Program, with emphasis on the health-effects research it has funded since inception in 2011. We describe sentinel research publications, and how science has impacted the program. We provide examples relating studies in this special issue to important roles in the WTC Health Program research agenda. Finally, we provide a perspective on future research needs.
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Affiliation(s)
- Robert D. Daniels
- World Trade Center Health Program (WTCHP), Centers for Disease Control and Prevention (CDC) National Institute for Occupational Safety and Health (NIOSH) Washington District Columbia USA
| | - Travis L. Kubale
- World Trade Center Health Program (WTCHP), Centers for Disease Control and Prevention (CDC) National Institute for Occupational Safety and Health (NIOSH) Washington District Columbia USA
| | - Dori B. Reissman
- World Trade Center Health Program (WTCHP), Centers for Disease Control and Prevention (CDC) National Institute for Occupational Safety and Health (NIOSH) Washington District Columbia USA
| | - John Howard
- Office of the Director National Institute for Occupational Safety and Health (NIOSH) Washington District Columbia USA
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Daniels RD, Carreón T, Bilics JA, Reissman DB, Howard J. The World Trade Center Health Program: Petitions for adding qualifying health conditions. Am J Ind Med 2021; 64:885-892. [PMID: 34128231 PMCID: PMC8518601 DOI: 10.1002/ajim.23267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 12/21/2022]
Abstract
The federally mandated World Trade Center Health Program provides limited health benefits for qualifying health conditions related to the 9/11 terrorist attacks. A qualifying health condition is an illness or health condition for which the member's exposure to airborne toxins, any other hazard, or any other adverse condition resulting from the 9/11 terrorist attacks is considered substantially likely to be a significant factor in aggravating, contributing to, or causing the illness or health condition. These qualifying health conditions are listed in federal regulations. The regulations also provide a process for amending this list. This commentary describes the methods developed for adding health conditions to the list of qualifying health conditions and discusses changes to the list that have occurred during the Program's 2011-2020 period.
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Affiliation(s)
- Robert D. Daniels
- World Trade Center Health Program (WTCHP), Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH) Washington DC USA
| | - Tania Carreón
- World Trade Center Health Program (WTCHP), Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH) Washington DC USA
| | - Jessica A. Bilics
- World Trade Center Health Program (WTCHP), Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH) Washington DC USA
| | - Dori B. Reissman
- World Trade Center Health Program (WTCHP), Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH) Washington DC USA
| | - John Howard
- National Institute for Occupational Safety and Health (NIOSH) Washington DC USA
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Jirapatnakul A, Yip R, Branch AD, Lewis S, Crane M, Yankelevitz DF, Henschke CI. Dose-response relationship between World Trade Center dust exposure and hepatic steatosis. Am J Ind Med 2021; 64:837-844. [PMID: 34328231 DOI: 10.1002/ajim.23269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/04/2021] [Accepted: 05/17/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The World Trade Center (WTC) attack exposed thousands of workers to toxic chemicals that have been linked to liver diseases and cancers. This study examined the relationship between the intensity of WTC dust exposure and the risk of hepatic steatosis in the WTC General Responders Cohort (GRC). METHODS All low-dose computed tomography (CT) scans of the chest performed on the WTC GRC between September 11, 2001 and December 31, 2018, collected as part of the World Trade Center Health Program, were reviewed. WTC dust exposure was categorized into five groups based on WTC arrival time. CT liver density was estimated using an automated algorithm, statistics-based liver density estimation from imaging. The relationship between the intensity of WTC dust exposure and the risk of hepatic steatosis was examined using univariate and multivariable regression analyses. RESULTS Of the 1788 WTC responders, 258 (14.4%) had liver attenuation less than 40 Hounsfield units (HU < 40) on their earliest CT. Median time after September 11, 2001 and the earliest available CT was 11.3 years (interquartile range: 8.0-14.9 years). Prevalence of liver attenuation less than 40 HU was 17.0% for arrivals on September 11, 2001, 16.0% for arrivals on (September 12, 2001 or September 13, 2001), 10.9% for arrivals on September 14-30, 2001, and 9.0% for arrivals on January 10, 2001 or later (p = 0.0015). A statistically significant trend of increasing liver steatosis was observed with earlier arrival times (p < 0.0001). WTC arrival time remained a significant independent factor for decreased liver attenuation after controlling for other covariates. CONCLUSIONS Early arrival at the WTC site was significantly associated with increasing hepatic steatosis.
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Affiliation(s)
- Artit Jirapatnakul
- Department of Radiology Icahn School of Medicine at Mount Sinai New York New York USA
| | - Rowena Yip
- Department of Radiology Icahn School of Medicine at Mount Sinai New York New York USA
| | - Andrea D. Branch
- Division of Liver Diseases, Department of Medicine Icahn School of Medicine at Mount Sinai New York New York USA
| | - Sara Lewis
- Department of Radiology Icahn School of Medicine at Mount Sinai New York New York USA
| | - Michael Crane
- Department of Environmental Medicine and Public Health Icahn School of Medicine at Mount Sinai New York New York USA
| | - David F. Yankelevitz
- Department of Radiology Icahn School of Medicine at Mount Sinai New York New York USA
| | - Claudia I. Henschke
- Department of Radiology Icahn School of Medicine at Mount Sinai New York New York USA
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15
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Goldfarb DG, Zeig‐Owens R, Kristjansson D, Li J, Brackbill RM, Farfel MR, Cone JE, Kahn AR, Qiao B, Schymura MJ, Webber MP, Dasaro CR, Lucchini RG, Todd AC, Prezant DJ, Hall CB, Boffetta P. Cancer survival among World Trade Center rescue and recovery workers: A collaborative cohort study. Am J Ind Med 2021; 64:815-826. [PMID: 34288025 PMCID: PMC8515734 DOI: 10.1002/ajim.23278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND World Trade Center (WTC)-exposed responders may be eligible to receive no-cost medical monitoring and treatment for certified conditions, including cancer. The survival of responders with cancer has not previously been investigated. METHODS This study compared the estimated relative survival of WTC-exposed responders who developed cancer while enrolled in two WTC medical monitoring and treatment programs in New York City (WTC-MMTP responders) and WTC-exposed responders not enrolled (WTC-non-MMTP responders) to non-responders from New York State (NYS-non-responders), all restricted to the 11-southernmost NYS counties, where most responders resided. Parametric survival models estimated cancer-specific and all-cause mortality. Follow-up ended at death or on December 31, 2016. RESULTS From January 1, 2005 to December 31, 2016, there were 2,037 cancer cases and 303 deaths (248 cancer-related deaths) among WTC-MMTP responders, 564 cancer cases, and 143 deaths (106 cancer-related deaths) among WTC-non-MMTP responders, and 574,075 cancer cases and 224,040 deaths (158,645 cancer-related deaths) among the NYS-non-responder population. Comparing WTC-MMTP responders with NYS-non-responders, the cancer-specific mortality hazard ratio (HR) was 0.72 (95% confidence interval [CI] = 0.64-0.82), and all-cause mortality HR was 0.64 (95% CI = 0.58-0.72). The cancer-specific HR was 0.94 (95% CI = 0.78-1.14), and all-cause mortality HR was 0.93 (95% CI = 0.79-1.10) comparing WTC-non-MMTP responders to the NYS-non-responder population. CONCLUSIONS WTC-MMTP responders had lower mortality compared with NYS-non-responders, after controlling for demographic factors and temporal trends. There may be survival benefits from no-out-of-pocket-cost medical care which could have important implications for healthcare policy, however, other occupational and socioeconomic factors could have contributed to some of the observed survival advantage.
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Affiliation(s)
- David G. Goldfarb
- Department of MedicineMontefiore Medical CenterNew YorkNew YorkUSA
- Fire Department of the City of New York (FDNY)BrooklynNew YorkUSA
- Department of Environmental, Occupational and Geospatial Health SciencesCity University of New York Graduate School of Public Health and Health PolicyNew YorkNew YorkUSA
| | - Rachel Zeig‐Owens
- Department of MedicineMontefiore Medical CenterNew YorkNew YorkUSA
- Fire Department of the City of New York (FDNY)BrooklynNew YorkUSA
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Dana Kristjansson
- Department of Hematology and OncologyIcahn School of Medicine at Mount Sinai, Tisch Cancer InstituteNew YorkNew YorkUSA
- Department of Genetics and BioinformaticsNorwegian Institute of Public HealthOsloNorway
- Center of Fertility and HealthNorwegian Institute of Public HealthOsloNorway
| | - Jiehui Li
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
| | - Robert M. Brackbill
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
| | - Mark R. Farfel
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
| | - James E. Cone
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
| | - Amy R. Kahn
- New York State Department of HealthBureau of Cancer EpidemiologyAlbanyNew YorkUSA
| | - Baozhen Qiao
- New York State Department of HealthBureau of Cancer EpidemiologyAlbanyNew YorkUSA
| | - Maria J. Schymura
- New York State Department of HealthBureau of Cancer EpidemiologyAlbanyNew YorkUSA
| | - Mayris P. Webber
- Fire Department of the City of New York (FDNY)BrooklynNew YorkUSA
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Christopher R. Dasaro
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Roberto G. Lucchini
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Andrew C. Todd
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - David J. Prezant
- Department of MedicineMontefiore Medical CenterNew YorkNew YorkUSA
- Fire Department of the City of New York (FDNY)BrooklynNew YorkUSA
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Charles B. Hall
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Paolo Boffetta
- Department of Hematology and OncologyIcahn School of Medicine at Mount Sinai, Tisch Cancer InstituteNew YorkNew YorkUSA
- Stony Brook Cancer CenterStony Brook UniversityStony BrookNew YorkUSA
- Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
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16
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Azofeifa A, Martin GR, Howard J. World Trade Center Health Program, 2012-2020: Implications for Clinicians and Health Care Systems. JAMA 2021; 326:1147-1148. [PMID: 34499713 PMCID: PMC10714221 DOI: 10.1001/jama.2021.15739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Alejandro Azofeifa
- World Trade Center Health Program, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Washington, DC
| | - Gayatri R Martin
- World Trade Center Health Program, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Washington, DC
| | - John Howard
- World Trade Center Health Program, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Washington, DC
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Health Trends among 9/11 Responders from 2011-2021: A Review of World Trade Center Health Program Statistics. Prehosp Disaster Med 2021; 36:621-626. [PMID: 34550060 DOI: 10.1017/s1049023x21000881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION In a single day, the September 11, 2001 US terrorist attacks (9/11) killed nearly 3,000 people, including 412 first responders. More than 91,000 responders were exposed to a range of hazards during the recovery and clean-up operation that followed. Various health programs track the on-going health effects of 9/11, including the World Trade Center (WTC) Health Program (WTCHP). The objective of this research was to review WTCHP statistics reported by the Centers for Disease Control and Prevention (CDC) to analyze health trends among enrolled responders as the 20-year anniversary of the terrorist attacks approaches. METHODS The WTCHP statistics reported by the CDC were analyzed to identify health trends among enrolled responders from 2011 through 2021. Statistics for non-responders were excluded. RESULTS A total of 80,745 responders were enrolled in the WTCHP as of March 2021: 62,773 were classified as general responders; 17,023 were Fire Department of New York (FDNY) responders; and 989 were Pentagon and Shanksville responders. Of the total responders in the program, 3,439 are now deceased. Just under 40% of responders with certified health issues were aged 45-64 and 83% were male. The top three certified conditions among enrolled responders were: aerodigestive disorders; cancer; and mental ill health. The top ten certified cancers have remained the same over the last five years, however, leukemia has now overtaken colon and bladder cancer as the 20-year anniversary approaches. Compared to the general population, 9/11 first responders had a higher rate of all cancers combined, as well as higher rates of prostate cancer, thyroid cancer, and leukemia. DISCUSSION Trends in these program statistics should be viewed with some caution. While certain illnesses have been linked with exposure to the WTC site, differences in age, sex, ethnicity, smoking status, and other factors between exposed and unexposed groups should also be considered. Increased rates of some illnesses among this cohort may be associated with heightened surveillance rather than an actual increase in disease. Still, cancer in general, as well as lung disease, heart disease, and posttraumatic stress disorder (PTSD), seem to be increasing among 9/11 responders, even now close to 20 years later. CONCLUSION Responders should continue to avail themselves of the health care and monitoring offered through programs like the WTCHP.
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Calvert GM, Reissman D, Howard J. World Trade Center Health Program: 20 years after 9/11. Occup Environ Med 2021; 78:697-698. [PMID: 34507964 DOI: 10.1136/oemed-2021-107770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/29/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Geoffrey M Calvert
- World Trade Center Health Program, NIOSH, Washington DC, District of Columbia, USA
| | - Dori Reissman
- World Trade Center Health Program, NIOSH, Washington DC, District of Columbia, USA
| | - John Howard
- World Trade Center Health Program, NIOSH, Washington DC, District of Columbia, USA
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Azofeifa A, Martin GR, Santiago-Colón A, Reissman DB, Howard J. World Trade Center Health Program - United States, 2012-2020. MMWR. SURVEILLANCE SUMMARIES : MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES 2021; 70:1-21. [PMID: 34499632 PMCID: PMC8480994 DOI: 10.15585/mmwr.ss7004a1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PROBLEM/CONDITION After the September 11, 2001, terrorist attacks on the United States, approximately 400,000 persons were exposed to toxic contaminants and other factors that increased their risk for certain physical and mental health conditions. Shortly thereafter, both federal and nonfederal funds were provided to support various postdisaster activities, including medical monitoring and treatment. In 2011, as authorized by the James Zadroga 9/11 Health and Compensation Act of 2010, the CDC World Trade Center (WTC) Health Program began providing medical screening, monitoring, and treatment of 9/11-related health conditions for WTC responders (i.e., persons who were involved in rescue, response, recovery, cleanup, and related support activities after the September 11, 2001, terrorist attacks) and affected WTC survivors (i.e., persons who were present in the dust or dust cloud on 9/11 or who worked, lived, or attended school, child care centers, or adult day care centers in the New York City disaster area). REPORTING PERIOD COVERED 2012-2020. DESCRIPTION OF SYSTEM The U.S. Department of Health and Human Services WTC Health Program is administered by the director of CDC's National Institute for Occupational Safety and Health. The WTC Health Program uses a multilayer administrative claims system to process members' authorized program health benefits. Administrative claims data are primarily generated by clinical providers in New York and New Jersey at the Clinical Centers of Excellence and outside those states by clinical providers in the Nationwide Provider Network. This report describes WTC Health Program trends for selected indicators during 2012-2020. RESULTS In 2020, a total of 104,223 members were enrolled in the WTC Health Program, of which 73.4% (n = 76,543) were responders and 26.6% (n = 27,680) were survivors. WTC Health Program members are predominantly male (78.5%). The median age of members was 51 years (interquartile range [IQR]: 44-57) in 2012 and 59 years (IQR: 52-66) in 2020. During 2012-2020, enrollment and number of certifications of WTC-related health conditions increased among members, with the greatest changes observed among survivors. Overall, at enrollment, most WTC Health Program members lived in New York (71.7%), New Jersey (9.3%), and Florida (5.7%). In 2020, the total numbers of cancer and noncancer WTC-related certifications among members were 20,612 and 50,611, respectively. Skin cancer, male genital system cancers, and in situ neoplasms (e.g., skin and breast) are the most common WTC-related certified cancer conditions. The most commonly certified noncancer conditions are in the aerodigestive and mental health categories. The average number of WTC-related certified conditions per certified member is 2.7. In 2020, a total of 40,666 WTC Health Program members received annual monitoring and screening examinations (with an annual average per calendar year of 35,245). In 2020, the total number of WTC Health Program members who received treatment was 41,387 (with an annual average per calendar year of 32,458). INTERPRETATION Since 2011, the WTC Health Program has provided health care for a limited number of 9/11-related health conditions both for responders and survivors of the terrorist attacks. Over the study period, program enrollment and WTC certification increased, particularly among survivors. As the members age, increased use of health services and costs within the WTC Health Program are expected; chronic diseases, comorbidities, and other health-related conditions unrelated to WTC exposures are more common in older populations, which might complicate the clinical management of WTC-related health conditions. PUBLIC HEALTH ACTION Analysis of administrative claims data in the context of WTC research findings can better clarify the health care use patterns of WTC Health Program members. This information guides programmatic decision-making and might also help guide future disaster preparedness and response health care efforts. Strengthening the WTC Health Program health informatics infrastructure is warranted for timely programmatic and research decision-making.
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Cone JE, Santiago-Colón A, Lucchini R. 9/11 Health Update. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126383. [PMID: 34204753 PMCID: PMC8296210 DOI: 10.3390/ijerph18126383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/09/2021] [Indexed: 11/17/2022]
Affiliation(s)
- James E. Cone
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 10013, USA
- Correspondence:
| | - Albeliz Santiago-Colón
- World Trade Center Health Program, National Institute for Occupational Safety and Health, Cincinnati, OH 45226, USA;
| | - Roberto Lucchini
- School of Public Health and Social Work, Florida International University, Miami, FL 33199, USA;
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21
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Daniels RD, Clouston SAP, Hall CB, Anderson KR, Bennett DA, Bromet EJ, Calvert GM, Carreón T, DeKosky ST, Diminich ED, Finch CE, Gandy S, Kreisl WC, Kritikos M, Kubale TL, Mielke MM, Peskind ER, Raskind MA, Richards M, Sano M, Santiago-Colón A, Sloan RP, Spiro A, Vasdev N, Luft BJ, Reissman DB. A Workshop on Cognitive Aging and Impairment in the 9/11-Exposed Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E681. [PMID: 33466931 PMCID: PMC7830144 DOI: 10.3390/ijerph18020681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 12/11/2022]
Abstract
The terrorist attacks on 11 September 2001 potentially exposed more than 400,000 responders, workers, and residents to psychological and physical stressors, and numerous hazardous pollutants. In 2011, the World Trade Center Health Program (WTCHP) was mandated to monitor and treat persons with 9/11-related adverse health conditions and conduct research on physical and mental health conditions related to the attacks. Emerging evidence suggests that persons exposed to 9/11 may be at increased risk of developing mild cognitive impairment. To investigate further, the WTCHP convened a scientific workshop that examined the natural history of cognitive aging and impairment, biomarkers in the pathway of neurodegenerative diseases, the neuropathological changes associated with hazardous exposures, and the evidence of cognitive decline and impairment in the 9/11-exposed population. Invited participants included scientists actively involved in health-effects research of 9/11-exposed persons and other at-risk populations. Attendees shared relevant research results from their respective programs and discussed several options for enhancements to research and surveillance activities, including the development of a multi-institutional collaborative research network. The goal of this report is to outline the meeting's agenda and provide an overview of the presentation materials and group discussion.
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Affiliation(s)
- Robert D. Daniels
- World Trade Center Health Program, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC 20201, USA; (K.R.A.); (G.M.C.); (T.C.); (T.L.K.); (A.S.-C.); (D.B.R.)
| | - Sean A. P. Clouston
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (S.A.P.C.); (E.J.B.); (E.D.D.); (M.K.); (B.J.L.)
| | - Charles B. Hall
- Department of Epidemiology & Population Health (Biostatistics), Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Kristi R. Anderson
- World Trade Center Health Program, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC 20201, USA; (K.R.A.); (G.M.C.); (T.C.); (T.L.K.); (A.S.-C.); (D.B.R.)
| | - David A. Bennett
- Department of Neurological Sciences, Rush Medical College, Rush University, Chicago, IL 60612, USA;
| | - Evelyn J. Bromet
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (S.A.P.C.); (E.J.B.); (E.D.D.); (M.K.); (B.J.L.)
| | - Geoffrey M. Calvert
- World Trade Center Health Program, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC 20201, USA; (K.R.A.); (G.M.C.); (T.C.); (T.L.K.); (A.S.-C.); (D.B.R.)
| | - Tania Carreón
- World Trade Center Health Program, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC 20201, USA; (K.R.A.); (G.M.C.); (T.C.); (T.L.K.); (A.S.-C.); (D.B.R.)
| | - Steven T. DeKosky
- McKnight Brain Institute, University of Florida, Gainesville, FL 32611, USA;
| | - Erica D. Diminich
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (S.A.P.C.); (E.J.B.); (E.D.D.); (M.K.); (B.J.L.)
| | - Caleb E. Finch
- USC Leonard Davis School of Gerontology, Los Angeles, CA 90089, USA;
| | - Sam Gandy
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (S.G.); (M.S.)
| | - William C. Kreisl
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, New York, NY 10032, USA;
| | - Minos Kritikos
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (S.A.P.C.); (E.J.B.); (E.D.D.); (M.K.); (B.J.L.)
| | - Travis L. Kubale
- World Trade Center Health Program, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC 20201, USA; (K.R.A.); (G.M.C.); (T.C.); (T.L.K.); (A.S.-C.); (D.B.R.)
| | - Michelle M. Mielke
- Division of Epidemiology and Department of Neurology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA;
| | - Elaine R. Peskind
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA;
| | - Murray A. Raskind
- Northwest Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, WA 98108, USA;
| | - Marcus Richards
- Faculty of Population Health Sciences, University College London, London WC1E 6BT, UK;
| | - Mary Sano
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (S.G.); (M.S.)
| | - Albeliz Santiago-Colón
- World Trade Center Health Program, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC 20201, USA; (K.R.A.); (G.M.C.); (T.C.); (T.L.K.); (A.S.-C.); (D.B.R.)
| | - Richard P. Sloan
- Division of Behavioral Medicine, Columbia University, New York, NY 10027, USA;
| | - Avron Spiro
- Boston University Schools of Public Health and Medicine and Veterans Affairs Boston Healthcare System, Boston, MA 02130, USA;
| | - Neil Vasdev
- Azrieli Centre for Neuro-Radiochemistry, Brain Health Imaging Centre, Centre for Addiction and Mental Health (CAMH) & Department of Psychiatry, University of Toronto, Toronto, ON M5S, Canada;
| | - Benjamin J. Luft
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (S.A.P.C.); (E.J.B.); (E.D.D.); (M.K.); (B.J.L.)
| | - Dori B. Reissman
- World Trade Center Health Program, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC 20201, USA; (K.R.A.); (G.M.C.); (T.C.); (T.L.K.); (A.S.-C.); (D.B.R.)
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