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Cleven KL, Zeig-Owens R, Mueller AK, Vaeth B, Hall CB, Choi J, Goldfarb DG, Schecter DE, Weiden MD, Nolan A, Salzman SH, Jaber N, Cohen HW, Prezant DJ. Interstitial Lung Disease and Progressive Pulmonary Fibrosis: a World Trade Center Cohort 20-Year Longitudinal Study. Lung 2024:10.1007/s00408-024-00697-z. [PMID: 38713420 DOI: 10.1007/s00408-024-00697-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/09/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE World Trade Center (WTC) exposure is associated with obstructive airway diseases and sarcoidosis. There is limited research regarding the incidence and progression of non-sarcoidosis interstitial lung diseases (ILD) after WTC-exposure. ILD encompasses parenchymal diseases which may lead to progressive pulmonary fibrosis (PPF). We used the Fire Department of the City of New York's (FDNY's) WTC Health Program cohort to estimate ILD incidence and progression. METHODS This longitudinal study included 14,525 responders without ILD prior to 9/11/2001. ILD incidence and prevalence were estimated and standardized to the US 2014 population. Poisson regression modeled risk factors, including WTC-exposure and forced vital capacity (FVC), associated with ILD. Follow-up time ended at the earliest of incident diagnosis, end of study period/case ascertainment, transplant or death. RESULTS ILD developed in 80/14,525 FDNY WTC responders. Age, smoking, and gastroesophageal reflux disease (GERD) prior to diagnosis were associated with incident ILD, though FVC was not. PPF developed in 40/80 ILD cases. Among the 80 cases, the average follow-up time after ILD diagnosis was 8.5 years with the majority of deaths occurring among those with PPF (PPF: n = 13; ILD without PPF: n = 6). CONCLUSIONS The prevalence of post-9/11 ILD was more than two-fold greater than the general population. An exposure-response gradient could not be demonstrated. Half the ILD cases developed PPF, higher than previously reported. Age, smoking, and GERD were risk factors for ILD and PPF, while lung function was not. This may indicate that lung function measured after respirable exposures would not identify those at risk for ILD or PPF.
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Affiliation(s)
- Krystal L Cleven
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Rachel Zeig-Owens
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
- Bureau of Health Services, Fire Department of the City of New York, 9 Metrotech Center, Brooklyn, NY, 11201, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alexandra K Mueller
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
- Bureau of Health Services, Fire Department of the City of New York, 9 Metrotech Center, Brooklyn, NY, 11201, USA
| | - Brandon Vaeth
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
- Bureau of Health Services, Fire Department of the City of New York, 9 Metrotech Center, Brooklyn, NY, 11201, USA
| | - Charles B Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jaeun Choi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David G Goldfarb
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
- Bureau of Health Services, Fire Department of the City of New York, 9 Metrotech Center, Brooklyn, NY, 11201, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David E Schecter
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Michael D Weiden
- Bureau of Health Services, Fire Department of the City of New York, 9 Metrotech Center, Brooklyn, NY, 11201, USA
- New York University Grossman School of Medicine, New York, NY, USA
| | - Anna Nolan
- Bureau of Health Services, Fire Department of the City of New York, 9 Metrotech Center, Brooklyn, NY, 11201, USA
- New York University Grossman School of Medicine, New York, NY, USA
| | - Steve H Salzman
- Bureau of Health Services, Fire Department of the City of New York, 9 Metrotech Center, Brooklyn, NY, 11201, USA
| | - Nadia Jaber
- Bureau of Health Services, Fire Department of the City of New York, 9 Metrotech Center, Brooklyn, NY, 11201, USA
| | - Hillel W Cohen
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David J Prezant
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA.
- Bureau of Health Services, Fire Department of the City of New York, 9 Metrotech Center, Brooklyn, NY, 11201, USA.
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
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Lancet EA, Asaeda G, Zeig-Owens R, Prezant DJ. Emergency Medical Services Use in New York City Amidst Record-Breaking Fine Particulate Matter Levels from the Canadian Wildfires, June 2023. Ann Emerg Med 2024:S0196-0644(24)00198-7. [PMID: 38691068 DOI: 10.1016/j.annemergmed.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 05/03/2024]
Affiliation(s)
- Elizabeth A Lancet
- Office of Medical Affairs, Fire Department of the City of New York, Brooklyn, NY.
| | - Glenn Asaeda
- Office of Medical Affairs, Fire Department of the City of New York, Brooklyn, NY
| | - Rachel Zeig-Owens
- Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY; Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - David J Prezant
- Office of Medical Affairs, Fire Department of the City of New York, Brooklyn, NY; Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY; Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY; Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
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Goldfarb DG, Prezant DJ, Zeig-Owens R, Hall CB, Schwartz T, Liu Y, Kavouras IG. Association of firefighting exposures with lung function using a novel job exposure matrix (JEM). Occup Environ Med 2024; 81:84-91. [PMID: 38233128 DOI: 10.1136/oemed-2023-109155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/17/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVES Characterisation of firefighters' exposures to dangerous chemicals in smoke from non-wildfire incidents, directly through personal monitoring and indirectly from work-related records, is scarce. The aim of this study was to evaluate the association between smoke particle exposures (P) and pulmonary function. METHODS The study period spanned from January 2010 through September 2021. Routine firefighting P were estimated using fire incident characteristics, response data and emission factors from a novel job exposure matrix. Linear mixed effects modelling was employed to estimate changes in pulmonary function as measured by forced expiratory volume in one second (FEV1). Models controlled for age, race/ethnicity, height, smoking and weight. RESULTS Every 1000 kg P was associated with 13 mL lower FEV1 (β=-13.34; 95% CI=-13.98 to -12.70) over the entire 12-year follow-up period. When analysing exposures within 3 months before PFT measurements, 1000 kg P was associated with 27 mL lower FEV1 (β=-26.87; 95% CI=-34.54 to -19.20). When evaluating P estimated within 3 months of a pulmonary function test (PFT), stronger associations were observed among those most highly exposed to the World Trade Center (WTC) disaster (β=-12.90; 95% CI=-22.70 to -2.89); the association of cumulative exposures was similar for both highly and less highly exposed individuals. DISCUSSION Smoke particle exposures were observed to have modest short-term and long-term associations with pulmonary function, particularly in those who, previously, had high levels of WTC exposure. Future work examining the association between P and pulmonary function among non-WTC exposed firefighters will be essential for disentangling the effects of ageing, routine firefighting and WTC exposures.
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Affiliation(s)
- David G Goldfarb
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Environmental and Geospatial Health Sciences, City University of New York Graduate School of Public Health and Health Policy, New York city, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David J Prezant
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
| | - Rachel Zeig-Owens
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Charles B Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Theresa Schwartz
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
| | - Yang Liu
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
| | - Ilias G Kavouras
- Department of Environmental and Geospatial Health Sciences, City University of New York Graduate School of Public Health and Health Policy, New York city, New York, USA
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Mueller AK, Cohen H, Singh A, Webber MP, Hall CB, Prezant DJ, Zeig-Owens R. Self-reported Cardiovascular Disease in Career Firefighters With and Without World Trade Center Exposure. J Occup Environ Med 2024; 66:135-140. [PMID: 37907410 DOI: 10.1097/jom.0000000000003007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
OBJECTIVE To assess the effect of World Trade Center (WTC) exposure on cardiovascular disease (CVD) in career firefighters. Methods: Firefighters from four US cities completed health questionnaires that provide information about demographics, CVD diagnoses, and CVD risk factors. Firefighters were also compared with respondents of the 2019 National Health Interview Survey. Results: Greater WTC exposure was positively associated with combined coronary artery disease, myocardial infarction, and angina (termed "CAD") when comparing WTC-exposed with non-WTC-exposed firefighters. Compared with the National Health Interview Survey population, firefighters had lower odds of CAD and stroke. Conclusions: An occupationally appropriate comparison is important to mitigate potential bias from the healthy worker effect. While the risk of CVD in WTC-exposed and non-WTC-exposed firefighters was significantly lower than a general US population, we observed an exposure gradient where greater WTC exposure was associated with greater odds of CVD.
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Affiliation(s)
- Alexandra K Mueller
- From the Fire Department of the City of New York, Bureau of Health Services, 9 Metrotech Center, Brooklyn, New York (A.K.M., A.S., M.P.W., D.J.P., R.Z.-O.); Pulmonology Division, Department of Medicine, Montefiore Medical Center, Bronx, New York (A.K.M., A.S., D.J.P., R.Z.-O.); and Department of Epidemiology and Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York (H.C., M.P.W., C.B.H., D.J.P., R.Z.-O.)
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Cannon MF, Goldfarb DG, Zeig-Owens RA, Hall CB, Choi J, Cohen HW, Prezant DJ, Weiden MD. Normal Lung Function and Mortality in World Trade Center Responders and NHANES III Participants. Am J Respir Crit Care Med 2024. [PMID: 38163381 DOI: 10.1164/rccm.202309-1654oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024] Open
Abstract
RATIONALE Low forced expiratory volume at one second (FEV1) is a biomarker of increased mortality. The association of normal lung function and mortality is not well described. OBJECTIVE To evaluate the FEV1-mortality association among participants with normal lung function. METHODS 10,999 Fire Department of the City of New York (FDNY) responders and 10,901 NHANES III participants, ages 18-65 with FEV1 ≥80% predicted, were analyzed, with FEV1 percent predicted calculated using Global Lung Function Initiative Global race-neutral reference equations. Mortality data were obtained from linkages to the National Death Index. Cox proportional hazards models estimated the association between FEV1 and all-cause mortality, controlling for age, sex, race/ethnicity, smoking history, and, for FDNY, work assignment. Cohorts were followed for a maximum of 20.3 years. MEASUREMENTS AND MAIN RESULTS We observed 504/10,999 deaths (4.6%) for FDNY and 1,237/10,901 deaths (9.4% [weighted]) for NHANES III. Relative to FEV1 ≥120% predicted, mortality was significantly higher for FEV1 100-109%, 90-99%, and 80-89% predicted in the FDNY cohort. In the NHANES III cohort, mortality was significantly higher for FEV1 90-99% and 80-89% predicted. Each 10% higher predicted FEV1 was associated with 15% (HR=0.85, 95% CI 0.80-0.91) and 23% (HR=0.77, 95% CI 0.71-0.84) lower mortality for FDNY and NHANES III, respectively. CONCLUSIONS In both cohorts, higher FEV1 is associated with lower mortality, suggesting higher FEV1 is a biomarker of better health. These findings demonstrate that a single cross-sectional measurement of FEV1 is predictive of mortality over two decades, even when FEV1 is in the normal range.
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Affiliation(s)
- Madeline F Cannon
- Montefiore Medical Center, 2013, Department of Medicine, Bronx, New York, United States
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, United States
| | - David G Goldfarb
- Montefiore Medical Center, 2013, Department of Medicine, Bronx, New York, United States
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, United States
- Albert Einstein College of Medicine, 2006, Department of Epidemiology and Population Health, Bronx, New York, United States
| | - Rachel A Zeig-Owens
- Montefiore Medical Center, 2013, Department of Medicine, Bronx, New York, United States
- Fire Department of the City of New York, 101588, Bureau of Health Services, Brooklyn, New York, United States
- Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, New York, United States
| | - Charles B Hall
- Albert Einstein College of Medicine, 2006, Department of Epidemiology and Population Health, Bronx, New York, United States
| | - Jaeun Choi
- Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, New York, United States
| | - Hillel W Cohen
- Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, New York, United States
| | - David J Prezant
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, United States
- Montefiore Medical Center, Department of Medicine, Bronx, New York, United States
- Albert Einstein College of Medicine, 2006, Department of Epidemiology and Population Health, Bronx, New York, United States
| | - Michael D Weiden
- Fire Department of the City of New York, 101588, Bureau of Health Services, Brooklyn, New York, United States
- New York University Grossman School of Medicine, 12296, Division of Pulmonary, Critical Care, and Sleep Medicine, New York, New York, United States;
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Khalifeh M, Goldfarb DG, Zeig-Owens R, Todd AC, Shapiro MZ, Carwile M, Dasaro CR, Li J, Yung J, Farfel MR, Brackbill RM, Cone JE, Qiao B, Schymura MJ, Prezant DJ, Hall C, Boffetta P. Cancer incidence in World Trade Center rescue and recovery workers by race and ethnicity. Am J Ind Med 2023; 66:1048-1055. [PMID: 37746817 DOI: 10.1002/ajim.23539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION It is unclear whether differences in health outcomes by racial and ethnic groups among World Trade Center (WTC) rescue and recovery workers reflect those of the population of New York State (NYS) or show distinct patterns. We assessed cancer incidence in WTC workers by self-reported race and ethnicity, and compared it to population figures for NYS. METHODS A total of 61,031 WTC workers enrolled between September 11, 2001 and January 10, 2012 were followed to December 31, 2015. To evaluate the association between race/ethnicity and cancer risk, Poisson regression analysis was used to estimate hazard ratios (HR) adjusted for WTC exposure, age, calendar year, sex and, for lung cancer, cigarette smoking. RESULTS In comparison to Whites, Black workers had a higher incidence of prostate cancer (HR = 1.99, 95% CI = 1.69-2.34) and multiple myeloma (HR = 3.57, 95% CI = 1.97-6.45), and a lower incidence of thyroid (HR = 0.41, 95% CI = 0.22-0.78) and colorectal cancer (HR = 0.57; 95% CI = 0.33-0.98). Hispanic workers had a higher incidence of liver cancer (HR = 4.03, 95% CI = 2.23-7.28). Compared with NYS population, White workers had significantly higher incidence of prostate cancer (HR = 1.26, 95% CI = 1.18-1.35) and thyroid cancer (HR = 1.80, 95% CI = 1.55-2.08), while Black workers had significantly higher incidence of prostate cancer (HR = 1.22, 95% CI = 1.05-1.40). CONCLUSION Cancer incidence in WTC workers generally reflects data from the NYS population, but some differences were identified that merit further investigation.
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Affiliation(s)
- Malak Khalifeh
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
| | - David G Goldfarb
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Fire Department of the City of New York, Brooklyn, New York, USA
| | - Rachel Zeig-Owens
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Andrew C Todd
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Moshe Z Shapiro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Madeline Carwile
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christopher R Dasaro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jiehui Li
- New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Janette Yung
- New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Mark R Farfel
- New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Robert M Brackbill
- New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - James E Cone
- New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Baozhen Qiao
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, New York, USA
| | - Maria J Schymura
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, New York, USA
| | - David J Prezant
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Charles Hall
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Colbeth HL, Zeig-Owens R, Hall CB, Webber MP, Schwartz TM, Prezant DJ. Correction: Colbeth et al. Mortality among Fire Department of the City of New York Rescue and Recovery Workers Exposed to the World Trade Center Disaster, 2001-2017. Int. J. Environ. Res. Public Health 2020, 17, 6266. Int J Environ Res Public Health 2023; 20:6585. [PMID: 37623206 PMCID: PMC10454049 DOI: 10.3390/ijerph20166585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 07/07/2023] [Indexed: 08/26/2023]
Abstract
The original publication [...].
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Affiliation(s)
- Hilary L. Colbeth
- Fire Department of the City of New York, Bureau of Health Services, 9 Metrotech Center, Brooklyn, NY 11201, USA
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, NY 10467, USA
| | - Rachel Zeig-Owens
- Fire Department of the City of New York, Bureau of Health Services, 9 Metrotech Center, Brooklyn, NY 11201, USA
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, NY 10467, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Charles B. Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Mayris P. Webber
- Fire Department of the City of New York, Bureau of Health Services, 9 Metrotech Center, Brooklyn, NY 11201, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Theresa M. Schwartz
- Fire Department of the City of New York, Bureau of Health Services, 9 Metrotech Center, Brooklyn, NY 11201, USA
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, NY 10467, USA
| | - David J. Prezant
- Fire Department of the City of New York, Bureau of Health Services, 9 Metrotech Center, Brooklyn, NY 11201, USA
- Department of Medicine, Pulmonology Division, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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Goldfarb DG, Hall CB, Choi J, Zeig-Owens R, Cohen HW, Cannon M, Prezant DJ, Weiden MD. Association of Lung Function Decline with All-Cause and Cancer-Cause Mortality after World Trade Center Dust Exposure. Ann Am Thorac Soc 2023; 20:1136-1143. [PMID: 36961515 PMCID: PMC10405606 DOI: 10.1513/annalsats.202212-1011oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/24/2023] [Indexed: 03/25/2023] Open
Abstract
Rationale: In numerous cohorts, lung function decline is associated with all-cause and cardiovascular-cause mortality, but the association between the decrease in forced expiratory volume in 1 second (FEV1) and cancer-cause mortality, particularly after occupational/environmental exposure(s), is unclear. Exposure to dust/smoke from the World Trade Center (WTC) disaster caused inflammation and lung injury in Fire Department of the City of New York rescue/recovery workers. In addition, prior research found that >10% of the cohort experienced greater than twice the age-related decrease in FEV1 (⩾64 ml/yr). Objectives: To evaluate the association of longitudinal lung function with all-cause and cancer-cause mortality after exposure to the WTC disaster. Methods: We conducted a prospective cohort study using longitudinal prebronchodilator FEV1 data for 12,264 WTC-exposed firefighters and emergency medical service providers. All-cause and cancer-cause mortality were ascertained using National Death Index data from September 12, 2001, through December 31, 2021. Joint longitudinal survival models evaluated the association of baseline FEV1 and change in FEV1 from baseline with all-cause and cancer-cause mortality adjusted for age, race/ethnicity, height, smoking, work assignment (firefighters vs. emergency medical service providers), and WTC exposure. Results: By December 31, 2021, 607 of the 12,264 individuals in the cohort (4.9%) had died (crude rate = 259.5 per 100,000 person-years), and 190 of 12,264 (1.5%) had died from cancer (crude rate = 81.2 per 100,000 person-years). Baseline FEV1 was ⩾80% predicted in 10,970 of the 12,264 (89.4%); final FEV1 was ⩾80% in 9,996 (81.5%). Lower FEV1 at baseline was associated with greater risk for all-cause mortality (hazard ratio [HR] per liter = 2.32; 95% confidence interval [95% CI] = 1.98-2.72) and cancer-cause mortality (HR per liter = 1.99; 95% CI = 1.49-2.66). Longitudinally, each 100-ml/yr decrease in FEV1 was associated with an 11% increase in all-cause mortality (HR = 1.11; 95% CI = 1.06-1.15) and a 7% increase in cancer-cause mortality (HR = 1.07; 95% CI = 1.00-1.15). Compared with FEV1 decrease <64 ml/yr, those with FEV1 decrease ⩾64 ml/yr had higher all-cause (HR = 2.91; 95% CI = 2.37-3.56) and cancer-cause mortality (HR = 2.68; 95% CI = 1.90-3.79). Conclusions: Baseline FEV1 and longitudinal FEV1 decrease are associated with increased risk of all-cause and cancer-cause mortality in a previously healthy occupational cohort, the majority of whom had normal lung function, after intense exposure to dust/smoke. Further investigation is needed to define pathways by which lung function impacts mortality after an irritant exposure.
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Affiliation(s)
- David G. Goldfarb
- Department of Medicine, Montefiore Medical Center, Bronx, New York
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York
| | - Charles B. Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; and
| | - Jaeun Choi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; and
| | - Rachel Zeig-Owens
- Department of Medicine, Montefiore Medical Center, Bronx, New York
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; and
| | - Hillel W. Cohen
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; and
| | - Madeline Cannon
- Department of Medicine, Montefiore Medical Center, Bronx, New York
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York
| | - David J. Prezant
- Department of Medicine, Montefiore Medical Center, Bronx, New York
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; and
| | - Michael D. Weiden
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
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Singh A, Zeig-Owens R, Cannon M, Webber MP, Goldfarb DG, Daniels RD, Prezant DJ, Boffetta P, Hall CB. All-cause and cause-specific mortality in a cohort of WTC-exposed and non-WTC-exposed firefighters. Occup Environ Med 2023; 80:297-303. [PMID: 36972975 PMCID: PMC10523283 DOI: 10.1136/oemed-2022-108703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/10/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE To compare mortality rates in World Trade Center (WTC)-exposed Fire Department of the City of New York (FDNY) firefighters with rates in similarly healthy, non-WTC-exposed/non-FDNY firefighters, and compare mortality in each firefighter cohort with the general population. METHODS 10 786 male WTC-exposed FDNY firefighters and 8813 male non-WTC-exposed firefighters from other urban fire departments who were employed on 11 September 2001 were included in the analyses. Only WTC-exposed firefighters received health monitoring via the WTC Health Programme (WTCHP). Follow-up began 11 September 2001 and ended at the earlier of death date or 31 December 2016. Death data were obtained from the National Death Index and demographics from the fire departments. We estimated standardised mortality ratios (SMRs) in each firefighter cohort versus US males using demographic-specific US mortality rates. Poisson regression models estimated relative rates (RRs) of all-cause and cause-specific mortality in WTC-exposed versus non-WTC-exposed firefighters, controlling for age and race. RESULTS Between 11 September 2001 and 31 December 2016, there were 261 deaths among WTC-exposed firefighters and 605 among non-WTC-exposed. Both cohorts had reduced all-cause mortality compared with US males (SMR (95% CI)=0.30 (0.26 to 0.34) and 0.60 (0.55 to 0.65) in WTC-exposed and non-WTC-exposed, respectively). WTC-exposed firefighters also had lower rates of all-cause mortality (RR=0.54, 95% CI=0.49 to 0.59) and cancer-specific, cardiovascular-specific and respiratory disease-specific mortality compared with non-WTC-exposed firefighters. CONCLUSION Both firefighter cohorts had lower than expected all-cause mortality. Fifteen years post 11 September 2001, mortality was lower in WTC-exposed versus non-WTC-exposed firefighters. Lower mortality in the WTC-exposed suggests not just a healthy worker effect, but additional factors such as greater access to free health monitoring and treatment that they receive via the WTCHP.
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Affiliation(s)
- Ankura Singh
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Rachel Zeig-Owens
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Madeline Cannon
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Mayris P Webber
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David G Goldfarb
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Robert D Daniels
- Division of Science integration, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - David J Prezant
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Charles B Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
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10
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Mueller AK, Singh A, Webber MP, Hall CB, Prezant DJ, Zeig-Owens R. Comparing self-reported obstructive airway disease in firefighters with and without World Trade Center exposure. Am J Ind Med 2023; 66:243-251. [PMID: 36597815 DOI: 10.1002/ajim.23455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/21/2022] [Accepted: 12/01/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND The degree to which routine, non-World Trade Center (WTC) firefighting exposures contribute to the WTC exposure-obstructive airway disease (OAD) relationship is unknown. Our objective was to compare the frequency of self-reported OAD diagnoses in WTC-exposed firefighters from the Fire Department of the City of New York (FDNY) compared with non-WTC-exposed firefighters from other cities and the general population. METHODS A total of 9792 WTC-exposed male FDNY firefighters and 3138 non-WTC-exposed male firefighters from Chicago, Philadelphia, and San Francisco who were actively employed on 9/11/01 and completed a health questionnaire were included. Logistic regression estimated odds ratios of self-reported asthma and COPD diagnoses in firefighters (WTC-exposed vs. non-WTC-exposed; all firefighters vs. general population), adjusting for age, race, smoking status, and last medical visit. RESULTS WTC-exposed firefighters were, on average, younger on 9/11 (mean ± SD = 40.2 ± 7.4 vs. 44.1 ± 9.1) and less likely to report ever-smoking (32.9% vs. 41.8%) than non-WTC-exposed firefighters. Odds of any OAD and asthma were 4.5 and 6.3 times greater, respectively, in WTC-exposed versus non-WTC-exposed. Odds of COPD were also greater in WTC-exposed versus non-WTC-exposed, particularly among never-smokers. Compared with the general population, WTC-exposed firefighters had greater odds of both asthma and COPD, while the nonexposed had lower odds of asthma and greater odds of COPD. CONCLUSIONS Odds ratios for OAD diagnoses were greater in WTC-exposed firefighters versus both non-WTC-exposed and the general population after adjusting for covariates. While asthma and other OADs are known occupational hazards of firefighting, WTC exposure significantly compounded these adverse respiratory effects.
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Affiliation(s)
- Alexandra K Mueller
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Division of Pulmonology, Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Ankura Singh
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Division of Pulmonology, Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Mayris P Webber
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Charles B Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - David J Prezant
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Division of Pulmonology, Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Rachel Zeig-Owens
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Division of Pulmonology, Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
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11
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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. Environ Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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Goldfarb DG, Prezant DJ, Zeig-Owens R, Schwartz T, Liu Y, Kavouras IG. Development of a job-exposure matrix (JEM) for exposure to smoke particle mass among firefighters of the Fire Department of the City of New York (FDNY). Occup Environ Med 2023; 80:104-110. [PMID: 36635097 DOI: 10.1136/oemed-2022-108549] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/15/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVES A refined job exposure matrix (JEM) based on incident types and severities and response characteristics was developed for firefighters to estimate quantities of smoke particles emitted during structural and non-structural fire incidents from 2010 to 2021. METHODS The cohort included a subset of 3237 Fire Department of the City of New York firefighters who responded to at least one incident between 2010 and 2021, prior to retirement. Fire incident data included dates, type, severity (alarm level) and location. Response data included dates worked, firehouse, position titles and shift lengths for each firefighter. The quantity of smoke particle mass generated during structural and non-structural fires adjusted by individual firefighter engagement was computed using the United States Environmental Protection Agency AP-42 emissions framework. Correlations between years of employment, fire responses and career total particle mass concentration by firefighter were examined. Linear regression models were fit and corresponding R2 values were calculated. RESULTS Firefighters responded to a median of 424.7 (IQR=202.3-620.0) annual incidents/person; 17.6% were fire incidents (median=77.1; IQR=40.4-114.0). Structural fires were the most common type of fire incident (72.5% of annual incidents/person; median=55.9; IQR=29.6-85.5). Incident severity (alarm level) and firefighter engagement (position title) appeared to differentiate between high and low exposure regimes (R2=0.43). Incident severity explained most of the variability of particle exposures (R2=0.90). CONCLUSIONS Using the JEM, job-related smoke particle concentrations were estimated to vary by incident type, incident severity and firefighter engagement, highlighting the importance of using refined measures, so that future studies can more accurately evaluate associations between firefighting and health outcomes.
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Affiliation(s)
- David G Goldfarb
- Department of Environmental, Occupational, and Geospatial Health Sciences, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA .,Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA.,Department of Medicine, Montefiore Medical Center, Brooklyn, New York, USA
| | - David J Prezant
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
| | - Rachel Zeig-Owens
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA.,Department of Medicine, Montefiore Medical Center, Brooklyn, New York, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Theresa Schwartz
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA.,Department of Medicine, Montefiore Medical Center, Brooklyn, New York, USA
| | - Yang Liu
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
| | - Ilias G Kavouras
- Department of Environmental, Occupational, and Geospatial Health Sciences, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
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13
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Zeig-Owens R, Goldfarb DG, Luft BJ, Yang X, Murata K, Ramanathan L, Thoren K, Doddi S, Shah UA, Mueller AK, Hall CB, Giricz O, Verma A, Prezant DJ, Landgren O. Myeloma precursor disease (MGUS) among rescue and recovery workers exposed to the World Trade Center disaster. Blood Cancer J 2022; 12:120. [PMID: 35995768 PMCID: PMC9395354 DOI: 10.1038/s41408-022-00709-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 11/09/2022] Open
Abstract
An elevated risk of myeloma precursor disease, monoclonal gammopathy of undetermined significance (MGUS), was identified among Fire Department of the City of New York (FDNY) World Trade Center (WTC)-exposed firefighters. Further investigation was needed to determine if these findings were reproducible in a more heterogeneous WTC-exposed rescue/recovery workers cohort, the Stony Brook University-General Responder Cohort GRC (SBU-GRC). MGUS risk was compared between the cohorts and to published general population estimates from Olmsted County, MN, USA. In this observational seroprevalence study, odds ratios (OR) and age-standardized risk ratios (RR) of MGUS (M-spike and light-chain-MGUS combined), M-spike, and light-chain-MGUS were estimated using logistic regression. Age-standardized prevalences were calculated for white males aged 50–79; RRs were estimated by comparing risk in the WTC-exposed cohort with the Olmsted County screened cohort. SBU-GRC had elevated odds of MGUS compared with FDNY (OR = 1.38; 95%CI = 1.00–1.89). The age-standardized prevalence of MGUS was 9.0/100 persons (95%CI = 7.5–10.6), over two-fold higher than the general population (RR = 2.08; 95%CI = 1.72–2.51); the age-standardized prevalence of light-chain-MGUS was 3.5-fold higher (RR = 3.54; 95%CI = 2.52–4.97). This study adds to mounting evidence supporting an association between WTC/environmental exposures and MGUS among rescue/recovery workers. Access to MGUS screenings for the entire WTC-exposed cohort could allow for treatment interventions that improve survival.
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Affiliation(s)
- Rachel Zeig-Owens
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA.,Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David G Goldfarb
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA.,Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY, USA
| | - Benjamin J Luft
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Xiaohua Yang
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Kazunori Murata
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lakshmi Ramanathan
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katie Thoren
- Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Sital Doddi
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Urvi A Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Alexandra K Mueller
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA.,Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY, USA
| | - Charles B Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Orsi Giricz
- The Leukemia & Lymphoma Society, Rye Brook, NY, USA
| | - Amit Verma
- Division of Hemato-Oncology, Department of Oncology, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY, USA
| | - David J Prezant
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY, USA.,Department of Medicine, Division of Pulmonary Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, New York, NY, USA
| | - Ola Landgren
- Myeloma Division, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.
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14
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Cleven KL, Zeig-Owens R, Goldfarb DG, Schwartz T, Prezant DJ. Risk Factors for COVID-19 in a Retired FDNY WTC-Exposed Cohort. IJERPH 2022; 19:ijerph19158891. [PMID: 35897262 PMCID: PMC9331420 DOI: 10.3390/ijerph19158891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 02/04/2023]
Abstract
We evaluated the incidence and risk factors for COVID-19 in a prospectively followed cohort of Fire Department of the City of New York (FDNY) World Trade Center (WTC)-exposed workers, thus reducing the potential for selection bias, a limitation in published studies of hospitalized individuals. Participants were retired FDNY WTC-exposed rescue/recovery workers with ≥1 medical visit between 1 March 2020 and 1 August 2021. The cumulative incidence was calculated using self-reported COVID-19 diagnoses. Cox regression was performed to evaluate the association of WTC-exposure and COVID-19, adjusting for history of comorbidities, age, race, work assignment (emergency medical service providers vs. firefighter), and sex. The cumulative incidence of COVID-19 was 130 per 1000. The adjusted models showed the risk of infection was greater in those with highest WTC exposure versus less exposure (hazard ratio (HR) = 1.14 (95% CI 1.00–1.31)). Older age was associated with a lower risk of infection HR = 0.97 (95% CI 0.96–0.98). WTC-associated diseases (obstructive airways disease and interstitial lung disease) were not COVID-19 risk factors. This study is the first to show an association between WTC exposure and the risk of COVID-19. While participants are retired from FDNY work, the youngest individuals may still be in the workforce, explaining why younger age was a significant risk for COVID-19.
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Affiliation(s)
- Krystal L. Cleven
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10467, USA; (R.Z.-O.); (D.G.G.); (T.S.); (D.J.P.)
- Correspondence: ; Tel.: +1-718-403-4416
| | - Rachel Zeig-Owens
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10467, USA; (R.Z.-O.); (D.G.G.); (T.S.); (D.J.P.)
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY 11201, USA
- Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - David G. Goldfarb
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10467, USA; (R.Z.-O.); (D.G.G.); (T.S.); (D.J.P.)
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY 11201, USA
| | - Theresa Schwartz
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10467, USA; (R.Z.-O.); (D.G.G.); (T.S.); (D.J.P.)
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY 11201, USA
| | - David J. Prezant
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10467, USA; (R.Z.-O.); (D.G.G.); (T.S.); (D.J.P.)
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY 11201, USA
- Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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15
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Ferastraoaru D, Zeig-Owens R, Goldfarb DG, Mueller AK, Hall CB, Weiden MD, Schwartz T, Prezant DJ, Rosenstreich D. Relationship between low serum IgE levels and malignancies in 9/11 World Trade Center responders. Ann Allergy Asthma Immunol 2022; 129:769-775. [PMID: 35872243 DOI: 10.1016/j.anai.2022.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/21/2022] [Accepted: 07/11/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Individuals with very low immunoglobulin E-(IgE)-levels have a high risk of developing malignancy. Previous studies have shown that World Trade Center (WTC)-responders exposed to carcinogens have an elevated risk of some cancers. OBJECTIVE To evaluate the association between low-serum IgE levels and cancer development in WTC-exposed-responders. METHODS IgE-levels were measured in 1,851 WTC-responders after 9/11/2001. This is the first pilot study in humans comparing the odds of developing cancer in this high-risk population, between the "low-IgE" (IgE in the lowest 3 rd percentile) versus "non-low IgE" participants. RESULTS A significantly higher proportion of hematologic malignancies was found in low-IgE (4/55, 7.3%) compared with non-low IgE (26/1,796, 1.5%, p<0.01) responders. The proportion of solid tumors were similar in both groups (5.5% vs 11.4%, p>0.05). After adjustment for relevant confounders (race, sex, age at blood draw, WTC-arrival time, smoking status), the low-IgE-participants had 7.81 times greater odds (95% CI=1.77-29.35) of developing hematologic cancer when compared with non-low-IgE-participants. The hematologic cancers found in this cohort were leukemia (n=1), multiple myeloma (n=1) and lymphoma (n=2). No statistical significance was found when estimating the odds-ratio for solid tumors in relation to IgE levels. CONCLUSION WTC-responders with low serum IgE levels had the highest odds of developing hematologic malignancies. This hypothesis-generating study suggests that low serum IgE levels might be associated with the development of specific malignancies in at-risk individuals exposed to carcinogens. Larger, multicenter studies with adequate follow up of individuals with different IgE levels are needed to better evaluate this relationship.
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Affiliation(s)
| | - Rachel Zeig-Owens
- Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY; Fire Department of the City of New York (FDNY), Brooklyn, NY
| | - David G Goldfarb
- Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY; Fire Department of the City of New York (FDNY), Brooklyn, NY
| | - Alexandra K Mueller
- Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY; Fire Department of the City of New York (FDNY), Brooklyn, NY
| | - Charles B Hall
- Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY
| | - Michael D Weiden
- Fire Department of the City of New York (FDNY), Brooklyn, NY; New York University Grossman School of Medicine, New York, NY
| | - Theresa Schwartz
- Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY; Fire Department of the City of New York (FDNY), Brooklyn, NY
| | - David J Prezant
- Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY; Fire Department of the City of New York (FDNY), Brooklyn, NY
| | - David Rosenstreich
- Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY
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Jasra S, Giricz O, Zeig-Owens R, Pradhan K, Goldfarb DG, Barreto-Galvez A, Silver AJ, Chen J, Sahu S, Gordon-Mitchell S, Choudhary GS, Aluri S, Bhagat TD, Shastri A, Bejan CA, Stockton SS, Spaulding TP, Thiruthuvanathan V, Goto H, Gerhardt J, Haider SH, Veerappan A, Bartenstein M, Nwankwo G, Landgren O, Weiden MD, Lekostaj J, Bender R, Fletcher F, Greenberger L, Ebert BL, Steidl U, Will B, Nolan A, Madireddy A, Savona MR, Prezant DJ, Verma A. High burden of clonal hematopoiesis in first responders exposed to the World Trade Center disaster. Nat Med 2022; 28:468-471. [DOI: 10.1038/s41591-022-01708-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/19/2022] [Indexed: 12/21/2022]
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17
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Li J, Yung J, Qiao B, Takemoto E, Goldfarb DG, Zeig-Owens R, Cone JE, Brackbill RM, Farfel MR, Kahn AR, Schymura MJ, Shapiro MZ, Dasaro CR, Todd AC, Kristjansson D, Prezant DJ, Boffetta P, Hall CB. Cancer Incidence in World Trade Center Rescue and Recovery Workers: 14 Years of Follow-Up. J Natl Cancer Inst 2022; 114:210-219. [PMID: 34498043 PMCID: PMC8826586 DOI: 10.1093/jnci/djab165] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Statistically significantly increased cancer incidence has been reported from 3 cohorts of World Trade Center (WTC) disaster rescue and recovery workers. We pooled data across these cohorts to address ongoing public concerns regarding cancer risk 14 years after WTC exposure. METHODS From a combined deduplicated cohort of 69 102 WTC rescue and recovery workers, a sample of 57 402 workers enrolled before 2009 and followed through 2015 was studied. Invasive cancers diagnosed in 2002-2015 were identified from 13 state cancer registries. Standardized incidence ratios (SIRs) were used to assess cancer incidence. Adjusted hazard ratios (aHRs) were estimated from Cox regression to examine associations between WTC exposures and cancer risk. RESULTS Of the 3611 incident cancers identified, 3236 were reported as first-time primary (FP) cancers, with an accumulated 649 724 and 624 620 person-years of follow-up, respectively. Incidence for combined FP cancers was below expectation (SIR = 0.96, 95% confidence interval [CI] = 0.93 to 0.99). Statistically significantly elevated SIRs were observed for melanoma-skin (SIR = 1.43, 95% CI = 1.24 to 1.64), prostate (SIR = 1.19, 95% CI = 1.11 to 1.26), thyroid (SIR = 1.81, 95% CI = 1.57 to 2.09), and tonsil (SIR = 1.40, 95% CI = 1.00 to 1.91) cancer. Those arriving on September 11 had statistically significantly higher aHRs than those arriving after September 17, 2001, for prostate (aHR = 1.61, 95% CI = 1.33 to 1.95) and thyroid (aHR = 1.77, 95% CI = 1.11 to 2.81) cancers, with a statistically significant exposure-response trend for both. CONCLUSIONS In the largest cohort of 9/11 rescue and recovery workers ever studied, overall cancer incidence was lower than expected, and intensity of WTC exposure was associated with increased risk for specific cancer sites, demonstrating the value of long-term follow-up studies after environmental disasters.
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Affiliation(s)
- Jiehui Li
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY, USA
| | - Janette Yung
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY, USA
| | - Baozhen Qiao
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, NY, USA
| | - Erin Takemoto
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY, USA
| | - David G Goldfarb
- Fire Department of the City of New York (FDNY), Brooklyn, NY, USA
- Department of Medicine, Montefiore Medical Center, New York, NY, USA
| | - Rachel Zeig-Owens
- Fire Department of the City of New York (FDNY), Brooklyn, NY, USA
- Department of Medicine, Montefiore Medical Center, New York, NY, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - James E Cone
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY, USA
| | - Robert M Brackbill
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY, USA
| | - Mark R Farfel
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY, USA
| | - Amy R Kahn
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, NY, USA
| | - Maria J Schymura
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, NY, USA
| | - Moshe Z Shapiro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher R Dasaro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew C Todd
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dana Kristjansson
- Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, Oslo, Norway
| | - David J Prezant
- Fire Department of the City of New York (FDNY), Brooklyn, NY, USA
- Department of Medicine, Montefiore Medical Center, New York, NY, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Paolo Boffetta
- Medicine Department of Family, Population and Preventive Medicine Health Sciences, Stony Brook University, Stony Brook Cancer Center, Stony Brook, NY, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Charles B Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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18
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Boffetta P, Goldfarb DG, Zeig-Owens R, Kristjansson D, Li J, Brackbill RM, Farfel MR, Cone JE, Yung J, Kahn AR, Qiao B, Schymura MJ, Webber MP, Prezant DJ, Dasaro CR, Todd AC, Hall CB. Temporal Aspects of the Association between Exposure to the World Trade Center Disaster and Risk of Cutaneous Melanoma. JID Innov 2022; 2:100063. [PMID: 35146479 PMCID: PMC8801528 DOI: 10.1016/j.xjidi.2021.100063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
Rescue/recovery workers who responded to the World Trade Center (WTC) attacks were exposed to known/suspected carcinogens. Studies have identified a trend toward an elevated risk of cutaneous melanoma in this population; however, few found significant increases. Furthermore, temporal aspects of the association have not been investigated. A total of 44,540 non-Hispanic White workers from the WTC Combined Rescue/Recovery Cohort were studied between March 12, 2002 and December 31, 2015. Cancer data were obtained through linkages with 13 state registries. Poisson regression was used to estimate hazard ratios and 95% confidence intervals using the New York State population as the reference; change points in hazard ratios were estimated using profile likelihood. We observed 247 incident cases of melanoma. No increase in incidence was detected during 2002-2004. From 2005 to 2015, the hazard ratio was 1.34 (95% confidence interval = 1.18-1.52). A dose‒response relationship was observed by arrival time at the WTC site. Risk was elevated just over 3 years after the attacks. Whereas WTC-related exposures to UVR or other agents might have contributed to this result, exposures other than those at the WTC site, enhanced medical surveillance, and lack of a control group with a similar proportion of rescue/recovery workers cannot be discounted. Our results support continued study of this population for melanoma.
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Affiliation(s)
- Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - David G. Goldfarb
- Department of Medicine, Montefiore Medical Center, New York, New York, USA
- Fire Department of the City of New York (FDNY), Brooklyn, New York, USA
- Department of Environmental, Occupational and Geospatial Health Sciences, City University of New York Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Rachel Zeig-Owens
- Department of Medicine, Montefiore Medical Center, New York, New York, USA
- Fire Department of the City of New York (FDNY), Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Dana Kristjansson
- Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, Oslo, Norway
- Center of Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jiehui Li
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Robert M. Brackbill
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Mark R. Farfel
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - James E. Cone
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Janette Yung
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Amy R. Kahn
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Baozhen Qiao
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Maria J. Schymura
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Mayris P. Webber
- Department of Medicine, Montefiore Medical Center, New York, New York, USA
- Fire Department of the City of New York (FDNY), Brooklyn, New York, USA
| | - David J. Prezant
- Department of Medicine, Montefiore Medical Center, New York, New York, USA
- Fire Department of the City of New York (FDNY), Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Christopher R. Dasaro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrew C. Todd
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Charles B. Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
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19
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Cleven KL, Rosenzvit C, Nolan A, Zeig-Owens R, Kwon S, Weiden MD, Skerker M, Halpren A, Prezant DJ. Twenty-Year Reflection on the Impact of World Trade Center Exposure on Pulmonary Outcomes in Fire Department of the City of New York (FDNY) Rescue and Recovery Workers. Lung 2021; 199:569-578. [PMID: 34766209 PMCID: PMC8583580 DOI: 10.1007/s00408-021-00493-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/29/2021] [Indexed: 12/17/2022]
Abstract
After the terrorist attacks on September 11, 2001 (9/11), many rescue/recovery workers developed respiratory symptoms and pulmonary diseases due to their extensive World Trade Center (WTC) dust cloud exposure. Nearly all Fire Department of the City of New York (FDNY) workers were present within 48 h of 9/11 and for the next several months. Since the FDNY had a well-established occupational health service for its firefighters and Emergency Medical Services workers prior to 9/11, the FDNY was able to immediately start a rigorous monitoring and treatment program for its WTC-exposed workers. As a result, respiratory symptoms and diseases were identified soon after 9/11. This focused review summarizes the WTC-related respiratory diseases that developed in the FDNY cohort after 9/11, including WTC cough syndrome, obstructive airways disease, accelerated lung function decline, airway hyperreactivity, sarcoidosis, and obstructive sleep apnea. Additionally, an extensive array of biomarkers has been identified as associated with WTC-related respiratory disease. Future research efforts will not only focus on further phenotyping/treating WTC-related respiratory disease but also on additional diseases associated with WTC exposure, especially those that take decades to develop, such as cardiovascular disease, cancer, and interstitial lung disease.
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Affiliation(s)
- Krystal L Cleven
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Carla Rosenzvit
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Anna Nolan
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY, USA.,Pulmonary, Critical Care and Sleep Medicine Division, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA.,Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Rachel Zeig-Owens
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.,The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY, USA.,Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sophia Kwon
- Pulmonary, Critical Care and Sleep Medicine Division, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Michael D Weiden
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY, USA.,Pulmonary, Critical Care and Sleep Medicine Division, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA.,Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Molly Skerker
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.,The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY, USA
| | - Allison Halpren
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY, USA
| | - David J Prezant
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.,The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY, USA.,Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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20
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Kwon S, Lee M, Crowley G, Schwartz T, Zeig-Owens R, Prezant DJ, Liu M, Nolan A. Dynamic Metabolic Risk Profiling of World Trade Center Lung Disease: A Longitudinal Cohort Study. Am J Respir Crit Care Med 2021; 204:1035-1047. [PMID: 34473012 DOI: 10.1164/rccm.202006-2617oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Rationale: Metabolic syndrome (MetSyn) increases the risk of World Trade Center (WTC) lung injury (LI). However, the temporal relationship of MetSyn, exposure intensity, and lung dysfunction is not well understood. Objective: To model the association of longitudinal MetSyn characteristics with WTC lung disease to define modifiable risk. Methods: Firefighters, for whom consent was obtained (N = 5,738), were active duty on September 11, 2001 (9/11). WTC-LI (n = 1,475; FEV1% predicted <lower limit of normal [LLN]) and non-WTC-LI (n = 4,263; FEV1% predicted ⩾LLN at all exams) was the primary outcome, and FVC% predicted <LLN and FEV1/FVC <0.70 were secondary outcomes. We assessed 1) the effect of concurrent MetSyn on longitudinal lung function by linear mixed models, 2) the temporal effect of MetSyn and exposure by Weibull proportional hazards, 3) the effects of MetSyn's rate of change by two-stage models, and 4) the nonlinear joint effect of longitudinal MetSyn components by a partially linear single-index model (PLSI). Measurements and Main Results: WTC-LI cases were more often ever-smokers, arrived in the morning (9/11), and had MetSyn. Body mass index ⩾30 kg/m2 and high-density lipoprotein <40 mg/dl were most contributory to concurrent loss of FEV1% predicted and FVC% predicted while conserving FEV1/FVC. Body mass index ⩾30 kg/m2 and dyslipidemia significantly predicted WTC-LI, FVC% predicted <LLN in a Weibull proportional hazards model. Dynamic risk assessment of WTC-LI on the basis of MetSyn and exposure showed how reduction of MetSyn factors further reduces WTC-LI likelihood in susceptible populations. PLSI demonstrates that MetSyn has a nonlinear relationship with WTC lung disease, and increases in cumulative MetSyn risk factors exponentially increase WTC-LI risk. An interactive metabolic-risk modeling application was developed to simplify PLSI interpretation. Conclusions: MetSyn and WTC exposure contribute to the development of lung disease. Dynamic risk assessment may be used to encourage treatment of MetSyn in susceptible populations. Future studies will focus on dietary intervention as a disease modifier.
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Affiliation(s)
- Sophia Kwon
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine
| | - Myeonggyun Lee
- Division of Biostatistics, Department of Population Health, and
| | - George Crowley
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine
| | - Theresa Schwartz
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, New York; and
| | - Rachel Zeig-Owens
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, New York; and.,Department of Epidemiology and Population Health and
| | - David J Prezant
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, New York; and.,Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Mengling Liu
- Division of Biostatistics, Department of Population Health, and.,Department of Environmental Medicine, New York University School of Medicine, New York, New York
| | - Anna Nolan
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine.,Department of Environmental Medicine, New York University School of Medicine, New York, New York.,Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, New York; and
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21
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Goldfarb DG, Colbeth HL, Skerker M, Webber MP, Prezant DJ, Dasaro CR, Todd AC, Kristjansson D, Li J, Brackbill RM, Farfel MR, Cone JE, Yung J, Kahn AR, Qiao B, Schymura MJ, Boffetta P, Hall CB, Zeig-Owens R. Impact of healthcare services on thyroid cancer incidence among World Trade Center-exposed rescue and recovery workers. Am J Ind Med 2021; 64:861-872. [PMID: 34275137 PMCID: PMC8796202 DOI: 10.1002/ajim.23277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND A recent study of World Trade Center (WTC)-exposed firefighters and emergency medical service workers demonstrated that elevated thyroid cancer incidence may be attributable to frequent medical testing, resulting in the identification of asymptomatic tumors. We expand on that study by comparing the incidence of thyroid cancer among three groups: WTC-exposed rescue/recovery workers enrolled in a New York State (NYS) WTC-medical monitoring and treatment program (MMTP); WTC-exposed rescue/recovery workers not enrolled in an MMTP (non-MMTP); and the NYS population. METHODS Person-time began on 9/12/2001 or at enrollment in a WTC cohort and ended at death or on 12/31/2015. Cancer data were obtained through linkages with 13 state cancer registries. We used Poisson regression to estimate rate ratios (RRs) and 95% confidence intervals (CIs) for MMTP and non-MMTP participants. NYS rates were used as the reference. To estimate potential changes over time in WTC-associated risk, change points in RRs were estimated using profile likelihood. RESULTS The thyroid cancer incidence rate among MMTP participants was more than twice that of NYS population rates (RR = 2.31; 95% CI = 2.00-2.68). Non-MMTP participants had a risk similar to NYS (RR = 0.96; 95% CI = 0.72-1.28). We observed no change points in the follow-up period. CONCLUSION Our findings support the hypothesis that no-cost screening (a benefit provided by WTC-MMTPs) is associated with elevated identification of thyroid cancer. Given the high survival rate for thyroid cancer, it is important to weigh the costs and benefits of treatment, as many of these cancers were asymptomatic and may have been detected incidentally.
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Affiliation(s)
- David G. Goldfarb
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, New York, USA
- Department of Environmental, Occupational and Geospatial Health Sciences, City University of New York Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Hilary L. Colbeth
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, New York, USA
| | - Molly Skerker
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, New York, USA
| | - Mayris P. Webber
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David J. Prezant
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Christopher R. Dasaro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrew C. Todd
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dana Kristjansson
- Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, Oslo, Norway
- Center of Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jiehui Li
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Robert M. Brackbill
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Mark R. Farfel
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - James E. Cone
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Janette Yung
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Amy R. Kahn
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, New York, USA
| | - Baozhen Qiao
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, New York, USA
| | - Maria J. Schymura
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, New York, USA
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Charles B. Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Rachel Zeig-Owens
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
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22
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Goldfarb DG, Putman B, Lahousse L, Zeig‐Owens R, Vaeth BM, Schwartz T, Hall CB, Prezant DJ, Weiden MD. Lung function decline before and after treatment of World Trade Center associated obstructive airways disease with inhaled corticosteroids and long-acting beta agonists. Am J Ind Med 2021; 64:853-860. [PMID: 34254700 PMCID: PMC9292780 DOI: 10.1002/ajim.23272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 02/06/2023]
Abstract
Background Greater than average loss of one‐second forced expiratory volume (FEV1) is a risk factor for asthma, chronic obstructive pulmonary disease (COPD), and asthma/COPD overlap syndrome in World Trade Center (WTC)‐exposed firefighters. Inhaled corticosteroids and long‐acting beta agonists (ICS/LABA) are used to treat obstructive airways disease but their impact on FEV1‐trajectory in this population is unknown. Methods The study population included WTC‐exposed male firefighters who were treated with ICS/LABA for 2 years or longer (with initiation before 2015), had at least two FEV1 measurements before ICS/LABA initiation and two FEV1 measurements posttreatment between September 11, 2001 and September 10, 2019. Linear mixed‐effects models were used to estimate FEV1‐slope pre‐ and post‐treatment. Results During follow‐up, 1023 WTC‐exposed firefighters were treated with ICS/LABA for 2 years or longer. When comparing intervals 6 years before and 6 years after treatment, participants had an 18.7 ml/year (95% confidence interval [CI]: 11.3–26.1) improvement in FEV1‐slope after adjustment for baseline FEV1, race, height, WTC exposure, weight change, blood eosinophil concentration, and smoking status. After stratification by median date of ICS/LABA initiation (January 14, 2010), earlier ICS/LABA‐initiators had a 32.5 ml/year (95% CI: 19.5–45.5) improvement in slope but later ICS/LABA‐initiators had a nonsignificant FEV1‐slope improvement (7.9 ml/year, 95% CI: −0.5 to 17.2). Conclusions WTC‐exposed firefighters treated with ICS/LABA had improved FEV1 slope after initiation, particularly among those who started earlier. Treatment was, however, not associated with FEV1‐slope improvement if started after the median initiation date (1/14/2010), likely because onset of disease began before treatment initiation. Research on alternative treatments is needed for patients with greater than average FEV1‐decline who have not responded to ICS/LABA.
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Affiliation(s)
- David G. Goldfarb
- Fire Department of the City of New York The Bureau of Health Services and the FDNY World Trade Center Health Program Brooklyn NY USA
- Department of Environmental, Occupational and Geospatial Health Sciences City University of New York Graduate School of Public Health and Health Policy New York NY USA
- Division of Pulmonary Medicine, Department of Medicine Montefiore Medical Center Bronx NY USA
| | - Barbara Putman
- Department of Bioanalysis, Faculty of Pharmaceutical Sciences Ghent University Ghent Belgium
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine and Department of Environmental Medicine New York University School of Medicine New York NY USA
| | - Lies Lahousse
- Department of Bioanalysis, Faculty of Pharmaceutical Sciences Ghent University Ghent Belgium
| | - Rachel Zeig‐Owens
- Fire Department of the City of New York The Bureau of Health Services and the FDNY World Trade Center Health Program Brooklyn NY USA
- Division of Pulmonary Medicine, Department of Medicine Montefiore Medical Center Bronx NY USA
- Division of Epidemiology, Department of Epidemiology and Population Health Albert Einstein College of Medicine Bronx NY USA
| | - Brandon M. Vaeth
- Fire Department of the City of New York The Bureau of Health Services and the FDNY World Trade Center Health Program Brooklyn NY USA
- Division of Pulmonary Medicine, Department of Medicine Montefiore Medical Center Bronx NY USA
| | - Theresa Schwartz
- Fire Department of the City of New York The Bureau of Health Services and the FDNY World Trade Center Health Program Brooklyn NY USA
- Division of Pulmonary Medicine, Department of Medicine Montefiore Medical Center Bronx NY USA
| | - Charles B. Hall
- Division of Biostatistics, Department of Epidemiology and Population Health Albert Einstein College of Medicine Bronx NY USA
| | - David J. Prezant
- Fire Department of the City of New York The Bureau of Health Services and the FDNY World Trade Center Health Program Brooklyn NY USA
- Division of Pulmonary Medicine, Department of Medicine Montefiore Medical Center Bronx NY USA
- Division of Epidemiology, Department of Epidemiology and Population Health Albert Einstein College of Medicine Bronx NY USA
| | - Michael D. Weiden
- Fire Department of the City of New York The Bureau of Health Services and the FDNY World Trade Center Health Program Brooklyn NY USA
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine and Department of Environmental Medicine New York University School of Medicine New York NY USA
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Mueller AK, Singh A, Webber MP, Hall CB, Prezant DJ, Zeig‐Owens R. PTSD symptoms, depressive symptoms, and subjective cognitive concerns in WTC-exposed and non-WTC-exposed firefighters. Am J Ind Med 2021; 64:803-814. [PMID: 34415073 DOI: 10.1002/ajim.23285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Firefighting has been associated with posttraumatic stress disorder (PTSD) and other mental health conditions. We previously found that among Fire Department of the City of New York (FDNY) responders to the World Trade Center (WTC) disaster, higher-intensity WTC-exposure predicted PTSD symptoms, depressive symptoms, and subjective cognitive concerns. The present study aims to compare these symptoms in the FDNY WTC-exposed cohort versus a comparison cohort of non-FDNY, non-WTC-exposed firefighters. METHODS The study population included WTC-exposed male firefighters from FDNY (N = 8466) and non-WTC-exposed male firefighters from Chicago (N = 1195), Philadelphia (N = 770), and San Francisco (N = 650) fire departments who were employed on 9/11/2001 and completed a health questionnaire between 3/1/2018 and 12/31/2020. Current PTSD symptoms, depressive symptoms, and subjective cognitive concerns were assessed via validated screening instruments. Multivariable linear regression analyses stratified by fire department estimated the impact of covariates on each outcome. RESULTS Adjusted mean PTSD symptom scores ranged from 23.5 ± 0.6 in Chicago firefighters to 25.8 ± 0.2 in FDNY, and adjusted mean depressive symptom scores ranged from 7.3 ± 0.5 in Chicago to 9.4 ± 0.6 in Philadelphia. WTC-exposure was associated with fewer subjective cognitive concerns (β = -0.69 ± 0.05, p < .001) after controlling for covariates. Across cohorts, older age was associated with more cognitive concerns, but fewer PTSD and depressive symptoms. CONCLUSIONS WTC-exposed firefighters had fewer cognitive concerns compared with non-WTC-exposed firefighters. We were unable to estimate associations between WTC exposure and PTSD symptoms or depressive symptoms due to variability between non-WTC-exposed cohorts. Longitudinal follow-up is needed to assess PTSD, depressive, and cognitive symptom trajectories in firefighter populations as they age.
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Affiliation(s)
- Alexandra K. Mueller
- Fire Department of the City of New York Bureau of Health Services Brooklyn New York USA
- Department of Medicine, Pulmonology Division Montefiore Medical Center Bronx New York USA
| | - Ankura Singh
- Fire Department of the City of New York Bureau of Health Services Brooklyn New York USA
- Department of Medicine, Pulmonology Division Montefiore Medical Center Bronx New York USA
| | - Mayris P. Webber
- Fire Department of the City of New York Bureau of Health Services Brooklyn New York USA
- Department of Epidemiology and Population Health Albert Einstein College of Medicine Bronx New York USA
| | - Charles B. Hall
- Department of Epidemiology and Population Health Albert Einstein College of Medicine Bronx New York USA
| | - David J. Prezant
- Fire Department of the City of New York Bureau of Health Services Brooklyn New York USA
- Department of Medicine, Pulmonology Division Montefiore Medical Center Bronx New York USA
| | - Rachel Zeig‐Owens
- Fire Department of the City of New York Bureau of Health Services Brooklyn New York USA
- Department of Medicine, Pulmonology Division Montefiore Medical Center Bronx New York USA
- Department of Epidemiology and Population Health Albert Einstein College of Medicine Bronx New York USA
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Goldfarb DG, Zeig-Owens R, Kristjansson D, Li J, Brackbill RM, Farfel MR, Cone JE, Yung J, Kahn AR, Qiao B, Schymura MJ, Webber MP, Dasaro CR, Shapiro M, Todd AC, Prezant DJ, Boffetta P, Hall CB. Temporal association of prostate cancer incidence with World Trade Center rescue/recovery work. Occup Environ Med 2021; 78:699-706. [PMID: 34507966 PMCID: PMC8458078 DOI: 10.1136/oemed-2021-107405] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/20/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The World Trade Center (WTC) attacks on 11 September 2001 created a hazardous environment with known and suspected carcinogens. Previous studies have identified an increased risk of prostate cancer in responder cohorts compared with the general male population. OBJECTIVES To estimate the length of time to prostate cancer among WTC rescue/recovery workers by determining specific time periods during which the risk was significantly elevated. METHODS Person-time accruals began 6 months after enrolment into a WTC cohort and ended at death or 12/31/2015. Cancer data were obtained through linkages with 13 state cancer registries. New York State was the comparison population. We used Poisson regression to estimate hazard ratios and 95% CIs; change points in rate ratios were estimated using profile likelihood. RESULTS The analytic cohort included 54 394 male rescue/recovery workers. We observed 1120 incident prostate cancer cases. During 2002-2006, no association with WTC exposure was detected. Beginning in 2007, a 24% increased risk (HR: 1.24, 95% CI 1.16 to 1.32) was observed among WTC rescue/recovery workers when compared with New York State. Comparing those who arrived earliest at the disaster site on the morning of 11 September 2001 or any time on 12 September 2001 to those who first arrived later, we observed a positive, monotonic, dose-response association in the early (2002-2006) and late (2007-2015) periods. CONCLUSIONS Risk of prostate cancer was significantly elevated beginning in 2007 in the WTC combined rescue/recovery cohort. While unique exposures at the disaster site might have contributed to the observed effect, screening practices including routine prostate specific antigen screening cannot be discounted.
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Affiliation(s)
- David G Goldfarb
- Department of Medicine, Division of Pulmonary Medicine, Montefiore Medical Center, Bronx, New York, USA
- Bureau of Health Services, World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York, USA
| | - Rachel Zeig-Owens
- Department of Medicine, Division of Pulmonary Medicine, Montefiore Medical Center, Bronx, New York, USA
- Bureau of Health Services, World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Division of Epidemiology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Dana Kristjansson
- Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, Oslo, Norway
- Center of Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jiehui Li
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Robert M Brackbill
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Mark R Farfel
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - James E Cone
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Janette Yung
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Amy R Kahn
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Baozhen Qiao
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Maria J Schymura
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Mayris P Webber
- Bureau of Health Services, World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Division of Epidemiology, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Epidemiology and Population Health, Division of Epidemiology, Montefiore Medical Center, Bronx, New York, USA
| | - Christopher R Dasaro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Moshe Shapiro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrew C Todd
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David J Prezant
- Department of Medicine, Division of Pulmonary Medicine, Montefiore Medical Center, Bronx, New York, USA
- Bureau of Health Services, World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Division of Epidemiology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Charles B Hall
- Department of Epidemiology & Population Health, Division of Biostatistics, Albert Einstein College of Medicine, Bronx, New York, USA
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Webber MP, Singh A, Zeig-Owens R, Salako J, Skerker M, Hall CB, Goldfarb DG, Jaber N, Daniels RD, Prezant DJ. Cancer incidence in World Trade Center-exposed and non-exposed male firefighters, as compared with the US adult male population: 2001-2016. Occup Environ Med 2021; 78:707-714. [PMID: 34507965 PMCID: PMC8458058 DOI: 10.1136/oemed-2021-107570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/29/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare cancer incidence in Fire Department of the City of New York (FDNY) firefighters who worked at the World Trade Center (WTC) site to incidence in a population of non-WTC-exposed firefighters, the Career Firefighter Health Study (CFHS) cohort, and to compare rates from each firefighter cohort to rates in demographically similar US males. METHODS FDNY (N=10 786) and CFHS (N=8813) cohorts included male firefighters who were active on 11 September 2001 (9/11) and were followed until death or 31 December 2016. Cases were identified from 15 state cancer registries. Poisson regression models assessed cancers in each group (FDNY and CFHS) versus US males, and associations between group and cancer rates; these models estimated standardised incidence ratios (SIRs) and adjusted relative rates (RRs), respectively. Secondary analyses assessed surveillance bias and smoking history. RESULTS We identified 915 cancer cases in 841 FDNY firefighters and 1002 cases in 909 CFHS firefighters. FDNY had: higher rates for all cancers (RR=1.13; 95% CI 1.02 to 1.25), prostate (RR=1.39; 95% CI 1.19 to 1.63) and thyroid cancer (RR=2.53; 95% CI 1.37 to 4.70); younger median ages at diagnosis (55.6 vs 59.4; p<0.001, all cancers); and more cases with localised disease when compared with CFHS. Compared with US males, both firefighter cohorts had elevated SIRs for prostate cancer and melanoma. Control for surveillance bias in FDNY reduced most differences. CONCLUSIONS Excess cancers occurred in WTC-exposed firefighters relative to each comparison group, which may partially be explained by heightened surveillance. Two decades post-9/11, clearer understanding of WTC-related risk requires extended follow-up and modelling studies (laboratory or animal based) to identify workplace exposures in all firefighters.
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Affiliation(s)
- Mayris P Webber
- Division of Epidemiology, Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
| | - Ankura Singh
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Rachel Zeig-Owens
- Division of Epidemiology, Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Joke Salako
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Molly Skerker
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Charles B Hall
- Division of Biostatistics, Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - David G Goldfarb
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nadia Jaber
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
| | - Robert D Daniels
- World Trade Center Health Program, Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio, USA
| | - David J Prezant
- Division of Epidemiology, Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
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Weiden MD, Singh A, Goldfarb DG, Putman B, Zeig‐Owens R, Schwartz T, Cohen HW, Prezant DJ. Serum Th-2 cytokines and FEV 1 decline in WTC-exposed firefighters: A 19-year longitudinal study. Am J Ind Med 2021; 64:845-852. [PMID: 34288008 PMCID: PMC9290799 DOI: 10.1002/ajim.23276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 01/07/2023]
Abstract
Background Accelerated‐FEV1‐decline, defined as rate of decline in FEV1 > 64 ml/year, is a risk factor for asthma and chronic obstructive pulmonary disease in World Trade Center (WTC)‐exposed firefighters. Accelerated‐FEV1‐decline in this cohort is associated with elevated blood eosinophil concentrations, a mediator of Th‐2 response. We hypothesized that an association exists between Th‐2 biomarkers and FEV1 decline rate in those with accelerated‐FEV1‐decline. Methods Serum was drawn from Fire Department of the City of New York (FDNY) firefighters 1–6 months (early) (N = 816) and 12–13 years (late) (N = 983) after 9/11/2001. Th‐2 biomarkers IL‐4, IL‐13, and IL‐5 were assayed by multiplex Luminex. Individual FEV1 decline rates were calculated using spirometric measurements taken: (1) between 9/11/2001 and 9/10/2020 for the early biomarker group and (2) between late measurement date and 9/10/2020 for the late biomarker group. Associations of early and late Th‐2 biomarkers with subsequent FEV1 decline rates were analyzed using multivariable linear regression controlling for demographics, smoking status, and other potential confounders. Results In WTC‐exposed firefighters with accelerated‐FEV1‐decline, IL‐4, IL‐13, and IL‐5 measured 1–6 months post‐9/11/2001 were associated with greater FEV1 decline ml/year between 9/11/2001 and 9/10/2020 (−2.9 ± 1.4 ml/year per IL‐4 doubling; −8.4 ± 1.2 ml/year per IL‐13 doubling; −7.9 ± 1.3 ml/year per IL‐5 doubling). Among late measured Th‐2 biomarkers, only IL‐4 was associated with subsequent FEV1 decline rate (−4.0 ± 1.6 ml/year per IL‐4 doubling). Conclusions In WTC‐exposed firefighters with accelerated‐FEV1‐decline, elevated serum IL‐4 measured both 1–6 months and 12–13 years after 9/11 is associated with greater FEV1 decline/year. Drugs targeting the IL‐4 pathway may improve lung function in this high‐risk subgroup.
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Affiliation(s)
- Michael D. Weiden
- The Bureau of Health Services and the FDNY World Trade Center Health Program Brooklyn New York USA
- Fire Department of the City of New York Brooklyn New York USA
- Department of Medicine New York University School of Medicine New York New York USA
- Department of Environmental Medicine, Pulmonary, Critical Care and Sleep Medicine Division New York University School of Medicine New York New York USA
| | - Ankura Singh
- The Bureau of Health Services and the FDNY World Trade Center Health Program Brooklyn New York USA
- Fire Department of the City of New York Brooklyn New York USA
- Department of Medicine, Pulmonary Medicine Division Montefiore Medical Center and Albert Einstein College of Medicine Bronx New York USA
| | - David G. Goldfarb
- The Bureau of Health Services and the FDNY World Trade Center Health Program Brooklyn New York USA
- Fire Department of the City of New York Brooklyn New York USA
- Department of Medicine, Pulmonary Medicine Division Montefiore Medical Center and Albert Einstein College of Medicine Bronx New York USA
| | - Barbara Putman
- Department of Medicine New York University School of Medicine New York New York USA
- Department of Environmental Medicine, Pulmonary, Critical Care and Sleep Medicine Division New York University School of Medicine New York New York USA
- Department of Bioanalysis, Faculty of Pharmaceutical Sciences Ghent University Ghent Belgium
| | - Rachel Zeig‐Owens
- The Bureau of Health Services and the FDNY World Trade Center Health Program Brooklyn New York USA
- Fire Department of the City of New York Brooklyn New York USA
- Department of Medicine, Pulmonary Medicine Division Montefiore Medical Center and Albert Einstein College of Medicine Bronx New York USA
- Department of Epidemiology and Population Health, Division of Epidemiology Albert Einstein College of Medicine Bronx New York USA
| | - Theresa Schwartz
- The Bureau of Health Services and the FDNY World Trade Center Health Program Brooklyn New York USA
- Fire Department of the City of New York Brooklyn New York USA
- Department of Medicine, Pulmonary Medicine Division Montefiore Medical Center and Albert Einstein College of Medicine Bronx New York USA
| | - Hillel W. Cohen
- Department of Epidemiology and Population Health, Division of Epidemiology Albert Einstein College of Medicine Bronx New York USA
| | - David J. Prezant
- The Bureau of Health Services and the FDNY World Trade Center Health Program Brooklyn New York USA
- Fire Department of the City of New York Brooklyn New York USA
- Department of Medicine, Pulmonary Medicine Division Montefiore Medical Center and Albert Einstein College of Medicine Bronx New York USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Crowley G, Kim J, Kwon S, Lam R, Prezant DJ, Liu M, Nolan A. PEDF, a pleiotropic WTC-LI biomarker: Machine learning biomarker identification and validation. PLoS Comput Biol 2021; 17:e1009144. [PMID: 34288906 PMCID: PMC8328304 DOI: 10.1371/journal.pcbi.1009144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 08/02/2021] [Accepted: 06/03/2021] [Indexed: 12/01/2022] Open
Abstract
Biomarkers predict World Trade Center-Lung Injury (WTC-LI); however, there remains unaddressed multicollinearity in our serum cytokines, chemokines, and high-throughput platform datasets used to phenotype WTC-disease. To address this concern, we used automated, machine-learning, high-dimensional data pruning, and validated identified biomarkers. The parent cohort consisted of male, never-smoking firefighters with WTC-LI (FEV1, %Pred< lower limit of normal (LLN); n = 100) and controls (n = 127) and had their biomarkers assessed. Cases and controls (n = 15/group) underwent untargeted metabolomics, then feature selection performed on metabolites, cytokines, chemokines, and clinical data. Cytokines, chemokines, and clinical biomarkers were validated in the non-overlapping parent-cohort via binary logistic regression with 5-fold cross validation. Random forests of metabolites (n = 580), clinical biomarkers (n = 5), and previously assayed cytokines, chemokines (n = 106) identified that the top 5% of biomarkers important to class separation included pigment epithelium-derived factor (PEDF), macrophage derived chemokine (MDC), systolic blood pressure, macrophage inflammatory protein-4 (MIP-4), growth-regulated oncogene protein (GRO), monocyte chemoattractant protein-1 (MCP-1), apolipoprotein-AII (Apo-AII), cell membrane metabolites (sphingolipids, phospholipids), and branched-chain amino acids. Validated models via confounder-adjusted (age on 9/11, BMI, exposure, and pre-9/11 FEV1, %Pred) binary logistic regression had AUCROC [0.90(0.84–0.96)]. Decreased PEDF and MIP-4, and increased Apo-AII were associated with increased odds of WTC-LI. Increased GRO, MCP-1, and simultaneously decreased MDC were associated with decreased odds of WTC-LI. In conclusion, automated data pruning identified novel WTC-LI biomarkers; performance was validated in an independent cohort. One biomarker—PEDF, an antiangiogenic agent—is a novel, predictive biomarker of particulate-matter-related lung disease. Other biomarkers—GRO, MCP-1, MDC, MIP-4—reveal immune cell involvement in WTC-LI pathogenesis. Findings of our automated biomarker identification warrant further investigation into these potential pharmacotherapy targets. Disease related to air pollution causes millions of deaths annually. Large swathes of the general population, as well as certain occupations such as 1st responders and military personnel, are exposed to particulate matter (PM)—a major component of air pollution. Our longitudinal cohort of FDNY firefighters exposed to the World Trade Center dust cloud on 9/11 is a unique research opportunity to characterize the impact of a single, intense PM exposure by looking at pre- and post-exposure phenotype; however, PM-related lung disease and PM’s systemic effects are complex and call for a systems biological approach coupled with novel computational modelling techniques to fully understand pathogenesis. In the present study, we integrate clinical and environmental biomarkers with the serum metabolome, cytokines, and chemokines to develop a model for early disease detection and identification of potential signaling cascades of PM-related chronic lung disease.
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Affiliation(s)
- George Crowley
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, New York, United States of America
| | - James Kim
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, New York, United States of America
| | - Sophia Kwon
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, New York, United States of America
| | - Rachel Lam
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, New York, United States of America
| | - David J. Prezant
- Bureau of Health Services, Fire Department of New York, Brooklyn, New York, United States of America
- Department of Medicine, Pulmonary Medicine Division, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Mengling Liu
- Department of Environmental Medicine, New York University School of Medicine, New York, New York, United States of America
- Department of Population Health, Division of Biostatistics, New York University School of Medicine, New York, New York, United States of America
| | - Anna Nolan
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, New York, United States of America
- Bureau of Health Services, Fire Department of New York, Brooklyn, New York, United States of America
- Department of Environmental Medicine, New York University School of Medicine, New York, New York, United States of America
- * E-mail:
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Lai PH, Lancet EA, Weiden MD, Webber MP, Zeig-Owens R, Hall CB, Prezant DJ. Characteristics Associated With Out-of-Hospital Cardiac Arrests and Resuscitations During the Novel Coronavirus Disease 2019 Pandemic in New York City. JAMA Cardiol 2021; 5:1154-1163. [PMID: 32558876 PMCID: PMC7305567 DOI: 10.1001/jamacardio.2020.2488] [Citation(s) in RCA: 203] [Impact Index Per Article: 67.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Question What characteristics are associated with out-of-hospital cardiac arrests and death during the COVID-19 pandemic in New York City? Findings In this population-based cross-sectional study of 5325 patients with out-of-hospital cardiac arrests, the number undergoing resuscitation was 3-fold higher during the 2020 COVID-19 period compared with during the comparison period in 2019. Patients with out-of-hospital cardiac arrest during 2020 were older, less likely to be white, and more likely to have specific comorbidities and substantial reductions in return and sustained return of spontaneous circulation. Meaning Identifying patients at risk for out-of-hospital cardiac arrest and death during the COVID-19 pandemic should lead to interventions in the outpatient setting to help reduce out-of-hospital deaths. Importance Risk factors for out-of-hospital death due to novel coronavirus disease 2019 (COVID-19) are poorly defined. From March 1 to April 25, 2020, New York City, New York (NYC), reported 17 118 COVID-19–related deaths. On April 6, 2020, out-of-hospital cardiac arrests peaked at 305 cases, nearly a 10-fold increase from the prior year. Objective To describe the characteristics (race/ethnicity, comorbidities, and emergency medical services [EMS] response) associated with outpatient cardiac arrests and death during the COVID-19 pandemic in NYC. Design, Setting, and Participants This population-based, cross-sectional study compared patients with out-of-hospital cardiac arrest receiving resuscitation by the NYC 911 EMS system from March 1 to April 25, 2020, compared with March 1 to April 25, 2019. The NYC 911 EMS system serves more than 8.4 million people. Exposures The COVID-19 pandemic. Main Outcomes and Measures Characteristics associated with out-of-hospital arrests and the outcomes of out-of-hospital cardiac arrests. Results A total of 5325 patients were included in the main analysis (2935 men [56.2%]; mean [SD] age, 71 [18] years), 3989 in the COVID-19 period and 1336 in the comparison period. The incidence of nontraumatic out-of-hospital cardiac arrests in those who underwent EMS resuscitation in 2020 was 3 times the incidence in 2019 (47.5/100 000 vs 15.9/100 000). Patients with out-of-hospital cardiac arrest during 2020 were older (mean [SD] age, 72 [18] vs 68 [19] years), less likely to be white (611 of 2992 [20.4%] vs 382 of 1161 [32.9%]), and more likely to have hypertension (2134 of 3989 [53.5%] vs 611 of 1336 [45.7%]), diabetes (1424 of 3989 [35.7%] vs 348 of 1336 [26.0%]), and physical limitations (2259 of 3989 [56.6%] vs 634 of 1336 [47.5%]). Compared with 2019, the odds of asystole increased in the COVID-19 period (odds ratio [OR], 3.50; 95% CI, 2.53-4.84; P < .001), as did the odds of pulseless electrical activity (OR, 1.99; 95% CI, 1.31-3.02; P = .001). Compared with 2019, the COVID-19 period had substantial reductions in return of spontaneous circulation (ROSC) (727 of 3989 patients [18.2%] vs 463 of 1336 patients [34.7%], P < .001) and sustained ROSC (423 of 3989 patients [10.6%] vs 337 of 1336 patients [25.2%], P < .001), with fatality rates exceeding 90%. These associations remained statistically significant after adjustment for potential confounders (OR for ROSC, 0.59 [95% CI, 0.50-0.70; P < .001]; OR for sustained ROSC, 0.53 [95% CI, 0.43-0.64; P < .001]). Conclusions and Relevance In this population-based, cross-sectional study, out-of-hospital cardiac arrests and deaths during the COVID-19 pandemic significantly increased compared with the same period the previous year and were associated with older age, nonwhite race/ethnicity, hypertension, diabetes, physical limitations, and nonshockable presenting rhythms. Identifying patients with the greatest risk for out-of-hospital cardiac arrest and death during the COVID-19 pandemic should allow for early, targeted interventions in the outpatient setting that could lead to reductions in out-of-hospital deaths.
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Affiliation(s)
- Pamela H Lai
- Office of Medical Affairs, Fire Department of the City of New York, Brooklyn, New York
| | - Elizabeth A Lancet
- Office of Medical Affairs, Fire Department of the City of New York, Brooklyn, New York
| | - Michael D Weiden
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York.,Pulmonary, Critical Care and Sleep Medicine Division, Department of Medicine and Department of Environmental Medicine, New York University School of Medicine, New York
| | - Mayris P Webber
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York.,Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Rachel Zeig-Owens
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York.,Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.,Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Charles B Hall
- Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - David J Prezant
- Office of Medical Affairs, Fire Department of the City of New York, Brooklyn, New York.,Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York.,Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
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Lancet EA, Gonzalez D, Alexandrou NA, Zabar B, Lai PH, Hall CB, Braun J, Zeig‐Owens R, Isaacs D, Ben‐Eli D, Reisman N, Kaufman B, Asaeda G, Weiden MD, Nolan A, Teo H, Wei E, Natsui S, Philippou C, Prezant DJ. Prehospital hypoxemia, measured by pulse oximetry, predicts hospital outcomes during the New York City COVID-19 pandemic. J Am Coll Emerg Physicians Open 2021; 2:e12407. [PMID: 33748809 PMCID: PMC7967703 DOI: 10.1002/emp2.12407] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/02/2021] [Accepted: 02/24/2021] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To determine if oxygen saturation (out-of-hospital SpO2), measured by New York City (NYC) 9-1-1 Emergency Medical Services (EMS), was an independent predictor of coronavirus disease 2019 (COVID-19) in-hospital mortality and length of stay, after controlling for the competing risk of death. If so, out-of-hospital SpO2 could be useful for initial triage. METHODS A population-based longitudinal study of adult patients transported by EMS to emergency departments (ED) between March 5 and April 30, 2020 (the NYC COVID-19 peak period). Inclusion required EMS prehospital SpO2 measurement while breathing room air, transport to emergency department, and a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription polymerase chain reaction test. Multivariable logistic regression modeled mortality as a function of prehospital SpO2, controlling for covariates (age, sex, race/ethnicity, and comorbidities). A competing risk model also was performed to estimate the absolute risks of out-of-hospital SpO2 on the cumulative incidence of being discharged from the hospital alive. RESULTS In 1673 patients, out-of-hospital SpO2 and age were independent predictors of in-hospital mortality and length of stay, after controlling for the competing risk of death. Among patients ≥66 years old, the probability of death was 26% with an out-of-hospital SpO2 >90% versus 54% with an out-of-hospital SpO2 ≤90%. Among patients <66 years old, the probability of death was 11.5% with an out-of-hospital SpO2 >90% versus 31% with an out-of-hospital SpO2 ≤ 90%. An out-of-hospital SpO2 level ≤90% was associated with over 50% decreased likelihood of being discharged alive, regardless of age. CONCLUSIONS Out-of-hospital SpO2 and age predicted in-hospital mortality and length of stay: An out-of-hospital SpO2 ≤90% strongly supports a triage decision for immediate hospital admission. For out-of-hospital SpO2 >90%, the decision to admit depends on multiple factors, including age, resource availability (outpatient vs inpatient), and the potential impact of new treatments.
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Affiliation(s)
- Elizabeth A. Lancet
- Office of Medical AffairsFire Department of the City of New YorkBrooklynNew YorkUSA
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Dario Gonzalez
- Office of Medical AffairsFire Department of the City of New YorkBrooklynNew YorkUSA
| | | | - Benjamin Zabar
- Office of Medical AffairsFire Department of the City of New YorkBrooklynNew YorkUSA
| | - Pamela H. Lai
- Office of Medical AffairsFire Department of the City of New YorkBrooklynNew YorkUSA
| | - Charles B. Hall
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - James Braun
- Office of Medical AffairsFire Department of the City of New YorkBrooklynNew YorkUSA
| | - Rachel Zeig‐Owens
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
- Bureau of Health ServicesFire Department of the City of New YorkBrooklynNew YorkUSA
| | - Douglas Isaacs
- Office of Medical AffairsFire Department of the City of New YorkBrooklynNew YorkUSA
| | - David Ben‐Eli
- Office of Medical AffairsFire Department of the City of New YorkBrooklynNew YorkUSA
| | - Nathan Reisman
- Office of Medical AffairsFire Department of the City of New YorkBrooklynNew YorkUSA
| | - Bradley Kaufman
- Office of Medical AffairsFire Department of the City of New YorkBrooklynNew YorkUSA
| | - Glenn Asaeda
- Office of Medical AffairsFire Department of the City of New YorkBrooklynNew YorkUSA
| | - Michael D. Weiden
- Bureau of Health ServicesFire Department of the City of New YorkBrooklynNew YorkUSA
- Pulmonary, Critical Care, and Sleep Medicine Division, Department of MedicineNYU School of MedicineNew YorkNew YorkUSA
| | - Anna Nolan
- Bureau of Health ServicesFire Department of the City of New YorkBrooklynNew YorkUSA
- Pulmonary Medicine Division, Department of MedicineMontefiore Medical Center and Albert Einstein College of MedicineBronxNew YorkUSA
| | - Hugo Teo
- New York City Health + HospitalsNew YorkNew YorkUSA
| | - Eric Wei
- New York City Health + HospitalsNew YorkNew YorkUSA
| | - Shaw Natsui
- New York City Health + HospitalsNew YorkNew YorkUSA
| | | | - David J. Prezant
- Office of Medical AffairsFire Department of the City of New YorkBrooklynNew YorkUSA
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
- Bureau of Health ServicesFire Department of the City of New YorkBrooklynNew YorkUSA
- Pulmonary Medicine Division, Department of MedicineMontefiore Medical Center and Albert Einstein College of MedicineBronxNew YorkUSA
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Brackbill RM, Kahn AR, Li J, Zeig-Owens R, Goldfarb DG, Skerker M, Farfel MR, Cone JE, Yung J, Walker DJ, Solomon A, Qiao B, Schymura MJ, Dasaro CR, Kristjansson D, Webber MP, Lucchini RG, Todd AC, Prezant DJ, Boffetta P, Hall CB. Combining Three Cohorts of World Trade Center Rescue/Recovery Workers for Assessing Cancer Incidence and Mortality. Int J Environ Res Public Health 2021; 18:1386. [PMID: 33546187 PMCID: PMC7913216 DOI: 10.3390/ijerph18041386] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/30/2021] [Accepted: 01/31/2021] [Indexed: 02/02/2023]
Abstract
Three cohorts including the Fire Department of the City of New York (FDNY), the World Trade Center Health Registry (WTCHR), and the General Responder Cohort (GRC), each funded by the World Trade Center Health Program have reported associations between WTC-exposures and cancer. Results have generally been consistent with effect estimates for excess incidence for all cancers ranging from 6 to 14% above background rates. Pooling would increase sample size and de-duplicate cases between the cohorts. However, pooling required time consuming steps: obtaining Institutional Review Board (IRB) approvals and legal agreements from entities involved; establishing an honest broker for managing the data; de-duplicating the pooled cohort files; applying to State Cancer Registries (SCRs) for matched cancer cases; and finalizing analysis data files. Obtaining SCR data use agreements ranged from 6.5 to 114.5 weeks with six states requiring >20 weeks. Records from FDNY (n = 16,221), WTCHR (n = 29,372), and GRC (n = 33,427) were combined de-duplicated resulting in 69,102 unique individuals. Overall, 7894 cancer tumors were matched to the pooled cohort, increasing the number cancers by as much as 58% compared to previous analyses. Pooling resulted in a coherent resource for future research for studies on rare cancers and mortality, with more representative of occupations and WTC- exposure.
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Affiliation(s)
- Robert M. Brackbill
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (J.L.); (M.R.F.); (J.E.C.); (J.Y.); (D.J.W.); (A.S.)
| | - Amy R. Kahn
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, NY 12237, USA; (A.R.K.); (B.Q.); (M.J.S.)
| | - Jiehui Li
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (J.L.); (M.R.F.); (J.E.C.); (J.Y.); (D.J.W.); (A.S.)
| | - Rachel Zeig-Owens
- Fire Department of the City of New York (FDNY), Brooklyn, NY 11201, USA; (R.Z.-O.); (D.G.G.); (M.S.); (M.P.W.); (D.J.P.)
- Department of Medicine, Montefiore Medical Center, New York, NY 10467, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - David G. Goldfarb
- Fire Department of the City of New York (FDNY), Brooklyn, NY 11201, USA; (R.Z.-O.); (D.G.G.); (M.S.); (M.P.W.); (D.J.P.)
- Department of Medicine, Montefiore Medical Center, New York, NY 10467, USA
| | - Molly Skerker
- Fire Department of the City of New York (FDNY), Brooklyn, NY 11201, USA; (R.Z.-O.); (D.G.G.); (M.S.); (M.P.W.); (D.J.P.)
- Department of Medicine, Montefiore Medical Center, New York, NY 10467, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Mark R. Farfel
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (J.L.); (M.R.F.); (J.E.C.); (J.Y.); (D.J.W.); (A.S.)
| | - James E. Cone
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (J.L.); (M.R.F.); (J.E.C.); (J.Y.); (D.J.W.); (A.S.)
| | - Janette Yung
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (J.L.); (M.R.F.); (J.E.C.); (J.Y.); (D.J.W.); (A.S.)
| | - Deborah J. Walker
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (J.L.); (M.R.F.); (J.E.C.); (J.Y.); (D.J.W.); (A.S.)
| | - Adrienne Solomon
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (J.L.); (M.R.F.); (J.E.C.); (J.Y.); (D.J.W.); (A.S.)
| | - Baozhen Qiao
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, NY 12237, USA; (A.R.K.); (B.Q.); (M.J.S.)
| | - Maria J. Schymura
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, NY 12237, USA; (A.R.K.); (B.Q.); (M.J.S.)
| | - Christopher R. Dasaro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.R.D.); (R.G.L.); (A.C.T.)
| | - Dana Kristjansson
- Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, 0456 Oslo, Norway;
| | - Mayris P. Webber
- Fire Department of the City of New York (FDNY), Brooklyn, NY 11201, USA; (R.Z.-O.); (D.G.G.); (M.S.); (M.P.W.); (D.J.P.)
- Department of Medicine, Montefiore Medical Center, New York, NY 10467, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Roberto G. Lucchini
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.R.D.); (R.G.L.); (A.C.T.)
| | - Andrew C. Todd
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.R.D.); (R.G.L.); (A.C.T.)
| | - David J. Prezant
- Fire Department of the City of New York (FDNY), Brooklyn, NY 11201, USA; (R.Z.-O.); (D.G.G.); (M.S.); (M.P.W.); (D.J.P.)
- Department of Medicine, Montefiore Medical Center, New York, NY 10467, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY 11794, USA;
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Charles B. Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
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Maura F, Diamond B, Maclachlan KH, Derkach A, Yellapantula VD, Rustad EH, Hultcrantz M, Shah UA, Hong J, Landau HJ, Iacobuzio-Donahue CA, Papaemmanuil E, Irby S, Crowley L, Crane M, Webber MP, Goldfarb DG, Zeig-Owens R, Giricz O, Verma A, Prezant DJ, Dogan A, Shah SP, Zhang Y, Landgren O. 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. Clin Cancer Res 2021; 27:2111-2118. [PMID: 33504553 DOI: 10.1158/1078-0432.ccr-20-2245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 12/21/2020] [Accepted: 01/22/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE 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. EXPERIMENTAL DESIGN We performed WGS of nine CD138-positive bone marrow mononuclear samples from patients who were diagnosed with plasma cell disorders after the WTC disaster. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Francesco Maura
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. .,Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Benjamin Diamond
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kylee H Maclachlan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andriy Derkach
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Venkata D Yellapantula
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Even H Rustad
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Urvi A Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jessica Hong
- Center for Hematological Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Heather J Landau
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Elli Papaemmanuil
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Shani Irby
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Mayris P Webber
- Department of Medicine, Montefiore Medical Center, Bronx, New York.,Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - David G Goldfarb
- Mount Sinai School of Medicine, New York, New York.,Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York
| | - Rachel Zeig-Owens
- Department of Medicine, Montefiore Medical Center, Bronx, New York.,Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Orsi Giricz
- Division of Hemato-Oncology, Department of Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Amit Verma
- Division of Hemato-Oncology, Department of Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - David J Prezant
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York.,Division of Pulmonary Medicine, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, New York, New York
| | - Ahmet Dogan
- Hematopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sohrab P Shah
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yanming Zhang
- Cytogenetics Laboratory, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ola Landgren
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. .,Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
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Lam R, Kwon S, Riggs J, Sunseri M, Crowley G, Schwartz T, Zeig-Owens R, Colbeth H, Halpren A, Liu M, Prezant DJ, Nolan A. Dietary phenotype and advanced glycation end-products predict WTC-obstructive airways disease: a longitudinal observational study. Respir Res 2021; 22:19. [PMID: 33461547 PMCID: PMC7812653 DOI: 10.1186/s12931-020-01596-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/03/2020] [Indexed: 01/02/2023] Open
Abstract
Background Diet is a modifier of metabolic syndrome which in turn is associated with World Trade Center obstructive airways disease (WTC-OAD). We have designed this study to (1) assess the dietary phenotype (food types, physical activity, and dietary habits) of the Fire Department of New York (FDNY) WTC-Health Program (WTC-HP) cohort and (2) quantify the association of dietary quality and its advanced glycation end product (AGE) content with the development of WTC-OAD. Methods WTC-OAD, defined as developing WTC-Lung Injury (WTC-LI; FEV1 < LLN) and/or airway hyperreactivity (AHR; positive methacholine and/or positive bronchodilator response). Rapid Eating and Activity Assessment for Participants-Short Version (REAP-S) deployed on 3/1/2018 in the WTC-HP annual monitoring assessment. Clinical and REAP-S data of consented subjects was extracted (7/17/2019). Diet quality [low-(15–19), moderate-(20–29), and high-(30–39)] and AGE content per REAP-S questionnaire were assessed for association with WTC-OAD. Regression models adjusted for smoking, hyperglycemia, hypertension, age on 9/11, WTC-exposure, BMI, and job description. Results N = 9508 completed the annual questionnaire, while N = 4015 completed REAP-S and had spirometry. WTC-OAD developed in N = 921, while N = 3094 never developed WTC-OAD. Low- and moderate-dietary quality, eating more (processed meats, fried foods, sugary drinks), fewer (vegetables, whole-grains),and having a diet abundant in AGEs were significantly associated with WTC-OAD. Smoking was not a significant risk factor of WTC-OAD. Conclusions REAP-S was successfully implemented in the FDNY WTC-HP monitoring questionnaire and produced valuable dietary phenotyping. Our observational study has identified low dietary quality and AGE abundant dietary habits as risk factors for pulmonary disease in the context of WTC-exposure. Dietary phenotyping, not only focuses our metabolomic/biomarker profiling but also further informs future dietary interventions that may positively impact particulate matter associated lung disease.
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Affiliation(s)
- Rachel Lam
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University, School of Medicine, New York, NY, USA
| | - Sophia Kwon
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University, School of Medicine, New York, NY, USA
| | - Jessica Riggs
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University, School of Medicine, New York, NY, USA
| | - Maria Sunseri
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University, School of Medicine, New York, NY, USA
| | - George Crowley
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University, School of Medicine, New York, NY, USA
| | - Theresa Schwartz
- Fire Department of New York, Bureau of Health Services, Brooklyn, NY, USA
| | - Rachel Zeig-Owens
- Fire Department of New York, Bureau of Health Services, Brooklyn, NY, USA
| | - Hilary Colbeth
- Fire Department of New York, Bureau of Health Services, Brooklyn, NY, USA
| | - Allison Halpren
- Fire Department of New York, Bureau of Health Services, Brooklyn, NY, USA
| | - Mengling Liu
- Division of Biostatistics, Departments of Population Health, New York University School of Medicine, New York, NY, USA.,Department of Environmental Medicine, New York University, School of Medicine, New York, NY, USA
| | - David J Prezant
- Fire Department of New York, Bureau of Health Services, Brooklyn, NY, USA.,Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Anna Nolan
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University, School of Medicine, New York, NY, USA. .,Fire Department of New York, Bureau of Health Services, Brooklyn, NY, USA. .,Department of Environmental Medicine, New York University, School of Medicine, New York, NY, USA. .,Department of Medicine, Division of Pulmonary, Critical Care and Sleep, New York University, School of Medicine, New Bellevue, 16 S Room 16 (Office), 16N Room 20 (Lab), 462 1st Avenue, New York, NY, 10016, USA.
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Weiden MD, Zeig-Owens R, Singh A, Schwartz T, Liu Y, Vaeth B, Nolan A, Cleven KL, Hurwitz K, Beecher S, Prezant DJ. Pre-COVID-19 lung function and other risk factors for severe COVID-19 in first responders. ERJ Open Res 2021; 7:00610-2020. [PMID: 33527077 PMCID: PMC7607970 DOI: 10.1183/23120541.00610-2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/06/2020] [Indexed: 01/09/2023] Open
Abstract
Risk factors for #COVID19 infection and severe disease (hospitalisation or death) in NYC first responders: greater pre-pandemic rate of FEV1 decline is associated with severe COVID-19, as is emergency medical service work versus firefighting https://bit.ly/3nZPuZY.
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Affiliation(s)
- Michael D. Weiden
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Dept of the City of New York, Brooklyn, NY, USA
- Pulmonary, Critical Care and Sleep Medicine Division, Depts of Medicine and Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - Rachel Zeig-Owens
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Dept of the City of New York, Brooklyn, NY, USA
- Pulmonary Medicine Division, Dept of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
- Division of Epidemiology, Dept of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ankura Singh
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Dept of the City of New York, Brooklyn, NY, USA
- Pulmonary Medicine Division, Dept of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Theresa Schwartz
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Dept of the City of New York, Brooklyn, NY, USA
- Pulmonary Medicine Division, Dept of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yang Liu
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Dept of the City of New York, Brooklyn, NY, USA
- Pulmonary Medicine Division, Dept of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Brandon Vaeth
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Dept of the City of New York, Brooklyn, NY, USA
- Pulmonary Medicine Division, Dept of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Anna Nolan
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Dept of the City of New York, Brooklyn, NY, USA
- Pulmonary, Critical Care and Sleep Medicine Division, Depts of Medicine and Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - Krystal L. Cleven
- Pulmonary Medicine Division, Dept of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Karen Hurwitz
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Dept of the City of New York, Brooklyn, NY, USA
| | - Shenecia Beecher
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Dept of the City of New York, Brooklyn, NY, USA
| | - David J. Prezant
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Dept of the City of New York, Brooklyn, NY, USA
- Pulmonary Medicine Division, Dept of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
- Office of Medical Affairs, Fire Dept of the City of New York, Brooklyn, NY, USA
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Putman B, Lahousse L, Goldfarb DG, Zeig-Owens R, Schwartz T, Singh A, Vaeth B, Hall CB, Lancet EA, Webber MP, Cohen HW, Prezant DJ, Weiden MD. Factors Predicting Treatment of World Trade Center-Related Lung Injury: A Longitudinal Cohort Study. Int J Environ Res Public Health 2020; 17:E9056. [PMID: 33291671 PMCID: PMC7730939 DOI: 10.3390/ijerph17239056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/20/2020] [Accepted: 12/02/2020] [Indexed: 01/06/2023]
Abstract
The factors that predict treatment of lung injury in occupational cohorts are poorly defined. We aimed to identify patient characteristics associated with initiation of treatment with inhaled corticosteroid/long-acting beta-agonist (ICS/LABA) >2 years among World Trade Center (WTC)-exposed firefighters. The study population included 8530 WTC-exposed firefighters. Multivariable logistic regression assessed the association of patient characteristics with ICS/LABA treatment for >2 years over two-year intervals from 11 September 2001-10 September 2017. Cox proportional hazards models measured the association of high probability of ICS/LABA initiation with actual ICS/LABA initiation in subsequent intervals. Between 11 September 2001-1 July 2018, 1629/8530 (19.1%) firefighters initiated ICS/LABA treatment for >2 years. Forced Expiratory Volume in 1 s (FEV1), wheeze, and dyspnea were consistently and independently associated with ICS/LABA treatment. High-intensity WTC exposure was associated with ICS/LABA between 11 September 2001-10 September 2003. The 10th percentile of risk for ICS/LABA between 11 September 2005-10 Septmeber 2007 was associated with a 3.32-fold increased hazard of actual ICS/LABA initiation in the subsequent 4 years. In firefighters with WTC exposure, FEV1, wheeze, and dyspnea were independently associated with prolonged ICS/LABA treatment. A high risk for treatment was identifiable from routine monitoring exam results years before treatment initiation.
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Affiliation(s)
- Barbara Putman
- Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, 9000 Ghent, Belgium; (B.P.); (L.L.)
- Pulmonary, Critical Care and Sleep Medicine Division, Department of Medicine and Department of Environmental Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - Lies Lahousse
- Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, 9000 Ghent, Belgium; (B.P.); (L.L.)
| | - David G. Goldfarb
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY 11201, USA; (D.G.G.); (R.Z.-O.); (T.S.); (A.S.); (B.V.); (M.P.W.); (D.J.P.)
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Rachel Zeig-Owens
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY 11201, USA; (D.G.G.); (R.Z.-O.); (T.S.); (A.S.); (B.V.); (M.P.W.); (D.J.P.)
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10467, USA
- Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Theresa Schwartz
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY 11201, USA; (D.G.G.); (R.Z.-O.); (T.S.); (A.S.); (B.V.); (M.P.W.); (D.J.P.)
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Ankura Singh
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY 11201, USA; (D.G.G.); (R.Z.-O.); (T.S.); (A.S.); (B.V.); (M.P.W.); (D.J.P.)
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Brandon Vaeth
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY 11201, USA; (D.G.G.); (R.Z.-O.); (T.S.); (A.S.); (B.V.); (M.P.W.); (D.J.P.)
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Charles B. Hall
- Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Elizabeth A. Lancet
- The Office of Medical Affairs, Fire Department of the City of New York, Brooklyn, NY 11201, USA;
| | - Mayris P. Webber
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY 11201, USA; (D.G.G.); (R.Z.-O.); (T.S.); (A.S.); (B.V.); (M.P.W.); (D.J.P.)
- Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Hillel W. Cohen
- Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - David J. Prezant
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY 11201, USA; (D.G.G.); (R.Z.-O.); (T.S.); (A.S.); (B.V.); (M.P.W.); (D.J.P.)
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10467, USA
- The Office of Medical Affairs, Fire Department of the City of New York, Brooklyn, NY 11201, USA;
| | - Michael D. Weiden
- Pulmonary, Critical Care and Sleep Medicine Division, Department of Medicine and Department of Environmental Medicine, New York University School of Medicine, New York, NY 10016, USA
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY 11201, USA; (D.G.G.); (R.Z.-O.); (T.S.); (A.S.); (B.V.); (M.P.W.); (D.J.P.)
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Prezant DJ, Lancet EA, Zeig‐Owens R, Lai PH, Appel D, Webber MP, Braun J, Hall CB, Asaeda G, Kaufman B, Weiden MD. System impacts of the COVID-19 pandemic on New York City's emergency medical services. J Am Coll Emerg Physicians Open 2020; 1:1205-1213. [PMID: 33392524 PMCID: PMC7771735 DOI: 10.1002/emp2.12301] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To describe the impact of the COVID-19 pandemic on New York City's (NYC) 9-1-1 emergency medical services (EMS) system and assess the efficacy of pandemic planning to meet increased demands. METHODS Longitudinal analysis of NYC 9-1-1 EMS system call volumes, call-types, and response times during the COVID-19 peak-period (March 16-April 15, 2020) and post-surge period (April 16-May 31, 2020) compared with the same 2019 periods. RESULTS EMS system received 30,469 more calls from March 16-April 15, 2020 compared with March 16-April 15, 2019 (161,815 vs 127,962; P < 0.001). On March 30, 2020, call volume increased 60% compared with the same 2019 date. The majority were for respiratory (relative risk [RR] = 2.50; 95% confidence interval [CI] = 2.44-2.56) and cardiovascular (RR = 1.85; 95% CI = 1.82-1.89) call-types. The proportion of high-acuity, life-threatening call-types increased compared with 2019 (42.3% vs 36.4%). Planned interventions to prioritize high-acuity calls resulted in the average response time increasing by 3 minutes compared with an 11-minute increase for low low-acuity calls. Post-surge, EMS system received fewer calls compared with 2019 (154,310 vs 193,786; P < 0.001). CONCLUSIONS COVID-19-associated NYC 9-1-1 EMS volume surge was primarily due to respiratory and cardiovascular call-types. As the pandemic stabilized, call volume declined to below pre-pandemic levels. Our results highlight the importance of EMS system-wide pandemic crisis planning.
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Affiliation(s)
- David J. Prezant
- Bureau of Health Services and the FDNY World Trade Center Health ProgramFire Department of the City of New YorkBrooklynNew YorkUSA
- Office of Medical AffairsFire Department of the City of New YorkBrooklynNew YorkUSA
- Department of MedicinePulmonary Medicine DivisionMontefiore Medical Center and Albert Einstein College of MedicineBronxNew YorkUSA
| | - Elizabeth A. Lancet
- Office of Medical AffairsFire Department of the City of New YorkBrooklynNew YorkUSA
| | - Rachel Zeig‐Owens
- Bureau of Health Services and the FDNY World Trade Center Health ProgramFire Department of the City of New YorkBrooklynNew YorkUSA
- Department of MedicinePulmonary Medicine DivisionMontefiore Medical Center and Albert Einstein College of MedicineBronxNew YorkUSA
- Division of EpidemiologyDepartment of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Pamela H. Lai
- Office of Medical AffairsFire Department of the City of New YorkBrooklynNew YorkUSA
| | - David Appel
- Bureau of Health Services and the FDNY World Trade Center Health ProgramFire Department of the City of New YorkBrooklynNew YorkUSA
- Department of MedicinePulmonary Medicine DivisionMontefiore Medical Center and Albert Einstein College of MedicineBronxNew YorkUSA
| | - Mayris P. Webber
- Bureau of Health Services and the FDNY World Trade Center Health ProgramFire Department of the City of New YorkBrooklynNew YorkUSA
- Division of EpidemiologyDepartment of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - James Braun
- Office of Medical AffairsFire Department of the City of New YorkBrooklynNew YorkUSA
| | - Charles B. Hall
- Division of BiostatisticsDepartment of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Glenn Asaeda
- Office of Medical AffairsFire Department of the City of New YorkBrooklynNew YorkUSA
| | - Bradley Kaufman
- Office of Medical AffairsFire Department of the City of New YorkBrooklynNew YorkUSA
| | - Michael D. Weiden
- Bureau of Health Services and the FDNY World Trade Center Health ProgramFire Department of the City of New YorkBrooklynNew YorkUSA
- Department of Environmental Medicine and Department of Medicine, Pulmonary, Critical Care and Sleep Medicine DivisionNew York University School of MedicineNew YorkNew YorkUSA
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Haider SH, Veerappan A, Crowley G, Caraher EJ, Ostrofsky D, Mikhail M, Lam R, Wang Y, Sunseri M, Kwon S, Prezant DJ, Liu M, Schmidt AM, Nolan A. Multiomics of World Trade Center Particulate Matter-induced Persistent Airway Hyperreactivity. Role of Receptor for Advanced Glycation End Products. Am J Respir Cell Mol Biol 2020; 63:219-233. [PMID: 32315541 DOI: 10.1165/rcmb.2019-0064oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Pulmonary disease after World Trade Center particulate matter (WTC-PM) exposure is associated with dyslipidemia and the receptor for advanced glycation end products (RAGE); however, the mechanisms are not well understood. We used a murine model and a multiomics assessment to understand the role of RAGE in the pulmonary long-term effects of a single high-intensity exposure to WTC-PM. After 1 month, WTC-PM-exposed wild-type (WT) mice had airway hyperreactivity, whereas RAGE-deficient (Ager-/-) mice were protected. PM-exposed WT mice also had histologic evidence of airspace disease, whereas Ager-/- mice remained unchanged. Inflammatory mediators such as G-CSF (granulocyte colony-stimulating factor), IP-10 (IFN-γ-induced protein 10), and KC (keratinocyte chemoattractant) were differentially expressed after WTC-PM exposure. WTC-PM induced α-SMA, DIAPH1 (protein diaphanous homolog 1), RAGE, and significant lung collagen deposition in WT compared with Ager-/- mice. Compared with WT mice with PM exposure, relative expression of phosphorylated to total CREB (cAMP response element-binding protein) and JNK (c-Jun N-terminal kinase) was significantly increased in the lung of PM-exposed Ager-/- mice, whereas Akt (protein kinase B) was decreased. Random forests of the refined lung metabolomic profile classified subjects with 92% accuracy; principal component analysis captured 86.7% of the variance in three components and demonstrated prominent subpathway involvement, including known mediators of lung disease such as vitamin B6 metabolites, sphingolipids, fatty acids, and phosphatidylcholines. Treatment with a partial RAGE antagonist, pioglitazone, yielded similar fold-change expression of metabolites (N6-carboxymethyllysine, 1-methylnicotinamide, N1+N8-acetylspermidine, and succinylcarnitine [C4-DC]) between WT and Ager-/- mice exposed to WTC-PM. RAGE can mediate WTC-PM-induced airway hyperreactivity and warrants further investigation.
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Affiliation(s)
- Syed H Haider
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine
| | - Arul Veerappan
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine
| | - George Crowley
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine
| | - Erin J Caraher
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine
| | - Dean Ostrofsky
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine
| | - Mena Mikhail
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine
| | - Rachel Lam
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine
| | - Yuyan Wang
- Division of Biostatistics, Department of Population Health
| | - Maria Sunseri
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine
| | - Sophia Kwon
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine
| | - David J Prezant
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, New York; and.,Division of Pulmonary Medicine, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Mengling Liu
- Division of Biostatistics, Department of Population Health.,Department of Environmental Medicine, and
| | - Ann Marie Schmidt
- Diabetes Research Program, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, New York University School of Medicine, New York, New York
| | - Anna Nolan
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine.,Department of Environmental Medicine, and.,Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, New York; and
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Kwon S, Riggs J, Crowley G, Lam R, Young IR, Nayar C, Sunseri M, Mikhail M, Ostrofsky D, Veerappan A, Zeig-Owens R, Schwartz T, Colbeth H, Liu M, Pompeii ML, St-Jules D, Prezant DJ, Sevick MA, Nolan A. Food Intake REstriction for Health OUtcome Support and Education (FIREHOUSE) Protocol: A Randomized Clinical Trial. Int J Environ Res Public Health 2020; 17:E6569. [PMID: 32916985 PMCID: PMC7559064 DOI: 10.3390/ijerph17186569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 01/08/2023]
Abstract
Fire Department of New York (FDNY) rescue and recovery workers exposed to World Trade Center (WTC) particulates suffered loss of forced expiratory volume in 1 s (FEV1). Metabolic Syndrome increased the risk of developing WTC-lung injury (WTC-LI). We aim to attenuate the deleterious effects of WTC exposure through a dietary intervention targeting these clinically relevant disease modifiers. We hypothesize that a calorie-restricted Mediterranean dietary intervention will improve metabolic risk, subclinical indicators of cardiopulmonary disease, quality of life, and lung function in firefighters with WTC-LI. To assess our hypothesis, we developed the Food Intake REstriction for Health OUtcome Support and Education (FIREHOUSE), a randomized controlled clinical trial (RCT). Male firefighters with WTC-LI and a BMI > 27 kg/m2 will be included. We will randomize subjects (1:1) to either: (1) Low Calorie Mediterranean (LoCalMed)-an integrative multifactorial, technology-supported approach focused on behavioral modification, nutritional education that will include a self-monitored diet with feedback, physical activity recommendations, and social cognitive theory-based group counseling sessions; or (2) Usual Care. Outcomes include reduction in body mass index (BMI) (primary), improvement in FEV1, fractional exhaled nitric oxide, pulse wave velocity, lipid profiles, targeted metabolic/clinical biomarkers, and quality of life measures (secondary). By implementing a technology-supported LoCalMed diet our FIREHOUSE RCT may help further the treatment of WTC associated pulmonary disease.
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Affiliation(s)
- Sophia Kwon
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, New York University, New York, NY 10016, USA; (S.K.); (J.R.); (G.C.); (R.L.); (I.R.Y.); (C.N.); (M.S.); (M.M.); (D.O.); (A.V.)
| | - Jessica Riggs
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, New York University, New York, NY 10016, USA; (S.K.); (J.R.); (G.C.); (R.L.); (I.R.Y.); (C.N.); (M.S.); (M.M.); (D.O.); (A.V.)
| | - George Crowley
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, New York University, New York, NY 10016, USA; (S.K.); (J.R.); (G.C.); (R.L.); (I.R.Y.); (C.N.); (M.S.); (M.M.); (D.O.); (A.V.)
| | - Rachel Lam
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, New York University, New York, NY 10016, USA; (S.K.); (J.R.); (G.C.); (R.L.); (I.R.Y.); (C.N.); (M.S.); (M.M.); (D.O.); (A.V.)
| | - Isabel R. Young
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, New York University, New York, NY 10016, USA; (S.K.); (J.R.); (G.C.); (R.L.); (I.R.Y.); (C.N.); (M.S.); (M.M.); (D.O.); (A.V.)
| | - Christine Nayar
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, New York University, New York, NY 10016, USA; (S.K.); (J.R.); (G.C.); (R.L.); (I.R.Y.); (C.N.); (M.S.); (M.M.); (D.O.); (A.V.)
| | - Maria Sunseri
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, New York University, New York, NY 10016, USA; (S.K.); (J.R.); (G.C.); (R.L.); (I.R.Y.); (C.N.); (M.S.); (M.M.); (D.O.); (A.V.)
| | - Mena Mikhail
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, New York University, New York, NY 10016, USA; (S.K.); (J.R.); (G.C.); (R.L.); (I.R.Y.); (C.N.); (M.S.); (M.M.); (D.O.); (A.V.)
| | - Dean Ostrofsky
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, New York University, New York, NY 10016, USA; (S.K.); (J.R.); (G.C.); (R.L.); (I.R.Y.); (C.N.); (M.S.); (M.M.); (D.O.); (A.V.)
| | - Arul Veerappan
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, New York University, New York, NY 10016, USA; (S.K.); (J.R.); (G.C.); (R.L.); (I.R.Y.); (C.N.); (M.S.); (M.M.); (D.O.); (A.V.)
| | - Rachel Zeig-Owens
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, NY 11201, USA; (R.Z.-O.); (T.S.); (H.C.); (D.J.P.)
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Theresa Schwartz
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, NY 11201, USA; (R.Z.-O.); (T.S.); (H.C.); (D.J.P.)
| | - Hilary Colbeth
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, NY 11201, USA; (R.Z.-O.); (T.S.); (H.C.); (D.J.P.)
| | - Mengling Liu
- Department of Population Health, Division of Biostatistics, New York University School of Medicine, New York, NY 10016, USA;
- Department of Environmental Medicine, School of Medicine, New York University, New York, NY 10016, USA
| | - Mary Lou Pompeii
- Department of Population Health, Division of Health and Behavior, Center for Healthful Behavior Change, School of Medicine, New York University, New York, NY 10016, USA; (M.L.P.); (D.S.-J.); (M.A.S.)
| | - David St-Jules
- Department of Population Health, Division of Health and Behavior, Center for Healthful Behavior Change, School of Medicine, New York University, New York, NY 10016, USA; (M.L.P.); (D.S.-J.); (M.A.S.)
| | - David J. Prezant
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, NY 11201, USA; (R.Z.-O.); (T.S.); (H.C.); (D.J.P.)
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Mary Ann Sevick
- Department of Population Health, Division of Health and Behavior, Center for Healthful Behavior Change, School of Medicine, New York University, New York, NY 10016, USA; (M.L.P.); (D.S.-J.); (M.A.S.)
- Departments of Medicine, Division of Endocrinology, School of Medicine, New York University, New York, NY 10016, USA
| | - Anna Nolan
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, New York University, New York, NY 10016, USA; (S.K.); (J.R.); (G.C.); (R.L.); (I.R.Y.); (C.N.); (M.S.); (M.M.); (D.O.); (A.V.)
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, NY 11201, USA; (R.Z.-O.); (T.S.); (H.C.); (D.J.P.)
- Department of Environmental Medicine, School of Medicine, New York University, New York, NY 10016, USA
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Colbeth HL, Zeig-Owens R, Hall CB, Webber MP, Schwartz TM, Prezant DJ. Mortality among Fire Department of the City of New York Rescue and Recovery Workers Exposed to the World Trade Center Disaster, 2001-2017. Int J Environ Res Public Health 2020; 17:E6266. [PMID: 32872174 PMCID: PMC7504578 DOI: 10.3390/ijerph17176266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 12/21/2022]
Abstract
The World Trade Center (WTC) attacks on 9/11/2001 have consistently been associated with elevated rates of physical and mental health morbidities, while evidence about mortality has been limited. We examined mortality between 9/12/2001 and 12/31/2017 among 15,431 WTC-exposed Fire Department of the City of New York (FDNY) firefighters and emergency medical service providers (EMS), specifically assessing associations between intensity of WTC-exposure and mortality risk. Standardized mortality ratios (SMR) and 95% confidence intervals (CI) compared FDNY cohort mortality with the US general population using life table analysis. Deaths were identified via linkage to the National Death Index. Cox proportional hazards regression models were used to identify associations between intensity of WTC-exposure and mortality, accounting for age, sex, race/ethnicity, smoking history, and other relevant confounders. We identified 546 deaths and a lower than expected all-cause mortality rate (SMR = 0.34; 95% CI, 0.31–0.37). 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.
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Affiliation(s)
- Hilary L. Colbeth
- Fire Department of the City of New York, Bureau of Health Services, 9 Metrotech Center, Brooklyn, NY 11201, USA; (H.L.C.); (M.P.W.); (T.M.S.); (D.J.P.)
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, NY 10467, USA
| | - Rachel Zeig-Owens
- Fire Department of the City of New York, Bureau of Health Services, 9 Metrotech Center, Brooklyn, NY 11201, USA; (H.L.C.); (M.P.W.); (T.M.S.); (D.J.P.)
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, NY 10467, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Charles B. Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Mayris P. Webber
- Fire Department of the City of New York, Bureau of Health Services, 9 Metrotech Center, Brooklyn, NY 11201, USA; (H.L.C.); (M.P.W.); (T.M.S.); (D.J.P.)
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
- Department of Epidemiology and Population Health, Montefiore Medical Center, Bronx, New York, NY 10467, USA
| | - Theresa M. Schwartz
- Fire Department of the City of New York, Bureau of Health Services, 9 Metrotech Center, Brooklyn, NY 11201, USA; (H.L.C.); (M.P.W.); (T.M.S.); (D.J.P.)
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, NY 10467, USA
| | - David J. Prezant
- Fire Department of the City of New York, Bureau of Health Services, 9 Metrotech Center, Brooklyn, NY 11201, USA; (H.L.C.); (M.P.W.); (T.M.S.); (D.J.P.)
- Department of Medicine, Pulmonology Division, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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Prezant DJ, Zeig-Owens R, Schwartz T, Liu Y, Hurwitz K, Beecher S, Weiden MD. Medical Leave Associated With COVID-19 Among Emergency Medical System Responders and Firefighters in New York City. JAMA Netw Open 2020; 3:e2016094. [PMID: 32706380 PMCID: PMC7382005 DOI: 10.1001/jamanetworkopen.2020.16094] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
This cohort study examines use of medical leave among emergency medical service (EMS) responders and firefighters in New York, New York, during the coronavirus disease 2019 (COVID-19) pandemic compared with earlier periods.
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Affiliation(s)
- David J. Prezant
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York
- Office of Medical Affairs, Fire Department of the City of New York, Brooklyn, New York
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Rachel Zeig-Owens
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
- Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Theresa Schwartz
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Yang Liu
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Karen Hurwitz
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York
| | - Shenecia Beecher
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York
| | - Michael D. Weiden
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York
- Pulmonary, Critical Care and Sleep Medicine Division, Department of Medicine and Department of Environmental Medicine, New York University School of Medicine, New York, New York
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Colbeth HL, Genere N, Hall CB, Jaber N, Brito JP, El Kawkgi OM, Goldfarb DG, Webber MP, Schwartz TM, Prezant DJ, Zeig-Owens R. Evaluation of Medical Surveillance and Incidence of Post-September 11, 2001, Thyroid Cancer in World Trade Center-Exposed Firefighters and Emergency Medical Service Workers. JAMA Intern Med 2020; 180:888-895. [PMID: 32310290 PMCID: PMC7171583 DOI: 10.1001/jamainternmed.2020.0950] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Elevated incidence rates of thyroid cancer among World Trade Center (WTC)-exposed individuals may be associated with the identification of asymptomatic cancers during medical surveillance. OBJECTIVE To examine the association between WTC exposure and thyroid cancer among Fire Department of the City of New York (hereafter, Fire Department) rescue/recovery workers as well as the association with medical surveillance. DESIGN, SETTING, AND PARTICIPANTS This closed-cohort study classified the method of detection (asymptomatic and symptomatic) of thyroid cancers in 14 987 men monitored through the Fire Department-WTC Health Program diagnosed from September 12, 2001, to December 31, 2018. Age-, sex-, and histologic-specific Fire Department incidence rates were calculated and compared with demographically similar men in Olmsted County, Minnesota, from the Rochester Epidemiology Project using age-standardized rates, relative rates (RRs), and 95% CIs. The secondary analysis was restricted to papillary carcinomas. EXPOSURES World Trade Center exposure was defined as rescue/recovery work at the WTC site from September 11, 2001, to July 25, 2002. MAIN OUTCOMES AND MEASURES The outcomes evaluated comprised (1) number of incident thyroid cancers and their detection method categorizations in the Fire Department and Rochester Epidemiology Project cohorts; (2) Fire Department, Rochester Epidemiology Project, and Surveillance, Epidemiology, and End Results-21 age-standardized incidence rates of thyroid cancer; and (3) RRs comparing Fire Department and Rochester Epidemiology Project overall and by detection method categorization. RESULTS Seventy-two post-9/11 Fire Department cases of thyroid cancer were identified. Among the 65 cases (90.3%) with a categorized detection method, 53 cases (81.5%) were asymptomatic and 12 cases (18.5%) were symptomatic. Median (interquartile range) age at diagnosis was 50.2 (44.0-58.6) vs 46.6 (43.9-52.9) years for asymptomatic vs symptomatic cases. Associated primarily with asymptomatic cancers, the overall age-standardized incidence of Fire Department thyroid cancers (24.7; 95% CI, 17.4-52.3) was significantly higher than the Rochester Epidemiology Project (10.4; 95% CI, 8.5-12.7) and Surveillance, Epidemiology, and End Results-21 (9.1; 95% CI, 9.0-9.1) per 100 000 person-years. Furthermore, the RR of thyroid cancer among symptomatic men in Fire Department cases was not significantly different from that of men in the Rochester Epidemiology Project (0.8; 95% CI, 0.4-1.5); however, the rate of asymptomatic cancers was more than 3-fold that of the Rochester Epidemiology Project rate (RR, 3.1; 95% CI, 2.1-4.7). CONCLUSIONS AND RELEVANCE Excess asymptomatic thyroid cancer in Fire Department WTC-exposed rescue/recovery workers is apparently attributable to the identification of occult lesions during medical surveillance. Among WTC-exposed cohorts and the general population, these findings appear to have important implications for how thyroid cancer incidence rates are interpreted and how diagnoses should be managed.
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Affiliation(s)
- Hilary L Colbeth
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York.,Montefiore Medical Center, Pulmonology Division, Department of Medicine, Bronx, New York
| | - Natalia Genere
- Mayo Clinic, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Rochester, Minnesota
| | - Charles B Hall
- Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, New York.,Albert Einstein College of Medicine, Saul R. Korey Department of Neurology, Bronx, New York
| | - Nadia Jaber
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York
| | - Juan P Brito
- Mayo Clinic, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Rochester, Minnesota.,Mayo Clinic, Knowledge and Evaluation Research Unit, Rochester, Minnesota
| | - Omar M El Kawkgi
- Mayo Clinic, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Rochester, Minnesota.,Mayo Clinic, Knowledge and Evaluation Research Unit, Rochester, Minnesota
| | - David G Goldfarb
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York.,Montefiore Medical Center, Pulmonology Division, Department of Medicine, Bronx, New York
| | - Mayris P Webber
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York.,Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, New York.,Montefiore Medical Center, Department of Epidemiology and Population Health, Bronx, New York
| | - Theresa M Schwartz
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York.,Montefiore Medical Center, Pulmonology Division, Department of Medicine, Bronx, New York
| | - David J Prezant
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York.,Albert Einstein College of Medicine, Department of Medicine, Pulmonology Division, Bronx, New York
| | - Rachel Zeig-Owens
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York.,Montefiore Medical Center, Pulmonology Division, Department of Medicine, Bronx, New York.,Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, New York
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Singh A, Zeig-Owens R, Hall CB, Liu Y, Rabin L, Schwartz T, Webber MP, Appel D, Prezant DJ. World Trade Center exposure, post-traumatic stress disorder, and subjective cognitive concerns in a cohort of rescue/recovery workers. Acta Psychiatr Scand 2020; 141:275-284. [PMID: 31721141 DOI: 10.1111/acps.13127] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine whether World Trade Center (WTC)-exposure intensity and post-traumatic stress disorder (PTSD) are associated with subjective cognitive change in rescue/recovery workers. METHOD The population included 7875 rescue/recovery workers who completed a subjective cognition measure, the Cognitive Function Instrument (CFI), between 3/1/2018 and 2/28/2019 during routine monitoring, indicating whether they had experienced cognitive and functional difficulties in the past year. Higher scores indicated greater self-perceived cognitive change. Probable PTSD, depression, and alcohol abuse were evaluated by validated mental health screeners. Logistic regression assessed the associations of WTC exposure and current PTSD with top-quartile (≥2) CFI score, and of early post-9/11 PTSD with top-quartile CFI in a subpopulation (N = 6440). Models included demographics, smoking, depression, and alcohol abuse as covariates. RESULTS Mean age at CFI completion was 56.7 ± 7.7 (range: 36-81). Participants with high-intensity WTC exposure had an increased likelihood of top-quartile CFI score (odds ratio[OR] vs. low exposure: 1.32, 95%CI: 1.07-1.64), controlling for covariates. Current and early PTSD were both associated with top-quartile CFI (OR: 3.25, 95%CI: 2.53-4.19 and OR: 1.56, 95%CI: 1.26-1.93) respectively. CONCLUSIONS High-intensity WTC exposure was associated with self-reported cognitive change 17 years later in rescue/recovery workers, as was PTSD. Highly WTC-exposed subgroups may benefit from additional cognitive evaluation and monitoring of cognition over time.
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Affiliation(s)
- A Singh
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY, USA.,Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - R Zeig-Owens
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY, USA.,Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - C B Hall
- Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.,Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Y Liu
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY, USA.,Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - L Rabin
- Department of Psychology, Brooklyn College and The Graduate Center of CUNY, Brooklyn, NY, USA
| | - T Schwartz
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY, USA.,Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - M P Webber
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY, USA.,Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - D Appel
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY, USA.,Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - D J Prezant
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY, USA.,Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Flamme GA, Deiters KK, Stephenson MR, Themann CL, Murphy WJ, Byrne DC, Goldfarb DG, Zeig-Owens R, Hall C, Prezant DJ, Cone JE. Population-based age adjustment tables for use in occupational hearing conservation programs. Int J Audiol 2019; 59:S20-S30. [PMID: 31846396 PMCID: PMC10108722 DOI: 10.1080/14992027.2019.1698068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: In occupational hearing conservation programmes, age adjustments may be used to subtract expected age effects. Adjustments used in the U.S. came from a small dataset and overlooked important demographic factors, ages, and stimulus frequencies. The present study derived a set of population-based age adjustment tables and validated them using a database of exposed workers.Design: Cross-sectional population-based study and retrospective longitudinal cohort study for validation.Study sample: Data from the U.S. National Health and Nutrition Examination Survey (unweighted n = 9937) were used to produce these tables. Male firefighters and emergency medical service workers (76,195 audiograms) were used for validation.Results: Cross-sectional trends implied less change with age than assumed in current U.S. regulations. Different trends were observed among people identifying with non-Hispanic Black race/ethnicity. Four age adjustment tables (age range: 18-85) were developed (women or men; non-Hispanic Black or other race/ethnicity). Validation outcomes showed that the population-based tables matched median longitudinal changes in hearing sensitivity well.Conclusions: These population-based tables provide a suitable replacement for those implemented in current U.S. regulations. These tables address a broader range of worker ages, account for differences in hearing sensitivity across race/ethnicity categories, and have been validated for men using longitudinal data.
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Affiliation(s)
- Gregory A Flamme
- Stephenson and Stephenson Research and Consulting (SASRAC), Forest Grove, OR, USA
| | - Kristy K Deiters
- Stephenson and Stephenson Research and Consulting (SASRAC), Forest Grove, OR, USA
| | - Mark R Stephenson
- Stephenson and Stephenson Research and Consulting (SASRAC), Forest Grove, OR, USA
| | - Christa L Themann
- Hearing Loss Prevention Team, National Institute for Occupational Safety and Health (NIOSH), CDC, Cincinnati, OH, USA
| | - William J Murphy
- Hearing Loss Prevention Team, National Institute for Occupational Safety and Health (NIOSH), CDC, Cincinnati, OH, USA
| | - David C Byrne
- Hearing Loss Prevention Team, National Institute for Occupational Safety and Health (NIOSH), CDC, Cincinnati, OH, USA
| | - David G Goldfarb
- FDNY World Trade Center Health Program, Bureau of Health Services, Fire Department of the City of New York, New York, NY, USA.,Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Rachel Zeig-Owens
- FDNY World Trade Center Health Program, Bureau of Health Services, Fire Department of the City of New York, New York, NY, USA.,Department of Medicine, Montefiore Medical Center, Bronx, NY, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - Charles Hall
- FDNY World Trade Center Health Program, Bureau of Health Services, Fire Department of the City of New York, New York, NY, USA.,Department of Medicine, Montefiore Medical Center, Bronx, NY, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - David J Prezant
- FDNY World Trade Center Health Program, Bureau of Health Services, Fire Department of the City of New York, New York, NY, USA.,Department of Medicine, Montefiore Medical Center, Bronx, NY, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - James E Cone
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, NY, USA
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Putman B, Lahousse L, Zeig-Owens R, Singh A, Hall CB, Liu Y, Schwartz T, Goldfarb D, Webber MP, Prezant DJ, Weiden MD. Low serum IgA and airway injury in World Trade Center-exposed firefighters: a 17-year longitudinal study. Thorax 2019; 74:1182-1184. [PMID: 31611340 DOI: 10.1136/thoraxjnl-2019-213715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/19/2019] [Accepted: 09/17/2019] [Indexed: 11/04/2022]
Abstract
Serum IgA ≤70 mg/dL (low IgA) is associated with exacerbations of chronic obstructive pulmonary disease. The association of low IgA with longitudinal lung function is poorly defined. This study included 917 World Trade Center (WTC)-exposed firefighters with longitudinal spirometry measured between September 2001 and September 2018 and IgA measured between October 2001 and March 2002. Low IgA, compared with IgA >70 mg/dL, was associated with lower forced expiratory volume in 1 s (FEV1) % predicted in the year following 11 September 2001 (94.1% vs 98.6%, p<0.001), increased risk of FEV1/FVC <0.70 (HR 3.8, 95% CI 1.6 to 8.8) and increased antibiotic treatment (22.5/100 vs 11.6/100 person-years, p=0.002). Following WTC exposure, early IgA ≤70 mg/dL was associated with worse lung function and increased antibiotic treatment.
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Affiliation(s)
- Barbara Putman
- Department of Medicine, New York University School of Medicine, New York, New York, USA
- Department of Bioanalysis, Ghent University, Gent, Belgium
| | - Lies Lahousse
- Department of Bioanalysis, Ghent University, Gent, Belgium
| | - Rachel Zeig-Owens
- The Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ankura Singh
- The Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Medicine, Montefiore Medical Centre, Bronx, New York, USA
| | - Charles B Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Yang Liu
- The Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Medicine, Montefiore Medical Centre, Bronx, New York, USA
| | - Theresa Schwartz
- The Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Medicine, Montefiore Medical Centre, Bronx, New York, USA
| | - David Goldfarb
- The Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Medicine, Montefiore Medical Centre, Bronx, New York, USA
| | - Mayris P Webber
- The Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David J Prezant
- The Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Medicine, Montefiore Medical Centre, Bronx, New York, USA
| | - Michael D Weiden
- Department of Medicine, New York University School of Medicine, New York, New York, USA
- The Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
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Landgren O, Zeig-Owens R, Giricz O, Goldfarb D, Murata K, Thoren K, Ramanathan L, Hultcrantz M, Dogan A, Nwankwo G, Steidl U, Pradhan K, Hall CB, Cohen HW, Jaber N, Schwartz T, Crowley L, Crane M, Irby S, Webber MP, Verma A, Prezant DJ. Multiple Myeloma and Its Precursor Disease Among Firefighters Exposed to the World Trade Center Disaster. JAMA Oncol 2019; 4:821-827. [PMID: 29710195 PMCID: PMC6145680 DOI: 10.1001/jamaoncol.2018.0509] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Question Are environmental exposures from the World Trade Center disaster site associated with multiple myeloma and its precursor disease, monoclonal gammopathy of undetermined significance (MGUS), in New York City firefighters? Findings In this case series, 16 participants were diagnosed with multiple myeloma after September 11, 2001, with a median age of disease onset of 57 years, and in subsets with relevant data, a high proportion of the cases had light-chain myeloma, and plasma cells were CD20 positive. In the screening study, World Trade Center exposure was found to be statistically significantly associated with light-chain MGUS and overall MGUS. Meaning World Trade Center disaster exposures are associated with myeloma precursor disease (MGUS) and may be a risk factor for the development of multiple myeloma at an earlier age. Importance The World Trade Center (WTC) attacks on September 11, 2001, created an unprecedented environmental exposure to known and suspected carcinogens suggested to increase the risk of multiple myeloma. Multiple myeloma is consistently preceded by the precursor states of monoclonal gammopathy of undetermined significance (MGUS) and light-chain MGUS, detectable in peripheral blood. Objective To characterize WTC-exposed firefighters with a diagnosis of multiple myeloma and to conduct a screening study for MGUS and light-chain MGUS. Design, Setting, and Participants Case series of multiple myeloma in firefighters diagnosed between September 11, 2001, and July 1, 2017, together with a seroprevalence study of MGUS in serum samples collected from Fire Department of the City of New York (FDNY) firefighters between December 2013 and October 2015. Participants included all WTC-exposed FDNY white, male firefighters with a confirmed physician diagnosis of multiple myeloma (n = 16) and WTC-exposed FDNY white male firefighters older than 50 years with available serum samples (n = 781). Exposures WTC exposure defined as rescue and/or recovery work at the WTC site between September 11, 2001, and July 25, 2002. Main Outcomes and Measures Multiple myeloma case information, and age-adjusted and age-specific prevalence rates for overall MGUS (ie, MGUS and light-chain MGUS), MGUS, and light-chain MGUS. Results Sixteen WTC-exposed white male firefighters received a diagnosis of multiple myeloma after September 11, 2001; median age at diagnosis was 57 years (interquartile range, 50-68 years). Serum/urine monoclonal protein isotype/free light-chain data were available for 14 cases; 7 (50%) had light-chain multiple myeloma. In a subset of 7 patients, myeloma cells were assessed for CD20 expression; 5 (71%) were CD20 positive. In the screening study, we assayed peripheral blood from 781 WTC-exposed firefighters. The age-standardized prevalence rate of MGUS and light-chain MGUS combined was 7.63 per 100 persons (95% CI, 5.45-9.81), 1.8-fold higher than rates from the Olmsted County, Minnesota, white male reference population (relative rate, 1.76; 95% CI, 1.34-2.29). The age-standardized prevalence rate of light-chain MGUS was more than 3-fold higher than in the same reference population (relative rate, 3.13; 95% CI, 1.99-4.93). Conclusions and Relevance Environmental exposure to the WTC disaster site is associated with myeloma precursor disease (MGUS and light-chain MGUS) and may be a risk factor for the development of multiple myeloma at an earlier age, particularly the light-chain subtype.
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Affiliation(s)
- Ola Landgren
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rachel Zeig-Owens
- Department of Medicine, Montefiore Medical Center, Bronx, New York.,Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Orsolya Giricz
- Division of Hemato-Oncology, Department of Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - David Goldfarb
- Department of Medicine, Montefiore Medical Center, Bronx, New York.,Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York
| | - Kaznouri Murata
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Katie Thoren
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lakshmi Ramanathan
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ahmet Dogan
- Department of Hematopathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - George Nwankwo
- Division of Hemato-Oncology, Department of Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Ulrich Steidl
- Division of Hemato-Oncology, Department of Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Kith Pradhan
- Division of Hemato-Oncology, Department of Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Charles B Hall
- Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Hillel W Cohen
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Nadia Jaber
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York
| | - Theresa Schwartz
- Department of Medicine, Montefiore Medical Center, Bronx, New York.,Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York
| | | | | | - Shani Irby
- Department of Hematopathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mayris P Webber
- Department of Medicine, Montefiore Medical Center, Bronx, New York.,Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Amit Verma
- Division of Hemato-Oncology, Department of Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - David J Prezant
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York.,Department of Medicine, Division of Pulmonary Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, New York, New York
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Cohen HW, Zeig-Owens R, Joe C, Hall CB, Webber MP, Weiden MD, Cleven KL, Jaber N, Skerker M, Yip J, Schwartz T, Prezant DJ. Long-term Cardiovascular Disease Risk Among Firefighters After the World Trade Center Disaster. JAMA Netw Open 2019; 2:e199775. [PMID: 31490535 PMCID: PMC6735414 DOI: 10.1001/jamanetworkopen.2019.9775] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Published studies examining the association between World Trade Center (WTC) exposure on and after September 11, 2001, and longer-term cardiovascular disease (CVD) outcomes have reported mixed findings. OBJECTIVE To assess whether WTC exposure was associated with elevated CVD risk in Fire Department of the City of New York (FDNY) firefighters. DESIGN, SETTINGS, AND PARTICIPANTS In this cohort study, the association between WTC exposure and the risk of CVD was assessed between September 11, 2001, and December 31, 2017, in FDNY male firefighters. Multivariable Cox regression analyses were used to estimate CVD risk in association with 2 measures of WTC exposure: arrival time to the WTC site and duration of work at the WTC site. Data analyses were conducted from May 1, 2018, to March 8, 2019. MAIN OUTCOMES AND MEASURES The primary CVD outcome included myocardial infarction, stroke, unstable angina, coronary artery surgery or angioplasty, or CVD death. The secondary outcome (all CVD) included all primary outcome events or any of the following: transient ischemic attack; stable angina, defined as either use of angina medication or cardiac catheterization without intervention; cardiomyopathy; and other CVD (aortic aneurysm, peripheral arterial vascular intervention, and carotid artery surgery). RESULTS There were 489 primary outcome events among 9796 male firefighters (mean [SD] age on September 11, 2001, was 40.3 [7.4] years and 7210 individuals [73.6%] were never smokers). Age-adjusted incident rates of CVD were higher for firefighters with greater WTC exposure. The multivariable adjusted hazard ratio (HR) for the primary CVD outcome was 1.44 (95% CI, 1.09-1.90) for the earliest arrival group compared with those who arrived later. Similarly, those who worked at the WTC site for 6 or more months vs those who worked less time at the site were more likely to have a CVD event (HR, 1.30; 95% CI, 1.05-1.60). Well-established CVD risk factors, including hypertension (HR, 1.41; 95% CI, 1.10-1.80), hypercholesterolemia (HR, 1.56; 95% CI, 1.28-1.91), diabetes (HR, 1.99; 95% CI, 1.33-2.98), and smoking (current: HR, 2.13; 95% CI, 1.68-2.70; former: HR, 1.55; 95% CI, 1.23-1.95), were significantly associated with CVD in the multivariable models. Analyses with the all-CVD outcome were similar. CONCLUSIONS AND RELEVANCE The findings of the study suggest a significant association between greater WTC exposure and long-term CVD risk. The findings appear to reinforce the importance of long-term monitoring of the health of survivors of disasters.
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Affiliation(s)
- Hillel W. Cohen
- Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Rachel Zeig-Owens
- Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
- The Bureau of Health Services and the Fire Department of the City of New York World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Cynthia Joe
- The Bureau of Health Services and the Fire Department of the City of New York World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Charles B. Hall
- Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Mayris P. Webber
- The Bureau of Health Services and the Fire Department of the City of New York World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York
- Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Michael D. Weiden
- The Bureau of Health Services and the Fire Department of the City of New York World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York
- Pulmonary, Critical Care, and Sleep Medicine Division, Department of Medicine, New York University School of Medicine, New York
- Pulmonary, Critical Care, and Sleep Medicine Division, Department of Environmental Medicine, New York University School of Medicine, New York
| | - Krystal L. Cleven
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Nadia Jaber
- The Bureau of Health Services and the Fire Department of the City of New York World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York
| | - Molly Skerker
- The Bureau of Health Services and the Fire Department of the City of New York World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Jennifer Yip
- The Bureau of Health Services and the Fire Department of the City of New York World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Theresa Schwartz
- The Bureau of Health Services and the Fire Department of the City of New York World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - David J. Prezant
- The Bureau of Health Services and the Fire Department of the City of New York World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
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Kwon S, Crowley G, Caraher EJ, Haider SH, Lam R, Veerappan A, Yang L, Liu M, Zeig-Owens R, Schwartz TM, Prezant DJ, Nolan A. Validation of Predictive Metabolic Syndrome Biomarkers of World Trade Center Lung Injury: A 16-Year Longitudinal Study. Chest 2019; 156:486-496. [PMID: 30836056 PMCID: PMC6717118 DOI: 10.1016/j.chest.2019.02.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/07/2019] [Accepted: 02/13/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Metabolic syndrome (MetSyn) predicted future development of World Trade Center lung injury (WTC-LI) in a subgroup of firefighters who never smoked and were male. An intracohort validation of MetSyn as a predictor of WTC-LI is examined in the cohort exposed to the World Trade Center (WTC) that has been followed longitudinally for 16 years. METHODS Results of pulmonary function tests (n = 98,221) in workers exposed to the WTC (n = 9,566) were evaluated. A baseline cohort of firefighters who had normal FEV1 before 9/11 and who had had serum drawn before site closure on July 24, 2002 (n = 7,487) was investigated. Case subjects with WTC-LI (n = 1,208) were identified if they had at least two measured instances of FEV1 less than the lower limit of normal (LLN). Cox proportional hazards modeled early MetSyn biomarker ability to predict development of FEV1 less than the LLN. RESULTS Case subjects were more likely to smoke, be highly exposed, and have MetSyn. There was a significant exposure dose response; the individuals most highly exposed had a 30.1% increased risk of developing WTC-LI, having MetSyn increased risk of developing WTC-LI by 55.7%, and smoking increased risk by 15.2%. There was significant interaction between smoking and exposure. CONCLUSIONS We validated the usefulness of MetSyn to predict future WTC-LI in a larger population of individuals who were exposed. MetSyn defined by dyslipidemia, insulin resistance, and cardiovascular disease suggests that systemic inflammation can contribute to future lung function loss.
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Affiliation(s)
- Sophia Kwon
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York, NY
| | - George Crowley
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York, NY
| | - Erin J Caraher
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York, NY
| | - Syed Hissam Haider
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York, NY
| | - Rachel Lam
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York, NY
| | - Arul Veerappan
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York, NY
| | - Lei Yang
- Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, NY
| | - Mengling Liu
- Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, NY
| | - Rachel Zeig-Owens
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, New York, NY; Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, New York, NY
| | - Theresa M Schwartz
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, New York, NY; Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, New York, NY
| | - David J Prezant
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, New York, NY; Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, New York, NY
| | - Anna Nolan
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York, NY; Department of Environmental Medicine, New York University School of Medicine, New York, NY; Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, New York, NY.
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Colbeth HL, Zeig-Owens R, Webber MP, Goldfarb DG, Schwartz TM, Hall CB, Prezant DJ. Post-9/11 Peripheral Neuropathy Symptoms among World Trade Center-Exposed Firefighters and Emergency Medical Service Workers. Int J Environ Res Public Health 2019; 16:ijerph16101727. [PMID: 31100846 PMCID: PMC6572143 DOI: 10.3390/ijerph16101727] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/08/2019] [Accepted: 05/14/2019] [Indexed: 12/17/2022]
Abstract
Peripheral neuropathy can result from numerous conditions including metabolic disorders, inflammatory disease, or exposure to environmental or biological toxins. We analyzed questionnaire data from 9239 Fire Department of the City of New York (FDNY) World Trade Center (WTC)-exposed firefighters and emergency medical service workers (EMS) to evaluate the association between work at the WTC site and subsequent peripheral neuropathy symptoms using the validated Diabetic Neuropathy Symptom (DNS) score. We grouped the population into an "Indicated" group with conditions known to be associated with paresthesia (N = 2059) and a "Non-Indicated" group without conditions known to be associated (N = 7180). The level of WTC exposure was categorized by time of arrival to the WTC. Overall, 25% of workers aged 40 and older reported peripheral neuropathy symptoms: 30.6% in the Indicated and 23.8% in the Non-Indicated groups, respectively. Multivariable logistic models performed on the Non-Indicated group, and on the Non-Indicated in comparison with non-WTC exposed National Health and Nutrition Examination Survey (NHANES), found that the highest level of WTC-exposure was significantly associated with DNS positive outcomes, after controlling for potential confounders. In conclusion, this study suggests that symptoms of peripheral neuropathy and paresthesias are common and are associated with WTC-exposure intensity.
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Affiliation(s)
- Hilary L Colbeth
- Fire Department of the City of New York, Bureau of Health Services, 9 Metrotech Center, Brooklyn, NY 11201, USA.
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, NY 10467, USA.
| | - Rachel Zeig-Owens
- Fire Department of the City of New York, Bureau of Health Services, 9 Metrotech Center, Brooklyn, NY 11201, USA.
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, NY 10467, USA.
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
| | - Mayris P Webber
- Fire Department of the City of New York, Bureau of Health Services, 9 Metrotech Center, Brooklyn, NY 11201, USA.
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
- Department of Epidemiology and Population Health, Montefiore Medical Center, Department of Epidemiology and Population Health, Bronx, New York, NY 10467, USA.
| | - David G Goldfarb
- Fire Department of the City of New York, Bureau of Health Services, 9 Metrotech Center, Brooklyn, NY 11201, USA.
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, NY 10467, USA.
| | - Theresa M Schwartz
- Fire Department of the City of New York, Bureau of Health Services, 9 Metrotech Center, Brooklyn, NY 11201, USA.
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, NY 10467, USA.
| | - Charles B Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
| | - David J Prezant
- Fire Department of the City of New York, Bureau of Health Services, 9 Metrotech Center, Brooklyn, NY 11201, USA.
- Department of Medicine, Pulmonology Division, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
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Colbeth HL, Zeig‐Owens R, Liu Y, Webber MP, Schwartz TM, Hall CB, Prezant DJ. Persistent self-reported ear and hearing problems among World Trade Center-exposed firefighters and emergency medical service workers, 2001-2017-A longitudinal cohort analysis. Am J Ind Med 2019; 62:43-49. [PMID: 30523633 DOI: 10.1002/ajim.22925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND The goal of this study was to estimate the impact of exposure to the World Trade Center (WTC) site on annual and persistent rates of otalgia and hearing impairment among Fire Department of the City of New York (FDNY) Firefighters and Emergency Medical Service Workers (EMS). METHODS Responders completed routine physical health questionnaires at monitoring visits. We used logistic and marginal logistic regression models to explore the association between otalgia and hearing impairment and WTC arrival time. RESULTS The highest-exposed group had greater odds of persistent ear symptoms (OR 1.33, 95%CI 1.11-1.59) compared with the least-exposed; the odds of persistent hearing problems between the groups were not significantly different. We found consistent WTC-exposure gradients when the average population odds of these outcomes were assessed each year. CONCLUSIONS Our findings demonstrate that the odds of long-term ear symptoms were significantly associated with the intensity of WTC exposure.
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Affiliation(s)
- Hilary L. Colbeth
- Fire Department of the City of New YorkBureau of Health ServicesBrooklynNew York
- Pulmonology Division, Department of MedicineMontefiore Medical CenterBronxNew York
| | - Rachel Zeig‐Owens
- Fire Department of the City of New YorkBureau of Health ServicesBrooklynNew York
- Pulmonology Division, Department of MedicineMontefiore Medical CenterBronxNew York
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew York
| | - Yang Liu
- Fire Department of the City of New YorkBureau of Health ServicesBrooklynNew York
- Pulmonology Division, Department of MedicineMontefiore Medical CenterBronxNew York
| | - Mayris P. Webber
- Fire Department of the City of New YorkBureau of Health ServicesBrooklynNew York
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew York
- Department of Epidemiology and Population HealthMontefiore Medical CenterBronxNew York
| | - Theresa M. Schwartz
- Fire Department of the City of New YorkBureau of Health ServicesBrooklynNew York
- Pulmonology Division, Department of MedicineMontefiore Medical CenterBronxNew York
| | - Charles B. Hall
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew York
| | - David J. Prezant
- Fire Department of the City of New YorkBureau of Health ServicesBrooklynNew York
- Pulmonology Division, Department of MedicineAlbert Einstein College of MedicineBronxNew York
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50
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Putman B, Zeig-Owens R, Singh A, Hall CB, Schwartz T, Webber MP, Cohen HW, Prezant DJ, Bachert C, Weiden MD. Risk factors for post-9/11 chronic rhinosinusitis in Fire Department of the City of New York workers. Occup Environ Med 2018; 75:884-889. [DOI: 10.1136/oemed-2018-105297] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/14/2018] [Accepted: 09/28/2018] [Indexed: 12/12/2022]
Abstract
ObjectivesChronic rhinosinusitis (CRS) has high socioeconomic burden but underexplored risk factors. The collapse of the World Trade Center (WTC) towers on 11 September 2001 (9/11) caused dust and smoke exposure, leading to paranasal sinus inflammation and CRS. We aim to determine which job tasks are risk factors for CRS in WTC-exposed Fire Department of the City of New York (FDNY) firefighters and emergency medical services (EMS) workers.MethodsThis cohort study included a 16-year follow-up of 11 926 WTC-exposed FDNY rescue/recovery workers with data on demographics, WTC exposure, job tasks and first post-9/11 complete blood counts. Using multivariable Cox regression, we assessed the associations of WTC exposure, work assignment (firefighter/EMS), digging and rescue tasks at the WTC site and blood eosinophil counts with subsequent CRS, adjusting for potential confounders.ResultsThe rate of CRS was higher in firefighters than EMS (1.80/100 person-years vs 0.70/100 person-years; p<0.001). The combination of digging and rescue work was a risk factor for CRS (HR 1.54, 95% CI 1.23 to 1.94, p<0.001) independent of work assignment and WTC exposure.ConclusionsCompared with EMS, firefighters were more likely to engage in a combination of digging and rescue work, which was a risk factor for CRS. Chronic irritant exposures associated with digging and rescue work may account for higher post-9/11 CRS rates among firefighters.
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