Mortality among survivors of the Sept 11, 2001, World Trade Center disaster: results from the World Trade Center Health Registry cohort.
Jordan-HT; Brackbill-RM; Cone-JE; Debchoudhury-I; Farfel-MR; Greene-CM; Hadler-JL; Kennedy-J; Li-J; Liff-J; Stayner-L; Stellman-SD
Lancet 2011 Sep; 378(9794):879-887
Background: The Sept 11, 2001 (9/11) World Trade Center (WTC) disaster has been associated with several subacute and chronic health effects, but whether excess mortality after 9/11 has occurred is unknown. We tested whether excess mortality has occurred in people exposed to the WTC disaster. Methods: In this observational cohort study, deaths occurring in 2003-09 in WTC Health Registry participants residing in New York City were identified through linkage to New York City vital records and the National Death Index. Eligible participants were rescue and recovery workers and volunteers; lower Manhattan area residents, workers, school staff and students; and commuters and passers-by on 9/11. Study participants were categorised as rescue and recovery workers (including volunteers), or non-rescue and non-recovery participants. Standardised mortality ratios (SMR) were calculated with New York City rates from 2000-09 as the reference. Within the cohort, proportional hazards were used to examine the relation between a three-tiered WTC-related exposure level (high, intermediate, or low) and total mortality. Findings: We identifi ed 156 deaths in 13 337 rescue and recovery workers and 634 deaths in 28 593 non-rescue and nonrecovery participants. All-cause SMRs were signifi cantly lower than that expected for rescue and recovery participants (SMR 0·45, 95% CI 0·38-0·53) and non-rescue and non-recovery participants (0·61, 0·56-0·66). No significantly increased SMRs for diseases of the respiratory system or heart, or for haematological malignancies were found. In nonrescue and non-recovery participants, both intermediate and high levels of WTC-related exposure were signifi cantly associated with mortality when compared with low exposure (adjusted hazard ratio 1·22, 95% CI 1·01-1·48, for intermediate exposure and 1·56, 1·15-2·12, for high exposure). High levels of exposure in non-rescue and non-recovery individuals, when compared with low exposed non-rescue and non-recovery individuals, were associated with heartdisease- related mortality (adjusted hazard ratio 2·06, 1·10-3·86). In rescue and recovery participants, level of WTCrelated exposure was not signifi cantly associated with all-cause mortality (adjusted hazard ratio 1·25, 95% CI 0·56-2·78, for high exposure and 1·03, 0·52-2·06, for intermediate exposure when compared with low exposure). Interpretation: This exploratory study of mortality in a well defi ned cohort of 9/11 survivors provides a baseline for continued surveillance. Additional follow-up is needed to establish whether these associations persist and whether a similar association over time will occur in rescue and recovery participants.
Analytical-processes; Biohazards; Biological-effects; Biological-factors; Biological-monitoring; Biological-systems; Biostatistics; Exposure-assessment; Exposure-methods; Health-hazards; Health-programs; Health-surveys; Medical-monitoring; Mortality-data; Mortality-rates; Mortality-surveys; Occupational-exposure; Occupational-hazards; Occupational-health; Physical-reactions; Physical-stress; Physiological-effects; Physiological-factors; Physiological-measurements; Physiological-response; Public-health; Quantitative-analysis; Rescue-measures; Rescue-workers; Risk-analysis; Risk-factors; Statistical-analysis; Work-areas; Work-environment; Worker-health; Work-operations
Dr James E Cone, World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, 7th fl oor, Long Island City, NY 11101, USA
New York City Health/Mental Hygiene