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Health Trends among 9/11 Responders from 2011–2021: A Review of World Trade Center Health Program Statistics

Published online by Cambridge University Press:  02 September 2021

Erin Smith*
Affiliation:
Edith Cowan University, School of Medical and Health Sciences, Joondalup, Perth, Western Australia
Lisa Holmes
Affiliation:
Edith Cowan University, School of Medical and Health Sciences, Joondalup, Perth, Western Australia
Brigid Larkin
Affiliation:
Edith Cowan University, School of Medical and Health Sciences, Joondalup, Perth, Western Australia
*
Correspondence: Associate Professor Erin Smith Edith Cowan University School of Medical and Health Sciences Joondalup, Perth, Western Australia E-mail: Erin.Smith@ecu.edu.au

Abstract

Introduction:

In a single day, the September 11, 2001 US terrorist attacks (9/11) killed nearly 3,000 people, including 412 first responders. More than 91,000 responders were exposed to a range of hazards during the recovery and clean-up operation that followed. Various health programs track the on-going health effects of 9/11, including the World Trade Center (WTC) Health Program (WTCHP). The objective of this research was to review WTCHP statistics reported by the Centers for Disease Control and Prevention (CDC) to analyze health trends among enrolled responders as the 20-year anniversary of the terrorist attacks approaches.

Methods:

The WTCHP statistics reported by the CDC were analyzed to identify health trends among enrolled responders from 2011 through 2021. Statistics for non-responders were excluded.

Results:

A total of 80,745 responders were enrolled in the WTCHP as of March 2021: 62,773 were classified as general responders; 17,023 were Fire Department of New York (FDNY) responders; and 989 were Pentagon and Shanksville responders. Of the total responders in the program, 3,439 are now deceased. Just under 40% of responders with certified health issues were aged 45-64 and 83% were male. The top three certified conditions among enrolled responders were: aerodigestive disorders; cancer; and mental ill health. The top ten certified cancers have remained the same over the last five years, however, leukemia has now overtaken colon and bladder cancer as the 20-year anniversary approaches. Compared to the general population, 9/11 first responders had a higher rate of all cancers combined, as well as higher rates of prostate cancer, thyroid cancer, and leukemia.

Discussion:

Trends in these program statistics should be viewed with some caution. While certain illnesses have been linked with exposure to the WTC site, differences in age, sex, ethnicity, smoking status, and other factors between exposed and unexposed groups should also be considered. Increased rates of some illnesses among this cohort may be associated with heightened surveillance rather than an actual increase in disease. Still, cancer in general, as well as lung disease, heart disease, and posttraumatic stress disorder (PTSD), seem to be increasing among 9/11 responders, even now close to 20 years later.

Conclusion:

Responders should continue to avail themselves of the health care and monitoring offered through programs like the WTCHP.

Type
Special Report
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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References

Savitz, D, Oxman, R, Metzger, K, et al. Epidemiologic research on man-made disasters: strategies and implications of cohort definition for World Trade Center worker and volunteer surveillance program. Mt Sinai J Med. 2008;75(2):7787.CrossRefGoogle ScholarPubMed
Lippmann, M, Cohen, MD, Chen, L. Health effects of World Trade Center (WTC) dust: an unprecedented disaster with inadequate risk management. Crit Rev Toxicol. 2015;45(6):492530.CrossRefGoogle ScholarPubMed
Santiago-Colon, A, Daniels, R, Reissman, D, et al. World Trade Center Health Program: first decade of research. Int J Environ Res Public Health. 2020;17(19):7290.CrossRefGoogle Scholar
Centers for Disease Control and Prevention. World Trade Center Health Program Requirements for Enrollment, Appeals, Certification of Health Conditions, and Reimbursement. Atlanta, Georgia USA: CDC; 2011.Google Scholar
Centers for Disease Control and Prevention. World Trade Center Health Program Requirements for the Addition of New WTC-Related Health Conditions. Atlanta, Georgia USA: CDC; 2011.Google Scholar
Centers for Disease Control and Prevention. World Trade Center Health Program, Program Statistics. https://www.cdc.gov/wtc/ataglance.html. Accessed on June 12, 2021.Google Scholar
Solan, S, Wallenstein, S, Shapiro, M, et al. Cancer incidence in world trade center rescue and recovery workers, 2001-2008. Environ Health Perspect. 2013;121(6):699704.CrossRefGoogle ScholarPubMed
Boffetta, P, Zeig-Owens, R, Wallenstein, S, et al. Cancer in World Trade Center responders: findings from multiple cohorts and options for future study. Am J Ind Med. 2016;59(2):96105.CrossRefGoogle ScholarPubMed
Shapiro, MZ, Wallenstein, SR, Dasaro, CR, et al. Cancer in general responders participating in World Trade Center Health Programs, 2003–2013. JNCI Cancer Spectrum. 2020;4(1):pkz090.CrossRefGoogle Scholar
Shallis, RM, Weiss, JJ, Deziel, NC, Gore, SD. A clandestine culprit with critical consequences: benzene and acute myeloid leukemia. Blood Reviews. 2021;47:100736.CrossRefGoogle ScholarPubMed
Zeig-Owens, R, Webber, MP, Hall, CB, et al. Early assessment of cancer outcomes in New York City firefighters after the 9/11 attacks: an observational cohort study. Lancet. 2011;378(9794):898905.CrossRefGoogle Scholar
Moir, W, Zeig-Owens, R, Daniels, RD, et al. Post-9/11 cancer incidence in World Trade Center-exposed New York City firefighters as compared to a pooled cohort of firefighters from San Francisco, Chicago, and Philadelphia (9/11/2001-2009). Am J Ind Med. 2016;59(9):722730.CrossRefGoogle Scholar
Van Gerwen, M, Cerutti, JM, Rapp, J, et al. Post-9/11 excess risk of thyroid cancer: surveillance or exposure? Am J Ind Med. 2021. Epub ahead of print.CrossRefGoogle Scholar
Colbeth, HL, Genere, N, Hall, CB, et al. 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(6):888895.CrossRefGoogle ScholarPubMed
Tuminello, S, van Gerwen, M, Genden, E, et al. Increased incidence of thyroid cancer among World Trade Center first responders: a descriptive epidemiological assessment. Int J Environ Res Public Health. 2019;16(7):1258.CrossRefGoogle ScholarPubMed
Gupta, S, Supta, A, Saini, AK, et al. Prostate cancer: how young is too young? Curr Urol. 2017;9(4):212215.CrossRefGoogle Scholar
Gong, Y, Wang, L, Yu, H, et al. Prostate cancer in World Trade Center responders demonstrates evidence of an inflammatory cascade. Mol Cancer Res. 2019;17(8):16061612.CrossRefGoogle ScholarPubMed
Stark, T, Livas, L, Kyprianou, N. Inflammation in prostate cancer progression and therapeutic targeting. Transl Androl Urol. 2015;4(4):455463.Google ScholarPubMed
The 9/11 toll still grows: more than 16,000 Ground Zero responders who got sick found eligible for awards. ABC News. https://abcnews.go.com/US/911-toll-growsl-16000-ground-responders-sick-found/story?id=57669657. Accessed June 30, 2021.Google Scholar
FBI. Inside the FBI: First Responders and 9/11-Related Illnesses, Part 3 The Growing Numbers. https://www.fbi.gov/audio-repository/inside-podcast-9-11-related-illnesses-part-3-041819.mp3/view. Accessed June 27, 2021.Google Scholar
Cohen, HW, Zeig-Owens, R, Joe, C, et al. Long-term cardiovascular disease risk among firefighters after the World Trade Center disaster. JAMA Netw Open. 2019;2(9).CrossRefGoogle Scholar
Smith, EC, Holmes, L, Burkle, FM. The physical and mental health challenges experienced by 9/11 first responders and recovery workers: a review of the literature. Prehosp Disaster Med. 2019:34(6):625631.CrossRefGoogle ScholarPubMed
Hamwey, MK, Gargano, LM, Friedman, LG, et al. Post-traumatic stress disorder among survivors of the September 11, 2001, World Trade Center attacks: a review of the literature. Int J Environ Res Public Health. 2020;17(12):4344.CrossRefGoogle ScholarPubMed
Jordan, HT, Osahan, S, Li, J, et al. Persistent mental and physical health impact of exposure to the September 11, 2001, World Trade Center terrorist attacks. Environ Health. 2019;18(12).CrossRefGoogle Scholar
Cone, JE, Li, J, Kornblith, E, et al. Chronic probable PTSD in police responders in the world trade center health registry ten to eleven years after 9/11. Am J Ind Med. 2015;58(5):483493.CrossRefGoogle Scholar
Clouston, SA, Kotov, R, Pietrzak, RH, et al. Cognitive impairment among World Trade Center responders: long-term implications of re-experiencing the 9/11 terrorist attacks. Alzheimers Dement (Amst). 2016;4:6775.CrossRefGoogle ScholarPubMed
National Institute of Mental Health. Post-traumatic stress disorder (PTSD). https://www.nimh.nih.gov/health/statistics/post-traumatic-stress-disorder-ptsd. Accessed June 27, 2021.Google Scholar
Lowell, A, Suarez-Jimenez, B, Helpman, L, et al. 9/11-related PTSD among highly exposed populations: a systematic review 15 years after the attack. Psychol Med. 2018;48(4):537553.CrossRefGoogle ScholarPubMed
Neria, Y, DiGrande, L, Adams, BG. Posttraumatic stress disorder following the September 11, 2001, terrorist attacks: a review of the literature among highly exposed populations. Am Psychol. 2011;66(6):429446.CrossRefGoogle ScholarPubMed
Singh, A, Zeig-Owens, R, Rabin, L, et al. PTSD and depressive symptoms as potential mediators of the association between World Trade Center exposure and subjective cognitive concerns in rescue/recovery workers. Int J Environ Res Public Health. 2020;17(16):5683.CrossRefGoogle ScholarPubMed
Singh, A, Zeig-Owens, R, Hall, CB, et al. World Trade Center exposure, post-traumatic stress disorder, and subjective cognitive. Acta Psychiatrica Scandinavica. 2019;141(3):275284.CrossRefGoogle ScholarPubMed
Clouston, SAP, Deri, Y, Horton, M. Reduced cortical thickness in World Trade Center responders with cognitive impairment. Alzheimer’s Dement. 2020;12:e12059.Google ScholarPubMed
Brown, AD, Antonius, D, Kramer, M, Root, JC, Hirst, W. Trauma centrality and PTSD in veterans returning from Iraq and Afghanistan. J Traum Stress. 2010;23(4):496499.CrossRefGoogle ScholarPubMed
Brandes, D, Ben-Schachar, G, Gilboa, A, et al. PTSD symptoms and cognitive performance in recent trauma survivors. Psychiatry Res. 2002:110(3):231238.CrossRefGoogle ScholarPubMed
Shalev, AY, Gevonden, M, Ratanatharathorn, A, at al. Estimating the risk of PTSD in recent trauma survivors: results of the International Consortium to Predict PTSD (ICPP). World Psychiatry. 2019;18(1):7787.CrossRefGoogle Scholar
Diab, O, DePierro, J, Cancelmo, L, et al. Mental healthcare needs in World Trade Center responders: results from a large, population-based health monitoring cohort. Adm Policy Ment Health. 2020;47(3):427434.CrossRefGoogle ScholarPubMed
Asbestos, 9/11, and the World Trade Centre. https://www.asbestos.com/world-trade-center/. Accessed June 28, 2021.Google Scholar
COVID-19 has killed dozens of 9/11 first responders. NBC News. https://www.nbcnews.com/news/us-news/covid-19-has-killed-dozens-9-11-first-responders-n1239885. Accessed June 28, 2021.Google Scholar
Why the 9/11 Death Toll Is Still Rising Today. Newsweek. https://www.newsweek.com/how-many-people-died-911-thousands-perishing-september-11-related-illnesses-1531058. Accessed June 29, 2021.Google Scholar
Rodriguez, A, Muylaert, B. How many 9/11 survivors have died of COVID-19? At least 42 – and likely many more. https://www.thecity.nyc/2020/9/10/21431746/how-many-9-11-survivors-have-died-of-covid-19. Accessed July 1, 2021.Google Scholar
Stratton, SJ. Using pre-existing databases for prehospital and disaster research. Prehosp Disaster Med. 2015;30(1):12 CrossRefGoogle ScholarPubMed
Kaji, AH, Schriger, D, Green, S. Looking through the retroscope: reducing bias in emergency medicine chart review studies. Ann Emerg Med. 2014;64(3):292298.CrossRefGoogle Scholar
Worster, A, Bledsoe, RD, Cleve, P, Fernandes, CM, Upadhye, S, Eva, K. Reassessing the methods of medical record review studies in emergency medicine research. Ann Emerg Med. 2005;45(4):448451.CrossRefGoogle ScholarPubMed
Gilbert, EH, Lowenstein, SR, Kiziol-McClain, J, Barta, DC, Steiner, J. Chart reviews in emergency medicine research: where are the methods? Ann Emerg Med. 1996;27(3):305308.CrossRefGoogle Scholar
Newman, DM. Protecting worker and public health during responses to catastrophic disasters - learning from the World Trade Center experience. Am J Ind Med. 2014;57(11):12951298.CrossRefGoogle ScholarPubMed
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