Article Text

other Versions

Original article
Risk factors for and consequences of persistent lower respiratory symptoms among World Trade Center Health Registrants 10 years after the disaster
  1. Stephen M Friedman1,
  2. Mark R Farfel1,
  3. Carey Maslow1,
  4. Hannah T Jordan1,
  5. Jiehui Li1,
  6. Howard Alper1,
  7. James E Cone1,
  8. Steven D Stellman2,
  9. Robert M Brackbill1
  1. 1New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
  2. 2Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
  1. Correspondence to Dr. Stephen M. Friedman, New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 125 Worth Street, New York, NY 10013, USA; Sfriedm2{at}


Objectives The prevalence of persistent lower respiratory symptoms (LRS) among rescue/recovery workers, local area workers, residents and passers-by in the World Trade Center Health Registry (WTCHR) was analysed to identify associated factors and to measure its effect on quality of life (QoL) 10 years after 9/11/2001.

Methods This cross-sectional study included 18 913 adults who completed 3 WTCHR surveys (2003–2004 (Wave 1 (W1)), 2006–2007 (Wave 2 (W2)) and 2011–2012 (Wave 3 (W3)). LRS were defined as self-reported cough, wheeze, dyspnoea or inhaler use in the 30 days before survey. The prevalence of three LRS outcomes: LRS at W1; LRS at W1 and W2; and LRS at W1, W2 and W3 (persistent LRS) was compared with no LRS on WTC exposure and probable mental health conditions determined by standard screening tests. Diminished physical and mental health QoL measures were examined as potential LRS outcomes, using multivariable logistic and Poisson regression.

Results Of the 4 outcomes, persistent LRS was reported by 14.7%. Adjusted ORs for disaster exposure, probable post-traumatic stress disorder (PTSD) at W2, lacking college education and obesity were incrementally higher moving from LRS at W1, LRS at W1 and W2 to persistent LRS. Half of those with persistent LRS were comorbid for probable PTSD, depression or generalised anxiety disorder. Enrollees with persistent LRS were 3 times more likely to report poor physical health and ∼ 50% more likely to report poor mental health than the no LRS group.

Conclusions LRS, accompanied by mental health conditions and decreased QoL, have persisted for at least 10 years after 9/11/2001. Affected adults require continuing surveillance and treatment.

Statistics from

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.