Elsevier

Preventive Medicine

Volume 53, Issue 6, 1 December 2011, Pages 364-369
Preventive Medicine

Trends in respiratory diagnoses and symptoms of firefighters exposed to the World Trade Center disaster: 2005–2010

https://doi.org/10.1016/j.ypmed.2011.09.001Get rights and content

Abstract

Objectives

To compare the prevalence of self-reported respiratory diagnoses in World Trade Center-exposed Fire Department of New York City firefighters to the prevalence in demographically similar National Health Interview Survey participants by year; and, 2) to describe the prevalence of World Trade Center-related symptoms up to 9 years post-9/11.

Methods

We analyzed 45,988 questionnaires completed by 10,999 firefighters from 10/2/2001 to 9/11/2010. For comparison of diagnosis rates, we calculated 95% confidence intervals around yearly firefighter prevalence estimates and generated odds ratios and confidence intervals to compare the odds of diagnoses in firefighters to the National Health Interview Survey prevalence, by smoking status.

Results

Overall, World Trade Center-exposed firefighters had higher respiratory diagnosis rates than the National Health Interview Survey; Fire Department of New York City rates also varied less by smoking status. In 2009, bronchitis rates in firefighters aged 45–65 were 13.3 in smokers versus 13.1 in never-smokers while in the National Health Interview Survey, bronchitis rates were doubled for smokers: 4.3 vs. 2.1. In serial cross-sectional analyses, the prevalence of most symptoms stabilized by 2005, at ~ 10% for cough to ~ 48% for sinus.

Conclusions

We found generally higher rates of respiratory diagnoses in World Trade Center-exposed firefighters compared to US males, regardless of smoking status. This underscores the impact of World Trade Center exposure and the need for continued monitoring and treatment of this population.

Highlights

► There is continued evidence of respiratory symptoms in WTC-exposed firefighters. ► We compare rates of physician diagnoses in these firefighters to rates in US males. ► Rates of respiratory diagnoses are generally higher in WTC-exposed firefighters. ► In 2009, firefighters reported more diagnoses of sinusitis, bronchitis, and COPD. ► The chronic burden of WTC-related illness supports ongoing monitoring and treatment.

Introduction

The 9/11 terrorist attacks on the World Trade Center (WTC) created a man-made disaster of devastating magnitude, resulting in the release of great volumes of dust and debris into the environment. It has been estimated that approximately 70% of the towers' structural components were pulverized during the collapse, producing small and large inhalable particulates (Lioy et al., 2002).

Adverse short-and medium-term respiratory effects in Fire Department of New York City (FDNY) first responders and others have been widely documented (Banauch et al., 2003, Levin et al., 2002, Lin et al., 2005, Lin et al., 2010, Reibman et al., 2005, Wheeler et al., 2007). Our FDNY team first reported WTC cough syndrome (Prezant et al., 2002) and more recently demonstrated that work-related exposures on and after 9/11 increased the odds of aerodigestive symptoms up to four years later (Webber et al., 2009). Others have reported persistent lower respiratory symptoms in moderately-exposed workers 5 years post-9/11 (Mauer et al., 2010), and in NYC residents 5 to 8 years post-9/11 (Reibman et al., 2009). Further, we documented a lack of recovery in pulmonary function in FDNY rescue/recovery workers 7 years post-9/11 (Aldrich et al., 2010). While the WTC Registry has reported an association between acute exposure and self-reports of doctor-diagnosed asthma (Brackbill et al., 2009), no study to date has reported on the full spectrum of doctor-diagnosed respiratory diseases post-9/11.

The goals of the current analyses are: 1) to compare the prevalence of specific self-reported diagnosed respiratory conditions in WTC-exposed FDNY firefighters to the prevalence in demographically similar participants in the National Health Interview Survey (NHIS) during the same year; and, 2) to describe the current prevalence of respiratory and gastroesophageal reflux symptoms (GERS) up to 9 years after 9/11.

Section snippets

Methods

Beginning in October of 2001, the FDNY Bureau of Health Services expanded their periodic medical examinations, performed at 12–18 month intervals, to include self-administered physical and mental health questionnaires. In 2005, questions were added to capture self-reports of doctor-diagnoses of upper and lower respiratory conditions and GERS. The study was approved by the Montefiore Medical Center Institutional Review Board and participation required written informed consent.

Characteristics of the population

From October 2, 2001 to September 11, 2009, 45,988 surveys were collected from the 10,999 WTC-exposed firefighters. Participants' mean (± SD) age on 9/11 was 41.0 (± 8.4) years and 63.7% never smoked. Overall, 15.1% were in arrival group 1, 60.8% in arrival group 2; 14.0% in arrival group 3 and 10.1% in arrival group 4. The overall mean duration of work at the WTC site was 4.1 (± 2.8) months. In the last study year (year 9), 30.0% were in the 18–44 age group, 64% in the 45–65 age group, and 6.1%

Discussion

This study of 10,999 WTC-exposed white male firefighters demonstrates their significantly greater likelihood of reporting doctor-diagnosed respiratory conditions compared with demographically similar US males surveyed as part of NHIS during the same time period. From 2005, the first year FDNY obtained information about doctor-diagnoses to 2009, we found that the annual prevalence of diagnoses increased, especially for bronchitis (from 8.0% to 13.0% in younger and from 8.7% to 13.2% in older

Conclusion

Firefighters exposed to the WTC continue to bear a heavy disease burden, even 9 years post-9/11. These findings reinforce and extend our earlier ones, adding the specificity of doctor diagnoses. Our recommendations remain: (1) strict enforcement of strategies to provide protection from environmental hazards, particularly during disaster recovery and clean-up phases, when such protection is feasible; and, (2) continued monitoring of the exposed and treatment of the affected.

Conflict of interest statement

Several of the authors are employed by the Fire Department of New York City. This in no way interfered with the authors' freedom to design, conduct, interpret and publish research. All authors have declared that there are no actual or potential competing financial interests.

Acknowledgments

This work was supported by the National Institute for Occupational Safety and Health (NIOSH) RO1-OH07350.

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