Objective To determine whether lung function trajectories after 9/11/2001 (9/11) differed by sex or race/ethnicity in World Trade Center-exposed Fire Department of the City of New York emergency medical service (EMS) workers.
Method Serial cross-sectional study of pulmonary function tests (PFTs) taken between 9/11 and 9/10/2015. We used data from routine PFTs (forced expiratory volume in 1 s (FEV1) and FEV1% predicted), conducted at 12–18 month intervals. FEV1 and FEV1% predicted were assessed over time, stratified by sex, and race/ethnicity. We also assessed FEV1 and FEV1% predicted in current, former and never-smokers.
Results Among 1817 EMS workers, 334 (18.4%) were women, 979 (53.9%) self-identified as white and 939 (51.6%) were never-smokers. The median follow-up was 13.1 years (IQR 10.5–13.6), and the median number of PFTs per person was 11 (IQR 7–13). After large declines associated with 9/11, there was no discernible recovery in lung function. In analyses limited to never-smokers, the trajectory of decline in adjusted FEV1 and FEV1% predicted was relatively parallel for men and women in the 3 racial/ethnic groups. Similarly, small differences in FEV1 annual decline between groups were not clinically meaningful. Analyses including ever-smokers were essentially the same.
Conclusions 14 years after 9/11, most EMS workers continued to demonstrate a lack of lung function recovery. The trajectories of lung function decline, however, were parallel by sex and by race/ethnicity. These findings support the use of routine, serial measures of lung function over time in first responders and demonstrate no sex or racial sensitivity to exposure-related lung function decline.
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Contributors TKA, MV, RZ-O, CBH and DJP designed the study, analysed and interpreted the data. TKA and DJP had the initial idea for the study. TKA, MV, RZ-O, CBH and DJP had full access to the data. TKA, MV, RZ-O and DJP drafted the first manuscript with critical revisions from CBH, TS, WM, MPW, HWC, AN, MDW, VC and KJK. All authors have approved the final manuscript.
Funding National Institutes of Health, 10.13039/100000002, R01HL119326, National Institute of Occupational Safety and Health, 200-2011-39378, 200-2011-39383.
Competing interests None declared.
Patient consent Obtained.
Ethics approval Montefiore Medical Center.
Provenance and peer review Not commissioned; externally peer reviewed.