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Risk factors for post-9/11 chronic rhinosinusitis in Fire Department of the City of New York workers
  1. Barbara Putman1,2,
  2. Rachel Zeig-Owens2,3,4,
  3. Ankura Singh2,3,
  4. Charles B Hall5,
  5. Theresa Schwartz2,3,
  6. Mayris P Webber2,4,
  7. Hillel W Cohen4,
  8. David J Prezant2,3,
  9. Claus Bachert6,
  10. Michael D Weiden1,2
  1. 1 Pulmonary, Critical Care and Sleep Medicine Division, Departments of Medicine and Environmental Medicine, New York University School of Medicine, New York City, New York, USA
  2. 2 The Bureau of Health Services and Office of Medical Affairs, Fire Department of the City of New York, Brooklyn, New York, USA
  3. 3 Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
  4. 4 Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
  5. 5 Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
  6. 6 Upper Airway Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
  1. Correspondence to Dr Michael D Weiden, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Environmental Medicine, New York University School of Medicine, Bellevue Hospital, New York City NY 10016, USA; michael.weiden{at}


Objectives Chronic rhinosinusitis (CRS) has high socioeconomic burden but underexplored risk factors. The collapse of the World Trade Center (WTC) towers on 11 September 2001 (9/11) caused dust and smoke exposure, leading to paranasal sinus inflammation and CRS. We aim to determine which job tasks are risk factors for CRS in WTC-exposed Fire Department of the City of New York (FDNY) firefighters and emergency medical services (EMS) workers.

Methods This cohort study included a 16-year follow-up of 11 926 WTC-exposed FDNY rescue/recovery workers with data on demographics, WTC exposure, job tasks and first post-9/11 complete blood counts. Using multivariable Cox regression, we assessed the associations of WTC exposure, work assignment (firefighter/EMS), digging and rescue tasks at the WTC site and blood eosinophil counts with subsequent CRS, adjusting for potential confounders.

Results The rate of CRS was higher in firefighters than EMS (1.80/100 person-years vs 0.70/100 person-years; p<0.001). The combination of digging and rescue work was a risk factor for CRS (HR 1.54, 95% CI 1.23 to 1.94, p<0.001) independent of work assignment and WTC exposure.

Conclusions Compared with EMS, firefighters were more likely to engage in a combination of digging and rescue work, which was a risk factor for CRS. Chronic irritant exposures associated with digging and rescue work may account for higher post-9/11 CRS rates among firefighters.

  • chronic rhinosinusitis
  • longitudinal studies
  • occupational exposure
  • World Trade Center disaster

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  • Contributors MDW had full access to all of the data in the study and agrees to be accountable for all aspects of the work so that questions related to the accuracy and integrity of the research are appropriately investigated and resolved. MDW conceived the study, and designed it in conjunction with BP, RZO, CBH and DJP. MDW, BP, AS, RZO and TS analysed and interpreted the data. MDW, BP, AS and RZO drafted the first manuscript with critical revisions from CBH, DJP, MPW, TS, HWC and CB. All authors approved the final manuscript.

  • Funding This study was supported by NIOSH contracts (numbers 200-2011-39383, 200-2011-39378, 200-2017-93426, 200-2017-93326) and grant U01-OH010726.

  • Competing interests All authors received support from grants and/or contracts from the National Institute of Occupational Safety and Health and/or NIH/NHLBI.

  • Patient consent Not required.

  • Ethics approval Montefiore Medical Center/Albert Einstein College of Medicine Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.