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World Trade Center-related physical and mental health burden among New York City Fire Department emergency medical service workers
  1. Jennifer Yip1,2,
  2. Rachel Zeig-Owens1,2,
  3. Mayris P Webber1,3,4,
  4. Andrea Kablanian1,
  5. Charles B Hall3,4,
  6. Madeline Vossbrinck1,2,
  7. Xiaoxue Liu1,2,
  8. Jessica Weakley1,2,
  9. Theresa Schwartz1,2,
  10. Kerry J Kelly1,
  11. David J Prezant1,5,6
  1. 1Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
  2. 2Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
  3. 3Department of Epidemiology and Population Health, Montefiore Medical Center, Bronx, New York, USA
  4. 4Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
  5. 5Department of Pulmonary Medicine, Montefiore Medical Center, Bronx, New York, USA
  6. 6Department of Medicine, Pulmonary Division, Albert Einstein College of Medicine, Bronx, New York, USA
  1. Correspondence to Dr Mayris P Webber, Bureau of Health Services, Fire Department of the City of New York, 9 Metrotech Center, 5E-63-K, Brooklyn, NY 11201 USA; Mayris.Webber{at}


Objectives To describe the health burden among Fire Department of the City of New York (FDNY) emergency medical service (EMS) workers and examine its association with work at the World Trade Center (WTC) disaster site.

Methods In this observational cohort study, we used FDNY physician diagnoses to estimate the cumulative incidence of physical health conditions including rhinosinusitis, gastroesophageal reflux disease (GERD), obstructive airways disease (OAD) and cancer among EMS workers and demographically similar firefighters who were active on 11 September 2001 (9/11). Validated screening instruments were used to estimate the prevalence of probable post-traumatic stress disorder (PTSD), probable depression and probable harmful alcohol use. We also analysed the association between health conditions and WTC-exposure.

Results Among 2281 EMS workers, the 12-year post-9/11 cumulative incidence (11 September 2001 to 31 December 2013) of rhinosinusitis was 10.6%; GERD 12.1%; OAD 11.8%; cancer 3.1%. The prevalence of probable PTSD up to 12 years after exposure was 7%; probable depression 16.7%; and probable harmful alcohol use 3%. Compared with unexposed, EMS workers who arrived earliest at the site had higher adjusted relative risks (aRR) for most conditions, including rhinosinusitis (aRR=3.7; 95% CI 2.2 to 6.0); GERD (aRR=3.8; 95% CI 2.4 to 6.1); OAD (aRR=2.4: 95% CI 1.7 to 3.6); probable PTSD (aRR=7.0; 95% CI 3.6 to 13.5); and, probable depression (aRR=2.3; 95% CI 1.6 to 3.1).

Conclusions In this 12-year study, we documented a high burden of health conditions associated with WTC-exposure among FDNY EMS workers. These findings underscore the importance of continued monitoring and treatment of this workforce.

  • World Trade Center
  • Health Burden
  • EMS Workers
  • Cumulative Incidence
  • Relative Risks

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