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Original research
All-cause and cause-specific mortality in a cohort of WTC-exposed and non-WTC-exposed firefighters
  1. Ankura Singh1,2,
  2. Rachel Zeig-Owens1,2,3,
  3. Madeline Cannon1,2,
  4. Mayris P Webber1,3,
  5. David G Goldfarb1,2,
  6. Robert D Daniels4,
  7. David J Prezant1,2,3,
  8. Paolo Boffetta5,6,
  9. Charles B Hall3
  1. 1Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
  2. 2Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
  3. 3Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
  4. 4Division of Science integration, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
  5. 5Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
  6. 6Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
  1. Correspondence to Dr Rachel Zeig-Owens, Department of Medicine, Montefiore Medical Center, Bronx, NY 11201, USA; rachel.zeig-owens{at}fdny.nyc.gov

Abstract

Objective To compare mortality rates in World Trade Center (WTC)-exposed Fire Department of the City of New York (FDNY) firefighters with rates in similarly healthy, non-WTC-exposed/non-FDNY firefighters, and compare mortality in each firefighter cohort with the general population.

Methods 10 786 male WTC-exposed FDNY firefighters and 8813 male non-WTC-exposed firefighters from other urban fire departments who were employed on 11 September 2001 were included in the analyses. Only WTC-exposed firefighters received health monitoring via the WTC Health Programme (WTCHP). Follow-up began 11 September 2001 and ended at the earlier of death date or 31 December 2016. Death data were obtained from the National Death Index and demographics from the fire departments. We estimated standardised mortality ratios (SMRs) in each firefighter cohort versus US males using demographic-specific US mortality rates. Poisson regression models estimated relative rates (RRs) of all-cause and cause-specific mortality in WTC-exposed versus non-WTC-exposed firefighters, controlling for age and race.

Results Between 11 September 2001 and 31 December 2016, there were 261 deaths among WTC-exposed firefighters and 605 among non-WTC-exposed. Both cohorts had reduced all-cause mortality compared with US males (SMR (95% CI)=0.30 (0.26 to 0.34) and 0.60 (0.55 to 0.65) in WTC-exposed and non-WTC-exposed, respectively). WTC-exposed firefighters also had lower rates of all-cause mortality (RR=0.54, 95% CI=0.49 to 0.59) and cancer-specific, cardiovascular-specific and respiratory disease-specific mortality compared with non-WTC-exposed firefighters.

Conclusion Both firefighter cohorts had lower than expected all-cause mortality. Fifteen years post 11 September 2001, mortality was lower in WTC-exposed versus non-WTC-exposed firefighters. Lower mortality in the WTC-exposed suggests not just a healthy worker effect, but additional factors such as greater access to free health monitoring and treatment that they receive via the WTCHP.

  • occupational health
  • mortality
  • epidemiology
  • firefighters

Data availability statement

Data are available on reasonable request. Data may be obtained from a third party and are not publicly available. Reasonable request for deidentified data will be considered by the investigators, the National Institute for Occupational Safety and Health, and the National Death Index.

https://doi.org/10.1136/oemed-2022-108703

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    Data availability statement

    Data are available on reasonable request. Data may be obtained from a third party and are not publicly available. Reasonable request for deidentified data will be considered by the investigators, the National Institute for Occupational Safety and Health, and the National Death Index.

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    Footnotes

    • Contributors CBH and RZ-O designed the study, with significant input from PB and MPW. RZ-O, AS, MC and RDD acquired the data. RZ-O, AS and CBH analysed and interpreted the data. AS drafted the manuscript, with critical revisions from RZ-O, CBH, MPW, DJP, RDD and PB. DGG validated the analyses. All authors approved the final manuscript. As the guarantor, RZ-O, accepts full responsibility for the finished work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

    • Funding This research was supported through the National Institute for Occupational Safety and Health (NIOSH) cooperative agreement numbers U01 OH011480, U01 OH011309 and U01 OHO11934, and contracts 200-2017-93326 and 75D301-22-P-15204.

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.