Mortality among survivors of the Sept 11, 2001, World Trade Center disaster: Results from the World Trade Center Health Registry cohort

New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA.
The Lancet (Impact Factor: 45.22). 09/2011; 378(9794):879-87. DOI: 10.1016/S0140-6736(11)60966-5
Source: PubMed

ABSTRACT The Sept 11, 2001 (9/11) World Trade Center (WTC) disaster has been associated with several subacute and chronic health effects, but whether excess mortality after 9/11 has occurred is unknown. We tested whether excess mortality has occurred in people exposed to the WTC disaster.
In this observational cohort study, deaths occurring in 2003-09 in WTC Health Registry participants residing in New York City were identified through linkage to New York City vital records and the National Death Index. Eligible participants were rescue and recovery workers and volunteers; lower Manhattan area residents, workers, school staff and students; and commuters and passers-by on 9/11. Study participants were categorised as rescue and recovery workers (including volunteers), or non-rescue and non-recovery participants. Standardised mortality ratios (SMR) were calculated with New York City rates from 2000-09 as the reference. Within the cohort, proportional hazards were used to examine the relation between a three-tiered WTC-related exposure level (high, intermediate, or low) and total mortality.
We identified 156 deaths in 13,337 rescue and recovery workers and 634 deaths in 28,593 non-rescue and non-recovery participants. All-cause SMRs were significantly lower than that expected for rescue and recovery participants (SMR 0·45, 95% CI 0·38-0·53) and non-rescue and non-recovery participants (0·61, 0·56-0·66). No significantly increased SMRs for diseases of the respiratory system or heart, or for haematological malignancies were found. In non-rescue and non-recovery participants, both intermediate and high levels of WTC-related exposure were significantly associated with mortality when compared with low exposure (adjusted hazard ratio 1·22, 95% CI 1·01-1·48, for intermediate exposure and 1·56, 1·15-2·12, for high exposure). High levels of exposure in non-rescue and non-recovery individuals, when compared with low exposed non-rescue and non-recovery individuals, were associated with heart-disease-related mortality (adjusted hazard ratio 2·06, 1·10-3·86). In rescue and recovery participants, level of WTC-related exposure was not significantly associated with all-cause mortality (adjusted hazard ratio 1·25, 95% CI 0·56-2·78, for high exposure and 1·03, 0·52-2·06, for intermediate exposure when compared with low exposure).
This exploratory study of mortality in a well defined cohort of 9/11 survivors provides a baseline for continued surveillance. Additional follow-up is needed to establish whether these associations persist and whether a similar association over time will occur in rescue and recovery participants.
US Centers for Disease Control and Prevention (National Institute for Occupational Safety and Health, Agency for Toxic Substances and Disease Registry, and National Center for Environmental Health); New York City Department of Health and Mental Hygiene.

19 Reads
  • Source
    • "Terrorist acts not only result in death, illness, and severe injury to members of the public and emergency services, they also impact adversely on social cohesion, accentuating divisions between different racial and religious groups [59]–[61]. They raise legitimate fears about safety and security [61], [62]. Trauma, multiple bereavements, and fear can have long-term consequences for psychological health [63]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background This study tests whether depression, psychosocial adversity, and limited social assets offer protection or suggest vulnerability to the process of radicalisation. Methods A population sample of 608 men and women of Pakistani or Bangladeshi origin, of Muslim heritage, and aged 18–45 were recruited by quota sampling. Radicalisation was measured by 16 questions asking about sympathies for violent protest and terrorism. Cluster analysis of the 16 items generated three groups: most sympathetic (or most vulnerable), most condemning (most resistant), and a large intermediary group that acted as a reference group. Associations were calculated with depression (PHQ9), anxiety (GAD7), poor health, and psychosocial adversity (adverse life events, perceived discrimination, unemployment). We also investigated protective factors such as the number social contacts, social capital (trust, satisfaction, feeling safe), political engagement and religiosity. Results Those showing the most sympathy for violent protest and terrorism were more likely to report depression (PHQ9 score of 5 or more; RR = 5.43, 1.35 to 21.84) and to report religion to be important (less often said religion was fairly rather than very important; RR = 0.08, 0.01 to 0.48). Resistance to radicalisation measured by condemnation of violent protest and terrorism was associated with larger number of social contacts (per contact: RR = 1.52, 1.26 to 1.83), less social capital (RR = 0.63, 0.50 to 0.80), unavailability for work due to housekeeping or disability (RR = 8.81, 1.06 to 37.46), and not being born in the UK (RR = 0.22, 0.08 to 0.65). Conclusions Vulnerability to radicalisation is characterised by depression but resistance to radicalisation shows a different profile of health and psychosocial variables. The paradoxical role of social capital warrants further investigation.
    PLoS ONE 09/2014; 9(9):e105918. DOI:10.1371/journal.pone.0105918 · 3.23 Impact Factor
  • Source
    • ". Increases in the incidence of these diseases was also not observed after the World Trade Center attacks, despite the atmospheric pollution caused by the huge dust clouds [12] [13] [14]. Although the reasons for these findings are unknown, the use of masks may have prevented parenchymal diseases or the observation time (o12 years) may be too short to accurately survey the occurrence of these diseases [15]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: A man was admitted to our hospital with shortness of breath. He was involved in making wood chips from contaminated debris created by the tsunami that occurred after the Great East Japan Earthquake. Fungi detected at his home and workplace were possible inducers of hypersensitivity pneumonitis, but the absence of precipitating antibodies countered this diagnosis. His rapid and progressive clinical course and surgical lung biopsy and bronchoalveolar lavage findings suggested acute interstitial pneumonia. Electron probe X-ray microanalysis revealed the deposition of excessive exogenous substances in bronchiolar regions. Inhalation of harmful materials was suspected to be the cause of acute lung injury.
    Respiratory Investigation 12/2012; 50(4):129-34. DOI:10.1016/j.resinv.2012.09.001
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: September 11 is first of all a cause of mourning, both for the immediate victims and for the dismal condition of humanity. Seeking to derive lessons for the future, the article explores the implications of the events along three lines: for the United States; for the Muslim world; and for the international community. With regard to the United States, September 11 disclosed the vulnerability of the country in the midst of a relentlessly shrinking and interdependent world. This realization calls into question the deeply ingrained American preference for isolationism and/or unilateralism (that is, the preference for playing by no rules but one's own). With regard to the Muslim world, September 11 disclosed the lack of a viable political agenda (outside and apart from terrorism and the use/abuse of religion) - thus underscoring the need for a political reconstruction of the dar al-Islam. With regard to the international community, September 11 revealed the weakness of mediating institutions between hegemonic globalism and fragmented localism, hence counseling the building of regional institutions (after the model of the European Union).
    Industrial Health 01/2011; 49(6):673-6. · 1.12 Impact Factor
Show more