More than 50,000 rescue and recovery workers are estimated to have given assistance after the World Trade Center (WTC) attacks. Data gathered from more than 27,000 of these workers shows that this unique population continue to suffer a high burden of physical and mental illness. The findings are reported in an Article in this week's 9/11 special issue of The Lancet, written by Dr Juan P Wisnivesky, Mount Sinai School of Medicine, New York, USA, and colleagues.
The researchers looked at various conditions among 27 449 participants enrolled in the WTC Screening, Monitoring, and Treatment Program, a federally funded program that provides regular physical and mental health examinations to WTC rescue and recovery workers. The study population included police officers, firefighters, construction workers, and municipal workers. Workers were divided into four categories based on their level of exposure (days at WTC site, work in the pile of debris, and exposure to dust cloud). The categories were: low (14% of workers), intermediate (65%), high (18%), and very high exposure (3%). Most of them were men (86%), more than half were white (57%), and the study population had a median age of 38 years on the day of the attacks.
The enrolee's 9-year cumulative incidence of asthma was 28%, sinusitis 42%, and gastrooesophageal reflux disease (GERD) 39%. Their 9-year cumulative incidence for spirometric abnormalities was 42%; three-quarters of these abnormalities were low forced vital capacity. The authors say: "Inhalation of toxic, highly alkaline dust (pH=10) is the probable cause of upper and lower respiratory injury in rescue and recovery workers."
In rescue and recovery workers, cumulative incidence of depression was 28%, PTSD 32%, and panic disorder 21%. In police officers, cumulative incidence of depression was 7%, post-traumatic stress disorder 9%, and panic disorder 8%. The authors say: "Previous studies have shown that New York City police officers were at lower risk than some responders for developing mental health disorders after the WTC attacks. Possible reasons for these findings include training, previous experience in dealing with similar stressors, self-selection of individuals with high resilience during recruitment into the workforce, and possible under-reporting of psychological symptoms because of perceived job-related repercussions."
The researchers found that incidence of most disorders was highest in workers with greatest WTC exposure. Risk of asthma, sinusitis, and GERD was greatest in workers with the highest levels of exposure. Overall, almost a tenth of rescue and recovery workers reported physician diagnosis of all of these three disorders, while 18% reported a diagnosis of 2 of out of 3. Extensive comorbidity was also reported within and between physical and mental health disorders. The percentage of rescue workers with asthma, sinusitis, and GERD who reported at least one mental health condition were 48%, 38%, and 43%, respectively. Similarly, 69%, 70%, and 72% of rescue workers with PTSD, depression, and panic disorder reported a physician diagnosis of at least one physical condition, respectively.
The authors conclude: "Our findings show a substantial burden of persistent physical and mental disorders in rescue and recovery workers who rushed to the site of the WTC and labored there for weeks and months 10 years ago. Many of these individuals now suffer from multiple health problems. The findings of this study emphasise the need for continued monitoring and treatment of the rescue and recovery worker population and underscore the importance of providing adequate health monitoring and treatment for these individuals. Planning for future disasters should anticipate the probability of persistent physical and mental illness in rescue and recovery workers."
In a linked Comment, Dr Matthew P. Mauer, New York State Department of Health, Troy, NY, USA, says: "We now know that, in one of the largest WTC rescue and recovery cohorts, health effects have persisted for almost a decade. These latest findings leave no doubt about the necessity of continuing health monitoring, treatment, and research for WTC rescue and recovery workers."
He concludes: "Fortunately, our knowledge of these effects is rapidly improving, and studies such as that reported by Wisnivesky and colleagues represent important steps forward. One cannot help but wonder what will be reported when we mark the 20th anniversary of this tragedy. For now, the view ahead is still murky, much like the plumes of acrid smoke that rose in New York City a decade ago."
To interview Dr Juan P Wisnivesky, Mount Sinai School of Medicine, New York, USA, please contact Christie Corbett, Media Relations. T) +1 212-241-9200 E) christie.corbett@mountsinai.org Dr Matthew P. Mauer, New York State Department of Health Troy, NY, USA. E) mpm08@health.state.ny.us
Note to editors: The study refers to numbers at risk for each condition. This indicates the number of rescue as recovery workers at the beginning of each year after 9/11 who were free of disease and actively followed by the program
Journal
The Lancet