Mortality among Fire Department of the City of New York Rescue and Recovery Workers Exposed to the World Trade Center Disaster, 2001–2017
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Ascertainment of Deaths
2.3. Statistical Analysis
3. Results
3.1. Characteristics of the Study Sample
3.2. Mortality Among the Full Cohort
3.3. Race, Work Assignment, and WTC-Exposure
3.4. Associations of WTC-exposure, Smoking History and Mortality
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Characteristic | Total Population | Deaths |
---|---|---|
N (%) | N (%) | |
Total | 15,431 (100) | 546 (100) |
Person-years of follow-up | 248,664.50 | 5977.9 (100) |
Age on 9/11/2001, median (IQR) | 39.9 (33.6–46.2) | 47.7 (41.9–57.1) |
BMI (kg/m2) at end of follow-up, mean (SD) 1 | 30.5 (5.0) | 30.2 (6.2) |
Year hired, mean (SD) | 1988 (10) | 1980 (12) |
WTC exposure Level | ||
High | 2370 (15.4) | 86 (15.8) |
Moderate | 9808 (63.6) | 294 (53.9) |
Low | 3253 (21.1) | 166 (30.4) |
Race/ethnicity | ||
non-Hispanic white | 13,456 (87.2) | 468 (85.7) |
Non-white 2 | 1975 (12.8) | 78 (14.3) |
Work assignment | ||
Firefighter | 13,266 (86.0) | 455 (83.3) |
Emergency medical service providers | 2165 (14.0) | 91 (16.7) |
Sex | ||
Male | 14,943 (96.8) | 532 (97.4) |
Female | 488 (3.2) | 14 (2.6) |
Smoking status | ||
Never smoker | 9397 (60.9) | 215 (39.4) |
Ever smoker | 5742 (37.2) | 277 (50.7) |
Unknown | 292 (1.9) | 54 (9.9) |
Age at death, median (IQR) | N/A | 58.9 (51.6–68.5) |
Years to death post-9/11/2001, median (IQR) | N/A | 11.6 (8.7–14.0) |
Cause (National Institute for Occupational Safety (NIOSH) Major Category) 2 | Observed | SMR (95% CI) |
---|---|---|
All causes | 546 | 0.34 (0.31–0.37) ** |
Tuberculosis and HIV related disease (01) | ≤5 | 0.15 (0.03–0.44) ** |
All cancers | 191 | 0.46 (0.40–0.54) ** |
MN buccal and pharynx (02) | ≤5 | 0.18 (0.02–0.65) ** |
MN digestive organs and peritoneum (03) | 70 | 0.56 (0.43–0.70) ** |
MN respiratory system (04) | 35 | 0.28 (0.20–0.39) ** |
MN breast (05) | ≤5 | 0.45 (0.01–2.51) |
MN female genital organs (06) | ≤5 | 1.09 (0.01–6.05) |
MN male genital organs (07) | 7 | 0.36 (0.14–0.74) ** |
MN urinary (08) | 11 | 0.47 (0.23–0.84) ** |
MN other and unspecified sites (09) | 33 | 0.49 (0.34–0.69) ** |
MN lymphatic and hematopoietic tissues (10) | 31 | 0.82 (0.56–1.16) |
Benign and unspecified neoplasms (11) | 6 | 1.14 (0.42–2.49) |
Diseases of the blood and blood-forming organs (12) | ≤5 | 0.31 (0.03–1.11) |
Diabetes mellitus (13) | 8 | 0.15 (0.06–0.29) ** |
Mental, psychoneurotic, and personality disorders (14) | 11 | 0.32 (0.16–0.58) ** |
Nervous system disorders (15) | 9 | 0.20 (0.09–0.38) ** |
Heart diseases (16) | 120 | 0.33 (0.27–0.40) ** |
Other diseases of the circulatory system (17) | 23 | 0.25 (0.16–0.38) ** |
Diseases of the respiratory system (18) | 28 | 0.27 (0.18–0.39) ** |
Diseases of the digestive system (19) | 20 | 0.21 (0.13–0.32) ** |
Diseases of the skin and subcutaneous tissues (20) | ≤5 | 0.91 (0.10–3.28) |
Diseases of the musculoskeletal and connective tissue systems (21) | ≤5 | 0.37 (0.04–1.33) |
Diseases of the genito-urinary system (22) | ≤5 | 0.08 (0.01–0.28) ** |
Symptoms and ill-defined conditions (23) | 11 | 0.52 (0.26–0.93) * |
Transportation injuries (24) | 13 | 0.23 (0.12–0.40) ** |
Falls (25) | 6 | 0.42 (0.15–0.91) * |
Other injury (26) | 41 | 0.45 (0.33–0.62) ** |
Violence (27) | 26 | 0.30 (0.20–0.44) ** |
Other and unspecified (residual and blank codes) causes (28) | 22 | 0.32 (0.20–0.48) ** |
Cause (NIOSH Major, Minor Category) 2 | Observed | SMR (95% CI) |
---|---|---|
HIV-related (01, 03) | ≤5 | 0.10 (0.01–0.37) ** |
MN esophagus (03, 08) | 13 | 0.69 (0.36–1.17) |
MN pancreas (03, 13) | 20 | 0.71 (0.43–1.09) |
MN trachea, bronchus, lung (04, 16) | 34 | 0.29 (0.20–0.40) ** |
MN melanoma (09, 29) | 7 | 0.72 (0.29–1.48) |
MN mesothelioma (09, 31) | ≤5 | 1.95 (0.52–5.00) |
MN brain and other nervous (09, 33) | 12 | 0.73 (0.38–1.28) |
MN eye (09, 34) | 0 | 0.00 (0.00–14.26) |
Non-Hodgkin’s lymphoma (10, 38) | 18 | 1.24 (0.73–1.95) |
Multiple myeloma (39) | ≤5 | 0.68 (0.22–1.59) |
BN eye, brain, other nervous (11, 41) | 0 | 0.00 (0.00–9.30) |
Alcoholism (14, 49) | 6 | 0.36 (0.13–0.78) ** |
Other nervous system diseases (15, 52) | 9 | 0.21 (0.10–0.40) ** |
Rheumatic heart disease (16, 53) | ≤5 | 0.82 (0.01–4.56) |
Hypertension w/heart disease (16, 54) | 7 | 0.23 (0.09–0.48) ** |
Ischemic heart disease (16, 55) | 85 | 0.33 (0.27–0.41) ** |
Cerebrovascular disease (17, 60) | 10 | 0.20 (0.09–0.36) ** |
Hypertension w/o heart disease (17, 61) | ≤5 | 0.33 (0.09–0.84) * |
Diseases of the arteries, veins, lymph nodes (17, 62) | 9 | 0.33 (0.15–0.63) ** |
Pneumonia (18, 65) | ≤5 | 0.26 (0.08–0.60) ** |
COPD (18, 66) | 12 | 0.20 (0.10–0.35) ** |
Hernia and intestinal obstruction (19, 73) | 0 | 0.00 (0.00–1.38) |
Chronic and unspecified renal failure (22, 82) | ≤5 | 0.06 (0.00–0.32) ** |
Motor vehicle-driver (24, 92) | 6 | 0.37 (0.14–0.81) ** |
Motor vehicle—pedestrian (24, 94) | ≤5 | 0.29 (0.03–1.07) |
Fire in building (26, 109) | 9 | 3.72 (1.70–7.06) ** |
Accidental poisoning (26, 112) | 24 | 0.42 (0.27–0.62) ** |
Suicide (27, 116) 3 | 23 | 0.34 (0.22–0.51) ** |
Assault and homicide (27, 117) | ≤5 | 0.16 (0.03–0.46) ** |
Cause (NIOSH Major Category) 2 | Non-Hispanic White | Non-White 3 | ||
---|---|---|---|---|
Observed | SMR (95% CI) | Observed | SMR (95% CI) | |
All causes | 468 | 0.33 (0.30–0.36) ** | 78 | 0.44 (0.35–0.55) ** |
Tuberculosis and HIV related disease (01) | ≤5 | 0.08 (0.00–0.44) ** | ≤5 | 0.29 (0.03–1.03) |
All cancers | 164 | 0.44 (0.38–0.52) ** | 27 | 0.66 (0.44–0.96) * |
MN buccal and pharynx (02) | ≤5 | 0.20 (0.02–0.74) ** | 0 | 0.00 (0.00–2.93) |
MN digestive organs and peritoneum (03) | 56 | 0.50 (0.38–0.65) ** | 14 | 0.99 (0.54–1.65) |
MN respiratory system (04) | 33 | 0.30 (0.20–0.41) ** | ≤5 | 0.17 (0.02–0.62) ** |
MN breast (05) | 0 | 0.00 (0.00–2.85) | ≤5 | 1.09 (0.01–6.05) |
MN female genital organs (06) | 0 | 0.00 (0.00–7.32) | ≤5 | 2.38 (0.03–13.25) |
MN male genital organs (07) | ≤5 | 0.29 (0.09–0.68) ** | ≤5 | 0.80 (0.09–2.90) |
MN urinary (08) | 11 | 0.50 (0.25–0.90) * | 0 | 0.00 (0.00–2.36) |
MN other and unspecified sites (09) | 30 | 0.48 (0.32–0.69) ** | ≤5 | 0.62 (0.12–1.81) |
MN lymphatic and hematopoietic tissues (10) | 27 | 0.78 (0.52–1.14) | ≤5 | 1.16 (0.31–2.97) |
Benign and unspecified neoplasms (11) | 6 | 1.27 (0.46–2.76) | 0 | 0.00 (0.00–7.17) |
Diseases of the blood and blood-forming organs (12) | ≤5 | 0.36 (0.04–1.31) | 0 | 0.00 (0.00–3.78) |
Diabetes mellitus (13) | ≤5 | 0.09 (0.02–0.22) ** | ≤5 | 0.53 (0.14–1.35) |
Mental, psychoneurotic, and personality disorders (14) | 10 | 0.32 (0.16–0.60) ** | ≤5 | 0.33 (0.00–1.81) |
Nervous system disorders (15) | 8 | 0.19 (0.08–0.38) ** | ≤5 | 0.28 (0.00–1.59) |
Heart diseases (16) | 98 | 0.30 (0.25–0.37) ** | 22 | 0.53 (0.33–0.81) ** |
Other diseases of the circulatory system (17) | 20 | 0.26 (0.16–0.40) ** | ≤5 | 0.21 (0.04–0.62) ** |
Diseases of the respiratory system (18) | 28 | 0.29 (0.19–0.42) ** | 0 | 0.00 (0.00–0.45) ** |
Diseases of the digestive system (19) | 19 | 0.22 (0.13–0.34) ** | ≤5 | 0.12 (0.00–0.69) ** |
Diseases of the skin and subcutaneous tissues (20) | ≤5 | 1.06 (0.14–3.84) | 0 | 0.00 (0.00–11.51) |
Diseases of the musculoskeletal and connective tissue systems (21) | ≤5 | 0.44 (0.05–1.57) | 0 | 0.00 (0.00–4.47) |
Diseases of the genito-urinary system (22) | ≤5 | 0.05 (0.0–0.26) ** | ≤5 | 0.22 (0.01–1.24) |
Symptoms and ill-defined conditions (23) | 11 | 0.59 (0.29–1.05) | 0 | 0.00 (0.00–1.42) |
Transportation injuries (24) | 12 | 0.24 (0.13–0.42) ** | ≤5 | 0.17 (0.00–0.93) * |
Falls (25) | ≤5 | 0.38 (0.12–0.88) * | ≤5 | 1.01 (0.03–5.63) |
Other injury (26) | 38 | 0.47 (0.33–0.64) ** | ≤5 | 0.33 (0.07–0.97) * |
Violence (27) | 22 | 0.29 (0.18–0.44) ** | ≤5 | 0.38 (0.10–0.98) * |
Other and unspecified (residual and blank codes) causes (28) | 15 | 0.25 (0.14–0.41) ** | 7 | 0.81 (0.33–1.67) |
Cause (NIOSH Major Category) 2 | Firefighters | Emergency Medical Service Providers | ||
---|---|---|---|---|
Observed | SMR | Observed | SMR | |
All causes | 455 | 0.31 (0.29–0.34) ** | 91 | 0.61 (0.49–0.75) ** |
Tuberculosis and HIV related disease (01) | ≤5 | 0.06 (0.0–0.36) ** | ≤5 | 0.46 (0.05–1.65) |
All cancers | 164 | 0.43 (0.37–0.51) ** | 27 | 0.81 (0.53–1.18) |
MN buccal and pharynx (02) | ≤5 | 0.20 (0.02–0.71) ** | 0 | 0.00 (0.00–3.86) |
MN digestive organs and peritoneum (03) | 60 | 0.52 (0.40–0.67) ** | 10 | 0.93 (0.45–1.72) |
MN respiratory system (04) | 32 | 0.28 (0.19–0.39) ** | ≤5 | 0.34 (0.07–0.99) * |
MN breast (05) | 0 | 0.00 (0.00–5.38) | ≤5 | 0.65 (0.02–3.64) |
MN female genital organs (06) | 0 | 0.00 (0.00–44.02) | ≤5 | 1.19 (0.03–6.61) |
MN male genital organs (07) | 6 | 0.33 (0.12–0.71) ** | ≤5 | 0.86 (0.02–4.79) |
MN urinary (08) | 10 | 0.45 (0.22–0.84) ** | ≤5 | 0.70 (0.02–3.88) |
MN other and unspecified sites (09) | 30 | 0.48 (0.33–0.69) ** | ≤5 | 0.59 (0.12–1.72) |
MN lymphatic and hematopoietic tissues (10) | 24 | 0.69 (0.44–1.02) | 7 | 2.43 (0.98–5.01) |
Benign and unspecified neoplasms (11) | ≤5 | 1.04 (0.34–2.44) | ≤5 | 2.17 (0.05–12.08) |
Diseases of the blood and blood-forming organs (12) | ≤5 | 0.17 (0.00–0.96) * | ≤5 | 1.46 (0.04–8.14) |
Diabetes mellitus (13) | ≤5 | 0.10 (0.03–0.24) ** | ≤5 | 0.56 (0.12–1.65) |
Mental, psychoneurotic, and personality disorders (14) | 9 | 0.29 (0.24–0.36) ** | ≤5 | 0.72 (0.09–2.60) |
Nervous system disorders (15) | 7 | 0.17 (0.07–0.34) ** | ≤5 | 0.62 (0.08–2.25) |
Heart diseases (16) | 97 | 0.29 (0.24–0.36) ** | 23 | 0.74 (0.47-1.12) |
Other diseases of the circulatory system (17) | 18 | 0.22 (0.13–0.35) ** | ≤5 | 0.53 (0.17–1.24) |
Diseases of the respiratory system (18) | 26 | 0.27 (0.17–0.39) ** | ≤5 | 0.29 (0.04–1.05) |
Diseases of the digestive system (19) | 18 | 0.21 (0.12–0.33) ** | ≤5 | 0.23 (0.03–0.85) * |
Diseases of the skin and subcutaneous tissues (20) | ≤5 | 0.51 (0.01–2.84) | ≤5 | 4.19 (0.11–23.35) |
Diseases of the musculoskeletal and connective tissue systems (21) | ≤5 | 0.42 (0.05–1.52) | 0 | 0.00 (0.00–5.47) |
Diseases of the genito-urinary system (22) | ≤5 | 0.04 (0.00–0.24) ** | ≤5 | 0.37 (0.01–2.05) |
Symptoms and ill-defined conditions (23) | 9 | 0.47 (0.22–0.90) * | ≤5 | 0.87 (0.11–3.15) |
Transportation injuries (24) | 12 | 0.25 (0.13–0.43) ** | ≤5 | 0.15 (0.00–0.84) * |
Falls (25) | ≤5 | 0.38 (0.12–0.88) * | ≤5 | 0.96 (0.02–5.32) |
Other injury (26) | 35 | 0.44 (0.31–0.61) ** | 6 | 0.56 (0.20–1.21) |
Violence (27) | 22 | 0.29 (0.18–0.44) ** | ≤5 | 0.37 (0.10–0.95) * |
Other and unspecified (residual and blank codes) causes (28) | 17 | 0.27 (0.16–0.44) ** | ≤5 | 0.70 (0.23–1.64) |
Cause (NIOSH Major Category) 2 | High Exposure | Moderate/Low Exposure | ||
---|---|---|---|---|
Observed | SMR (95% CI) | Observed | SMR (95% CI) | |
All causes | 86 | 0.41 (0.33–0.51) ** | 460 | 0.33 (0.30–0.36) ** |
Tuberculosis and HIV related disease (01) | ≤5 | 0.30 (0.01–1.66) | ≤5 | 0.12 (0.01–0.44) ** |
All cancers | 26 | 0.51 (0.33–0.74) ** | 165 | 0.46 (0.39–0.53) ** |
MN buccal and pharynx (02) | 0 | 0.00 (0.00–2.45) | ≤5 | 0.21 (0.03–0.76) ** |
MN digestive organs and peritoneum (03) | 12 | 0.73 (0.38–1.28) | 58 | 0.53 (0.40–0.69) ** |
MN respiratory system (04) | ≤5 | 0.20 (0.04–0.59) ** | 32 | 0.29 (0.20–0.42) ** |
MN breast (05) | 0 | 0.00 (00.0–9.53) | ≤5 | 0.55 (0.01–3.05) |
MN female genital organs (06) | 0 | 0.00 (0.00–20.23) | ≤5 | 1.34 (0.03–7.48) |
MN male genital organs (07) | ≤5 | 1.01 (0.12–3.63) | ≤5 | 0.28 (0.09–0.66) ** |
MN urinary (08) | ≤5 | 0.72 (0.09–2.60) | 9 | 0.44 (0.20–0.83) ** |
MN other and unspecified sites (09) | ≤5 | 0.46 (0.13–1.18) | 29 | 0.50 (0.33–0.71) ** |
MN lymphatic and hematopoietic tissues (10) | ≤5 | 0.66 (0.14–1.92) | 28 | 0.84 (0.56–1.21) |
Benign and unspecified neoplasms (11) | ≤5 | 1.50 (0.04–8.36) | ≤5 | 1.09 (0.35–2.55) |
Diseases of the blood and blood-forming organs (12) | 0 | 0.00 (0.00–4.75) | ≤5 | 0.35 (0.04–1.26) |
Diabetes mellitus (13) | ≤5 | 0.42 (0.09–1.24) | ≤5 | 0.11 (0.03–0.25) ** |
Mental, psychoneurotic, and personality disorders (14) | 0 | 0.00 (0.00–0.86) * | 11 | 0.37 (0.19–0.66) ** |
Nervous system disorders (15) | ≤5 | 0.20 (0.01–1.11) | 8 | 0.20 (0.09–0.39) ** |
Heart diseases (16) | 14 | 0.30 (0.16–0.51) ** | 106 | 0.34 (0.27–0.41) ** |
Other diseases of the circulatory system (17) | ≤5 | 0.17 (0.02–0.63) ** | 21 | 0.27 (0.16–0.41) ** |
Diseases of the respiratory system (18) | ≤5 | 0.43 (0.14–1.01) | 23 | 0.25 (0.16–0.37) ** |
Diseases of the digestive system (19) | ≤5 | 0.07 (0.00–0.41) ** | 19 | 0.23 (0.14–0.36) ** |
Diseases of the skin and subcutaneous tissues (20) | ≤5 | 3.43 (0.09–19.08) | ≤5 | 0.52 (0.01–2.92) |
Diseases of the musculoskeletal and connective tissue systems (21) | ≤5 | 1.39 (0.04–7.77) | ≤5 | 0.21 (0.01–1.18) |
Diseases of the genito-urinary system (22) | 0 | 0.00 (0.00–1.16) | ≤5 | 0.09 (0.01–0.32) ** |
Symptoms and ill-defined conditions (23) | ≤5 | 0.67 (0.08–2.42) | 9 | 0.49 (0.23–0.94) * |
Transportation injuries (24) | ≤5 | 0.47 (0.13–1.21) | 9 | 0.19 (0.09–0.36) ** |
Falls (25) | ≤5 | 1.11 (0.13–4.01) | ≤5 | 0.32 (0.09–0.82) * |
Other injury (26) | 11 | 0.78 (0.39–1.40) | 30 | 0.39 (0.27–0.56) ** |
Violence (27) | 7 | 0.52 (0.21–1.08) | 19 | 0.26 (0.16–0.40) ** |
Other and unspecified (residual and blank codes) causes (28) | ≤5 | 0.42 (0.11–1.08) | 18 | 0.30 (0.18–0.48) ** |
Variable | All-Cause Mortality | Cancer Mortality | Heart Disease Mortality | Respiratory Disease Mortality 2 | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
HR | 95% CI | AHR 1 | 95% CI | HR | 95% CI | AHR 1 | 95% CI | HR | 95% CI | AHR 1 | 95% CI | HR | 95% CI | AHR | 95% CI | |
WTC exposure (high vs. moderate/low) | 1.03 | 0.82–1.30 | 1.24 | 0.98–1.58 | 0.88 | 0.58–1.32 | 1.15 | 0.75–1.78 | 0.78 | 0.45–1.37 | 0.93 | 0.52–1.68 | 1.25 | 0.47–3.28 | 1.44 | 0.49–4.23 |
Age on 9/11/2001 (continuous, years) | 1.08 | 1.07–1.09 | 1.10 | 1.08–1.12 | 1.09 | 1.07–1.12 | 1.14 | 1.09–1.19 | ||||||||
BMI (continuous, kg/m 2) | 1.00 | 0.98–1.02 | 0.97 | 0.93–1.01 | 1.03 | 0.99–1.07 | 1.01 | 0.92–1.10 | ||||||||
Race (non-Hispanic white vs. non-white) 3 | 0.84 | 0.64–1.12 | 0.75 | 0.47–1.19 | 0.71 | 0.39–1.31 | N/A | N/A | ||||||||
Work assignment (firefighter vs. EMS) | 0.51 | 0.38–0.69 | 0.58 | 0.33–1.02 | 0.47 | 0.25–0.88 | 0.79 | 0.15–4.03 | ||||||||
Sex (male vs. female) | 1.52 | 0.84–2.74 | 1.05 | 0.40–2.77 | 1.65 | 0.46–5.89 | 0.34 | 0.03–3.50 | ||||||||
Smoking (ever vs. never) | 1.54 | 1.27–1.86 | 1.73 | 1.24–2.42 | 1.89 | 1.22–2.93 | 0.90 | 0.38–2.12 |
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Colbeth, H.L.; Zeig-Owens, R.; Hall, C.B.; Webber, M.P.; Schwartz, T.M.; Prezant, D.J. Mortality among Fire Department of the City of New York Rescue and Recovery Workers Exposed to the World Trade Center Disaster, 2001–2017. Int. J. Environ. Res. Public Health 2020, 17, 6266. https://doi.org/10.3390/ijerph17176266
Colbeth HL, Zeig-Owens R, Hall CB, Webber MP, Schwartz TM, Prezant DJ. Mortality among Fire Department of the City of New York Rescue and Recovery Workers Exposed to the World Trade Center Disaster, 2001–2017. International Journal of Environmental Research and Public Health. 2020; 17(17):6266. https://doi.org/10.3390/ijerph17176266
Chicago/Turabian StyleColbeth, Hilary L., Rachel Zeig-Owens, Charles B. Hall, Mayris P. Webber, Theresa M. Schwartz, and David J. Prezant. 2020. "Mortality among Fire Department of the City of New York Rescue and Recovery Workers Exposed to the World Trade Center Disaster, 2001–2017" International Journal of Environmental Research and Public Health 17, no. 17: 6266. https://doi.org/10.3390/ijerph17176266