title: An overview of 9/11 experiences and respiratory and mental health conditions among World Trade Center Health Registry enrollees.
abstract: To date, health effects of exposure to the September 11, 2001 disaster in New York City have been studied in specific groups, but no studies have estimated its impact across the different exposed populations. This report provides an overview of the World Trade Center Health Registry (WTCHR) enrollees, their exposures, and their respiratory and mental health outcomes 2-3 years post-9/11. Results are extrapolated to the estimated universe of people eligible to enroll in the WTCHR to determine magnitude of impact. Building occupants, persons on the street or in transit in lower Manhattan on 9/11, local residents, rescue and recovery workers/volunteers, and area school children and staff were interviewed and enrolled in the WTCHR between September 2003 and November 2004. A total of 71,437 people enrolled in the WTCHR, for 17.4% coverage of the estimated eligible exposed population (nearly 410,000); 30% were recruited from lists, and 70% were self-identified. Many reported being in the dust cloud from the collapsing WTC Towers (51%), witnessing traumatic events (70%), or sustaining an injury (13%). After 9/11, 67% of adult enrollees reported new or worsening respiratory symptoms, 3% reported newly diagnosed asthma, 16% screened positive for probable posttraumatic stress disorder (PTSD), and 8% for serious psychological distress (SPD). Newly diagnosed asthma was most common among rescue and recovery workers who worked on the debris pile (4.1%). PTSD was higher among those who reported Hispanic ethnicity (30%), household income < $25,000 (31%), or being injured (35%). Using previously published estimates of the total number of exposed people per WTCHR eligibility criteria, we estimate between 3,800 and 12,600 adults experienced newly diagnosed asthma and 34,600-70,200 adults experienced PTSD following the attacks, suggesting extensive adverse health impacts beyond the immediate deaths and injuries from the acute event.
authors.affiliation: New York City Department of Health and Mental Hygiene, New York, NY, USA. mfarfel@health.nyc.gov
authors.forename: Mark
authors.initials: M
authors.lastname: Farfel
authors.forename: Laura
authors.initials: L
authors.lastname: DiGrande
authors.forename: Robert
authors.initials: R
authors.lastname: Brackbill
authors.forename: Angela
authors.initials: A
authors.lastname: Prann
authors.forename: James
authors.initials: J
authors.lastname: Cone
authors.forename: Stephen
authors.initials: S
authors.lastname: Friedman
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Walker
authors.forename: Grant
authors.initials: G
authors.lastname: Pezeshki
authors.forename: Pauline
authors.initials: P
authors.lastname: Thomas
authors.forename: Sandro
authors.initials: S
authors.lastname: Galea
authors.forename: David
authors.initials: D
authors.lastname: Williamson
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Frieden
authors.forename: Lorna
authors.initials: L
authors.lastname: Thorpe
mesh_terms: D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000453:epidemiology / Q000209:etiology; D002648:Child; D003628:Database Management Systems; D004781:Environmental Exposure / Q000009:adverse effects*; D004785:Environmental Pollutants / Q000009:adverse effects*; D040362:Geographic Information Systems; D006801:Humans; D009111:Local Government; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D015995:Prevalence; D011635:Public Health Administration; D012042:Registries; D018635:Rescue Work; D012111:Residence Characteristics / Q000145:classification / Q000706:statistics & numerical data; D012140:Respiratory Tract Diseases / Q000453:epidemiology* / Q000209:etiology; D047851:September 11 Terrorist Attacks / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000209:etiology; D000078329:Workforce; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult
chemical_list: D004785:Environmental Pollutants
references.citation: J Okla State Med Assoc. 1999 Apr;92(4):193-8
references.pmid: 10213972
references.citation: Environ Sci Technol. 2006 Nov 15;40(22):6876-85
references.pmid: 17153990
references.citation: Gen Hosp Psychiatry. 2006 May-Jun;28(3):213-22
references.pmid: 16675364
references.citation: J Trauma Stress. 2008 Jun;21(3):264-73
references.pmid: 18553414
references.citation: Am J Psychiatry. 1997 Nov;154(11):1605-7
references.pmid: 9356574
references.citation: Br J Psychiatry. 1995 Aug;167(2):233-7
references.pmid: 7582675
references.citation: Chest. 1994 Aug;106(2):500-8
references.pmid: 7774327
references.citation: Chest. 2004 Apr;125(4):1256-64
references.pmid: 15078732
references.citation: N Engl J Med. 2001 Nov 15;345(20):1507-12
references.pmid: 11794216
references.citation: JAMA. 2002 Aug 7;288(5):633-6
references.pmid: 12150676
references.citation: Mil Med. 2002 Sep;167(9):777-82
references.pmid: 12363171
references.citation: Br J Psychiatry. 1997 Nov;171:478-82
references.pmid: 9463610
references.citation: Arch Gen Psychiatry. 1995 Dec;52(12):1048-60
references.pmid: 7492257
references.citation: J Consult Clin Psychol. 1998 Jun;66(3):586-90
references.pmid: 9642900
references.citation: J Trauma Stress. 2003 Jun;16(3):257-64
references.pmid: 12816338
references.citation: Am J Ind Med. 2002 Dec;42(6):545-7
references.pmid: 12439881
references.citation: Am J Psychiatry. 2007 Sep;164(9):1385-94
references.pmid: 17728424
references.citation: J Med Invest. 2005 Feb;52(1-2):80-4
references.pmid: 15751277
references.citation: Arch Gen Psychiatry. 2005 May;62(5):545-52
references.pmid: 15867108
references.citation: Environ Health Perspect. 2004 May;112(6):731-9
references.pmid: 15121517
references.citation: Am J Respir Crit Care Med. 2006 Aug 1;174(3):312-9
references.pmid: 16645172
references.citation: Behav Res Ther. 1996 Oct;34(10):775-86
references.pmid: 8952120
references.citation: Arch Gen Psychiatry. 2005 Jun;62(6):617-27
references.pmid: 15939839
references.citation: J Asthma. 2007 May;44(4):325-32
references.pmid: 17530533
references.citation: Arch Gen Psychiatry. 1997 Nov;54(11):1044-8
references.pmid: 9366662
references.citation: J Clin Psychol. 1989 Sep;45(5):729-35
references.pmid: 2808728
references.citation: J Nerv Ment Dis. 2001 Jul;189(7):442-8
references.pmid: 11504321
references.citation: Am J Public Health. 2006 May;96(5):880-8
references.pmid: 16571713
references.citation: Environ Res. 2005 Sep;99(1):85-92
references.pmid: 16053932
references.citation: Soz Praventivmed. 2001;46 Suppl 1:S3-42
references.pmid: 11851091
references.citation: Arch Gen Psychiatry. 2003 Feb;60(2):184-9
references.pmid: 12578436
references.citation: Arch Environ Health. 1983 May-Jun;38(3):138-43
references.pmid: 6870351
references.citation: N Engl J Med. 2002 Mar 28;346(13):982-7
references.pmid: 11919308
references.citation: J Nerv Ment Dis. 1992 Dec;180(12):760-6
references.pmid: 1469374
references.citation: Environ Health Perspect. 2007 Nov;115(11):1584-90
references.pmid: 18007989
references.citation: Am Rev Respir Dis. 1991 Nov;144(5):1058-64
references.pmid: 1952431
references.citation: Psychiatry. 2002 Fall;65(3):240-60
references.pmid: 12405080
references.citation: Chest. 2004 Apr;125(4):1248-55
references.pmid: 15078731
references.citation: J Occup Environ Med. 2002 Jul;44(7):601-5
references.pmid: 12134522
references.citation: MMWR Surveill Summ. 2006 Apr 7;55(2):1-18
references.pmid: 16601667
references.citation: Environ Health Perspect. 2006 Dec;114(12):1853-8
references.pmid: 17185275
references.citation: J Air Waste Manag Assoc. 2006 Jan;56(1):56-67
references.pmid: 16499147
references.citation: JAMA. 2002 Sep 11;288(10):1235-44
references.pmid: 12215130
references.citation: Am J Public Health. 1986 Mar;76(3 Suppl):25-37
references.pmid: 3946727
references.citation: Neuropsychopharmacology. 2005 Oct;30(10):1773-80
references.pmid: 16012534
references.citation: Gen Hosp Psychiatry. 2002 Nov-Dec;24(6):367-74
references.pmid: 12490337
references.citation: Am J Psychiatry. 2000 Apr;157(4):615-9
references.pmid: 10739422
references.citation: Am J Epidemiol. 2003 Sep 15;158(6):514-24
references.pmid: 12965877
references.citation: Am J Psychiatry. 1993 Oct;150(10):1517-23
references.pmid: 8379557
references.citation: Environ Health Perspect. 2008 Oct;116(10):1383-90
references.pmid: 18941582
references.citation: N Engl J Med. 2002 Sep 12;347(11):806-15
references.pmid: 12226151
references.citation: JAMA. 2002 Aug 7;288(5):581-8
references.pmid: 12150669
references.citation: Chest. 1990 Oct;98(4):928-9
references.pmid: 2209150
references.citation: Soc Sci Med. 2006 Jan;62(1):176-88
references.pmid: 16002196
references.citation: Environ Health. 2003 Aug 07;2(1):10
references.pmid: 12952547
references.citation: JAMA. 1999 Aug 25;282(8):755-62
references.pmid: 10463711
references.citation: Environ Health Perspect. 2002 Jul;110(7):703-14
references.pmid: 12117648
references.citation: J Asthma. 2007 Jan-Feb;44(1):65-70
references.pmid: 17365207
references.citation: J Trauma Stress. 1999 Jul;12(3):485-99
references.pmid: 10467557
references.citation: Stat Med. 2007 Apr 15;26(8):1688-701
references.pmid: 17285683
references.citation: J Trauma Stress. 2003 Oct;16(5):495-502
references.pmid: 14584634
references.citation: Environ Health Perspect. 2005 Apr;113(4):406-11
references.pmid: 15811830
references.citation: Environ Health Perspect. 2003 Jun;111(7):981-91
references.pmid: 12782502
references.citation: J Occup Environ Med. 2004 Feb;46(2):113-22
references.pmid: 14767214
references.citation: Am J Epidemiol. 2005 Sep 15;162(6):499-507
references.pmid: 16107572
references.citation: Psychol Med. 2002 Aug;32(6):959-76
references.pmid: 12214795