title: Persistence of multiple illnesses in World Trade Center rescue and recovery workers: a cohort study.
abstract: BACKGROUND
  More than 50,000 people participated in the rescue and recovery work that followed the Sept 11, 2001 (9/11) attacks on the World Trade Center (WTC). Multiple health problems in these workers were reported in the early years after the disaster. We report incidence and prevalence rates of physical and mental health disorders during the 9 years since the attacks, examine their associations with occupational exposures, and quantify physical and mental health comorbidities.
  
  
  METHODS
  In this longitudinal study of a large cohort of WTC rescue and recovery workers, we gathered data from 27,449 participants in the WTC Screening, Monitoring, and Treatment Program. The study population included police officers, firefighters, construction workers, and municipal workers. We used the Kaplan-Meier procedure to estimate cumulative and annual incidence of physical disorders (asthma, sinusitis, and gastro-oesophageal reflux disease), mental health disorders (depression, post-traumatic stress disorder [PTSD], and panic disorder), and spirometric abnormalities. Incidence rates were assessed also by level of exposure (days worked at the WTC site and exposure to the dust cloud).
  
  
  RESULTS
  9-year cumulative incidence of asthma was 27·6% (number at risk: 7027), sinusitis 42·3% (5870), and gastro-oesophageal reflux disease 39·3% (5650). In police officers, cumulative incidence of depression was 7·0% (number at risk: 3648), PTSD 9·3% (3761), and panic disorder 8·4% (3780). In other rescue and recovery workers, cumulative incidence of depression was 27·5% (number at risk: 4200), PTSD 31·9% (4342), and panic disorder 21·2% (4953). 9-year cumulative incidence for spirometric abnormalities was 41·8% (number at risk: 5769); three-quarters of these abnormalities were low forced vital capacity. Incidence of most disorders was highest in workers with greatest WTC exposure. Extensive comorbidity was reported within and between physical and mental health disorders.
  
  
  CONCLUSIONS
  9 years after the 9/11 WTC attacks, rescue and recovery workers continue to have a substantial burden of physical and mental health problems. These findings emphasise the need for continued monitoring and treatment of the WTC rescue and recovery population.
  
  
  BACKGROUND
  Centers for Disease Control and Prevention and National Institute for Occupational Safety and Health.
authors: Divisions of General Internal Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA. juan.wisnivesky@mssm.edu
authors: Juan P
authors: JP
authors: Wisnivesky
authors: Susan L
authors: SL
authors: Teitelbaum
authors: Andrew C
authors: AC
authors: Todd
authors: Paolo
authors: P
authors: Boffetta
authors: Michael
authors: M
authors: Crane
authors: Laura
authors: L
authors: Crowley
authors: Rafael E
authors: RE
authors: de la Hoz
authors: Cornelia
authors: C
authors: Dellenbaugh
authors: Denise
authors: D
authors: Harrison
authors: Robin
authors: R
authors: Herbert
authors: Hyun
authors: H
authors: Kim
authors: Yunho
authors: Y
authors: Jeon
authors: Julia
authors: J
authors: Kaplan
authors: Craig
authors: C
authors: Katz
authors: Stephen
authors: S
authors: Levin
authors: Ben
authors: B
authors: Luft
authors: Steven
authors: S
authors: Markowitz
authors: Jacqueline M
authors: JM
authors: Moline
authors: Fatih
authors: F
authors: Ozbay
authors: Robert H
authors: RH
authors: Pietrzak
authors: Moshe
authors: M
authors: Shapiro
authors: Vansh
authors: V
authors: Sharma
authors: Gwen
authors: G
authors: Skloot
authors: Steven
authors: S
authors: Southwick
authors: Lori A
authors: LA
authors: Stevenson
authors: Iris
authors: I
authors: Udasin
authors: Sylvan
authors: S
authors: Wallenstein
authors: Philip J
authors: PJ
authors: Landrigan
mesh_terms: D000328:Adult; D000397:Air Pollution / Q000009:adverse effects; D001249:Asthma / Q000453:epidemiology; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology; D004391:Dust; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology; D006801:Humans; D008297:Male; D008603:Mental Health; D009017:Morbidity; D009519:New York City / Q000453:epidemiology; D016584:Panic Disorder / Q000453:epidemiology; D018635:Rescue Work; D012140:Respiratory Tract Diseases / Q000453:epidemiology; D047851:September 11 Terrorist Attacks; D012852:Sinusitis / Q000453:epidemiology; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology
chemical_list: D004391:Dust