title: World Trade Center-related physical and mental health burden among New York City Fire Department emergency medical service workers.
abstract: OBJECTIVE
  To describe the health burden among Fire Department of the City of New York (FDNY) emergency medical service (EMS) workers and examine its association with work at the World Trade Center (WTC) disaster site.
  
  
  METHODS
  In this observational cohort study, we used FDNY physician diagnoses to estimate the cumulative incidence of physical health conditions including rhinosinusitis, gastroesophageal reflux disease (GERD), obstructive airways disease (OAD) and cancer among EMS workers and demographically similar firefighters who were active on 11 September 2001 (9/11). Validated screening instruments were used to estimate the prevalence of probable post-traumatic stress disorder (PTSD), probable depression and probable harmful alcohol use. We also analysed the association between health conditions and WTC-exposure.
  
  
  RESULTS
  Among 2281 EMS workers, the 12-year post-9/11 cumulative incidence (11 September 2001 to 31 December 2013) of rhinosinusitis was 10.6%; GERD 12.1%; OAD 11.8%; cancer 3.1%. The prevalence of probable PTSD up to 12 years after exposure was 7%; probable depression 16.7%; and probable harmful alcohol use 3%. Compared with unexposed, EMS workers who arrived earliest at the site had higher adjusted relative risks (aRR) for most conditions, including rhinosinusitis (aRR=3.7; 95% CI 2.2 to 6.0); GERD (aRR=3.8; 95% CI 2.4 to 6.1); OAD (aRR=2.4: 95% CI 1.7 to 3.6); probable PTSD (aRR=7.0; 95% CI 3.6 to 13.5); and, probable depression (aRR=2.3; 95% CI 1.6 to 3.1).
  
  
  CONCLUSIONS
  In this 12-year study, we documented a high burden of health conditions associated with WTC-exposure among FDNY EMS workers. These findings underscore the importance of continued monitoring and treatment of this workforce.
authors: Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA Department of Medicine, Montefiore Medical Center, Bronx, New York, USA.
authors: Jennifer
authors: J
authors: Yip
authors: Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA Department of Medicine, Montefiore Medical Center, Bronx, New York, USA.
authors: Rachel
authors: R
authors: Zeig-Owens
authors: Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA Department of Epidemiology and Population Health, Montefiore Medical Center, Bronx, New York, USA Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA.
authors: Mayris P
authors: MP
authors: Webber
authors: Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA.
authors: Andrea
authors: A
authors: Kablanian
authors: Department of Epidemiology and Population Health, Montefiore Medical Center, Bronx, New York, USA Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA.
authors: Charles B
authors: CB
authors: Hall
authors: Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA Department of Medicine, Montefiore Medical Center, Bronx, New York, USA.
authors: Madeline
authors: M
authors: Vossbrinck
authors: Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA Department of Medicine, Montefiore Medical Center, Bronx, New York, USA.
authors: Xiaoxue
authors: X
authors: Liu
authors: Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA Department of Medicine, Montefiore Medical Center, Bronx, New York, USA.
authors: Jessica
authors: J
authors: Weakley
authors: Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA Department of Medicine, Montefiore Medical Center, Bronx, New York, USA.
authors: Theresa
authors: T
authors: Schwartz
authors: Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA.
authors: Kerry J
authors: KJ
authors: Kelly
authors: Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA Department of Pulmonary Medicine, Montefiore Medical Center, Bronx, New York, USA Department of Medicine, Pulmonary Division, Albert Einstein College of Medicine, Bronx, New York, USA.
authors: David J
authors: DJ
authors: Prezant
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology / Q000209:etiology; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians / Q000523:psychology; D005260:Female; D061388:Firefighters; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000209:etiology*; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000209:etiology*; D009519:New York City / Q000453:epidemiology; D009784:Occupational Diseases / Q000453:epidemiology / Q000209:etiology; D016273:Occupational Exposure / Q000009:adverse effects*; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000209:etiology; D018635:Rescue Work; D012140:Respiratory Tract Diseases / Q000453:epidemiology / Q000209:etiology*; D047851:September 11 Terrorist Attacks; D012852:Sinusitis / Q000453:epidemiology / Q000209:etiology; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000209:etiology
keywords: Cumulative Incidence; EMS Workers; Health Burden; Relative Risks; World Trade Center