title: Post-September 11, 2001, Incidence of Systemic Autoimmune Diseases in World Trade Center-Exposed Firefighters and Emergency Medical Service Workers.
abstract: OBJECTIVE
  To estimate the incidence of selected systemic autoimmune diseases (SAIDs) in approximately 14,000 male rescue/recovery workers enrolled in the Fire Department of the City of New York (FDNY) World Trade Center (WTC) Health Program and to compare FDNY incidence to rates from demographically similar men in the Rochester Epidemiology Project (REP), a population-based database in Olmsted County, Minnesota.
  
  
  METHODS
  We calculated incidence for specific SAIDs (rheumatoid arthritis, psoriatic arthritis, systemic lupus erythematosus, and others) and combined SAIDs diagnosed from September 12, 2001, through September 11, 2014, and generated expected sex- and age-specific rates based on REP rates. Rates were stratified by level of WTC exposure (higher vs lower). Standardized incidence ratios (SIRs), which are the ratios of the observed number of cases in the FDNY group to the expected number of cases based on REP rates, and 95% CIs were calculated.
  
  
  RESULTS
  We identified 97 SAID cases. Overall, FDNY rates were not significantly different from expected rates (SIR, 0.97; 95% CI, 0.77-1.21). However, the lower WTC exposure group had 9.9 fewer cases than expected, whereas the higher WTC exposure group had 7.7 excess cases.
  
  
  CONCLUSIONS
  Most studies indicate that the healthy worker effect reduces the association between exposure and outcome by about 20%, which we observed in the lower WTC exposure group. Overall rates masked differences in incidence by level of WTC exposure, especially because the higher WTC exposure group was relatively small. Continued surveillance for early detection of SAIDs in high WTC exposure populations is required to identify and treat exposure-related adverse effects.
authors.affiliation: Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Fire Department of the City of New York, Bureau of Health Services, Brooklyn, NY. Electronic address: Mayris.Webber@fdny.nyc.gov.
authors.forename: Mayris P
authors.initials: MP
authors.lastname: Webber
authors.affiliation: Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Fire Department of the City of New York, Bureau of Health Services, Brooklyn, NY.
authors.forename: William
authors.initials: W
authors.lastname: Moir
authors.affiliation: Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Crowson
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Hillel W
authors.initials: HW
authors.lastname: Cohen
authors.affiliation: Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Fire Department of the City of New York, Bureau of Health Services, Brooklyn, NY.
authors.forename: Rachel
authors.initials: R
authors.lastname: Zeig-Owens
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Charles B
authors.initials: CB
authors.lastname: Hall
authors.affiliation: Division of Rheumatology, Hospital for Special Surgery, and Weill Cornell Medical College, New York, NY.
authors.forename: Jessica
authors.initials: J
authors.lastname: Berman
authors.affiliation: Department of Medicine, Division of Geriatric Medicine, New York University School of Medicine, New York, NY.
authors.forename: Basit
authors.initials: B
authors.lastname: Qayyum
authors.affiliation: Fire Department of the City of New York, Bureau of Health Services, Brooklyn, NY.
authors.forename: Nadia
authors.initials: N
authors.lastname: Jaber
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Matteson
authors.affiliation: Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Fire Department of the City of New York, Bureau of Health Services, Brooklyn, NY.
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Fire Department of the City of New York, Bureau of Health Services, Brooklyn, NY.
authors.forename: Kerry
authors.initials: K
authors.lastname: Kelly
authors.affiliation: Fire Department of the City of New York, Bureau of Health Services, Brooklyn, NY.
authors.forename: David J
authors.initials: DJ
authors.lastname: Prezant
mesh_terms: D000328:Adult; D000367:Age Factors; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D042241:Early Diagnosis; D061388:Firefighters / Q000706:statistics & numerical data*; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D009519:New York City; D016273:Occupational Exposure / Q000009:adverse effects / Q000706:statistics & numerical data; D018635:Rescue Work / Q000706:statistics & numerical data; D018570:Risk Assessment; D047851:September 11 Terrorist Attacks / Q000706:statistics & numerical data; D012737:Sex Factors