title: Mortality among World Trade Center rescue and recovery workers, 2002-2011.
abstract: BACKGROUND
  Rescue and recovery workers responding to the 2001 collapse of the World Trade Center (WTC) sustained exposures to toxic chemicals and have elevated rates of multiple morbidities.
  
  
  METHODS
  Using data from the World Trade Center Health Program and the National Death Index for 2002-2011, we examined standardized mortality ratios (SMR) and proportional cancer mortality ratios (PCMR) with indirect standardization for age, sex, race, and calendar year to the U.S. general population, as well as associations between WTC-related environmental exposures and all-cause mortality.
  
  
  RESULTS
  We identified 330 deaths among 28,918 responders (SMR 0.43, 95%CI 0.39-0.48). No cause-specific SMRs were meaningfully elevated. PCMRs were elevated for neoplasms of lymphatic and hematopoietic tissue (PCMR 1.76, 95%CI 1.06-2.75). Mortality hazard ratios showed no linear trend with exposure.
  
  
  CONCLUSIONS
  Consistent with a healthy worker effect, all-cause mortality among responders was not elevated. There was no clear association between intensity and duration of exposure and mortality. Surveillance is needed to monitor the proportionally higher cancer mortality attributed to lymphatic/hematopoietic neoplasms.
authors.affiliation: Department of Preventive Medicine, Mount Sinai School of Medicine, New York, New York.
authors.forename: Cheryl R
authors.initials: CR
authors.lastname: Stein
authors.affiliation: Department of Preventive Medicine, Mount Sinai School of Medicine, New York, New York.
authors.forename: Sylvan
authors.initials: S
authors.lastname: Wallenstein
authors.affiliation: Department of Preventive Medicine, Mount Sinai School of Medicine, New York, New York.
authors.forename: Moshe
authors.initials: M
authors.lastname: Shapiro
authors.affiliation: Department of Preventive Medicine, Mount Sinai School of Medicine, New York, New York.
authors.forename: Dana
authors.initials: D
authors.lastname: Hashim
authors.affiliation: Department of Population Health, Hofstra North Shore-Long Island Jewish School of Medicine, Great Neck, New York.
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Moline
authors.affiliation: Environmental and Occupational Health Sciences Institute, Robert Wood Johnson Medical Center, Piscataway, New Jersey.
authors.forename: Iris
authors.initials: I
authors.lastname: Udasin
authors.affiliation: Department of Preventive Medicine, Mount Sinai School of Medicine, New York, New York.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Crane
authors.affiliation: Department of Medicine, Stony Brook University, Stony Brook, New York.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Luft
authors.affiliation: Department of Preventive Medicine, Mount Sinai School of Medicine, New York, New York.
authors.forename: Roberto G
authors.initials: RG
authors.lastname: Lucchini
authors.affiliation: Department of Preventive Medicine, Mount Sinai School of Medicine, New York, New York.
authors.forename: William L
authors.initials: WL
authors.lastname: Holden
mesh_terms: D000328:Adult; D000393:Air Pollutants / Q000009:adverse effects; D002423:Cause of Death; D005260:Female; D015989:Healthy Worker Effect; D019337:Hematologic Neoplasms / Q000139:chemically induced / Q000401:mortality; D006801:Humans; D008223:Lymphoma / Q000139:chemically induced / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000139:chemically induced / Q000401:mortality; D009784:Occupational Diseases / Q000139:chemically induced / Q000401:mortality*; D016273:Occupational Exposure / Q000009:adverse effects; D016016:Proportional Hazards Models; D018635:Rescue Work / Q000706:statistics & numerical data*; D047851:September 11 Terrorist Attacks / Q000706:statistics & numerical data*; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000393:Air Pollutants
keywords: World Trade Center attack, 2001; cohort study; epidemiology; mortality; occupational exposure