Three large cohort studies examining health issues in World Trade Center rescuers paint a mixed picture, with disturbingly high rates of physical and mental disorders but a paradoxically low all-cause mortality rate thus far, compared with the general New York City population.

More than 50,000 people participated in rescue and recovery work following the 2001 attacks on the World Trade Center a decade ago. A cohort study involving 27,449 of those people who are enrolled in the federally funded WTC Screening, Monitoring, and Treatment Program showed a 9-year cumulative incidence of 28% for asthma, 42% for sinusitis, 39% for gastroesophageal reflux disease (GERD), and 42% for spirometric abnormalities.

Among nonpolice enrollees, the cumulative incidence of depression was 28%, post-traumatic stress disorder (PTSD) 32%, and panic disorder 21%. Police officers had rates of those mental disorders that were only one-third to one-fourth of those rates.

Andrea Booher/FEMA News Photo A New York firefighter digs through the rubble at Ground Zero while wearing a protective mask.

Comorbidities were common among the program enrollees, whose median age was 38 years. Overall, 8.6% of rescue and recovery workers had the triad of physician-diagnosed asthma, sinusitis, and GERD. Another 18% had two of the three diseases. Between 40% and 50% of workers with one or more of those medical diseases were also diagnosed with depression, PTSD, and/or panic disorder. Conversely, nearly 70% of workers with one or more of the psychiatric diagnoses also had asthma, GERD, and/or sinusitis.

"Our findings show a substantial burden of persistent physical and mental disorders in rescue and recovery workers who rushed to the site of the WTC and labored there for weeks and months 10 years ago. Many of these individuals now suffer from multiple health problems," concluded Dr. Juan P. Wisnivesky, of the Mount Sinai School of Medicine, New York, and his associates (Lancet 2011;378:888-97).

Mortality Lower Than Expected. Also appearing in the Lancet’s special 9/11 issue was a study demonstrating that all-cause mortality during 2003-2009 in 13,337 rescue and recovery workers was 55% lower than expected, based upon comparison to a demographically similar New York City general population. Mortality in 28,593 bystanders – nonparticipants in the rescue and recovery work who lived or worked in lower Manhattan – was 39% lower than expected. Both reductions were significant.

09/01/11  

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FROM THE LANCET

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