Epidemiology of Respiratory Health Outcomes Among World Trade Center Disaster Workers: Review of the Literature 10 Years After the September 11, 2001 Terrorist Attacks

Abstract

<jats:title>ABSTRACT</jats:title><jats:p>Tens of thousands of workers participated in rescue, recovery, and cleanup activities at the World Trade Center (WTC) site in lower Manhattan after the terrorist attacks on September 11, 2001 (9/11). The collapse of the WTC resulted in the release of a variety of airborne toxicants. To date, respiratory symptoms and diseases have been among the most examined health outcomes in studies of WTC disaster workers. A systematic review of the literature on respiratory health outcomes was undertaken to describe the available information on new onset of respiratory symptoms and diseases among WTC disaster workers after September 11, 2001. Independent risk factors for respiratory health outcomes included being caught in the dust and debris cloud, early arrival at the WTC site, longer duration of work, and delaying mask and respirator use. Methodological challenges in epidemiologic studies of WTC disaster workers involved study design, exposure misclassification, and limited information on potential confounders and effect modifiers. In the 10 years after 9/11, epidemiologic studies of WTC disaster workers have been essential in investigating the respiratory health consequences of WTC exposure. Longitudinal studies along with continued medical surveillance will be vital in understanding the long-term respiratory burden associated with occupational WTC exposure. (<jats:italic>Disaster Med Public Health Preparedness</jats:italic>. 2011;5:S189–S196)</jats:p>

Respiratory symptoms among search and rescue workers who responded to the 2016 Taiwan earthquake

“…The two major types of air pollutants included intermediate (2.5–10 µm) to large (>10 µm) respirable particulates from structural collapses and fires, as well as small particles (<2.5 µm) containing toxic combustion products, such as polycyclic aromatic hydrocarbons, from clean-up processes and gasoline-powered equipment 23 24. Independent risk factors for respiratory health outcomes were identified as being caught in the dust and debris cloud, early arrival at the World Trade Center site, longer work duration, and delaying use of mask and respirator 25. The increased respiratory symptoms may be an early indicator of a disease, and regular follow-up is necessary among the SRWs.…”

Quantitative bias analysis in an asthma study of rescue-recovery workers and volunteers from the 9/11 World Trade Center attacks

“…Additionally, capturing environmental data soon after a disaster may be difficult. Therefore, registry data of man-made disaster exposures generally lack specificity and thus rely on proxies [22, 23]. For instance, exposure to the 9/11 dust cloud as a “yes” or “no” response could have been interpreted numerous ways by those answering the WTCHR question.…”

“…Accordingly, efforts have been made to improve disaster studies [22, 25]. The methodological challenge of evaluating biases occurs in every area of epidemiology.…”

The implementation of medical monitoring programs following potentially hazardous exposures: a medico-legal perspective

“…In addition to medical monitoring, the World Trade Center Health Program also pays for treatment of a wide variety of health conditions provided that a program physician determines that 9/11-related exposures were a significant factor in causing or exacerbating the condition. Numerous studies have been published in the peer-reviewed medical literature using data collected by the World Trade Center Health Program and related World Trade Center Health Registry [26][27][28][29][30][31][32][33][34][35][36][37][38]. As with the FMMP, the World Trade Center Health Program is an extensive program, which may be more reflective of American sentiments towards World Trade Center responders than strict scientific principles, with funding in excess of $1 billion.…”