Health Trends among 9/11 Responders from 2011–2021: A Review of World Trade Center Health Program Statistics

Abstract

Introduction: In a single day, the September 11, 2001 US terrorist attacks (9/11) killed nearly 3,000 people, including 412 first responders. More than 91,000 responders were exposed to a range of hazards during the recovery and clean-up operation that followed. Various health programs track the on-going health effects of 9/11, including the World Trade Center (WTC) Health Program (WTCHP). The objective of this research was to review WTCHP statistics reported by the Centers for Disease Control and Prevention (CDC) to analyze health trends among enrolled responders as the 20-year anniversary of the terrorist attacks approaches. Methods: The WTCHP statistics reported by the CDC were analyzed to identify health trends among enrolled responders from 2011 through 2021. Statistics for non-responders were excluded. Results: A total of 80,745 responders were enrolled in the WTCHP as of March 2021: 62,773 were classified as general responders; 17,023 were Fire Department of New York (FDNY) responders; and 989 were Pentagon and Shanksville responders. Of the total responders in the program, 3,439 are now deceased. Just under 40% of responders with certified health issues were aged 45-64 and 83% were male. The top three certified conditions among enrolled responders were: aerodigestive disorders; cancer; and mental ill health. The top ten certified cancers have remained the same over the last five years, however, leukemia has now overtaken colon and bladder cancer as the 20-year anniversary approaches. Compared to the general population, 9/11 first responders had a higher rate of all cancers combined, as well as higher rates of prostate cancer, thyroid cancer, and leukemia. Discussion: Trends in these program statistics should be viewed with some caution. While certain illnesses have been linked with exposure to the WTC site, differences in age, sex, ethnicity, smoking status, and other factors between exposed and unexposed groups should also be considered. Increased rates of some illnesses among this cohort may be associated with heightened surveillance rather than an actual increase in disease. Still, cancer in general, as well as lung disease, heart disease, and posttraumatic stress disorder (PTSD), seem to be increasing among 9/11 responders, even now close to 20 years later. Conclusion: Responders should continue to avail themselves of the health care and monitoring offered through programs like the WTCHP.

Non-cancer health risks in firefighters: a systematic review

“…A total of 66 studies were identified in our systematic search of the four main databases. During the literature selection process, we excluded studies related to the World Trade Center (WTC) disaster that occurred on September 11, 2001 [ 82 ]. The WTC disaster released a large quantity and variety of toxicants into the environment, affecting rescue and recovery workers as well as community members.…”

A Prospective Post-disaster Longitudinal Follow-up Study of Emotional and Psychosocial Outcomes of the Oklahoma City Bombing Rescue and Recovery Workers During the First Quarter Century Afterward

“…A study of 9/11 responders using a full diagnostic assessment 11-13 years after the disaster found that 18% had a history of 9/11-related PTSD while 10% of the responders were still present (not remitted). 7 A large cohort of (> 91000) responders to the 9/11 attacks was assessed as part of a worker health care program, and a recent review of this work 8 found that in the second decade after the attacks, 16% still had current MH problems of which 11% were with PTSD, 3% with depression, and 3% with anxiety disorder. These disorders were assessed using a combination of structured diagnostic interviews, self-report symptom checklists, and clinician assessments or mental health treatments at different points in time.…”

Lifestyle and environmental factors may induce airway and systemic inflammation in firefighters

“…Although the International Agency for Research on Cancer (IARC) has identified outdoor air pollution as carcinogenic to humans, a recent IARC report has classified firefighting as only a possible carcinogen (Group 2B) (IARC 2013 , 2021 ; Barros et al 2021 ). However, some studies (Daniels et al 2014 ; Jalilian et al 2019 ; Soteriades et al 2019 ; Pinkerton et al 2020 ; Laroche and L'Espérance 2021 ; Smith et al 2021 ) indicated a significant increase in the incidence of, among others, rectal, prostate, bladder and testicular cancer, as well as mesothelioma and malignant melanoma in firefighters compared to the general population. Cancer as well as cardiovascular disease (sudden cardiac death (SCD) causes about 45% of on-duty fatalities) are the leading cause of death in this occupational group (International Association Of Fire Fighters—IAFF n.d. ; Soteriades et al 2011 ; Daniels et al 2014 ; Smith et al 2019b ).…”

“…It was observed that diseases such as cancer, lung disease, heart disease, and post-traumatic stress disorder appear to be more common in World Trade Center terrorist rescue workers than in the general population, even now over 20 years later (Smith et al 2021 ), and the risk of cancer death (e.g., in lung cancer and leukemia) increases with longer and frequent firefighters’ exposure to the fire environment (Daniels et al 2015 ). The impact of occupational exposure of firefighters on their health has been intensively studied in recent years, but still the evidence suggesting a cause-and-effect relationship is limited and unclear (Barros et al 2021 ).…”