Injury, intense dust exposure, and chronic disease among survivors of the World Trade Center terrorist attacks of September 11, 2001

Abstract

BackgroundThe World Trade Center attack of September 11, 2001 in New York City (9/11) exposed thousands of people to intense concentrations of hazardous materials that have resulted in reports of increased levels of asthma, heart disease, diabetes, and other chronic diseases along with psychological illnesses such as post-traumatic stress disorder (PTSD). Few studies have discriminated between health consequences of immediate (short-term or acute) intense exposures versus chronic residential or workplace exposures.MethodsWe used proportional hazards methods to determine adjusted hazard ratios (AHRs) for associations between several components of acute exposures (e.g., injury, immersion in the dust cloud) and four chronic disease outcomes: asthma, other non-neoplastic lung diseases, cardiovascular disease, and diabetes, in 8701 persons free of those conditions prior to exposure and who were physically present during or immediately after the World Trade Center attacks. Participants were followed prospectively up to 11 years post-9/11.ResultsHeart disease exhibited a dose-response association with sustaining injury (1 injury type: AHR =2.0, 95% CI (Confidence Interval) 1.1–3.6; 2 injury types: AHR = 3.1, 95% CI 1.2–7.9; 3 or more injury types: AHR = 6.8, 95% CI 2.0–22.6), while asthma and other lung diseases were both significantly associated with dust cloud exposure (AHR = 1.3, 95% CI 1.0–1.6). Diabetes was not associated with any of the predictors assessed in this study.ConclusionIn this study we demonstrated that the acute exposures of injury and dust cloud that were sustained on 9/11/2001 had significant associations with later heart and respiratory diseases. Continued monitoring of 9/11 exposed persons’ health by medical providers is warranted for the foreseeable future.

Psychosocial care for hospitalized young survivors after the terror attack on Utøya Island: A qualitative study of the survivors’ experiences

“…Also, it corresponds with findings from other studies on injured survivors after the July 22nd attacks demonstrating high levels of various somatic health problems both among hospitalized and non-hospitalized injured survivors (Grimholt et al, 2018;Manum et al, 2019;Wisloff-Aase et al, 2019). In the long-term aftermath of the attacks, studies have reported positive significant associations between trauma-sustained injury and heart and respiratory disease and reported reduced physical health functioning (Alper et al, 2017;Brackbill et al, 2019;Brackbill et al, 2014). Both being caught in the dust cloud and distress from being injured contributed to respiratory disease for this group (Brackbill et al, 2014).…”

“…Further, the predictive value of clinical measures of injury severity, such as ISS, have been investigated in a few studies, but the findings differ and are inconclusive (Greenspan & Kellermann, 2002;van Delft-Schreurs et al, 2017;Zatzick et al, 2003). A dose-response relationship has been found between number of injury types and later medical diagnoses (Alper, Yu, Stellman, & Brackbill, 2017;Brackbill et al, 2014). Further, initial pain levels and pain control, injuries to the brain, spinal cord, lower extremities, and longer hospitalization have been found to predict poorer selfreported physical health (Holmes et al, 2010;Ramchand et al, 2008;Soberg et al, 2012;Toft, Moller, & Laursen, 2010;van Delft-Schreurs et al, 2017).…”

“…Despite, or perhaps due to, the plausible relationship between injury and somatic health, this association has been limitedly, although increasingly, investigated after traumatic events (Afari et al, 2014;Brackbill et al, 2014;Pacella et al, 2013;van den Berg et al, 2005;Wachen et al, 2013). Studies after the September 11 attacks demonstrated a significant association between sustained injury and various outcomes of physical health (Alper et al, 2017;Brackbill et al, 2019;Brackbill et al, 2014). In a study conducted on survivors after the Oklahoma City bombing, hospitalized survivors reported chronic pain three times more often than persons treated by physicians and nine times more often than non-injured persons (Shariat, Mallonee, Kruger, Farmer, & North, 1999).…”

“…Brackbill et al (2014) found that all injury categories (1, 2, and 3 or more injuries) were at increased risk for later heart and respiratory disease. Also, a dose-response relationship has been found between the level of required care and number of somatic symptoms and medical diagnoses, and between the number of injury types and later respiratory and heart disease (Alper et al, 2017;Brackbill et al, 2014;Shariat et al, 1999). In studies assessing the effect of injury severity measured by ISS, a correlate corresponding with physical morbidity and mortality after physical trauma, the effect on later somatic health varies but often does not predict later self-reported physical health outcomes (Greenspan & Kellermann, 2002;Lovstad et al, 2019;van Delft-Schreurs et al, 2017;Wisloff-Aase et al, 2019;Zatzick et al, 2003).…”

World Trade Center Health Program: First Decade of Research

“…Increased risk of cardiovascular disease (CVD) has been linked to airborne particulate exposures [ 136 ] and severe psychological stress [ 136 , 137 , 138 , 139 ]; therefore, WTC exposures and experiences may potentially increase CVD risks. The relationship between WTC exposures and CVD has been examined in several studies [ 54 , 76 , 140 , 141 , 142 , 143 , 144 , 145 , 146 , 147 ]. Registry enrollees were studied most often [ 54 , 141 , 143 , 144 , 145 , 146 , 147 ].…”