Self-reported Cardiovascular Disease in Career Firefighters With and Without World Trade Center Exposure

Abstract

Objective To assess the effect of World Trade Center (WTC) exposure on cardiovascular disease (CVD) in career firefighters. Methods Firefighters from four US cities completed health questionnaires that provide information about demographics, CVD diagnoses, and CVD risk factors. Firefighters were also compared to respondents of the 2019 National Health Interview Survey (NHIS). Results Greater WTC exposure was positively associated with combined coronary artery disease, myocardial infarction, and angina (termed “CAD”) when comparing WTC-exposed to non-WTC-exposed firefighters. Compared with the NHIS population, firefighters had lower odds of CAD and stroke. Conclusion An occupationally appropriate comparison is important to mitigate potential bias from the healthy worker effect. While the risk of CVD in WTC-exposed and non-WTC-exposed firefighters was significantly lower than a general US population, we observed an exposure gradient where greater WTC exposure was associated with greater odds of CVD.