Health Department Announces New Research on Health Effects of The World Trade Center Disaster

Five research articles describe long-term health impacts of the World Trade Center attacks on rescue/ recovery workers and civilian survivors enrolled in the World Trade Center Health Registry

September 9, 2016 – As the fifteenth anniversary of the World Trade Center disaster nears, the Health Department announced new findings on the health impacts on rescue and recovery workers and civilians exposed to the September 11, 2001 terrorist attacks. The findings from the World Trade Center Health Registry, recently published in a special 9/11 issue of the American Journal of Industrial Medicine, highlight longer-term physical and mental health impacts. A summary of study findings include:

  1. More cancer cases than expected were found for all cancer types combined among rescue/recovery workers, and civilian survivors, compared with the New York State general population between 2007-2011 (11% and 8% respectively). Prostate cancer contributed substantially to the total excess of cancer across all sites.
  2. Asthma and post-traumatic stress disorder (PTSD) were each independently associated with both the persistence of Gastroesophageal Reflux Symptoms (GERS) that was present shortly after 9/11, as well as development of GERS years later in people without GERS in the early years after 9/11.
  3. Workers with 9/11-related chronic health conditions were more likely to experience early retirement or job loss. The likelihood of early retirement and job loss increased considerably when the worker also had PTSD.
  4. Enrollees who were in the World Trade Center Towers at the time of the attack were 30 percent more likely to have PTSD and 50 percent more likely to be frequent binge drinkers 10 years after 9/11.
  5. Workers involved in World Trade Center recovery at the Fresh Kills Landfill and on barges had an increased risk of new-onset asthma, with 5.4 percent of enrollees reporting newly diagnosed asthma through 2004.
“We are committed to learning as much as we can about the health effects of the World Trade Center disaster,” said Health Commissioner Dr. Mary T. Bassett. “Fifteen years later, the Department’s World Trade Center Health Registry is tracking the health of 71,000 people directly exposed to the attacks and referring them to care through the federal WTC Health Program. The Registry plays a critical role in understanding how disasters of this scope and nature affect the health and well-being of first responders, area workers and residents over time.”

“The findings contained in these very important World Trade Center Health Registry reports clarify what many of us have known for a long period of time: that dedicated DSNY workers involved in the massive WTC recovery operations at the attack site and at our barge and Fresh Kills sites were exposed to incredible health risks and challenges,” said Sanitation Commissioner Kathryn Garcia. “These workers carried out their essential jobs in a most professional manner under extremely adverse conditions and it is no surprise that some are now experiencing medical or psychological issues,” she added. “They all deserve our profound thanks and we appreciate that the Registry is focusing on their well-being.”

The publications provide updates on the course of previously reported 9/11-related health conditions, including common co-occurring conditions such as PTSD and asthma and how they influence the course of other 9/11-related conditions, such as GERS. The findings also include a first look at early retirement and job loss. The findings highlight the importance of long-term integrated care for mental and physical health conditions after a disaster and the benefits of having registries, such as the WTC Health Registry as part of a post-disaster response.

"As one of the authors of the James Zadroga 9/11 Health and Compensation Act, I have fought to make sure that the countless responders and survivors who have suffered from 9/11 related illnesses are guaranteed the care they need," said Congressman Jerry Nadler. "Unfortunately, for the last fifteen years, all signs have told us that the health effects of 9/11 exposures are ongoing and grave. The research findings announced today continue to bear this out. The World Trade Center Health Registry and the research it has enabled has helped make sure that the medical experts can do their jobs and that Congress can continue to support our 9/11 victims and heroes."

“Fifteen years after the 9/11 attacks we continue seeing how New Yorkers’ health has been affected. That’s why it was so critical Congress pass funding for the Zadroga Health Act, which cares for first responders and others suffering from 9/11-related ailments. These studies makes clear how extensive these problems are and underscores that we must continue caring for those who were harmed,” said Congresswoman Nydia M. Velásquez.

"An important component of providing adequate care, and creating appropriate policies and resources for 9/11 heroes and our communities is understanding long-term health impacts," said State Senator Daniel Squadron. “The WTC Health Registry is an important part of ensuring New York can fulfill its obligation to provide health resources to first responders and our community whose health could be at risk. Thank you to the New York City Department of Health and Mental Hygiene, the federal Agency for Toxic Substances and Disease Registry, and the National Institute of Occupational Safety and Health."

“With the important findings provided by the World Trade Center Health Registry, the health and well-being of our great city remains our highest priority,” said Assembly Member Alice Cancel. “I would like to commend the WTC Health Registry for their ongoing effort to help those of my Assembly District and the many more who were affected by the disaster of the World Trade Center 15 years ago. Their ongoing work continues to save lives."

“For a long time, we have believed that the physical and mental health impacts of 9/11 are long lasting but continued research is essential to determine the accuracy of that belief. It is vital to understanding these impacts more thoroughly so we can best support residents and recovery workers. I appreciate the efforts of the New York City Department of Health and Mental Hygiene and the leadership of Commissioner Bassett for continuing to track and study these impacts,” said Assembly Member Deborah J. Glick.

“As we approach the 15th anniversary of 9/11, the new findings published by the Health Department’s World Trade Center Health Registry reminds us that the impact of that horrific day did not end on September 12th, 2001. The continued analysis and research done by the New York City Health Department should be applauded as we continue to fight for the resources necessary to fully treat and heal our first responders,” said Brooklyn Borough President Eric L. Adams.

"The terrorist attacks of September 11, 2001, shook our city and our nation to its core, and we continue to feel the impact today. As our city continues to feel the aftermath of 9/11, it is important that we continue to chronicle and study the long-term health effects of this tragedy. These findings illustrate the deep and lasting wounds 9/11 caused by the attacks and their aftermath, and are an important resource for government and health officials to guide policy and treatment options for those who continue to suffer from the fallout. I thank the Health Department for their continued commitment to those affected by the horrible events of 15 years ago," said Bronx Borough President Ruben Díaz Jr.

“This information is crucial as we continue to seek the best possible care for people exposed to the World Trade Center attack,” said Council Member Corey Johnson, Chair of the Committee on Health. “As this research demonstrates, the health conditions that resulted from the attack are serious and wide-ranging. To successfully treat our fellow New Yorkers, we need to be armed with comprehensive, actionable data. That’s exactly what the Department of Health and Mental Hygiene is releasing, and I thank Commissioner Dr. Mary Bassett and her outstanding staff for this critical, life-saving work.”

“Fifteen years after the World Trade Center disaster, residents, workers and responders are still suffering from the negative physical and mental effects of one of the most devastating attacks in our nation’s history,” said Council Member Margaret S. Chin. “Because of the huge scale of this tragedy, it is incredibly important that we continue to monitor the long-term impacts so that we are in a better position to provide targeted services to those in need. I thank Mayor de Blasio and Commissioner Bassett for their commitment to the WTC Health Registry and to the health and well-being of residents of all ages, as well as the people who answered the call for help when our City needed it most.”

“I commend the New York City Department of Health and Mental Hygiene for spearheading these research studies to update all of us concerned about the mental and physical health of rescue and recovery workers, as well as civilians affected by the tragic 9/11 attack,” said New York City Council Member Andrew Cohen. “Among other important findings, symptoms of post-traumatic stress disorder that occurred due to building evacuation issues have been extensively documented, which will be helpful to us as we work to improve our disaster response approaches.”

Cancer Ten Years after 9/11

Since its inception, cancer surveillance has been a priority for the World Trade Center Health Registry. The Registry first examined cancer incidence from 2003 to 2008 in a study that found more cases than expected of prostate cancer, thyroid cancer, and multiple myeloma among rescue/recovery workers enrolled in the Registry, compared to the general New York State population. The article “Ten-year cancer incidence in rescue/recovery workers and civilians exposed to the September 11, 2001 terrorist attacks on the World Trade Center” presents findings from a follow up study of cancer incidence.

The study found that for all cancer sites combined from 2007-2011, there were 11 percent more cancer cases than expected among rescue/recovery workers, and 8 percent more among civilian survivors compared with the New York State general population. Prostate and thyroid cancer remained elevated among rescue/recovery workers. There were also a small, but higher than expected, incidence of skin melanoma in rescue/recovery workers and non-responder civilian survivors. Among civilian survivors, the study found elevated incidence of female breast cancer and non-Hodgkin’s lymphoma. The findings also provide limited evidence for a causal link between 9/11 exposure and cancer. These findings need to be substantiated by additional follow up studies over time.

Asthma and PTSD Impact on Gastroesophageal Reflux Symptoms (GERS)

Increased rates of GERS, asthma and PTSD have been frequently reported in those exposed to 9/11. The study “Effect of asthma and PTSD on persistence and onset of gastroesophageal reflux symptoms among adults exposed to the September 11, 2001, terrorist attacks” examined the interrelationships among these three conditions.

The study found that many (46.5%) participants with GERS developed shortly after 9/11 had persistent GERS almost 10 years later. Asthma and PTSD were each independently associated with both the persistence of GERS that was present shortly after 9/11, as well as development of GERS in people without early post-9/11 GERS. Enrollees who developed asthma soon after 9/11 compared to those who didn’t were 20% more likely to have persistent GERS and 50% more likely to develop GERS 10 years after 9/11. Enrollees with PTSD symptoms 2 to 3 years after 9/11 were 30% more likely than those without to have persistent GERS and 60% more likely to develop GERS 10 years after 9/11. These findings suggest that integrated physical and mental care could lessen the longer-term health effects of 9/11.

Chronic Conditions and Early Retirement or Job Loss

The study “Impact of 9/11-related chronic conditions and PTSD comorbidity on early retirement and job loss among WTC disaster rescue and recovery workers,” examined the economic impact of the 9/11 terrorist attacks. The research looked at the association between 9/11-related chronic health conditions, and early retirement and job loss. The study found that disasters like the 9/11 terrorist attacks have a large ripple effect on individual’s overall well-being, including their health, employment, and earnings.

Findings indicate that non-uniformed rescue/recovery workers with 9/11-related chronic health conditions were more likely to experience early retirement or job loss. The likelihood increased considerably when the worker also had PTSD. For example, workers with three or more chronic health conditions and PTSD had a 10 times higher likelihood of experiencing job loss, five to ten years after 9/11.

Mental Health Status of WTC Tower Survivors

“Mental health status of World Trade Center Tower survivors compared to other survivors a decade after September 11, 2001 Terrorist Attacks” is the first long-term study conducted on one of the most highly exposed 9/11 groups: the people who evacuated the Twin Towers. The study compares the mental health status of people who were in the World Trade Center (WTC) towers, other surrounding buildings, or on the street the morning of the September 11th terrorist attacks.

Evacuees of the WTC towers were 30 percent more likely to have PTSD and 50 percent more likely to be frequent binge drinkers 10 years after 9/11. Infrastructure challenges and behavioral challenges experienced during evacuation were significantly associated with having PTSD. Infrastructure challenges included access to stairways and exits. Behavioral challenges included perception of danger, panic, and anxiety. Understanding the effects of challenges to building evacuation on the long-term mental health status of survivors can help in the planning of continuing post-disaster treatment.

Asthma among Staten Island Fresh Kills Landfill and Barge Workers

The study “Asthma among Staten Island Fresh Kills Landfill and Barge Workers Following the September 11, 2001 World Trade Center Terrorist Attacks” is a look at the health of an understudied group. Asthma newly diagnosed between Sept. 2001 and Dec. 2004 was reported by 100 of the 1,836 (5.4%) enrollees included in this analysis. Workers with increased risk of new-onset asthma included those who had jobs involving sifting, digging, welding, and steel cutting, high landfill/barge exposure, were police and sanitation workers, or had probable PTSD. Post-9/11 asthma cumulative incidence among Staten Island landfill/barge workers was similar to that of other WTC disaster rescue and recovery workers.

About the World Trade Center Health Registry

The World Trade Center Health Registry became the largest post-disaster public health registry in United States history when 71,000 people directly exposed to the September 11th terrorist attacks voluntarily enrolled in 2003-2004. It is also one of the longest-running post-disaster registries globally. To date, the Registry has conducted three follow-up health surveys in 2006-07, 2011-12 and 2015-16. The Registry includes rescue and recovery workers and people who lived, worked, went to school or were on the street or in transit in Lower Manhattan. It monitors physical and mental health outcomes, quality of life, functioning, gaps in care and potential emerging health conditions.

The World Trade Center Health Registry continues to devote much effort to reaching out to enrollees to refer them to care at no cost through the federal World Trade Center Health Program. The Registry has become a leading source of new applications to the World Trade Center Health Program from responders and survivors and underrepresented groups, such as Spanish and Chinese speakers.

Enrollment in the Registry was completed in 2004. Registry findings continue to contribute to understanding the health impacts of 9/11 among all people exposed to the disaster. The Registry was established by the New York City Department of Health and Mental Hygiene and the federal Agency for Toxic Substances and Disease Registry. The National Institute of Occupational Safety and Health has funded the Registry since May 2009. As of September 2016, the Registry has published more than 75 peer-reviewed papers in scientific journals. More information about the Registry and its findings can be found on the Registry’s website, including brief videos reporting on these and other findings.

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