Steven Stellman - Mortality among survivors of the Sept 11, 2001, World Trade Center disaster: results from the World Trade Center Health Registry cohort

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      Jordan, H. T., Brackbill, R. M., Cone, J. E., Debchoudhury, I.,   Farfel, M. R., Greene, C. M., Hadler, J. L., Kennedy, J., Li, J.,   Liff, J., Stayner, L., Stellman, S. D. 378 (9794)   879-87-

      Abstract: BACKGROUND: The Sept 11, 2001 (9/11)   World Trade Center (WTC) disaster has been associated with   several subacute and chronic health effects, but whether excess   mortality after 9/11 has occurred is unknown. We tested whether   excess mortality has occurred in people exposed to the WTC   disaster. METHODS: In this observational cohort study, deaths   occurring in 2003-09 in WTC Health Registry participants residing   in New York City were identified through linkage to New York City   vital records and the National Death Index. Eligible participants   were rescue and recovery workers and volunteers; lower Manhattan   area residents, workers, school staff and students; and commuters   and passers-by on 9/11. Study participants were categorised as   rescue and recovery workers (including volunteers), or non-rescue   and non-recovery participants. Standardised mortality ratios   (SMR) were calculated with New York City rates from 2000-09 as   the reference. Within the cohort, proportional hazards were used   to examine the relation between a three-tiered WTC-related   exposure level (high, intermediate, or low) and total mortality.   FINDINGS: We identified 156 deaths in 13,337 rescue and recovery   workers and 634 deaths in 28,593 non-rescue and non-recovery   participants. All-cause SMRs were significantly lower than that   expected for rescue and recovery participants (SMR 0.45, 95% CI   0.38-0.53) and non-rescue and non-recovery participants (0.61,   0.56-0.66). No significantly increased SMRs for diseases of the   respiratory system or heart, or for haematological malignancies   were found. In non-rescue and non-recovery participants, both   intermediate and high levels of WTC-related exposure were   significantly associated with mortality when compared with low   exposure (adjusted hazard ratio 1.22, 95% CI 1.01-1.48, for   intermediate exposure and 1.56, 1.15-2.12, for high exposure).   High levels of exposure in non-rescue and non-recovery   individuals, when compared with low exposed non-rescue and   non-recovery individuals, were associated with   heart-disease-related mortality (adjusted hazard ratio 2.06,   1.10-3.86). In rescue and recovery participants, level of   WTC-related exposure was not significantly associated with   all-cause mortality (adjusted hazard ratio 1.25, 95% CI   0.56-2.78, for high exposure and 1.03, 0.52-2.06, for   intermediate exposure when compared with low exposure).   INTERPRETATION: This exploratory study of mortality in a well   defined cohort of 9/11 survivors provides a baseline for   continued surveillance. Additional follow-up is needed to   establish whether these associations persist and whether a   similar association over time will occur in rescue and recovery   participants. FUNDING: US Centers for Disease Control and   Prevention (National Institute for Occupational Safety and   Health, Agency for Toxic Substances and Disease Registry, and   National Center for Environmental Health); New York City   Department of Health and Mental Hygiene.

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