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International Journal of Environmental Research and Public Health

International Journal of Environmental Research and Public Health

Study Links Onsite 9/11 Disaster Relief with Pulmonary Fibrosis

Study Links Onsite 9/11 Disaster Relief with Pulmonary Fibrosis

A recent report has provided evidence that exposure to World Trade Center dust during the 9/11 disaster recovery is associated with increased risk of PF.


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In the International Journal of Environmental Research and Public Health, a group of investigators from the New York City Department of Health and Mental Hygiene have linked dust exposure from the collapse of the World Trade Center towers to pulmonary fibrosis in responders. *

The group explains that nearly half of those involved in the 9/11 relief efforts, lasting through June 2002, were directly exposed to the thick dust cloud on the day of the disaster, and that 93% of responders had begun relief work by the end of September, 2001. While the metals, asbestos, silica and wood dust in the toxic cloud have been previously associated with increased risk of PF, their exposure had not yet been explored in World Trade Center relief workers.

The researchers analyzed data from 19,300 responders enrolled in the WTC Health Registry between 2003 and 2004, following their progress through 2015 (11 years). Exposure was defined mainly as time spent within the dust cloud and working on the debris pile, coupled with intensity of the dust exposure. Additionally, other potential risk factors were taken into account such as age, gender, race, and smoking history, as well as any co-existing medical conditions often present with idiopathic pulmonary fibrosis (IPF), like chronic obstructive pulmonary disorder (COPD), diabetes, gastroesophageal reflux disease (GERD), obstructive sleep apnea (OSA), asthma, and depression/anxiety.

  • The group found 73 self-reported (doctor-confirmed) PF cases, or an incidence rate of about 1 new case per 300 people over 11 years for the 19,300 WTC workers, which far exceeds the estimated IPF incidence in the US general population.
  • They confirmed their theory that intensity of exposure is associated with elevated PF risk: responders with medium and very high levels of exposure were at significantly greater risk than those with low exposure.
  • PF incidence was greater in older adults; men, especially of Latin and Asian ethnicity; those with low income; and current smokers.
  • WTC workers with PF also had high prevelance of lung- and non lung-related conditions, similar to the physical and mental health issues experienced by those with PF in the general population.

Despite its potential biases (for example, self-reported results meant the inability to verify doctors’ findings), the authors conclude that the study found evidence of a relationship between WTC relief workers and PF, while adding weight to PF from occupational exposure. PF is a serious condition that WTC workers should also be watchful for, as early intervention can slow progression.

They recommend further research into this relationship using a larger sample from the WTC Health Registry.

The research article can be found at: https://www.mdpi.com/1660-4601/16/5/825

*Li, J., Cone, J.E., Brackbill, R.M. et al. (2019). Pulmonary fibrosis among World Trade Center Responders: Results from the WTC Health Registry Cohort. International Journal of Environmental Research and Public Health, 16(5), 825.

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