A 15-year follow-up study of mortality in a pooled cohort of World Trade Center rescue and recovery workers
A 15-year follow-up study of mortality in a pooled cohort of World Trade Center rescue and recovery workers
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DOI：
10.1016/j.envres.2022.115116
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发表时间：
2022-12-23
影响因子：
8.3
通讯作者：
Boffetta, Paolo
中科院分区：
文献类型：
--
作者：
Li, Jiehui;Hall, Charles B.;Boffetta, Paolo
导言：世界贸易中心（WTC）恐怖袭击的危险暴露与不良健康状况发生率增加有关，通常与死亡率增加有关。我们对WTC救援/恢复工作人员的合并队列进行了15年随访，评估了死亡率。材料和方法：我们从三个WTC暴露队列（N = 60,631）中汇总和去重复的WTC救援/恢复人员队列中分析了截至2016年的死亡率：纽约市消防局（FDNY）；世贸中心健康登记处（WTCHR）；和一般应答者队列（GRC）。估计标准化死亡率（SMRs）以评估美国和纽约州人口的死亡率。使用多变量Cox比例风险模型来检查世贸中心暴露（首次到达日期，在世贸中心瓦砾堆上工作）与死亡风险的关系。结果：在697,943.33人-年的随访中，有1912人死亡。当使用美国（SMR 0.43, 95%可信区间[CI] 0.42-0.45）和纽约州（SMR 0.51, 95% CI 0.49-0.53）作为参考人群时，全因死亡率的SMR均显著低于预期。28种主要死亡原因中，smr均未升高。非fdny /非grc成员在2001年9月11日至2001年9月17日到达世贸中心遗址与2001年9月18日至2002年6月30日到达世贸中心遗址的全因疾病、心脏病和吸烟相关死亡率高出30-50%。相反，2001年9月11日与2001年9月18日至2002年6月30日到达的FDNY成员的全因死亡率和吸烟相关死亡率降低了40%。非FDNY/非GRC成员的全因死亡率（校正风险比[aHR] 1.25, 95% CI 1.04-1.50）和GRC成员的癌症特异性死亡率（aHR 1.39, 95% CI 1.05-1.84）增加，但FDNY成员的死亡率风险较低。结论：与一般人群相比，我们没有观察到WTC救援/恢复人员的死亡率高于一般人群。然而，在一些高WTC暴露亚组中，死亡风险显著增加值得进一步调查。
Introduction: Hazardous exposures from the World Trade Center (WTC) terrorist attacks have been linked to increased incidence of adverse health conditions, often associated with increased mortality. We assessed mortality in a pooled cohort of WTC rescue/recovery workers over 15 years of follow-up.Materials and methods: We analyzed mortality through 2016 in a pooled and deduplicated cohort of WTC rescue/ recovery workers from three WTC-exposed cohorts (N = 60,631): the Fire Department of the City of New York (FDNY); the WTC Health Registry (WTCHR); and the General Responder Cohort (GRC). Standardized mortality ratios (SMRs) were estimated to assess mortality vs. the US and NY state populations. Multivariable Cox proportional hazards models were used to examine associations of WTC exposures (date of first arrival, working on the WTC debris pile) with mortality risk.Results: There were 1912 deaths over 697,943.33 person-years of follow-up. The SMR for all-cause mortality was significantly lower-than-expected, both when using US (SMR 0.43, 95% confidence interval [CI] 0.42-0.45) and NYS (SMR 0.51, 95% CI 0.49-0.53) as reference populations. SMRs were not elevated for any of the 28 major causes of death. Arriving at the WTC site on 9/11-9/17/2001 vs. 9/18/2001-6/30/2002 was associated with 30-50% higher risk of all-cause, heart disease and smoking-related mortality in non-FDNY/non-GRC members. Conversely, arriving on 9/11/2001 vs. 9/18/2001-6/30/2002 was associated with 40% lower all-cause and smoking-related mortality risk in FDNY members. Working on vs. off the WTC pile was associated with an increased risk of all-cause mortality in non-FDNY/non-GRC members (adjusted hazard ratio [aHR] 1.25, 95% CI 1.04-1.50), and cancer-specific mortality in GRC members (aHR 1.39, 95% CI 1.05-1.84), but lower mortality risks were found in FDNY members.Conclusions: We did not observe excess mortality among WTC rescue/recovery workers compared with general populations. However, significantly increased mortality risks among some sub-groups with high WTC exposure warrant further investigation.