Post-9/11 Incidence of Systemic Autoimmune Diseases in the FDNY Cohort

描述（由申请人提供）：这个为期两年的项目的总体目标是计算21，786名世界贸易中心（WTC）暴露和未暴露的消防员和紧急医疗服务人员中选定的全身性自身免疫性疾病（SAID）的发病率，并估计强烈的WTC暴露与SAID之间的关联。该提案源于纽约市消防局（FDNY）的WTC计划，在该计划中，调查人员可以完全访问FDNY的监测和治疗记录、出色的队列保留率、证明的联系成员的能力以及从就业记录中准确估计处于风险中的人员时间。将包括以下SAID诊断：系统性红斑狼疮（SLE）、抗磷脂综合征（APS）、系统性硬化症（SSc;弥漫性和局限性）、炎性肌炎（皮肌炎、多发性肌炎或包涵体肌炎）、干燥综合征、类风湿性关节炎（RA）和非RA炎性关节炎（即，银屑病关节炎和脊椎关节炎）。在WTC暴露队列中，尚未进行SAID发病率的流行病学研究。与世贸中心有关的SAID已经引起关注，因为以前对非世贸中心暴露工人的研究表明，暴露于二氧化硅、灰尘和化学品后风险增加，其中许多已知存在于世贸中心灾难现场。此外，对一些病例的临床观察触发了初步记录审查，通过审查，我们确认了31例9/11后病例，并确定了282例需要进一步审查的潜在病例。根据FDNY队列的健康状况及其人口统计学特征（主要是男性），我们预计病例数会比已经观察到的要少。 本提案的具体目标是：目标1：估计2001年9月11日至2013年9月10日纽约FDNY人群中SAID确诊病例的发生率;目标2：进行巢式病例对照研究，以估计WTC暴露对SAID所有亚型确诊病例的效应量

DESCRIPTION (provided by applicant): The overall goal of this two-year project is to calculate the incidence of selected systemic autoimmune diseases (SAID) in 21,786 World Trade Center (WTC)-exposed and unexposed firefighters and emergency medical service workers and to estimate the association between intense WTC exposure and SAID. This proposal originates from the WTC Program at the Fire Department of New York City (FDNY), where investigators have full access to FDNY monitoring and treatment records, excellent cohort retention rates, demonstrated ability to contact members, and accurate estimates of person-time at risk from employment records. The following SAID diagnoses will be included: systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), systemic sclerosis (SSc; both diffuse and limited), inflammatory myositis (dermatomyositis, polymyositis, or inclusion-body myositis), Sjogren's syndrome, rheumatoid arthritis (RA), and non-RA inflammatory arthritis (i.e., psoriatic arthritis and spondyloarthritis). There have been no epidemiologic studies of SAID incidence in WTC-exposed cohorts. WTC- related SAID has arisen as a concern because previous studies of non-WTC exposed workers have demonstrated increased risk after exposure to silica, dusts and chemicals, many of which were known to have been present at the WTC disaster site. Further, clinical observation of some cases triggered a preliminary record review through which we have confirmed 31 post-9/11 cases, and identified 282 potential cases requiring further review. Based on the health of the FDNY cohort and their demographic characteristics (mostly male), we would have expected fewer cases than already observed. The specific aims of this proposal are to: Aim 1: Estimate the incidence of confirmed cases of SAID in the FDNY population from 9/11/2001 until 9/10/2013; and Aim 2: Perform a nested case-control study to estimate the effect size of WTC exposure on confirmed cases of all subtypes of SAID combined