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名暴露于世界贸易中心(WTC)的消防员和紧急医疗服务人员中选定的系统性自身免疫性疾病(SAID)的发病率，并估计强烈暴露于WTC和SAID之间的联系。这项建议源于纽约市消防局(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，证明有能力联系成员，并根据就业记录准确估计面临风险的人员时间。以下诊断将包括：系统性红斑狼疮(SLE)、抗磷脂综合征(APS)、系统性硬化症(SSC；包括弥漫性和局限性)、炎症性肌炎(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炎症性关节炎(即牛皮癣关节炎和脊椎炎)。在暴露于WTC的队列中，尚无上述发病率的流行病学研究。与WTC相关的SAID之所以成为一个令人担忧的问题，是因为之前对非WTC接触工人的研究表明，接触二氧化硅、粉尘和化学品后风险增加，其中许多已知出现在WTC灾难现场。此外，对一些病例的临床观察引发了初步的记录审查，通过审查，我们已经确认了31例9/11事件后的病例，并确定了282例需要进一步审查的潜在病例。根据FDNY队列的健康状况和他们的人口统计特征(主要是男性)，我们预计病例会比之前观察到的要少。这项建议的具体目的是：目标1：估计2001年9月11日至2013年9月10日期间纽约地区人群中确诊病例的发病率；目标2：进行嵌套病例对照研究，以估计WTC暴露对上述合并所有亚型确诊病例的影响程度。

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