9/11-Related Illness Still Common

Significant health problems continue to affect people exposed to hazards 15 years after the collapse of the World Trade Center towers on September, 11, 2001. Steven Stellman, a professor of Epidemiology, is co-author of four new studies through the World Trade Center Health Registry that report on outcomes, including cancer, acid reflux, asthma, as well job loss and early retirement.

Led by scientists at the New York Department of Health and Mental Hygiene, the studies appear in a special 9/11-themed issue of the American Journal of Industrial Medicine.

“A decade and a half after the terrorist attacks of September 11, we have the clearest picture yet on the effects of the events on the health and wellbeing of those most affected,” says Stellman, the former research director of the Registry.

While the full extent of cancer risk to the affected population may not be known for years, the new research reveals that, as of 2011, rescue/recovery workers at the World Trade Center site had an 11 percent greater overall cancer risk compared to New York State norms. Other survivors experienced an 8 percent increase. The increases among both groups were most notable for cancers of the prostate and melanoma of the skin.

“On the day of the attacks, people in the vicinity of the site were exposed to intense concentrations of fine particulate dust containing hazardous substances, including many known carcinogens including asbestos and silica,” explains Stellman. “Fumes and dust also penetrated people’s homes and workplaces in lower Manhattan, leading to a lengthy and difficult decontamination process.”

Acid Reflux and PTSD

Gastroesophageal reflux disease, or GERD, is one of the most common health conditions reported among persons exposed to the attacks, affecting one in five Registry enrollees in the first two years after 9/11. In the new research, Stellman and his co-authors find that half of those with early GERD symptoms continued to report persistent symptoms ten years after 9/11, and were more likely to report continuing symptoms if they both had asthma and PTSD during the first three years after 9/11.

Many researchers think that GERD, PTSD, and asthma  are all related to to 9/11 exposures and have proposed biological mechanisms by which each of these diseases might exacerbate the others. However, Stellman cautions, there is still some uncertainty as to causal relationships since persons with one or two of these conditions are likely to have more medical exams that could lead to increased likelihood of the third diagnosis.

Staten Island Exposures

Between September, 2001 and July, 2002, nearly two million tons of debris at the WTC site were dismantled and transported by truck and barges for transfer to the Staten Island Fresh Kills Landfill for processing as part of the recovery efforts and criminal investigation. This mass of debris, which ranged from tons of fine dust to twisted metal girders, was meticulously examined for human remains that could aid identification of victims, as well as personal effects of the thousands who perished in the collapse of the buildings.

An estimated 15,000 workers carried out these operations on Staten Island, yet little was known about their specific tasks, exposures, and health outcomes until now. The new study finds that post-9/11-onset asthma was associated with two separate exposure measures: one representing a range of potential dust and fume exposures, and second, a more focused collection of job tasks that included digging, loading, dumping, and welding or steel cutting.

Jobs Picture

Ten years after the disaster, about 7 percent of non-uniformed rescue and recovery workers left their jobs prematurely, about half through early retirement and half due to health-related job loss. Among non-uniformed rescue/recovery workers age 60 or younger who were still working in 2008, those who endured the most serious 9/11-related health burden were most likely to retire early before reaching the age of 60, and most likely to be unemployed for health reasons.

For the one in five study participants with PTSD, the risk was compounded. Those with a chronic health condition and symptoms of 9/11-related PTSD had double the chances of early retirement, while the odds of health-related job loss increased as much as 10-fold, compared to relatively healthy workers

The Registry, which opened in 2003, has enrolled 71,000 people who lived, worked or went to school in the area of the disaster, or were involved in rescue and recovery efforts. Over the past 14 years, scientists have published nearly 70 papers using Registry data, covering many outcomes including physical and mental health, health care access and utilization, birth outcomes, child and adolescent behavior, quality of life, disaster response, and the added impact of Hurricane Sandy on 9/11 exposed persons.

According to Stellman, the Registry will continue to monitor the population to assess changes in health over time, emphasizing chronic illnesses that may take longer to appear, such as cancer, heart disease, and diabetes, as well as broader questions of health care access and utilization, and quality of life.

“We generously respond to disasters by providing immediate humanitarian aid, but disasters can also have a long lasting effect on many people,” he says. “Fifteen years is not a long time, particularly considering much of the data that we're reporting ends about three to five years earlier than today. For chronic diseases, much of the story is still to be written.”