An article in this week’s 9/11 special issue of The Lancet, written by Dr Juan P Wisnivesky of the Mount Sinai School of Medicine in New York, USA, and his colleagues states that from over 50,000 rescue and recovery workers estimated to have given assistance following the attack on the World Trade Center (WTC), data collected from 27,000 aid workers proves that a high number of individuals still suffer significantly under the burden of physical and mental illness.
Researchers examined various conditions among a total of 27,449 participants, including police officers, fire-fighters, construction workers, and municipal workers enrolled in the WTC Screening, Monitoring, and Treatment Program. The program, a federally funded system, provides regular physical and mental health examinations to WTC rescue and recovery workers.
Participants were split into four categories based on their level of exposure, i.e. days at WTC-site, work in the pile of debris, and exposure to dust cloud. The categories consisted of low exposure (14% of workers), intermediate (65%), high (18%), and very high exposure (3%). Most participants had an average age of 38 years on the day of the attack with 86% being male and over half (57%) being white.
9 years after the attack, participants’ had a cumulative incidence of 28 % suffering from asthma, 42% of sinusitis, 39% experienced gastro-esophageal reflux disease (GERD) with the cumulative incidence for spirometric abnormalities consisting of 42%, three-quarters of which were low forced vital capacity.
According to the authors:
“Inhalation of toxic, highly alkaline dust (pH=10-11) is the probable cause of upper and lower respiratory injury in rescue and recovery workers.”
While rescue and recovery workers showed a cumulative incidence rate of 28% suffering from depression, 32% from PTSD and 21% experiencing panic disorders, in police officers the cumulative incidence rate was 7%, 9%, and 8% respectively.
The authors state:
“Previous studies have shown that New York City police officers were at lower risk than some responders for developing mental health disorders after the WTC attacks. Possible reasons for these findings include training, previous experience in dealing with similar stressors, self-selection of individuals with high resilience during recruitment into the workforce, and possible under-reporting of psychological symptoms because of perceived job-related repercussions.”
The study revealed that incidence of most disorders was highest in workers with the greatest WTC exposure, such as the risk of asthma, sinusitis, and GERD. Of all participants, almost a tenth of rescue and recovery workers reported to having been diagnosed with all three disorders, while 18% reported to have been diagnosed with 2 out of these 3 conditions. 48 % of workers reported of being diagnosed with asthma, 38% with sinusitis and 43% with GERD.
69% of Rescue workers reported to be diagnosed by a physician with PTSD, 70% with depression and 72% were diagnosed with suffering from panic disorders. Participants also reported significant co-morbidity within and between physical and mental health disorders.
In a concluding statement the authors comment:
“Our findings show a substantial burden of persistent physical and mental disorders in rescue and recovery workers who rushed to the site of the WTC and labored there for weeks and months 10 years ago. Many of these individuals now suffer from multiple health problems. The findings of this study emphasize the need for continued monitoring and treatment of the rescue and recovery worker population and underscore the importance of providing adequate health monitoring and treatment for these individuals. Planning for future disasters should anticipate the probability of persistent physical and mental illness in rescue and recovery workers.”
Dr Matthew P. Mauer from the New York State Department of Health in Troy, NY, USA, says in a linked comment:
“We now know that, in one of the largest WTC rescue and recovery cohorts, health effects have persisted for almost a decade. These latest findings leave no doubt about the necessity of continuing health monitoring, treatment, and research for WTC rescue and recovery workers. Fortunately, our knowledge of these effects is rapidly improving, and studies such as that reported by Wisnivesky and colleagues represent important steps forward. One cannot help but wonder what will be reported when we mark the 20th anniversary of this tragedy. For now, the view ahead is still murky, much like the plumes of acrid smoke that rose in New York City a decade ago.”
Written by Petra Rattue