![[ Visit Client Website ]](images/banner.jpg)
BACKGROUND: The Fire Department of the City of New York World Trade Center (WTC) Health Program follows nearly 16,000 workers who participated in the WTC rescue/recovery effort. Clinical observation of rare systemic autoimmune diseases triggered this investigation. The goal of the current work is to test the a priori hypothesis that acute (arrival time at the WTC site) and chronic (months of WTC-related work) exposures were associated with risk of new onset systemic autoimmune diseases.
METHODS: We performed a nested case-control study by individually matching each rheumatologist-confirmed case of systemic autoimmune disease diagnosed between 9/12/2001 and 9/11/2013 (n=59) to 4 randomly selected controls (n=236) that were matched for year of hire (±1 year), gender, race and work assignment (firefighter or Emergency Medical Service). Rheumatologists were blinded to exposure status. Conditional odds ratios (COR) and 95% confidence intervals (95% CI) were derived from exact conditional logistic models.
RESULTS: Rheumatoid arthritis (37%) was the most common autoimmune diagnosis, followed by spondyloarthritis (22%), inflammatory myositis (14%), systemic lupus ethythematosus (12%), systemic sclerosis (5%), Sjögrens syndrome (5%), antiphospholipid syndrome (3%) and granulomatosis with polyangiitis (Wegener’s) (2%). The COR of autoimmune disease increased by 13% for each additional month worked at the WTC site (95% CI 1.02-1.26) and was independent of the association between high acute exposure (working at the WTC site during the morning of 9/11/2001) and disease outcome, which was elevated, but not statistically significant (COR 1.85 95% CI 0.86-3.89).
CONCLUSIONS: Prolonged work at the WTC site, independent of acute exposure, was an important predictor of post-9/11 systemic autoimmune diseases. World Trade Center Health Programs throughout New York City should expand surveillance efforts for those with extended exposures as early detection can facilitate early treatment, which has been shown to minimize organ damage and improve quality of life.