The attacks’ horrific impact continues to be felt, with research from Edith Cowan University in Australia revealing rescue workers are still battling significant health issues related to the event.
IMAGE: RESPONDERS CONTINUE TO FACE HEALTH ISSUES DUE TO 9/11. view more
CREDIT: UNSPLASH.
New research from Edith Cowan University (ECU) in Australia has revealed responders to the 9/11 terrorist attacks are still suffering 20 years later, with many facing significant health issues related to the event.
More than 91,000 responders were exposed to a range of hazards during recovery and clean-up operations, with 80,785 enrolling in the World Trade Center Health Program (WTCHP) set up after the attacks.
ECU Associate Professor Erin Smith is an expert in disaster and emergency response. Her analysis of WTCHP participants shows 3439 are now dead – far more than the 412 who died on the day of the attacks – with aerodigestive illness (34 per cent) the number one cause, ahead of cancer (30 per cent) and mental health (15 per cent).
Deaths attributed to these three factors and musculoskeletal and acute traumatic injuries have increased six-fold since the start of 2016.
More than 36,000 (45 per cent) WTCHP participants have respiratory illness, 16 per cent have cancer and a further 16 per cent have mental health illness.
An ongoing battle
Professor Smith said the ongoing effects of the attacks were clear, as 16,009 responders only enrolled in the WTCHP in the past five years.
“The number of responders enrolling in the program continues to steadily rise,” she said.
The research shows cancer among 9/11 responders is up 185 per cent over the past five years – with leukaemia emerging as particularly prevalent.
“Leukemia has overtaken colon and bladder cancer in the rankings,” Professor Smith said.
“This equates to an increase of 175 per cent in certified leukemia cases within this cohort of responders over a five-year period.
“It’s not surprising: there is a proven link between benzene exposure and acute myeloid leukemia, and benzene is found in jet fuel which was one of the toxic exposures at the WTC site.”
Prostate cancer is also common among responders, increasing 181 per cent since 2016. Although this fits with the age profile of many WTCHP participants, Professor Smith said some responders develop an aggressive, fast-growing form of prostate cancer.
“Inhaling the toxic dust at the WTC site potentially caused a cascading series of cellular events, increasing the number of inflammatory T-cells in some of these 9/11 responders,” she said.
“This increased inflammation may eventually lead to prostate cancer.”
The mental effects
It’s estimated 15 to 20 per cent of 9/11 responders are living with post-traumatic stress disorder symptoms – roughly four times the rate of the general population.
Despite 20 years having passed, many studies show PTSD is a growing problem for responders, which contrasts with the decline found in the general population.
“Even almost 20 years later, the prevalence of mental health disorders and need for mental health treatment remains elevated among this group of 9/11 responders: almost half of all responders report an ongoing need for mental health care,” Professor Smith said.
Researchers have also found many brain scans on 9/11 responders indicate the onset of early-stage dementia.
This is consistent with previous work noting cognitive impairment among responders occurs at about twice the rate of people 10 to 20 years older.
COVID and other emerging threats
Responders’ underlying conditions have also left them uniquely vulnerable to COVID-19, due to illnesses such as cancer and respiratory ailments.
More than 100 have died due to complications from the virus, which has also exacerbated many responders’ PTSD symptoms.
It’s also expected the number of responders with cancers associated with their exposure to asbestos at the World Trade Center site will rise in the coming years, as mesothelioma usually takes 20-50 years to develop.
“We are now beginning to understand the long-term effects of responding to the 9/11 terrorist attacks,” Professor Smith said.
“9/11-exposure is still causing both physical and mental health impact to responders and it’s likely responders are still developing illnesses related to their exposures.”
9/11 RESPONDER HEALTH STATISTICS
CAUSES OF DEATH (3439 FATALITIES)
Aerodigestive illness (34 per cent)
Cancer (30 per cent)
Mental health (15 per cent)
MOST COMMON CANCERS
Non-melanoma skin cancer
Prostate cancer
Melanoma
MOST COMMON AERODIGESTIVE ILLNESSES AMONG 9/11 RESPONDERS
Asthma
Chronic rhinosinusitis
Gastroesophageal reflux disease
Background
Erin Smith is an Associate Professor in Disaster and Emergency response at Edith Cowan University’s School of Medical and Health Sciences.
Based in Melbourne, she has spent the past 18 years researching the ongoing effects of the 9/11 attacks after meeting the widow of a firefighter at a Brooklyn café.
She has since had many research papers published on the topic.
Her latest paper, Health trends among 9/11 responders from 2011-2021: A review of World Trade Center Health Program statistics, is published in Prehospital and Disaster Medicine.
JOURNAL
Prehospital and Disaster Medicine
METHOD OF RESEARCH
Data/statistical analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Health Trends among 9/11 Responders from 2011–2021: A Review of World Trade Center Health Program Statistics
ARTICLE PUBLICATION DATE
1-Sep-2021
COI STATEMENT
None
Losing weight and treating excess levels of fat in the blood may help prevent lung disease in firefighters exposed to dangerous levels of fine particles from fire, smoke, and toxic chemicals on Sept. 11, 2001, a new study shows. Experts have long feared that this exposure would later lead to lung disease in first responders. High body mass index (BMI), an indicator of obesity, and exposure to the highest levels of toxins from the attack on the World Trade Center were the two greatest risk factors for lowered lung function, according to the study authors.
After two decades of research analyzing thousands of first responders, a new investigation led by researchers at NYU Grossman School of Medicine identified a cluster of five factors that predicted lung disease in these patients. Along with excess body fat, the combination of insulin resistance, high blood pressure, and increased levels of sugar and cholesterol in the blood are components of so-called metabolic syndrome, a group of medical issues known to raise the risk of heart disease, stroke, and diabetes.
Adjusting at least one of these factors, the study investigators found, can greatly lower the risk of firefighters’ developing lung disease within five years, even 20 years after toxic exposures at Ground Zero. For example, for a male firefighter of average height, a 7-pound weight loss could decrease his risk for lung injury by 20 percent.
“Our findings should reassure World Trade Center first responders that there are steps they can take to protect their lungs even decades after exposure,” says study co-lead author Sophia Kwon, DO, MPH. Kwon is a fellow in the Division of Pulmonary, Critical Care, and Sleep at NYU Langone Health.
In work presented earlier this year on 100 overweight 9/11 firefighters, the team found that placing patients on a calorie-restricted Mediterranean diet featuring unrefined grains, olive oil, fruits, and fish reduced their risk of lung disease. Those following the regimen for six months lost nearly 2 BMI points (from an average BMI of about 33 to an average of 31) and had fewer signs of lung disease than they had reported before the study period.
“These results offer firefighters a concrete way to lose weight and achieve the lung-health benefits predicted by our risk model,” says study co-lead author George Crowley, BA, a predoctoral fellow at NYU Langone.
Experts had previously understood that first responders who developed metabolic syndrome shortly after 9/11 were more likely to have higher rates of asthma. However, lung injury risks for a firefighter whose metabolic syndrome instead appeared later in life remained unclear until now.
The new study, publishing Sept. 2 in the American Journal of Respiratory and Critical Care Medicine, is part of what is likely the longest-running and most thorough exploration of the impact of metabolic syndrome on lung injury in 9/11 firefighters, according to the study authors. In addition, the investigation is the first to date to quantify how adjusting one or more of these risk factors changes lung disease risk.
For the investigation, the research team analyzed 20 years of data from more than 5,700 firefighters active on 9/11, of whom 1,475 later developed lung disease. Along with BMI, the data collected included smoking history, and whether they had served at the World Trade Center in early morning when pollutant exposure was at its peak.
“The lessons from our investigation can be applied not only to firefighters but to the millions of city dwellers exposed to air pollution on a daily basis,” says study senior author and pulmonologist Anna Nolan, MD. “They should be aware that while their environment poses real health risks, they may still minimize their risk of lung disease even if they cannot change their exposure.”
Nolan, a professor in the Departments of Medicine and Environmental Health at NYU Langone, cautions that while promising, the Mediterranean diet investigation only examined a small, specific group.
As a result, the research team next plans to expand the study to determine whether the diet could benefit a more diverse population who have been similarly exposed to urban pollutants. They also plan to explore how metabolic syndrome may affect other measures of lung function like asthma, says Nolan.
Funding for the study was provided by National Institutes of Health grants R01 HL119326 and CDC/NIOSH U01 OH11300, and National Institute of Environmental Health Sciences grant R01 ES032808. Further funding support was provided by the World Trade Center Health Program Clinical Centers of Excellence 200-2017-93426 and Data Center 200-2017-93326.
In addition to Kwon, Crowley, and Nolan, other NYU Langone investigators involved in the study included Myeonggyun Lee, MS, and Mengling Liu, PhD. Other study authors were Theresa Schwartz, MS; Rachel Zeig-Owens, DrPhil, MPH; and David Prezant, MD; at the Fire Department of New York in Brooklyn.
Media Inquiries
Shira Polan
212-404-4279
shira.polan@nyulangone.org
JOURNAL
American Journal of Respiratory and Critical Care Medicine
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Dynamic Metabolic Risk Profiling of World Trade Center-Lung Disease: A Longitudinal Cohort Study
ARTICLE PUBLICATION DATE
2-Sep-2021
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