Nested Case–Control Study of Selected Systemic Autoimmune Diseases in World Trade Center Rescue/Recovery Workers

Abstract

Objective To test the a priori hypothesis that acute and chronic work exposures to the World Trade Center (WTC) site on or after September 11, 2001 were associated with risk of new-onset systemic autoimmune diseases. Methods A nested case–control study was performed in WTC rescue/recovery workers who had received a rheumatologist-confirmed systemic auto-immune disease diagnosis between September 12, 2001 and September 11, 2013 (n = 59), each of whom was individually matched to 4 randomly selected controls (n = 236) on the basis of year of hire (±1 year), sex, race, and work assignment (firefighter or emergency medical service). Acute exposure was defined according to the earliest time of arrival (morning of 9/11 versus later) at the WTC site, and chronic exposure was defined as duration (number of months) of WTC site–related work. Rheumatologists were blinded with regard to each subject’s exposure status. The conditional odds ratios (CORs) with 95% confidence intervals (95% CIs) for incident autoimmune disease were derived from exact conditional logistic regression models. Results Rheumatoid arthritis was the most common autoimmune diagnosis (37% of subjects), followed by spondyloarthritis (22%), inflammatory myositis (14%), systemic lupus erythematosus (12%), systemic sclerosis (5%), Sjogren’s syndrome (5%), antiphospholipid syndrome (3%), and granulomatosis with polyangiitis (Wegener’s) (2%). The COR for incident autoimmune disease increased by 13% (COR 1.13, 95% CI 1.02–1.26) for each additional month worked at the WTC site. These odds were independent of the association between high acute exposure (working during the morning of 9/11) and disease outcome, which conveyed an elevated, but not statistically significant, risk (COR 1.85, 95% CI 0.86–3.89). Conclusion Prolonged work at the WTC site, independent of acute exposure, was an important predictor of post-9/11 systemic autoimmune diseases. The WTC Health Program 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.

Post–September 11, 2001, Incidence of Systemic Autoimmune Diseases in World Trade Center–Exposed Firefighters and Emergency Medical Service Workers

“…Projecting the deficit in cases observed in the lower exposure group, in which FDNY cases reached 83% of expectation, we would have anticipated 18.5 SAID cases among the higher exposure group, which is 11.5 cases fewer than were observed. This result of excess cases in the higher exposure group is supported by our recent case-control study 35 which, using different methodology, found similar results. In that study, prolonged work exposure conferred a 13% increased risk for each month at the WTC site compared with risk in those who worked only 1 month, and early arrival at the WTC site during the morning of 9/11 conferred an additional independent risk (conditional odds ratio, 1.85; 95% CI, 0.86–3.89).…”

Predictors of survival in coexistent hypersensitivity pneumonitis with autoimmune features

“…This pathophysiologic process may explain the autoimmune phenomenon observed in our study in which almost half of those subjects with HP who did not meet our HPAF criteria had either a positive ANA or CTD symptoms. Perhaps like cigarette smokers (25, 26) and coal workers who develop RA (27) , silica-exposed individuals who develop RA and SLE (28-31) , farmers at increased risk of primary systemic vasculitis (32) and the World Trade Center firefighters/rescue workers who developed diverse CTDs (33) , inhaled environmental exposures may trigger autoimmune processes in genetically susceptible individuals.…”

Head and neck cancers associated with exposure to the September 11, 2001 World Trade Center terrorist attacks

“…In this way, immunity plays a critical role in the development of HPV-associated cancers in particular. It has recently also become evident that WTC exposure is associated with autoimmune disease and possible immune dysregulation [16]. As a result, it is possible that systemic immune effects of WTC exposure may synergize with HPV mediated carcinogenesis.…”

“…It has recently also become evident that WTC exposure is associated with autoimmune disease and possible immune dysregulation. 16 As a result, it is possible that systemic immune effects of WTC exposure may synergize with HPV mediated carcinogenesis. Additionally, altered immunity and rheumatological disease have been linked to an inferior response to chemoradiation therapy for HPV1 OPC.…”