Post-9/11/2001 lung function trajectories by sex and race in World Trade Center-exposed New York City emergency medical service workers

Abstract

Objective To determine whether lung function trajectories after 9/11/2001 (9/11) differed by sex or race/ethnicity in World Trade Center-exposed Fire Department of the City of New York emergency medical service (EMS) workers. Method Serial cross-sectional study of pulmonary function tests (PFTs) taken between 9/11 and 9/10/2015. We used data from routine PFTs (forced expiratory volume in 1 s (FEV1) and FEV1% predicted), conducted at 12–18 month intervals. FEV1 and FEV1% predicted were assessed over time, stratified by sex, and race/ethnicity. We also assessed FEV1 and FEV1% predicted in current, former and never-smokers. Results Among 1817 EMS workers, 334 (18.4%) were women, 979 (53.9%) self-identified as white and 939 (51.6%) were never-smokers. The median follow-up was 13.1 years (IQR 10.5–13.6), and the median number of PFTs per person was 11 (IQR 7–13). After large declines associated with 9/11, there was no discernible recovery in lung function. In analyses limited to never-smokers, the trajectory of decline in adjusted FEV1 and FEV1% predicted was relatively parallel for men and women in the 3 racial/ethnic groups. Similarly, small differences in FEV1 annual decline between groups were not clinically meaningful. Analyses including ever-smokers were essentially the same. Conclusions 14 years after 9/11, most EMS workers continued to demonstrate a lack of lung function recovery. The trajectories of lung function decline, however, were parallel by sex and by race/ethnicity. These findings support the use of routine, serial measures of lung function over time in first responders and demonstrate no sex or racial sensitivity to exposure-related lung function decline.

Sex and Gender in Research on Healthcare Workers in Conflict Settings: A Scoping Review

“…Physical illnesses were studied in 15 (32%) articles. Only in one article did the study objectives state the aim to compare health outcomes between males and females; the findings showed no differences in lung function and recovery among male and female participants [ 64 ]. Another study reported the prevalence of rhinosinusitis, gastroesophageal reflux disease, and obstructive airway disease among emergency medical staff, with increased rates reported among females compared to males (for example, incidence of rhinosinusitis was 17% for females compared to 8.9% for males) [ 65 ].…”

“…Neurological and respiratory problems, gastroesophageal disorders, and musculoskeletal disorders have been reported among male and female healthcare workers, specifically EMS workers involved in disaster scenes [ 55 , 64 , 65 , 71 ]. While one study reported no sex/gender differences in physical health conditions, other studies reported women having higher prevalence of illnesses than men.…”

Lung function decline before and after treatment of World Trade Center associated obstructive airways disease with inhaled corticosteroids and long‐acting beta agonists

“…Additional details regarding linear mixedeffects models have been detailed previously. 11,18 Three models were evaluated: (1) without potential confounders;…”

“…Additionally, random slope models are sensitive to outlier values and thus, was not presented in the current study. Additional details regarding linear mixed‐effects models have been detailed previously 11,18 …”

World Trade Center Health Program: First Decade of Research

“…In 2016, the prevalence of age-adjusted asthma and GERD diagnosed after 9/11 in Registry enrollees ( n = 36,897) was 14.3% and 20.7%, respectively [ 16 ]. Similarly, several studies of FDNY responders have shown persistent bronchial hyperreactivity and accelerated declines in lung function in some subjects nearing two decades post-exposure [ 21 , 22 , 23 , 24 ].…”