Post-9/11 sarcoidosis in WTC-exposed firefighters and emergency medical service workers

Abstract

Introduction The World Trade Center (WTC) disaster released a huge quantity and variety of toxicants into the environment. To-date, studies from each of the three major cohorts of WTC-exposed workers have suggested “greater than expected” numbers of post-9/11 cases in some workers. We undertook this study to estimate the incidence of post-9/11 sarcoidosis in ~13,000 male firefighters and EMS workers enrolled in The Fire Department of the City of New York (FDNY) WTC Health Program; to compare FDNY incidence to rates from unexposed, demographically similar men in the Rochester Epidemiology Project (REP); and, to examine rates by level of WTC exposure. Methods We calculated incidence of sarcoidosis diagnosed from 9/12/2001 to 9/11/2015, and generated expected sex- and age-specific rates based on REP rates. Standardized incidence ratios (SIR) based on REP rates, and 95% confidence intervals (95% CI) were estimated. Two sensitivity analyses limited cases to those with intra-thoracic symptoms or biopsy confirmation. Results We identified 68 post-9/11 cases in the FDNY cohort. Overall, FDNY rates were significantly higher than expected rates (SIR= 2.8; 95% CI= 2.2, 3.6). Including only symptomatic cases, the SIR decreased (SIR= 2.2; 95% CI=1.5, 3.0), but remained significantly elevated. SIRs ranged from 2.7 (95% CI=2.0, 3.5) in the lower WTC exposure group to 4.2 (95% CI=1.9, 8.0) in the most highly exposed. Conclusions We found excess incident post-9/11 sarcoidosis in WTC-exposed workers. Continued surveillance, particularly of those most highly exposed, is necessary to identify those with sarcoidosis and to follow them for possible adverse effects including functional impairments and organ damage.

World Trade Center-Cardiorespiratory and Vascular Dysfunction: Assessing the Phenotype and Metabolome of a Murine Particulate Matter Exposure Model

“…Our study shows that a single exposure of WTC-PM is associated with acute and chronic cardiopulmonary changes. WTC-PM exposure has traditionally been known to cause pulmonary disease [7][8][9] . We demonstrate that there are early vascular and hemodynamic changes, evidence of hypermetabolic activity, collagen deposition, and oxidative stress following WTC-PM exposure.…”

Adoption Rate of Video-Assisted Thoracic Surgery for Lung Cancer Varies Widely in China

“…The authors of a recent report of sarcoidosis in WTC-exposed emergency workers and firefighters reported a standardized incidence ratio of 2-3 to 1. 6 2. Biological plausibility: Tobacco smoke, the principal cause of lung cancer, contains known carcinogens.…”

Dietary Phenotype and Advanced Glycation End-Products Predict WTC-Obstructive Airways Disease: a Longitudinal Observational Study

“…(15,16) It affects over 30% of US adults and 23% of participants in the Fire Department of New York (FDNY) WTC-Health Program (WTC-HP) program. (12)(13)(14)(15)(16)(17)(18)(19) Furthermore, metabolic biomarkers, elevated BMI, and a >2 kg/m 2 BMI increase predicted WTC-OAD. (15,(20)(21)(22)(23) Since high-caloric diets are key contributors to MetSyn, nutritional interventions to potentially reverse pulmonary dysfunction have been studied.…”

“…(9)(10)(11) Speci cally, Mediterranean diets characterized by high consumption of fruits, vegetables, and sh, were associated with lower COPD, whereas, western diets were signi cantly associated with higher risk of newly diagnosed COPD. (12)(13)(14)(15)(16) Metabolic syndrome (MetSyn) is a risk factor of cardiovascular, lung disease, and World Trade Center-OAD (WTC-OAD). (15,16) It affects over 30% of US adults and 23% of participants in the Fire Department of New York (FDNY) WTC-Health Program (WTC-HP) program.…”

“…(15,(20)(21)(22)(23) Since high-caloric diets are key contributors to MetSyn, nutritional interventions to potentially reverse pulmonary dysfunction have been studied. (14)(15)(16) Our in vitro and in vivo models identi ed that the receptor for AGE(RAGE) is associated with lung dysfunction after WTC-particulate matter (WTC-PM) exposure. Speci cally, RAGE de cient WTC-PM exposed mice were protected against WTC-OAD.…”