Background

Multiple chronic health conditions have been associated with exposure to the September 11, 2001 World Trade Center (WTC) terrorist attacks (9/11). We assessed whether excess deaths occurred during 2003–2014 among persons directly exposed to 9/11, and examined associations of 9/11-related exposures with mortality risk.

Materials and methods

Deaths occurring in 2003–2014 among members of the World Trade Center Health Registry, a cohort of rescue/recovery workers and lower Manhattan community members who were exposed to 9/11, were identified via linkage to the National Death Index. Participants’ overall levels of 9/11-related exposure were categorized as high, intermediate, or low. We calculated standardized mortality ratios (SMR) using New York City reference rates from 2003 to 2012. Proportional hazards were used to assess associations of 9/11-related exposures with mortality, accounting for age, sex, race/ethnicity and other potential confounders.

Results

We identified 877 deaths among 29,280 rescue/recovery workers (3.0%) and 1694 deaths among 39,643 community members (4.3%) during 308,340 and 416,448 person-years of observation, respectively. The SMR for all causes of death was 0.69 [95% confidence interval (CI) 0.65–0.74] for rescue/recovery workers and 0.86 (95% CI 0.82–0.90) for community members. SMRs for diseases of the cardiovascular and respiratory systems were significantly lower than expected in both groups. SMRs for several other causes of death were significantly elevated, including suicide among rescue recovery workers (SMR 1.82, 95% CI 1.35–2.39), and brain malignancies (SMR 2.25, 95% CI 1.48–3.28) and non-Hodgkin's lymphoma (SMR 1.79, 95% CI 1.24–2.50) among community members. Compared to low exposure, both intermediate [adjusted hazard ratio (AHR) 1.36, 95% CI 1.10–1.67] and high (AHR 1.41, 95% CI 1.06–1.88) levels of 9/11-related exposure were significantly associated with all-cause mortality among rescue/recovery workers (p-value for trend 0.01). For community members, intermediate (AHR 1.13, 95% CI 1.01–1.27), but not high (AHR 1.14, 95% CI 0.94–1.39) exposure was significantly associated with all-cause mortality (p-value for trend 0.03). AHRs for associations of overall 9/11-related exposure with heart disease- and cancer-related mortality were similar in magnitude to those for all-cause mortality, but with 95% CIs crossing the null value.

Conclusions

Overall mortality was not elevated. Among specific causes of death that were significantly elevated, suicide among rescue/recovery workers is a plausible long-term consequence of 9/11 exposure, and is potentially preventable. Elevated mortality due to other causes, including non-Hodgkin's lymphoma and brain cancer, and small but statistically significant associations of 9/11-related exposures with all-cause mortality hazard warrant additional surveillance.

中文翻译：

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暴露于2001年9月11日世界贸易中心（World Trade Center）恐怖袭击事件（2003-2014年）的救援人员和社区工作人员的死亡率

背景

与2001年9月11日世界贸易中心（WTC）恐怖袭击有关的多种慢性健康状况（9/11）。我们评估了在2003-2014年期间直接暴露于9/11的人群中是否发生了超额死亡，并研究了9/11相关的暴露与死亡风险之间的关联。

材料和方法

通过与国家死亡指数的联系，确定了2003-2014年世界贸易中心卫生登记处成员，一组救援人员/恢复工作者和曼哈顿下城社区成员中9/11的死亡人数。参与者的9/11相关暴露的总体水平被分类为高，中或低。我们使用2003年至2012年的纽约市参考比率来计算标准化死亡率（SMR）。使用比例危害评估了9/11相关暴露与死亡率的关联，并说明了年龄，性别，种族/民族和其他潜在的混杂因素。

结果

我们分别在308,340人年和416,448人年之间确定了29,280名救援人员/恢复人员（3.0％）中的877人死亡，以及39,643名社区成员中的1694人（4.3％）死亡。救援人员/恢复人员的所有死亡原因的SMR为0.69 [95％置信区间（CI）0.65-0.74]，社区成员的SMR为0.86（95％CI 0.82-0.90）。两组心血管和呼吸系统疾病的SMR均显着低于预期。导致其他几种死亡原因的SMR显着升高，包括抢救恢复工作者的自杀（SMR 1.82，95％CI 1.35–2.39），脑恶性肿瘤（SMR 2.25，95％CI 1.48–3.28）和非霍奇金淋巴瘤（SMR） 1.79，社区成员中95％的置信区间为1.24–2.50）。与低暴露相比，两者的中间[调整后的危险比（AHR）为1.36，95％CI为1.10-1。[67]和9/11相关暴露水平高（AHR 1.41，95％CI 1.06–1.88）与抢救/恢复工人的全因死亡率显着相关（趋势p值为0.01）。对于社区成员，中等（AHR 1.13，95％CI 1.01–1.27）但不高（AHR 1.14，95％CI 0.94–1.39）暴露与全因死亡率显着相关（趋势p值为0.03）。总体9/11相关暴露与心脏病和癌症相关死亡率相关的AHR与全因死亡率相关，但95％的置信区间超过了零值。94–1.39）暴露与全因死亡率显着相关（趋势0.03的p值）。总体9/11相关暴露与心脏病和癌症相关死亡率相关的AHR与全因死亡率相关，但95％的置信区间超过了零值。94–1.39）暴露与全因死亡率显着相关（趋势0.03的p值）。总体9/11相关暴露与心脏病和癌症相关死亡率相关的AHR与全因死亡率相关，但95％的置信区间超过了零值。

结论

总死亡率没有升高。在明显增加的具体死亡原因中，救援/恢复工人的自杀是9/11暴露的合理长期后果，并且有可能是可以预防的。由于其他原因引起的死亡率升高，包括非霍奇金淋巴瘤和脑癌，以及9/11相关暴露与全因死亡率危险之间的较小但具有统计学意义的关联值得进一步监测。