Demographics
Sociodemographic characteristics are reported in Table 1. Participants' mean age was 38 years on 9/11/2001 and 45 years at the time of their first WTCHP visit. Participants included in this study are primarily male (86.6%), White (56.3%), and non-Hispanic (76.6%). College Degree education was most common (63.8%), followed by High school or equivalent (20.8%).
Table 1
Sociodemographic characteristics of participants included in this study.
WTC-related health conditions
Frequencies of WTC-related physical or mental health conditions investigated in this study are reported in Table 2. Among the 34,096 responders included in this study, the most common health conditions were headaches (60%), respiratory disease (RESP) (46%), and gastroesophageal reflux disease (GERD) (34%). Diabetes was diagnosed in 17% of participants, and post-traumatic stress disorder (PTSD) was diagnosed in 10%. The co-occurrence of WTC-related health conditions is reported in Fig. 1. The most common health condition is headaches alone (n = 6,581). The most common subset of health conditions is the combination of GERD, RESP, and headaches (n = 4,778). The next most common combination is RESP and headaches (n = 2,487), followed by RESP alone (n = 1,610).
Table 2. Frequencies of WTC-related physical or mental health conditions investigated in this study (N = 34, 096)
Note
PTSD: post-traumatic stress disorder, GERD: gastroesophageal reflux disease
World Trade Center Exposome and related health outcomes
Results from gWQS analysis show a significant association between the WTC-exposome and all investigated health outcomes in both the positive direction (i.e., factors associated with an increased likelihood of health outcomes; risk factors) and the negative direction (i.e., factors associated with a decreased likelihood of health outcomes; protective factors). Estimates, 95% confidence intervals, and p-values for each model are reported in Table 3.
Table 3. Results from gWQS analyses among 34,096 WTC responders included in this study. For each health condition, associations between the WTC exposome and outcomes were modeled in the positive (risk factors) and the negative (protective factors) directions.
Note
CI: confidence interval, PTSD: post-traumatic stress disorder, GERD: gastroesophageal reflux disease, RESP: Respiratory disease
Risk and protective factors
Weights from gWQS models are shown in Fig. 2. The main risk factors for WTC-related health conditions include working in an enclosed area heavily contaminated with dust/debris, construction occupation before 9/11/01, working in an area/not open to the general atmosphere, exposure to blood and body fluids, heat/cold, human remains, and ergonomic risk factors during rescue and recovery efforts, performing search and rescue activities, and occupational exposure to dust, mineral or mining. The main protective factors for WTC-related health conditions include being employed full-time at the first WTCHP visit, performing the majority of shift south of Canal Street but neither on the pile nor in the pit; protective services or military occupation before 9/11/01, and police officer occupation on 9/11.
For PTSD, working in an enclosed area heavily contaminated with dust/debris, working in an area not open to the general atmosphere, construction occupation before 9/11/01, working with concrete, and sleeping on site contributed most to the harmful effect of the WTC-exposome. In contrast, being employed full-time at the first WTCHP visit, protective services or military occupation before 9/11/01, and police officer occupation at 9/11 contributed most to the protective effect of the WTC-exposome. For GERD, working in an enclosed area heavily contaminated with dust/debris, construction occupation before 9/11/01, and being exposed to blood and body fluids during rescue and recovery efforts contributed most to the harmful effect of the WTC-exposome. In contrast, WTC responders who reported full-time employment at the first WTCHP visit and performing the majority of the shift elsewhere (south of Canal Street) experienced less GERD. For respiratory diseases, knowing anyone who was killed on 9/11, working in an enclosed area heavily contaminated with dust/debris, and being exposed to human remains during rescue and recovery contributed most to the harmful effect of the WTC-exposome. Performing the majority of shift elsewhere (south of Canal Street), and being employed full-time at the first WTCHP visit contributed most to the protective effect of the WTC-exposome on respiratory outcomes. For diabetes, being exposed to heat/cold during rescue and recovery efforts, occupational exposure to dust, mineral, or mining, and being exposed to dust during rescue and recovery working contributed most to the harmful effect of the WTC-exposome, while reporting to consumed alcohol during the month after 9/11, and performing the majority of shift at landfill contributed most to the protective effect of the WTC-exposome. For headaches, construction occupation before 9/11/01, working in an enclosed area heavily contaminated with dust/debris, and working in an area/not open to the gen atmosphere contributed most to the harmful effect of the WTC-exposome, while protective services or military occupation before 9/11/01, and police officer occupation at 9/11 contributed most to the protective effect of the WTC-exposome. Detailed exposure profiles as they relate to increased and decreased associations for each WTC-related health outcome is shown in Supplementary Fig. 1.