Abstract
Objective
To estimate the incidence of selected systemic autoimmune diseases (SAIDs) in approximately
14,000 male rescue/recovery workers enrolled in the Fire Department of the City of
New York (FDNY) World Trade Center (WTC) Health Program and to compare FDNY incidence
to rates from demographically similar men in the Rochester Epidemiology Project (REP),
a population-based database in Olmsted County, Minnesota.
Patients and Methods
We calculated incidence for specific SAIDs (rheumatoid arthritis, psoriatic arthritis,
systemic lupus erythematosus, and others) and combined SAIDs diagnosed from September
12, 2001, through September 11, 2014, and generated expected sex- and age-specific
rates based on REP rates. Rates were stratified by level of WTC exposure (higher vs
lower). Standardized incidence ratios (SIRs), which are the ratios of the observed
number of cases in the FDNY group to the expected number of cases based on REP rates,
and 95% CIs were calculated.
Results
We identified 97 SAID cases. Overall, FDNY rates were not significantly different
from expected rates (SIR, 0.97; 95% CI, 0.77-1.21). However, the lower WTC exposure
group had 9.9 fewer cases than expected, whereas the higher WTC exposure group had
7.7 excess cases.
Conclusion
Most studies indicate that the healthy worker effect reduces the association between
exposure and outcome by about 20%, which we observed in the lower WTC exposure group.
Overall rates masked differences in incidence by level of WTC exposure, especially
because the higher WTC exposure group was relatively small. Continued surveillance
for early detection of SAIDs in high WTC exposure populations is required to identify
and treat exposure-related adverse effects.
Abbreviations and Acronyms:
EMS (emergency medical service), FDNY (Fire Department of the City of New York), RA (rheumatoid arthritis), REP (Rochester Epidemiology Project), SAID (systemic autoimmune disease), SIR (standardized incidence ratio), SLE (systemic lupus erythematosus), WTC (World Trade Center), 9/11 (September 11, 2001)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 09, 2015
Footnotes
Grant Support: This work was supported by Cooperative Agreement U01 OH010513 from the National Institute for Occupational Safety and Health, grant R01 AG034676 from the National Institute on Aging, and the Rochester Epidemiology Project (grant number R01-AG034676; Principal Investigators: Walter A. Rocca, MD, MPH, and Barbara P. Yawn, MD, MSc).
Identification
Copyright
© 2016 Published by Elsevier Inc.
