Cancer survival among World Trade Center rescue and recovery workers: A collaborative cohort study

David G Goldfarb; Rachel Zeig-Owens; Dana Kristjansson; Jiehui Li; Robert M Brackbill; Mark R Farfel; James E Cone; Amy R Kahn; Baozhen Qiao; Maria J Schymura; Mayris P Webber; Christopher R Dasaro; Roberto G Lucchini; Andrew C Todd; David J Prezant; Charles B Hall; Paolo Boffetta

doi:10.1002/ajim.23278

Cancer survival among World Trade Center rescue and recovery workers: A collaborative cohort study

Am J Ind Med. 2021 Oct;64(10):815-826. doi: 10.1002/ajim.23278. Epub 2021 Jul 19.

Authors

David G Goldfarb^{1

2

3}, Rachel Zeig-Owens^{1

2

4}, Dana Kristjansson^{5

6

7}, Jiehui Li⁸, Robert M Brackbill⁸, Mark R Farfel⁸, James E Cone⁸, Amy R Kahn⁹, Baozhen Qiao⁹, Maria J Schymura⁹, Mayris P Webber^{2

4}, Christopher R Dasaro¹⁰, Roberto G Lucchini¹⁰, Andrew C Todd¹⁰, David J Prezant^{1

2

4}, Charles B Hall⁴, Paolo Boffetta^{5

11

12}

Affiliations

¹ Department of Medicine, Montefiore Medical Center, New York, New York, USA.
² Fire Department of the City of New York (FDNY), Brooklyn, New York, USA.
³ Department of Environmental, Occupational and Geospatial Health Sciences, City University of New York Graduate School of Public Health and Health Policy, New York, New York, USA.
⁴ Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA.
⁵ Department of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, New York, USA.
⁶ Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, Oslo, Norway.
⁷ Center of Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.
⁸ New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA.
⁹ New York State Department of Health, Bureau of Cancer Epidemiology, Albany, New York, USA.
¹⁰ Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
¹¹ Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA.
¹² Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.

Abstract

Background: World Trade Center (WTC)-exposed responders may be eligible to receive no-cost medical monitoring and treatment for certified conditions, including cancer. The survival of responders with cancer has not previously been investigated.

Methods: This study compared the estimated relative survival of WTC-exposed responders who developed cancer while enrolled in two WTC medical monitoring and treatment programs in New York City (WTC-MMTP responders) and WTC-exposed responders not enrolled (WTC-non-MMTP responders) to non-responders from New York State (NYS-non-responders), all restricted to the 11-southernmost NYS counties, where most responders resided. Parametric survival models estimated cancer-specific and all-cause mortality. Follow-up ended at death or on December 31, 2016.

Results: From January 1, 2005 to December 31, 2016, there were 2,037 cancer cases and 303 deaths (248 cancer-related deaths) among WTC-MMTP responders, 564 cancer cases, and 143 deaths (106 cancer-related deaths) among WTC-non-MMTP responders, and 574,075 cancer cases and 224,040 deaths (158,645 cancer-related deaths) among the NYS-non-responder population. Comparing WTC-MMTP responders with NYS-non-responders, the cancer-specific mortality hazard ratio (HR) was 0.72 (95% confidence interval [CI] = 0.64-0.82), and all-cause mortality HR was 0.64 (95% CI = 0.58-0.72). The cancer-specific HR was 0.94 (95% CI = 0.78-1.14), and all-cause mortality HR was 0.93 (95% CI = 0.79-1.10) comparing WTC-non-MMTP responders to the NYS-non-responder population.

Conclusions: WTC-MMTP responders had lower mortality compared with NYS-non-responders, after controlling for demographic factors and temporal trends. There may be survival benefits from no-out-of-pocket-cost medical care which could have important implications for healthcare policy, however, other occupational and socioeconomic factors could have contributed to some of the observed survival advantage.

Keywords: World Trade Center; cancer; medical monitoring and treatment; mortality; rescue/recovery work.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Cohort Studies
Emergency Responders*
Humans
Neoplasms*
New York City / epidemiology
Proportional Hazards Models
September 11 Terrorist Attacks*

Abstract

Publication types

MeSH terms

Grants and funding