TY - JOUR
T1 - Cancer survival among World Trade Center rescue and recovery workers
T2 - A collaborative cohort study
AU - Goldfarb, David G.
AU - Zeig-Owens, Rachel
AU - Kristjansson, Dana
AU - Li, Jiehui
AU - Brackbill, Robert M.
AU - Farfel, Mark R.
AU - Cone, James E.
AU - Kahn, Amy R.
AU - Qiao, Baozhen
AU - Schymura, Maria J.
AU - Webber, Mayris P.
AU - Dasaro, Christopher R.
AU - Lucchini, Roberto G.
AU - Todd, Andrew C.
AU - Prezant, David J.
AU - Hall, Charles B.
AU - Boffetta, Paolo
N1 - Publisher Copyright:
© 2021 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals LLC
PY - 2021/10
Y1 - 2021/10
N2 - 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.
AB - 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.
KW - World Trade Center
KW - cancer
KW - medical monitoring and treatment
KW - mortality
KW - rescue/recovery work
UR - http://www.scopus.com/inward/record.url?scp=85110541171&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85110541171&partnerID=8YFLogxK
U2 - 10.1002/ajim.23278
DO - 10.1002/ajim.23278
M3 - Article
C2 - 34288025
AN - SCOPUS:85110541171
SN - 0271-3586
VL - 64
SP - 815
EP - 826
JO - American Journal of Industrial Medicine
JF - American Journal of Industrial Medicine
IS - 10
ER -
