Nested case-control study of selected systemic autoimmune diseases in world trade center rescue/recovery workers

M. P. Webber, W. Moir, R. Zeig-Owens, M. S. Glaser, N. Jaber, C. Hall, J. Berman, B. Qayyum, K. Loupasakis, K. Kelly, D. J. Prezant

Research output: Contribution to journalArticle

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Abstract

Objective To test the a priori hypothesis that acute and chronic work exposures to the World Trade Center (WTC) site on or after September 11, 2001 were associated with risk of new-onset systemic autoimmune diseases. Methods A nested case-control study was performed in WTC rescue/recovery workers who had received a rheumatologist-confirmed systemic autoimmune disease diagnosis between September 12, 2001 and September 11, 2013 (n=59), each of whom was individually matched to 4 randomly selected controls (n=236) on the basis of year of hire (±1 year), sex, race, and work assignment (firefighter or emergency medical service). Acute exposure was defined according to the earliest time of arrival (morning of 9/11 versus later) at the WTC site, and chronic exposure was defined as duration (number of months) of WTC site-related work. Rheumatologists were blinded with regard to each subject's exposure status. The conditional odds ratios (CORs) with 95% confidence intervals (95% CIs) for incident autoimmune disease were derived from exact conditional logistic regression models. Results Rheumatoid arthritis was the most common autoimmune diagnosis (37% of subjects), followed by spondyloarthritis (22%), inflammatory myositis (14%), systemic lupus erythematosus (12%), systemic sclerosis (5%), Sjögren's syndrome (5%), antiphospholipid syndrome (3%), and granulomatosis with polyangiitis (Wegener's) (2%). The COR for incident autoimmune disease increased by 13% (COR 1.13, 95% CI 1.02-1.26) for each additional month worked at the WTC site. These odds were independent of the association between high acute exposure (working during the morning of 9/11) and disease outcome, which conveyed an elevated, but not statistically significant, risk (COR 1.85, 95% CI 0.86-3.89). Conclusion Prolonged work at the WTC site, independent of acute exposure, was an important predictor of post-9/11 systemic autoimmune diseases. The WTC Health Program should expand surveillance efforts for those with extended exposures, as early detection can facilitate early treatment, which has been shown to minimize organ damage and improve quality of life.

Original languageEnglish (US)
Pages (from-to)1369-1376
Number of pages8
JournalArthritis and Rheumatology
Volume67
Issue number5
DOIs
StatePublished - May 1 2015

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Autoimmune Diseases
Case-Control Studies
Odds Ratio
Confidence Intervals
Logistic Models
Firefighters
Granulomatosis with Polyangiitis
Myositis
Antiphospholipid Syndrome
Systemic Scleroderma
Emergency Medical Services
Systemic Lupus Erythematosus
Rheumatoid Arthritis
Quality of Life
Health
Rheumatologists
Therapeutics

ASJC Scopus subject areas

  • Immunology
  • Immunology and Allergy
  • Rheumatology
  • Medicine(all)

Cite this

Nested case-control study of selected systemic autoimmune diseases in world trade center rescue/recovery workers. / Webber, M. P.; Moir, W.; Zeig-Owens, R.; Glaser, M. S.; Jaber, N.; Hall, C.; Berman, J.; Qayyum, B.; Loupasakis, K.; Kelly, K.; Prezant, D. J.

In: Arthritis and Rheumatology, Vol. 67, No. 5, 01.05.2015, p. 1369-1376.

Research output: Contribution to journalArticle

Webber, M. P. ; Moir, W. ; Zeig-Owens, R. ; Glaser, M. S. ; Jaber, N. ; Hall, C. ; Berman, J. ; Qayyum, B. ; Loupasakis, K. ; Kelly, K. ; Prezant, D. J. / Nested case-control study of selected systemic autoimmune diseases in world trade center rescue/recovery workers. In: Arthritis and Rheumatology. 2015 ; Vol. 67, No. 5. pp. 1369-1376.
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abstract = "Objective To test the a priori hypothesis that acute and chronic work exposures to the World Trade Center (WTC) site on or after September 11, 2001 were associated with risk of new-onset systemic autoimmune diseases. Methods A nested case-control study was performed in WTC rescue/recovery workers who had received a rheumatologist-confirmed systemic autoimmune disease diagnosis between September 12, 2001 and September 11, 2013 (n=59), each of whom was individually matched to 4 randomly selected controls (n=236) on the basis of year of hire (±1 year), sex, race, and work assignment (firefighter or emergency medical service). Acute exposure was defined according to the earliest time of arrival (morning of 9/11 versus later) at the WTC site, and chronic exposure was defined as duration (number of months) of WTC site-related work. Rheumatologists were blinded with regard to each subject's exposure status. The conditional odds ratios (CORs) with 95{\%} confidence intervals (95{\%} CIs) for incident autoimmune disease were derived from exact conditional logistic regression models. Results Rheumatoid arthritis was the most common autoimmune diagnosis (37{\%} of subjects), followed by spondyloarthritis (22{\%}), inflammatory myositis (14{\%}), systemic lupus erythematosus (12{\%}), systemic sclerosis (5{\%}), Sj{\"o}gren's syndrome (5{\%}), antiphospholipid syndrome (3{\%}), and granulomatosis with polyangiitis (Wegener's) (2{\%}). The COR for incident autoimmune disease increased by 13{\%} (COR 1.13, 95{\%} CI 1.02-1.26) for each additional month worked at the WTC site. These odds were independent of the association between high acute exposure (working during the morning of 9/11) and disease outcome, which conveyed an elevated, but not statistically significant, risk (COR 1.85, 95{\%} CI 0.86-3.89). Conclusion Prolonged work at the WTC site, independent of acute exposure, was an important predictor of post-9/11 systemic autoimmune diseases. The WTC Health Program should expand surveillance efforts for those with extended exposures, as early detection can facilitate early treatment, which has been shown to minimize organ damage and improve quality of life.",
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AU - Glaser, M. S.

AU - Jaber, N.

AU - Hall, C.

AU - Berman, J.

AU - Qayyum, B.

AU - Loupasakis, K.

AU - Kelly, K.

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N2 - Objective To test the a priori hypothesis that acute and chronic work exposures to the World Trade Center (WTC) site on or after September 11, 2001 were associated with risk of new-onset systemic autoimmune diseases. Methods A nested case-control study was performed in WTC rescue/recovery workers who had received a rheumatologist-confirmed systemic autoimmune disease diagnosis between September 12, 2001 and September 11, 2013 (n=59), each of whom was individually matched to 4 randomly selected controls (n=236) on the basis of year of hire (±1 year), sex, race, and work assignment (firefighter or emergency medical service). Acute exposure was defined according to the earliest time of arrival (morning of 9/11 versus later) at the WTC site, and chronic exposure was defined as duration (number of months) of WTC site-related work. Rheumatologists were blinded with regard to each subject's exposure status. The conditional odds ratios (CORs) with 95% confidence intervals (95% CIs) for incident autoimmune disease were derived from exact conditional logistic regression models. Results Rheumatoid arthritis was the most common autoimmune diagnosis (37% of subjects), followed by spondyloarthritis (22%), inflammatory myositis (14%), systemic lupus erythematosus (12%), systemic sclerosis (5%), Sjögren's syndrome (5%), antiphospholipid syndrome (3%), and granulomatosis with polyangiitis (Wegener's) (2%). The COR for incident autoimmune disease increased by 13% (COR 1.13, 95% CI 1.02-1.26) for each additional month worked at the WTC site. These odds were independent of the association between high acute exposure (working during the morning of 9/11) and disease outcome, which conveyed an elevated, but not statistically significant, risk (COR 1.85, 95% CI 0.86-3.89). Conclusion Prolonged work at the WTC site, independent of acute exposure, was an important predictor of post-9/11 systemic autoimmune diseases. The WTC Health Program should expand surveillance efforts for those with extended exposures, as early detection can facilitate early treatment, which has been shown to minimize organ damage and improve quality of life.

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