Post-9/11 sarcoidosis in WTC-exposed firefighters and emergency medical service workers

Mayris P. Webber, Jennifer Yip, Rachel Zeig-Owens, William Moir, Patompong Ungprasert, Cynthia S. Crowson, Charles B. Hall, Nadia Jaber, Michael D. Weiden, Eric L. Matteson, David J. Prezant

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Introduction: The World Trade Center (WTC) disaster released a huge quantity and variety of toxicants into the environment. To-date, studies from each of the three major cohorts of WTC-exposed workers have suggested "greater than expected" numbers of post-9/11 cases in some workers. We undertook this study to estimate the incidence of post-9/11 sarcoidosis in ∼13,000 male firefighters and EMS workers enrolled in The Fire Department of the City of New York (FDNY) WTC Health Program; to compare FDNY incidence to rates from unexposed, demographically similar men in the Rochester Epidemiology Project (REP); and, to examine rates by level of WTC exposure. Methods: We calculated incidence of sarcoidosis diagnosed from 9/12/2001 to 9/11/2015, and generated expected sex- and age-specific rates based on REP rates. Standardized incidence ratios (SIR) based on REP rates, and 95% confidence intervals (95% CI) were estimated. Two sensitivity analyses limited cases to those with intra-thoracic symptoms or biopsy confirmation. Results: We identified 68 post-9/11 cases in the FDNY cohort. Overall, FDNY rates were significantly higher than expected rates (SIR = 2.8; 95% CI = 2.2, 3.6). Including only symptomatic cases, the SIR decreased (SIR = 2.2; 95% CI = 1.5, 3.0), but remained significantly elevated. SIRs ranged from 2.7 (95% CI = 2.0, 3.5) in the lower WTC exposure group to 4.2 (95% CI = 1.9, 8.0) in the most highly exposed. Conclusions: We found excess incident post-9/11 sarcoidosis in WTC-exposed workers. Continued surveillance, particularly of those most highly exposed, is necessary to identify those with sarcoidosis and to follow them for possible adverse effects including functional impairments and organ damage.

Original languageEnglish (US)
JournalRespiratory Medicine
DOIs
StateAccepted/In press - Dec 5 2016

Fingerprint

Firefighters
Emergency Medical Services
Sarcoidosis
Incidence
Confidence Intervals
Epidemiology
Disasters
Thorax
Biopsy
Health

Keywords

  • Fire Department of the City of New York
  • Rochester Epidemiology Project
  • Sarcoidosis
  • World Trade Center

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Post-9/11 sarcoidosis in WTC-exposed firefighters and emergency medical service workers. / Webber, Mayris P.; Yip, Jennifer; Zeig-Owens, Rachel; Moir, William; Ungprasert, Patompong; Crowson, Cynthia S.; Hall, Charles B.; Jaber, Nadia; Weiden, Michael D.; Matteson, Eric L.; Prezant, David J.

In: Respiratory Medicine, 05.12.2016.

Research output: Contribution to journalArticle

Webber, Mayris P. ; Yip, Jennifer ; Zeig-Owens, Rachel ; Moir, William ; Ungprasert, Patompong ; Crowson, Cynthia S. ; Hall, Charles B. ; Jaber, Nadia ; Weiden, Michael D. ; Matteson, Eric L. ; Prezant, David J. / Post-9/11 sarcoidosis in WTC-exposed firefighters and emergency medical service workers. In: Respiratory Medicine. 2016.
@article{ea6c2d0faf3b49e78fb0b61c0cf02958,
title = "Post-9/11 sarcoidosis in WTC-exposed firefighters and emergency medical service workers",
abstract = "Introduction: The World Trade Center (WTC) disaster released a huge quantity and variety of toxicants into the environment. To-date, studies from each of the three major cohorts of WTC-exposed workers have suggested {"}greater than expected{"} numbers of post-9/11 cases in some workers. We undertook this study to estimate the incidence of post-9/11 sarcoidosis in ∼13,000 male firefighters and EMS workers enrolled in The Fire Department of the City of New York (FDNY) WTC Health Program; to compare FDNY incidence to rates from unexposed, demographically similar men in the Rochester Epidemiology Project (REP); and, to examine rates by level of WTC exposure. Methods: We calculated incidence of sarcoidosis diagnosed from 9/12/2001 to 9/11/2015, and generated expected sex- and age-specific rates based on REP rates. Standardized incidence ratios (SIR) based on REP rates, and 95{\%} confidence intervals (95{\%} CI) were estimated. Two sensitivity analyses limited cases to those with intra-thoracic symptoms or biopsy confirmation. Results: We identified 68 post-9/11 cases in the FDNY cohort. Overall, FDNY rates were significantly higher than expected rates (SIR = 2.8; 95{\%} CI = 2.2, 3.6). Including only symptomatic cases, the SIR decreased (SIR = 2.2; 95{\%} CI = 1.5, 3.0), but remained significantly elevated. SIRs ranged from 2.7 (95{\%} CI = 2.0, 3.5) in the lower WTC exposure group to 4.2 (95{\%} CI = 1.9, 8.0) in the most highly exposed. Conclusions: We found excess incident post-9/11 sarcoidosis in WTC-exposed workers. Continued surveillance, particularly of those most highly exposed, is necessary to identify those with sarcoidosis and to follow them for possible adverse effects including functional impairments and organ damage.",
keywords = "Fire Department of the City of New York, Rochester Epidemiology Project, Sarcoidosis, World Trade Center",
author = "Webber, {Mayris P.} and Jennifer Yip and Rachel Zeig-Owens and William Moir and Patompong Ungprasert and Crowson, {Cynthia S.} and Hall, {Charles B.} and Nadia Jaber and Weiden, {Michael D.} and Matteson, {Eric L.} and Prezant, {David J.}",
year = "2016",
month = "12",
day = "5",
doi = "10.1016/j.rmed.2017.06.004",
language = "English (US)",
journal = "Respiratory Medicine",
issn = "0954-6111",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Post-9/11 sarcoidosis in WTC-exposed firefighters and emergency medical service workers

AU - Webber, Mayris P.

AU - Yip, Jennifer

AU - Zeig-Owens, Rachel

AU - Moir, William

AU - Ungprasert, Patompong

AU - Crowson, Cynthia S.

AU - Hall, Charles B.

AU - Jaber, Nadia

AU - Weiden, Michael D.

AU - Matteson, Eric L.

AU - Prezant, David J.

PY - 2016/12/5

Y1 - 2016/12/5

N2 - Introduction: The World Trade Center (WTC) disaster released a huge quantity and variety of toxicants into the environment. To-date, studies from each of the three major cohorts of WTC-exposed workers have suggested "greater than expected" numbers of post-9/11 cases in some workers. We undertook this study to estimate the incidence of post-9/11 sarcoidosis in ∼13,000 male firefighters and EMS workers enrolled in The Fire Department of the City of New York (FDNY) WTC Health Program; to compare FDNY incidence to rates from unexposed, demographically similar men in the Rochester Epidemiology Project (REP); and, to examine rates by level of WTC exposure. Methods: We calculated incidence of sarcoidosis diagnosed from 9/12/2001 to 9/11/2015, and generated expected sex- and age-specific rates based on REP rates. Standardized incidence ratios (SIR) based on REP rates, and 95% confidence intervals (95% CI) were estimated. Two sensitivity analyses limited cases to those with intra-thoracic symptoms or biopsy confirmation. Results: We identified 68 post-9/11 cases in the FDNY cohort. Overall, FDNY rates were significantly higher than expected rates (SIR = 2.8; 95% CI = 2.2, 3.6). Including only symptomatic cases, the SIR decreased (SIR = 2.2; 95% CI = 1.5, 3.0), but remained significantly elevated. SIRs ranged from 2.7 (95% CI = 2.0, 3.5) in the lower WTC exposure group to 4.2 (95% CI = 1.9, 8.0) in the most highly exposed. Conclusions: We found excess incident post-9/11 sarcoidosis in WTC-exposed workers. Continued surveillance, particularly of those most highly exposed, is necessary to identify those with sarcoidosis and to follow them for possible adverse effects including functional impairments and organ damage.

AB - Introduction: The World Trade Center (WTC) disaster released a huge quantity and variety of toxicants into the environment. To-date, studies from each of the three major cohorts of WTC-exposed workers have suggested "greater than expected" numbers of post-9/11 cases in some workers. We undertook this study to estimate the incidence of post-9/11 sarcoidosis in ∼13,000 male firefighters and EMS workers enrolled in The Fire Department of the City of New York (FDNY) WTC Health Program; to compare FDNY incidence to rates from unexposed, demographically similar men in the Rochester Epidemiology Project (REP); and, to examine rates by level of WTC exposure. Methods: We calculated incidence of sarcoidosis diagnosed from 9/12/2001 to 9/11/2015, and generated expected sex- and age-specific rates based on REP rates. Standardized incidence ratios (SIR) based on REP rates, and 95% confidence intervals (95% CI) were estimated. Two sensitivity analyses limited cases to those with intra-thoracic symptoms or biopsy confirmation. Results: We identified 68 post-9/11 cases in the FDNY cohort. Overall, FDNY rates were significantly higher than expected rates (SIR = 2.8; 95% CI = 2.2, 3.6). Including only symptomatic cases, the SIR decreased (SIR = 2.2; 95% CI = 1.5, 3.0), but remained significantly elevated. SIRs ranged from 2.7 (95% CI = 2.0, 3.5) in the lower WTC exposure group to 4.2 (95% CI = 1.9, 8.0) in the most highly exposed. Conclusions: We found excess incident post-9/11 sarcoidosis in WTC-exposed workers. Continued surveillance, particularly of those most highly exposed, is necessary to identify those with sarcoidosis and to follow them for possible adverse effects including functional impairments and organ damage.

KW - Fire Department of the City of New York

KW - Rochester Epidemiology Project

KW - Sarcoidosis

KW - World Trade Center

UR - http://www.scopus.com/inward/record.url?scp=85020683242&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85020683242&partnerID=8YFLogxK

U2 - 10.1016/j.rmed.2017.06.004

DO - 10.1016/j.rmed.2017.06.004

M3 - Article

JO - Respiratory Medicine

JF - Respiratory Medicine

SN - 0954-6111

ER -