Post-9/11 sarcoidosis in WTC-exposed firefighters and emergency medical service workers. (November 2017)

• Record Type: Journal Article
• Authors: 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.
• Is Part Of: Respiratory medicine. Volume 132(2017)
• Page Start: 232
• Page End: 237
• Publication Date: 2017-11
• Subjects: Sarcoidosis -- World Trade Center -- Fire Department of the City of New York -- Rochester Epidemiology Project; Chest -- Diseases -- Periodicals; Chest -- Diseases -- Great Britain -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Appareil respiratoire -- Maladies -- Périodiques; Thorax -- Maladies -- Périodiques; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Electronic journals; 616.2
• DOI: 10.1016/j.rmed.2017.06.004
• Languages: English
• ISSNs: 0954-6111

Abstract

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. Highlights: We found 68 post-9/11 sarcoidosis cases in the FDNY WTC-exposed cohort (N = 13, 098). FDNY sarcoidosis incidence rates were significantly higher than expected (SIR = 2.8). Significantly elevated rates were observed among workers at all WTC exposure levels.