Health Conditions as Mediators of the Association Between World Trade Center Exposure and Health-Related Quality of Life in Firefighters and EMS Workers

J Occup Environ Med. 2016 Feb;58(2):200-6. doi: 10.1097/JOM.0000000000000597.


Objective: Studies have reported reduced health-related quality of life (HrQoL) in rescue/recovery workers for years postdisaster. Few have examined specific postdisaster physical and mental health conditions as mediators of the association between exposure to disaster and HrQoL.

Methods: We used the Short Form-12 to measure HrQoL in 7190 male World Trade Center (WTC)-exposed first responders. Potential mediators included physician diagnoses obtained from medical records and mental health conditions obtained from questionnaires.

Results: Among moderately and highly WTC-exposed workers, health conditions fully mediated the observed relationship between WTC-exposure and physical health functioning of HrQoL, and substantially mediated the association between WTC-exposure and mental health functioning.

Conclusions: Because WTC-related health conditions explain the relationship between WTC-exposure and HrQoL, medical monitoring with treatment of affected populations is necessary to mitigate the adverse effects of WTC-exposure on HrQoL.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Chronic Disease
  • Emergency Medical Technicians* / psychology
  • Firefighters* / psychology
  • Humans
  • Male
  • Mental Health*
  • Middle Aged
  • Occupational Diseases / etiology*
  • Occupational Diseases / psychology
  • Occupational Exposure / adverse effects*
  • Quality of Life*
  • Risk Factors
  • September 11 Terrorist Attacks*