Risk factors for and consequences of persistent lower respiratory symptoms among World Trade Center Health Registrants 10 years after the disaster

Occup Environ Med. 2016 Oct;73(10):676-84. doi: 10.1136/oemed-2015-103512. Epub 2016 Jul 22.


Objectives: The prevalence of persistent lower respiratory symptoms (LRS) among rescue/recovery workers, local area workers, residents and passers-by in the World Trade Center Health Registry (WTCHR) was analysed to identify associated factors and to measure its effect on quality of life (QoL) 10 years after 9/11/2001.

Methods: This cross-sectional study included 18 913 adults who completed 3 WTCHR surveys (2003-2004 (Wave 1 (W1)), 2006-2007 (Wave 2 (W2)) and 2011-2012 (Wave 3 (W3)). LRS were defined as self-reported cough, wheeze, dyspnoea or inhaler use in the 30 days before survey. The prevalence of three LRS outcomes: LRS at W1; LRS at W1 and W2; and LRS at W1, W2 and W3 (persistent LRS) was compared with no LRS on WTC exposure and probable mental health conditions determined by standard screening tests. Diminished physical and mental health QoL measures were examined as potential LRS outcomes, using multivariable logistic and Poisson regression.

Results: Of the 4 outcomes, persistent LRS was reported by 14.7%. Adjusted ORs for disaster exposure, probable post-traumatic stress disorder (PTSD) at W2, lacking college education and obesity were incrementally higher moving from LRS at W1, LRS at W1 and W2 to persistent LRS. Half of those with persistent LRS were comorbid for probable PTSD, depression or generalised anxiety disorder. Enrollees with persistent LRS were 3 times more likely to report poor physical health and ∼ 50% more likely to report poor mental health than the no LRS group.

Conclusions: LRS, accompanied by mental health conditions and decreased QoL, have persisted for at least 10 years after 9/11/2001. Affected adults require continuing surveillance and treatment.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Asthma / epidemiology
  • Cough / epidemiology
  • Cough / etiology*
  • Cross-Sectional Studies
  • Disasters
  • Dyspnea / epidemiology
  • Dyspnea / etiology*
  • Female
  • Health Status
  • Humans
  • Male
  • Mental Disorders / epidemiology
  • Mental Disorders / etiology
  • Middle Aged
  • Nebulizers and Vaporizers
  • New York City / epidemiology
  • Occupational Diseases / epidemiology
  • Occupational Diseases / etiology*
  • Quality of Life / psychology*
  • Registries
  • Regression Analysis
  • Rescue Work
  • Respiratory Sounds
  • Respiratory System
  • Risk Factors
  • September 11 Terrorist Attacks / psychology*
  • Stress Disorders, Post-Traumatic / epidemiology
  • Stress Disorders, Post-Traumatic / psychology*
  • Young Adult