Post-9/11/2001 lung function trajectories by sex and race in World Trade Center-exposed New York City emergency medical service workers

Occup Environ Med. 2017 Mar;74(3):200-203. doi: 10.1136/oemed-2016-103619. Epub 2016 Nov 3.


Objective: To determine whether lung function trajectories after 9/11/2001 (9/11) differed by sex or race/ethnicity in World Trade Center-exposed Fire Department of the City of New York emergency medical service (EMS) workers.

Method: Serial cross-sectional study of pulmonary function tests (PFTs) taken between 9/11 and 9/10/2015. We used data from routine PFTs (forced expiratory volume in 1 s (FEV1) and FEV1% predicted), conducted at 12-18 month intervals. FEV1 and FEV1% predicted were assessed over time, stratified by sex, and race/ethnicity. We also assessed FEV1 and FEV1% predicted in current, former and never-smokers.

Results: Among 1817 EMS workers, 334 (18.4%) were women, 979 (53.9%) self-identified as white and 939 (51.6%) were never-smokers. The median follow-up was 13.1 years (IQR 10.5-13.6), and the median number of PFTs per person was 11 (IQR 7-13). After large declines associated with 9/11, there was no discernible recovery in lung function. In analyses limited to never-smokers, the trajectory of decline in adjusted FEV1 and FEV1% predicted was relatively parallel for men and women in the 3 racial/ethnic groups. Similarly, small differences in FEV1 annual decline between groups were not clinically meaningful. Analyses including ever-smokers were essentially the same.

Conclusions: 14 years after 9/11, most EMS workers continued to demonstrate a lack of lung function recovery. The trajectories of lung function decline, however, were parallel by sex and by race/ethnicity. These findings support the use of routine, serial measures of lung function over time in first responders and demonstrate no sex or racial sensitivity to exposure-related lung function decline.

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Emergency Medical Services
  • Emergency Responders
  • Ethnicity
  • Female
  • Firefighters
  • Forced Expiratory Volume
  • Humans
  • Lung / physiopathology
  • Lung Diseases, Obstructive / epidemiology
  • Lung Diseases, Obstructive / etiology*
  • Lung Diseases, Obstructive / physiopathology*
  • Male
  • Middle Aged
  • New York City / epidemiology
  • Occupational Diseases / epidemiology
  • Occupational Diseases / etiology*
  • Occupational Diseases / physiopathology*
  • Occupational Exposure / adverse effects*
  • Recovery of Function
  • Respiratory Function Tests
  • Respiratory Insufficiency
  • September 11 Terrorist Attacks
  • Sex Distribution
  • Smoking / epidemiology
  • Spirometry