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. 2017 Nov:132:232-237.
doi: 10.1016/j.rmed.2017.06.004. Epub 2017 Jun 7.

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

Mayris P Webber  1 , Jennifer Yip  2 , Rachel Zeig-Owens  2 , William Moir  2 , Patompong Ungprasert  3 , Cynthia S Crowson  3 , Charles B Hall  4 , Nadia Jaber  2 , Michael D Weiden  5 , Eric L Matteson  3 , David J Prezant  2
Affiliations

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

Mayris P Webber et al. Respir Med. 2017 Nov.

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.

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Conflict of interest statement

Competing financial interests: The authors declare no competing interests.

Figures

Figure 1
Figure 1
Sarcoidosis Cases in FDNY study population over Time Footnote: Years in 9/11 years (i.e., Year 1 corresponds to 9/12/2001 – 9/11/2002)
Figure 2
Figure 2
SIRs Overall and by WTC Exposure Level Abbreviations: SIR = Standardized Incidence Ratio; LCL = Lower Confidence Limit; UCL = Upper Confidence Limit; Obs = Observed; Exp = Expected; Mo = Months Reference rates were obtained from REP’s sarcoidosis incidence rates from 2002 – 2013.
See this image and copyright information in PMC

Comment in

  • Sarcoidosis in WTC-Exposed workers.
    Reich JM. Reich JM. Respir Med. 2018 Nov;144S:S41. doi: 10.1016/j.rmed.2018.03.011. Epub 2018 Mar 10. Respir Med. 2018. PMID: 29545009 No abstract available.

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