TY - JOUR
T1 - Post-September 11, 2001, Incidence of Systemic Autoimmune Diseases in World Trade Center-Exposed Firefighters and Emergency Medical Service Workers
AU - Webber, Mayris P.
AU - Moir, William
AU - Crowson, Cynthia S.
AU - Cohen, Hillel W.
AU - Zeig-Owens, Rachel
AU - Hall, Charles B.
AU - Berman, Jessica
AU - Qayyum, Basit
AU - Jaber, Nadia
AU - Matteson, Eric L.
AU - Liu, Yang
AU - Kelly, Kerry
AU - Prezant, David J.
N1 - Funding Information:
Grant Support: This work was supported by Cooperative Agreement U01 OH010513 from the National Institute for Occupational Safety and Health , grant R01 AG034676 from the National Institute on Aging , and the Rochester Epidemiology Project (grant number R01-AG034676; Principal Investigators: Walter A. Rocca, MD, MPH, and Barbara P. Yawn, MD, MSc).
Funding Information:
The content of this article is solely the responsibility of the authors and does not necessarily reflect the official views of the National Institute for Occupational Safety and Health or the National Institutes of Health. This work was supported by Cooperative Agreement U01 OH010513 from the National Institute for Occupational Safety and Health, grant R01 AG034676 from the National Institute on Aging, and the Rochester Epidemiology Project (grant number R01-AG034676; Principal Investigators: Walter A. Rocca, MD, MPH, and Barbara P. Yawn, MD, MSc).
Publisher Copyright:
© 2016 Mayo Foundation for Medical Education and Research.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - Objective To estimate the incidence of selected systemic autoimmune diseases (SAIDs) in approximately 14,000 male rescue/recovery workers enrolled in the Fire Department of the City of New York (FDNY) World Trade Center (WTC) Health Program and to compare FDNY incidence to rates from demographically similar men in the Rochester Epidemiology Project (REP), a population-based database in Olmsted County, Minnesota. Patients and Methods We calculated incidence for specific SAIDs (rheumatoid arthritis, psoriatic arthritis, systemic lupus erythematosus, and others) and combined SAIDs diagnosed from September 12, 2001, through September 11, 2014, and generated expected sex- and age-specific rates based on REP rates. Rates were stratified by level of WTC exposure (higher vs lower). Standardized incidence ratios (SIRs), which are the ratios of the observed number of cases in the FDNY group to the expected number of cases based on REP rates, and 95% CIs were calculated. Results We identified 97 SAID cases. Overall, FDNY rates were not significantly different from expected rates (SIR, 0.97; 95% CI, 0.77-1.21). However, the lower WTC exposure group had 9.9 fewer cases than expected, whereas the higher WTC exposure group had 7.7 excess cases. Conclusion Most studies indicate that the healthy worker effect reduces the association between exposure and outcome by about 20%, which we observed in the lower WTC exposure group. Overall rates masked differences in incidence by level of WTC exposure, especially because the higher WTC exposure group was relatively small. Continued surveillance for early detection of SAIDs in high WTC exposure populations is required to identify and treat exposure-related adverse effects.
AB - Objective To estimate the incidence of selected systemic autoimmune diseases (SAIDs) in approximately 14,000 male rescue/recovery workers enrolled in the Fire Department of the City of New York (FDNY) World Trade Center (WTC) Health Program and to compare FDNY incidence to rates from demographically similar men in the Rochester Epidemiology Project (REP), a population-based database in Olmsted County, Minnesota. Patients and Methods We calculated incidence for specific SAIDs (rheumatoid arthritis, psoriatic arthritis, systemic lupus erythematosus, and others) and combined SAIDs diagnosed from September 12, 2001, through September 11, 2014, and generated expected sex- and age-specific rates based on REP rates. Rates were stratified by level of WTC exposure (higher vs lower). Standardized incidence ratios (SIRs), which are the ratios of the observed number of cases in the FDNY group to the expected number of cases based on REP rates, and 95% CIs were calculated. Results We identified 97 SAID cases. Overall, FDNY rates were not significantly different from expected rates (SIR, 0.97; 95% CI, 0.77-1.21). However, the lower WTC exposure group had 9.9 fewer cases than expected, whereas the higher WTC exposure group had 7.7 excess cases. Conclusion Most studies indicate that the healthy worker effect reduces the association between exposure and outcome by about 20%, which we observed in the lower WTC exposure group. Overall rates masked differences in incidence by level of WTC exposure, especially because the higher WTC exposure group was relatively small. Continued surveillance for early detection of SAIDs in high WTC exposure populations is required to identify and treat exposure-related adverse effects.
UR - http://www.scopus.com/inward/record.url?scp=84952837843&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84952837843&partnerID=8YFLogxK
U2 - 10.1016/j.mayocp.2015.09.019
DO - 10.1016/j.mayocp.2015.09.019
M3 - Article
C2 - 26682920
AN - SCOPUS:84952837843
SN - 0025-6196
VL - 91
SP - 23
EP - 32
JO - Mayo Clinic proceedings
JF - Mayo Clinic proceedings
IS - 1
ER -