September 10, 2026
3 min read
Key takeaways:
- Enrollees in the World Trade Center Health Program have better survival vs. non-enrollees.
- Health systems can improve disease management by coordinating efforts on research, surveillance and clinical care.
Twenty-five years after the Sept. 11 terrorist attacks, long-term follow-up of people exposed to the disaster offers important lessons for managing chronic disease in disaster-exposed populations, according to a review published in JAMA.
The review is based on data from the World Trade Center (WTC) Health Program, which was launched in 2011 to evaluate the health outcomes of those affected.
Enrollees in the World Trade Center Health Program have better survival vs. non-enrollees. Image: Adobe Stock
“The WTC Health Program has evolved into a national model for longitudinal care and surveillance of disaster-exposed populations,” John Howard, MD, director of CDC’s National Institute for Occupational Safety and Health, said in a press release. “By linking surveillance, clinical care and research, the program functions as a continuous learning model that informs clinical practice and advances understanding of the long-term effects of 9/11 exposures among an aging population.”
Alejandro Azofeifa, PhD, DDS, MPH, MSc, a scientist at the CDC, and colleagues aimed to capture new developments and insights of 9/11 and the WTC Health Program.
They found that people directly exposed to 9/11 experience more chronic conditions, “both related and unrelated” to the exposure, and worse quality of life vs. the general population, although those enrolled in the program have greater survival vs. non-enrollees.
For example, enrolled responders with cancer have 26% to 64% lower death rates compared with other New York residents “living in the same area across multiple cancer types, including prostate, lung, kidney and colorectal,” the CDC said.
The agency added that 54% of enrollees meeting the United States Preventive Services Task Force’s criteria for lung cancer screening underwent testing, which “far exceeds the 7.5% national lung cancer screening benchmark and the 18% actual U.S. national rate in 2022.”
Such findings show “the interplay between exposure-related risk and access to care,” the researchers wrote. “One-third of program members have no known 9/11-related health effects, which is a testament to the resilience of this population.”
Follow-up studies on these health effects, they noted, has determined they “are persistent rather than time limited.”
“Many affected individuals have experienced multimorbidity, including members who developed multiple conditions, listed here in descending order of prevalence within the program: cancer, respiratory disease, gastroesophageal reflux disease and mental disorders,” they wrote.
Mental health disorders like anxiety, major depression, PTSD and substance use disorders have remained prevalent in the years following 9/11 “despite program-covered treatment, underscoring the enduring psychological impact of disaster,” Azofeifa and colleagues noted.
They added follow-up data indicate “heterogeneous mental health trajectories, ranging from persistent symptoms to posttraumatic growth and improved mental quality of life.”
According to the researchers, evidence suggests that integrated health systems combining exposure assessment, surveillance, research and clinical care could improve the chronic disease management of those exposed.
Such an approach in the program has led encouraging developments in practice and evidence, they wrote, like “increased clinical recognition of obstructive sleep apnea among WTC-exposed individuals.”
Azofeifa and colleagues concluded that 9/11 “offers a moment to reflect on the courage and sacrifice of those selfless responders who answered the call of duty, as well as those who lived, worked or went to school in the New York City disaster.
“These observations underscore the importance of sustained surveillance, multidisciplinary clinical care and research to inform responses to future environmental and occupational disasters,” they wrote.
Perspective
I saw the effects of 9/11 immediately in the hospital. I have not suffered any health consequences that I’m aware of, but immediately several of my friends and staff in the hospital developed nuanced asthma, respiratory problems, etc. I saw a 40-year-old orthopedic surgeon who never had a problem suddenly become asthmatic after he was down on Ground Zero. The impact was real and measurable. The density of the smoke was overwhelming, and it and smell coming from the pile lasted for months.
It’s important for clinicians to know how much is still being discovered of the effects and to keep their clinical mind open to investigating new syndromes or ways of dealing with that event, which was so unprecedented. There is the psychological aspect, but the physical impact, considering the chemical exposure that was sustained, is undeniable. So, take those patients seriously forever.
Antonio M. Dajer, MD
NewYork-Presbyterian Hospital Lower Manhattan Hospital
Disclosures: Healio could not determine Dajer’s relevant financial disclosures at the time of publication.
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