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We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio 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
\u201cThe 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. \u201cBy 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.\u201d 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, \u201cboth related and unrelated\u201d 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 \u201cliving in the same area across multiple cancer types, including prostate, lung, kidney and colorectal,\u201d the CDC said. The agency added that 54% of enrollees meeting the United States Preventive Services Task Force\u2019s criteria for lung cancer screening underwent testing, which \u201cfar exceeds the 7.5% national lung cancer screening benchmark and the 18% actual U.S. national rate in 2022.\u201d Such findings show \u201cthe interplay between exposure-related risk and access to care,\u201d the researchers wrote. \u201cOne-third of program members have no known 9\/11-related health effects, which is a testament to the resilience of this population.\u201d Follow-up studies on these health effects, they noted, has determined they \u201care persistent rather than time limited.\u201d \u201cMany 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,\u201d they wrote. Mental health disorders like anxiety, major depression, PTSD and substance use disorders have remained prevalent in the years following 9\/11 \u201cdespite program-covered treatment, underscoring the enduring psychological impact of disaster,\u201d Azofeifa and colleagues noted. They added follow-up data indicate \u201cheterogeneous mental health trajectories, ranging from persistent symptoms to posttraumatic growth and improved mental quality of life.\u201d 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 \u201cincreased clinical recognition of obstructive sleep apnea among WTC-exposed individuals.\u201d Azofeifa and colleagues concluded that 9\/11 \u201coffers 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. \u201cThese observations underscore the importance of sustained surveillance, multidisciplinary clinical care and research to inform responses to future environmental and occupational disasters,\u201d they wrote. Perspective Back to Top I saw the effects of 9\/11 immediately in the hospital. I have not suffered any health consequences that I\u2019m 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\u2019s 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\u2019s relevant financial disclosures at the time of publication.
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