TY - JOUR
T1 - Cancer survival among World Trade Center rescue and recovery workers
T2 - A collaborative cohort study
AU - Goldfarb, David G.
AU - Zeig-Owens, Rachel
AU - Kristjansson, Dana
AU - Li, Jiehui
AU - Brackbill, Robert M.
AU - Farfel, Mark R.
AU - Cone, James E.
AU - Kahn, Amy R.
AU - Qiao, Baozhen
AU - Schymura, Maria J.
AU - Webber, Mayris P.
AU - Dasaro, Christopher R.
AU - Lucchini, Roberto G.
AU - Todd, Andrew C.
AU - Prezant, David J.
AU - Hall, Charles B.
AU - Boffetta, Paolo
N1 - Funding Information:
Rachel Zeig‐Owens has full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Molly Skerker, MPH provided substantial administrative support in the initial phase of this study. She did not receive financial compensation for this study. This study was supported through the National Institute for Occupational Safety and Health (NIOSH) cooperative agreements (U01OH011315, U01 OH011932, U01 OH011681, U01 OH011931, U01 OH011480, and U50/OH009739) and contracts (200‐2011‐39378, 200‐2011‐39383, 200‐2017‐93325, and 200‐2017‐93326). Additionally, this study was supported in part by cooperative agreement 6NU58DP006309 awarded to the New York State Department of Health by the Centers for Disease Control and Prevention (CDC) and by Contract 75N91018D00005 (Task Order 75N91018F00001) and grant P30 CA013330 from the National Cancer Institute (NCI), National Institutes of Health, Department of Health and Human Services. This study was also supported by cooperative agreement U50/ATU272750 from the Agency for Toxic Substances and Disease Registry (ATSDR), CDC, which included support from the National Center for Environmental Health, CDC; and by the New York City Department of Health and Mental Hygiene (NYC DOHMH). The funders have no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Publisher Copyright:
© 2021 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals LLC
PY - 2021/10
Y1 - 2021/10
N2 - Background: World Trade Center (WTC)-exposed responders may be eligible to receive no-cost medical monitoring and treatment for certified conditions, including cancer. The survival of responders with cancer has not previously been investigated. Methods: This study compared the estimated relative survival of WTC-exposed responders who developed cancer while enrolled in two WTC medical monitoring and treatment programs in New York City (WTC-MMTP responders) and WTC-exposed responders not enrolled (WTC-non-MMTP responders) to non-responders from New York State (NYS-non-responders), all restricted to the 11-southernmost NYS counties, where most responders resided. Parametric survival models estimated cancer-specific and all-cause mortality. Follow-up ended at death or on December 31, 2016. Results: From January 1, 2005 to December 31, 2016, there were 2,037 cancer cases and 303 deaths (248 cancer-related deaths) among WTC-MMTP responders, 564 cancer cases, and 143 deaths (106 cancer-related deaths) among WTC-non-MMTP responders, and 574,075 cancer cases and 224,040 deaths (158,645 cancer-related deaths) among the NYS-non-responder population. Comparing WTC-MMTP responders with NYS-non-responders, the cancer-specific mortality hazard ratio (HR) was 0.72 (95% confidence interval [CI] = 0.64–0.82), and all-cause mortality HR was 0.64 (95% CI = 0.58–0.72). The cancer-specific HR was 0.94 (95% CI = 0.78–1.14), and all-cause mortality HR was 0.93 (95% CI = 0.79–1.10) comparing WTC-non-MMTP responders to the NYS-non-responder population. Conclusions: WTC-MMTP responders had lower mortality compared with NYS-non-responders, after controlling for demographic factors and temporal trends. There may be survival benefits from no-out-of-pocket-cost medical care which could have important implications for healthcare policy, however, other occupational and socioeconomic factors could have contributed to some of the observed survival advantage.
AB - Background: World Trade Center (WTC)-exposed responders may be eligible to receive no-cost medical monitoring and treatment for certified conditions, including cancer. The survival of responders with cancer has not previously been investigated. Methods: This study compared the estimated relative survival of WTC-exposed responders who developed cancer while enrolled in two WTC medical monitoring and treatment programs in New York City (WTC-MMTP responders) and WTC-exposed responders not enrolled (WTC-non-MMTP responders) to non-responders from New York State (NYS-non-responders), all restricted to the 11-southernmost NYS counties, where most responders resided. Parametric survival models estimated cancer-specific and all-cause mortality. Follow-up ended at death or on December 31, 2016. Results: From January 1, 2005 to December 31, 2016, there were 2,037 cancer cases and 303 deaths (248 cancer-related deaths) among WTC-MMTP responders, 564 cancer cases, and 143 deaths (106 cancer-related deaths) among WTC-non-MMTP responders, and 574,075 cancer cases and 224,040 deaths (158,645 cancer-related deaths) among the NYS-non-responder population. Comparing WTC-MMTP responders with NYS-non-responders, the cancer-specific mortality hazard ratio (HR) was 0.72 (95% confidence interval [CI] = 0.64–0.82), and all-cause mortality HR was 0.64 (95% CI = 0.58–0.72). The cancer-specific HR was 0.94 (95% CI = 0.78–1.14), and all-cause mortality HR was 0.93 (95% CI = 0.79–1.10) comparing WTC-non-MMTP responders to the NYS-non-responder population. Conclusions: WTC-MMTP responders had lower mortality compared with NYS-non-responders, after controlling for demographic factors and temporal trends. There may be survival benefits from no-out-of-pocket-cost medical care which could have important implications for healthcare policy, however, other occupational and socioeconomic factors could have contributed to some of the observed survival advantage.
KW - World Trade Center
KW - cancer
KW - medical monitoring and treatment
KW - mortality
KW - rescue/recovery work
UR - http://www.scopus.com/inward/record.url?scp=85110541171&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85110541171&partnerID=8YFLogxK
U2 - 10.1002/ajim.23278
DO - 10.1002/ajim.23278
M3 - Article
C2 - 34288025
AN - SCOPUS:85110541171
SN - 0271-3586
VL - 64
SP - 815
EP - 826
JO - American Journal of Industrial Medicine
JF - American Journal of Industrial Medicine
IS - 10
ER -
