Henry S Sacks1, Margaret Smirnoff1, Deborah Carson1, Michael L Cooney1, Moshe Z Shapiro1, Christopher J Hahn1, Christopher R Dasaro1, Cynthia Crowson2, Ioannis Tassiulas3, Robert P Hirten3, Benjamin L Cohen3,4, Richard S Haber3, Terry F Davies3, David M Simpson3, Michael A Crane5, Denise J Harrison6, Benjamin J Luft7, Jacqueline M Moline8, Iris G Udasin9, Andrew C Todd1, Nancy L Sloan1, Susan L Teitelbaum1. 1. Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA. 2. Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. 3. Rheumatology Department, Icahn School of Medicine at Mount Sinai, New York, New York, USA. 4. Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, Ohio, USA. 5. Department of Environmental Medicine and Public Health, World Trade Center Health Program Clinical Center of Excellence, Icahn School of Medicine at Mount Sinai, New York, New York, USA. 6. Department of Medicine, Department of Environmental Medicine, World Trade Center Health Program Clinical Center of Excellence, NYU Langone Medical Center, New York University School of Medicine, New York, New York, USA. 7. Department of Medicine, World Trade Center Health Program Clinical Center of Excellence, Stony Brook University Medical Center, Stony Brook, New York, USA. 8. Department of Occupational Medicine, Epidemiology and Prevention, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, World Trade Center Health Program Clinical Center of Excellence, Hempstead, New York, USA. 9. Department of Environmental and Occupational Medicine, World Trade Center Health Program Clinical Center of Excellence, Environmental and Occupational Health Sciences Institute, Rutgers University Biomedical Sciences, Piscataway, New Jersey, USA.
Abstract
BACKGROUND: The World Trade Center (WTC) general responder cohort (GRC) was exposed to environmental toxins possibly associated with increased risk of developing autoimmune conditions. OBJECTIVES: Two study designs were used to assess incidence and risks of autoimmune conditions in the GRC. METHODS: Three clinically trained professionals established the status of possible GRC cases of autoimmune disorders adhering to diagnostic criteria, supplemented, as needed, by specialists' review of consenting responders' medical records. Nested case-control analyses using conditional logistic regression estimated the risk associated with high WTC exposure (being in the 9/11/2001 dust cloud or ≥median days' response worked) compared with low WTC exposure (all other GRC members'). Four controls were matched to each case on age at case diagnosis (±2 years), sex, race/ethnicity, and year of program enrollment. Sex-specific and sensitivity analyses were performed. GRC age- and sex-adjusted standardized incidence ratios (SIRs) were compared with the Rochester Epidemiology Project (REP). Complete REP inpatient and outpatient medical records were reviewed by specialists. Conditions meeting standardized criteria on ≥2 visits were classified as REP confirmed cases. RESULTS: Six hundred and twenty-eight responders were diagnosed with autoimmune conditions between 2002 and 2017. In the nested case-control analyses, high WTC exposure was not associated with autoimmune domains and conditions (rheumatologic domain odds ratio [OR] = 1.03, 95% confidence interval [CI] = 0.77, 1.37; rheumatoid arthritis OR = 1.12, 95% CI = 0.70, 1.77). GRC members had lower SIR than REP. Women's risks were generally greater than men's. CONCLUSIONS: The study found no statistically significant increased risk of autoimmune conditions with WTC exposures.
BACKGROUND: The World Trade Center (WTC) general responder cohort (GRC) was exposed to environmental toxins possibly associated with increased risk of developing autoimmune conditions. OBJECTIVES: Two study designs were used to assess incidence and risks of autoimmune conditions in the GRC. METHODS: Three clinically trained professionals established the status of possible GRC cases of autoimmune disorders adhering to diagnostic criteria, supplemented, as needed, by specialists' review of consenting responders' medical records. Nested case-control analyses using conditional logistic regression estimated the risk associated with high WTC exposure (being in the 9/11/2001 dust cloud or ≥median days' response worked) compared with low WTC exposure (all other GRC members'). Four controls were matched to each case on age at case diagnosis (±2 years), sex, race/ethnicity, and year of program enrollment. Sex-specific and sensitivity analyses were performed. GRC age- and sex-adjusted standardized incidence ratios (SIRs) were compared with the Rochester Epidemiology Project (REP). Complete REP inpatient and outpatient medical records were reviewed by specialists. Conditions meeting standardized criteria on ≥2 visits were classified as REP confirmed cases. RESULTS: Six hundred and twenty-eight responders were diagnosed with autoimmune conditions between 2002 and 2017. In the nested case-control analyses, high WTC exposure was not associated with autoimmune domains and conditions (rheumatologic domain odds ratio [OR] = 1.03, 95% confidence interval [CI] = 0.77, 1.37; rheumatoid arthritis OR = 1.12, 95% CI = 0.70, 1.77). GRC members had lower SIR than REP. Women's risks were generally greater than men's. CONCLUSIONS: The study found no statistically significant increased risk of autoimmune conditions with WTC exposures.
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