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Association of World Trade Center (WTC) Occupational Exposure Intensity with Chronic Obstructive Pulmonary Disease (COPD) and Asthma COPD Overlap (ACO)

  • WORLD TRADE CENTER (WTC) OCCUPATIONAL EXPOSURE
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Abstract

Introduction

Reported associations between World Trade Center (WTC) occupational exposure and chronic obstructive pulmonary disease (COPD) or asthma COPD overlap (ACO) have been inconsistent. Using spirometric case definitions, we examined that association in the largest WTC occupational surveillance cohort.

Methods

We examined the relation between early arrival at the 2001 WTC disaster site (when dust and fumes exposures were most intense) and COPD and ACO in workers with at least one good quality spirometry with bronchodilator response testing between 2002 and 2019, and no physician-diagnosed COPD before 9/11/2001. COPD was defined spirometrically as fixed airflow obstruction and ACO as airflow obstruction plus an increase of ≥ 400 ml in FEV1 after bronchodilator administration. We used a nested 1:4 case-control design matching on age, sex and height using incidence density sampling.

Results

Of the 17,928 study participants, most were male (85.3%) and overweight or obese (84.9%). Further, 504 (2.8%) and 244 (1.4%) study participants met the COPD and ACO spirometric case definitions, respectively. In multivariable analyses adjusted for smoking, occupation, cohort entry period, high peripheral blood eosinophil count and other covariates, early arrival at the WTC site was associated with both COPD (adjusted odds ratio [ORadj] = 1.34, 95% confidence interval [CI] 1.01–1.78) and ACO (ORadj = 1.55, 95%CI 1.04–2.32).

Conclusion

In this cohort of WTC workers, WTC exposure intensity was associated with spirometrically defined COPD and ACO. Our findings suggest that early arrival to the WTC site is a risk factor for the development of COPD or of fixed airway obstruction in workers with pre-existing asthma.

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Acknowledgements

The authors would like to thank all participants in this study, and the staff of the Mount Sinai WTC Health Program Clinical Center of Excellence, and the WTC General Responders Cohort Data Center. Preliminary results of this work were presented as an abstract at the 2021 International Congress of the European Respiratory Society (Eur Respir J 2021;58 (Suppl 65):PA3353, https://doi.org/10.1183/13993003.congress-2021.PA3353), and as a preprint in SSRN (http://dx.doi.org/10.2139/ssrn.4353884). Dr. Roberto Lucchini is presently at the Department of Occupational and Environmental Health Sciences of the Robert Stempel College of Public Health and Social Work at Florida International University, Miami, FL, USA.

Funding

This work was supported by cooperative agreements No. U01 OH011697 (RED, PI), U01 OH011300 (AN, PI), and contract 200-2017-93325 (WTC General Responders Cohort Data Center, RGL, PI) from the Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health (CDCP/NIOSH).

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Authors and Affiliations

  1. Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Rafael E. de la Hoz, Moshe Shapiro & Roberto G. Lucchini

  2. Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Rafael E. de la Hoz

  3. Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA

    Anna Nolan

  4. Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA

    Akshay Sood

  5. New York City Department of Health and Mental Hygiene, WTC Health Registry, New York, NY, USA

    James E. Cone

  6. Division of Pediatric Pulmonary Medicine, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA

    Juan C. Celedón

  7. Division of Occupational and Environmental Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, WTC HP CCE Box 1059, New York, NY, 10029, USA

    Rafael E. de la Hoz

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Contributions

RED, MS, and JCC designed and oversaw the study and selected analytical strategies. MS performed all statistical analyses. All authors contributed to writing, reviewed, and revised the drafts, and approved the final manuscript.

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Correspondence to Rafael E. de la Hoz.

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de la Hoz, R.E., Shapiro, M., Nolan, A. et al. Association of World Trade Center (WTC) Occupational Exposure Intensity with Chronic Obstructive Pulmonary Disease (COPD) and Asthma COPD Overlap (ACO). Lung 201, 325–334 (2023). https://doi.org/10.1007/s00408-023-00636-4

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