A Message from Thomas Farley, MD, MPH, the Commissioner of the New York City Department of Health and Mental Hygiene

Millions of people were affected by the September 11 terrorist attacks — from physical and mental health problems to financial loss. This large and diverse population had different exposures after the collapse of the World Trade Center (WTC), and health effects have varied as a result.

Thanks to recent research, we now know more about the health effects of 9/11. The WTC Medical Working Group's 2009 Annual Report on 9/11 Health includes a review of the latest medical research on potential health impacts of 9/11.

In addition, the WTC Health Bulletin offers New Yorkers advice on how to get information, treatment and help for 9/11-related health problems, such as free diagnostic and treatment services at the WTC Centers of Excellence.

What We Know

• Recent studies suggest that post-traumatic stress symptoms are the most common health effect of 9/11. Almost one in five (19%) adults enrolled in the Health Department's WTC Health Registry reported post-traumatic stress symptoms 5 to 6 years after 9/11, roughly 4 times the rate typically found in the general population.
  
  Risk factors for probable PTSD included:

• Intense dust cloud exposure or suffering an injury on 9/11
• Witnessing horror or knowing someone killed or injured on 9/11
• Little or no social support after 9/11

Rescue and recovery workers who started rescue work on or soon after 9/11 or who worked at the WTC site for a long time were also more likely to develop PTSD. Workers from non-emergency occupations also suffered high rates of PTSD.

• People who experienced trauma before or after 9/11, such as losing a job after the attacks, were at increased risk for developing PTSD.

• Those exposed to WTC-related dust were more likely to develop respiratory symptoms, sinus problems, asthma or lung problems. One in 10 (10%) Registry enrollees developed new-onset asthma within 6 years of 9/11, 3 times the national rate. New cases were highest during the first 16 months after 9/11.

• Intense dust cloud exposure on 9/11 increased everyone's risk for developing asthma. The risk was also increased among:
• rescue, recovery and clean-up workers who arrived early at the WTC site or worked at the WTC site for long periods of time;
• Lower Manhattan residents who didn't evacuate their homes, and
• Lower Manhattan residents and office workers who returned to homes or workplaces covered with a thick coating of dust.

• Many WTC-exposed people report heartburn, acid reflux or gastroesophageal reflux disease (GERD), often with respiratory or mental health symptoms. Since these symptoms are common among the general population, more research is needed to determine if there is a connection between them and WTC exposure.

• Recent data suggests elevated levels of sarcoidosis (an inflammatory disease mostly seen in the lungs) among firefighters in the first few years after 9/11. Researchers are studying sarcoidosis rates among other exposed groups

• WTC-related mental and physical health conditions often co-exist.

• Few studies have addressed the impact of WTC exposure on child and adolescent health, especially physical health, although data from the WTC Health Registry's baseline survey of 3,000 children and adolescents indicate that very young children caught in the dust cloud on 9/11 were at increased risk for developing asthma. In December 2008, the Registry completed a survey of child and adolescent enrollees. The results will help determine to what extent physical and mental health conditions have persisted among children after 9/11, and whether any new symptoms and conditions have emerged.

• Researchers are actively studying if there is a connection between WTC exposure and other long-term illnesses, such as cancer. They also are studying mortality rates in those affected.

What Additional Research Can Tell Us

• More about the prevalence and persistence of WTC-related conditions almost a decade after 9/11. The WTC Health Registry will begin its 3rd survey of more than 71,000 enrollees in 2010.
• The extent to which people with potential WTC-related health conditions are receiving treatment, and what coverage gaps remain
• The effectiveness of treatment for patients with WTC-related mental and physical health conditions
• Whether mortality and the incidence of cancer, chronic illnesses and other late emerging diseases among WTC-exposed populations is elevated compared to estimated rates for New York City if the WTC disaster had not occurred.
• How prevalent WTC-related depression, substance use and suicide are among WTC-exposed populations
• The impact of ongoing WTC-related physical health conditions on long-term mental health
• The impact of tobacco use on WTC-related respiratory conditions
• The impact of 9/11 on children who went to school or who lived in the area, whose parents were part of the rescue and recovery effort or who lost family members

Monitoring and Treatment for 9/11-Related Health Conditions

People affected by 9/11 are eligible for treatment and medication with no out-of-pocket costs at New York City's WTC Centers of Excellence. The Health Department also offers an insurance-like benefit to help cover mental health and substance use treatment for NYC residents affected by 9/11.

Representatives from the Centers also helped develop clinical guidelines for adults and children exposed to 9/11. The guidelines can be used by health care providers nationwide to diagnose and treat WTC-related health problems.

The Centers and the WTC Health Registry—all funded by the federal government—continue to provide clinicians, epidemiologists and other researchers with the kind of evidence that will help answer some of the unknowns over the long term. Their ongoing work will help better identify the people who are at greatest risk for becoming ill and further refine treatment options for people who already are sick.