Self-reported Cardiovascular Disease in Career Firefighters With and Without World Trade Center Exposure

Objective: To assess the effect of World Trade Center (WTC) exposure on cardiovascular disease (CVD) in career firefighters. Methods: Firefighters from four US cities completed health questionnaires that provide information about demographics, CVD diagnoses, and CVD risk factors. Firefighters were also compared with respondents of the 2019 National Health Interview Survey. Results: Greater WTC exposure was positively associated with combined coronary artery disease, myocardial infarction, and angina (termed CAD) when comparing WTC-exposed with non-WTC-exposed firefighters. Compared with the National Health Interview Survey population, firefighters had lower odds of CAD and stroke. Conclusions: An occupationally appropriate comparison is important to mitigate potential bias from the healthy worker effect. While the risk of CVD in WTC-exposed and non-WTC-exposed firefighters was significantly lower than a general US population, we observed an exposure gradient where greater WTC exposure was associated with greater odds of CVD.

Automated summary

This study assessed the impact of WTC exposure on CVD in career firefighters. Results showed a positive association between WTC exposure and CAD, with a dose-response relationship. Firefighters had a lower risk of CAD and stroke compared to the general population. The study emphasizes the importance of occupationally appropriate comparisons to mitigate bias from the healthy worker effect.