How combined exposures impacted World Trade Center responders’ health

Researchers from the Icahn School of Medicine at Mount Sinai have published a study in the journal Communications Medicine that sheds light on the profound health effects of environmental and chemical exposures experienced by rescue and recovery workers after the 9/11 World Trade Center (WTC) attacks.

The study, titled “The World Trade Center Exposome and Health Effects in 9/11 Rescue and Recovery Workers,” used data provided by the WTC Health Program General Responder Data Center at Mount Sinai to explore how harmful substances, contaminated environments, and hazardous materials contributed to conditions such as post-traumatic stress disorder (PTSD), gastroesophageal reflux disease, respiratory disorders, diabetes, and chronic headaches.

This innovative research used an exposomic framework, in which a person’s complete history of environmental exposures is studied, to examine the cumulative impact of combined exposures related to rescue and recovery efforts at the time of 9/11—known as the WTC exposome—on responders’ health.

It identifies both harmful and protective factors, providing a comprehensive understanding of disease development and resilience in disaster settings. Traditional studies often isolate single exposures, like air pollution or lead, while the exposomic framework considers the totality of exposures (chemical, physical, biological, and social) across the person’s life.

“Our study underscores the critical need to understand the combined effects of environmental exposures during disaster response,” said lead author Elza Rechtman, Ph.D., Instructor, Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai.

“Our findings may inform the development of targeted interventions and support the well-being of WTC responders. By identifying specific risk and resilience factors, we can also better protect and support responders in future disasters.”

The study highlights that working in high-risk environments, such as construction sites or areas contaminated with blood and body fluids, significantly increased responders’ risks of developing health problems. Conversely, the research also found that full-time employment may offer a protective effect, potentially related to the Healthy Worker Effect.

This phenomenon, observed in occupational health studies, suggests that healthier individuals are more likely to remain employed, while those with health issues may exit the workforce, leading to better health outcomes among workers. This is one example of the complex interplay between occupational roles and environmental exposures during disaster recovery efforts.

For clinicians, this research underscores the importance of accounting for specific environmental exposures when diagnosing and treating responders. By tailoring diagnostic and treatment strategies to these specific exposures, clinicians may improve patient outcomes and provide more effective, personalized care.

“Our findings also underline the urgent need to develop stronger protective measures for disaster responders and to implement policies that address the long-term health risks posed by complex environmental exposures,” Dr. Rechtman said. “Proactive policies can play a crucial role in mitigating these risks and ensuring the safety and well-being of responders.”

Additionally, the study demonstrates the value of an exposomic framework in disaster preparedness and response. As climate change increases the frequency and severity of natural disasters, this comprehensive approach may provide a critical tool for identifying and managing health risks.

The researchers plan to build on these findings by using longitudinal data from Mount Sinai’s World Trade Center Health Program to explore sex-specific effects and refine strategies for disease prevention and resilience in responders.