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Introduction: Hazardous exposures from the World Trade Center (WTC) terrorist attacks have been linked to increased incidence of adverse health conditions, often associated with increased mortality. We assessed mortality in a pooled cohort of WTC rescue/recovery workers over 15 years of follow-up., Materials and Methods: We analyzed mortality through 2016 in a pooled and deduplicated cohort of WTC rescue/recovery workers from three WTC-exposed cohorts (N = 60,631): the Fire Department of the City of New York (FDNY); the WTC Health Registry (WTCHR); and the General Responder Cohort (GRC). Standardized mortality ratios (SMRs) were estimated to assess mortality vs. the US and NY state populations. Multivariable Cox proportional hazards models were used to examine associations of WTC exposures (date of first arrival, working on the WTC debris pile) with mortality risk., Results: There were 1912 deaths over 697,943.33 person-years of follow-up. The SMR for all-cause mortality was significantly lower-than-expected, both when using US (SMR 0.43, 95% confidence interval [CI] 0.42-0.45) and NYS (SMR 0.51, 95% CI 0.49-0.53) as reference populations. SMRs were not elevated for any of the 28 major causes of death. Arriving at the WTC site on 9/11-9/17/2001 vs. 9/18/2001-6/30/2002 was associated with 30-50% higher risk of all-cause, heart disease and smoking-related mortality in non-FDNY/non-GRC members. Conversely, arriving on 9/11/2001 vs. 9/18/2001-6/30/2002 was associated with 40% lower all-cause and smoking-related mortality risk in FDNY members. Working on vs. off the WTC pile was associated with an increased risk of all-cause mortality in non-FDNY/non-GRC members (adjusted hazard ratio [aHR] 1.25, 95% CI 1.04-1.50), and cancer-specific mortality in GRC members (aHR 1.39, 95% CI 1.05-1.84), but lower mortality risks were found in FDNY members., Conclusions: We did not observe excess mortality among WTC rescue/recovery workers compared with general populations. However, significantly increased mortality risks among some sub-groups with high WTC exposure warrant further investigation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier Inc.)

Background: Multiple chronic health conditions have been associated with exposure to the September 11, 2001 World Trade Center (WTC) terrorist attacks (9/11). We assessed whether excess deaths occurred during 2003-2014 among persons directly exposed to 9/11, and examined associations of 9/11-related exposures with mortality risk., Materials and Methods: Deaths occurring in 2003-2014 among members of the World Trade Center Health Registry, a cohort of rescue/recovery workers and lower Manhattan community members who were exposed to 9/11, were identified via linkage to the National Death Index. Participants' overall levels of 9/11-related exposure were categorized as high, intermediate, or low. We calculated standardized mortality ratios (SMR) using New York City reference rates from 2003 to 2012. Proportional hazards were used to assess associations of 9/11-related exposures with mortality, accounting for age, sex, race/ethnicity and other potential confounders., Results: We identified 877 deaths among 29,280 rescue/recovery workers (3.0%) and 1694 deaths among 39,643 community members (4.3%) during 308,340 and 416,448 person-years of observation, respectively. The SMR for all causes of death was 0.69 [95% confidence interval (CI) 0.65-0.74] for rescue/recovery workers and 0.86 (95% CI 0.82-0.90) for community members. SMRs for diseases of the cardiovascular and respiratory systems were significantly lower than expected in both groups. SMRs for several other causes of death were significantly elevated, including suicide among rescue recovery workers (SMR 1.82, 95% CI 1.35-2.39), and brain malignancies (SMR 2.25, 95% CI 1.48-3.28) and non-Hodgkin's lymphoma (SMR 1.79, 95% CI 1.24-2.50) among community members. Compared to low exposure, both intermediate [adjusted hazard ratio (AHR) 1.36, 95% CI 1.10-1.67] and high (AHR 1.41, 95% CI 1.06-1.88) levels of 9/11-related exposure were significantly associated with all-cause mortality among rescue/recovery workers (p-value for trend 0.01). For community members, intermediate (AHR 1.13, 95% CI 1.01-1.27), but not high (AHR 1.14, 95% CI 0.94-1.39) exposure was significantly associated with all-cause mortality (p-value for trend 0.03). AHRs for associations of overall 9/11-related exposure with heart disease- and cancer-related mortality were similar in magnitude to those for all-cause mortality, but with 95% CIs crossing the null value., Conclusions: Overall mortality was not elevated. Among specific causes of death that were significantly elevated, suicide among rescue/recovery workers is a plausible long-term consequence of 9/11 exposure, and is potentially preventable. Elevated mortality due to other causes, including non-Hodgkin's lymphoma and brain cancer, and small but statistically significant associations of 9/11-related exposures with all-cause mortality hazard warrant additional surveillance., (Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)

We examined changes in ambient dust lead (Pb) levels associated with the demolition of older row houses containing lead paint in Baltimore, MD, USA. Our previous paper describes the three study sites, the demolition processes, and increases in the Pb dustfall rate during demolition (>40-fold) and debris removal (>6-fold) within 10 m of sites where wetting was of limited effectiveness. This paper presents the analysis of settled dust collected using a cyclone device from streets, sidewalks, and alleys within 100 m of study sites before, immediately after, and 1 month after demolition. We found acute increases in Pb loadings and dust loadings after demolition and debris removal that are of public health concern. Streets and alleys had the greatest increases in Pb loadings and the highest levels overall. At one site, geometric mean (GM) Pb loadings immediately after demolition increased 200% for streets to 8080 microg/ft(2), 138% for alleys to 6020 microg/ft(2), and 26% for sidewalks to 2170 microg/ft(2). One month after demolition, the GM Pb loadings for streets, alleys, and sidewalks were reduced on average by 41-67% from post-demolition levels and were below baseline levels for alleys and sidewalks. The other main site had smaller increases in GM Pb loadings immediately after demolition-18% for alleys to 1740 microg/ft(2) and 18% for sidewalks to 2050 microg/ft(2)-and a decrease of 29% for streets to 2730 microg/ft(2). Exterior dust is a public health concern because it is a pathway of ambient Pb exposure and a potential source of residential exposure via tracking and re-aerosolization and re-deposition. Our findings highlight the need to control demolition-related Pb deposition and to educate planners, contractors, and health and housing agencies. This is particularly important given the large numbers of aging US dwellings that will be razed as part of future urban redevelopment efforts.

Residential lead-based paint and settled dust are important sources of lead exposure in U.S. children. Scant information exists on the long-term effectiveness of alternative lead abatement practices. In this extended (1.5-3.5 years) follow-up study of comprehensive abatement, 179 wipe dust samples were collected in 13 occupied dwellings for which pre- and immediately postabatement (clearance) dust lead data were available. Dust lead loadings (mg/m2) 1.5 to 3.5 years postabatement were 16, 10, and 4% of preabatement levels for floors, window sills, and window wells, respectively. Furthermore, 78% of readings remained within Maryland's interim clearance standards, indicating that sustained reductions of dust lead hazards were achieved in comprehensively abated dwellings located in older unabated housing areas.

Lead-containing house dust is an important source of childhood lead exposure. Standard methods for collection of settled dust for evaluation of lead content have not been established. Little is known about the relationships between the various wipe and vacuum-based methods employed in past studies, preventing meaningful comparisons of results. This study characterized the relationship between a frequently used wipe dust collection method and a vacuum-based in-line filter method used to collect dust in a national survey of lead in paint and dust in U.S. housing. The correlation coefficient was 0.82 for estimates of lead loadings (PbD, mg/m2) from 71 pairs of side-by-side wipe and vacuum dust samples collected from uncarpeted floors, window sills, and exterior window wells in six dwellings. Geometric mean (GM) wipe PbD estimates exceeded those for vacuum samples by a factor of 3.9 and 5.7 for floors and window sills, respectively, findings consistent with the multiple sources of sample loss associated with the vacuum sampler. For window wells, the GM vacuum PbD estimate exceeded the GM wipe PbD estimate by a factor of 3.4, possibly due to the use of an alternative vacuum nozzle. The resulting increase in the estimated prevalence of U.S. homes with elevated dust lead loadings had wipe-sampling instead of vacuum-sampling methods been used in the national survey is discussed.

In this pilot study, we prospectively evaluated experimental practices for abating lead-based paint in six dwellings. These experimental abatements were based upon a new approach to abatement which reflects current understanding of low-level lead toxicity in children and the role of lead-contaminated dust as an important contributor to children's total body burden. Our previous study of traditional abatement practices in Baltimore showed them to be inadequate for reducing lead in both house dust and children's blood. Our experimental abatements resulted in significant reductions in house dust-lead levels (PbD) which persisted during 6-9 months of followup. Geometric mean PbD at floors, window sills, and window wells were respectively 5.6, 49.6, and 316.7 mg/m2 at preabatement, and respectively 0.6, 4.4, and 10.8 mg/m2 at 6-9 months. Experimental abatements involved (1) treatment of lead-painted surfaces above and below 4 ft from the floor, including interior and exterior components of windows; (2) sealing or covering of wooden floors; (3) procedures for containment of dust during abatement; and (4) a final cleanup using a high-efficiency particle air (HEPA) vacuum. We recommend that more research be done to further evaluate and compare the long-term efficacy of these and other abatement methodologies.