World Trade Center (WTC) Exposures and Cardiometabolic Risk Among WTC Health Program General Responders

Objectives. To assess the association between World Trade Center (WTC) exposures, cardiometabolic diseases (CMDs), and trajectories of glucose and systolic blood pressure (SBP) among WTC Health Program general responders (WTHPGR). Methods. We included monitoring visits (2003-2021) of WTHPGR who participated in the operations in New York City after the September 11, 2001, attack (n = 47 795). The WTC Health Program assessed WTC exposures using questionnaires and measured trajectories during monitoring study visits; CMDs were self-reported. We assessed associations with CMDs (hazard ratios and their corresponding 95% confidence intervals [CIs]) using survival analyses. We assessed associations with trajectories (odds ratios and their corresponding 95% CIs) using logistic regressions. Results. Interquartile range (IQR) increases in the number of days on-site in the 9 months following the attack were associated with increased diabetes (1.057; 95% CI = 1.025, 1.089) and hypertension (1.035; 95% CI = 1.014, 1.057) risks. IQR increases in hours on-site during September 2001 were associated with worsening glucose (1.040; 95% CI = 1.017, 1.064) and SBP (1.006; 95% CI = 1.001, 1.010) trajectories. Conclusions. WTC exposures are associated with higher CMD risk and worsening cardiometabolic trajectories among WTHPGR. Public Health implications. Linking WTC exposures to emerging diseases is vital because of its impact on health care costs and treatment access among WTHPGR. (Am J Public Health. 2025;115(7):1120-1128. https://doi.org/10.2105/AJPH.2025.308079).