Overcoming social determinants: World trade center health program monitoring use among the general responders

In the United States, social determinants of health (SDOH) influence preventive health care, morbidity and mortality. As World Trade Center (WTC) general responders' morbidity has been associated with SDOH, we assessed whether their morbidity was associated with WTC Health Program participation.

Five clinical center staff (in New York/New Jersey) collect periodic program data. Adjusted linear, linear mixed model and generalized estimating equation regressions compared general responders' monitoring visits frequencies between January 1, 2008 (when annual monitoring was recommended) and December 31, 2024 in 15,515 members with marginalized and advantaged SDOH (age, sex, race, ethnicity, health care insurance, marital, educational, income occupational and primary language status) characteristics (excludes 7910 non-consenting; 6953 attending <2 visits; 6968 not seen after 2021; and 15,579 with missing data).

No substantial (≥3 months) differences were observed. For example, Black (-0.8, 95% CI -1.3, -0.02) and Hispanic (-0.7, 95% CI -1.4, 0.1) members respectively attended monitoring visits approximately 0.75 months sooner than White and non-Hispanic members.

While the cohort has proportionately fewer people of color, women and elderly and more private health insurance coverage than the general population, the program has achieved remarkably similar health monitoring participation across the socio-economic spectrum.