Interstitial lung abnormalities and disease in World Trade Center workers

World Trade Center (WTC) rescue and recovery workers have developed several occupational exposure-related lower airway diseases and are on longitudinal health surveillance. The role of chest computed tomography (CT) in occupational health surveillance remains to be established.

We used semiquantitative visual chest CT measurements to investigate the association between pre-WTC or WTC occupational exposure indicators and interstitial lung abnormalities and disease (ILAD) in WTC workers and volunteers.

Participants were former WTC workers and volunteers who underwent periodic spirometry and chest CT examinations. We estimated the odds of ILAD, as assessed by the International Classification of High-resolution Computed Tomography for Occupational and Environmental Respiratory Diseases (ICOERD), in relation to pre-WTC and WTC occupational exposure indicators.

Of 918 participants, 175 (19%) had evidence of ILAD on post-WTC CT examinations, and were more likely older, non-Latino White, and to smoke cigarettes. None of the pre-WTC and WTC occupational exposure indicators were associated with post-WTC findings of ILAD. In post hoc subgroup analyses, the odds of ILAD among Latinos were 39% lower (ORadj 0.61, 95% CI 0.28-0.78), and the odds of having an intermediate-accelerated longitudinal FEV1 decline for the Polish subgroup were 71% higher (ORadj 1.71, 95% CI 0.94-3.14) compared to others.

Pre-WTC and WTC occupational exposure indicators were unassociated with presence of ILAD. Post hoc analyses revealed strong subgroup negative and positive associations among Latino or Polish subgroups and ILAD and intermediate-accelerated FEV1 decline, respectively, suggesting the need for further investigation into exposure differences among those subgroups.