Health Effects of World Trade Center Exposure

The collapse of the World Trade Center towers on 11 September 2001 released a complex mixture of dust, combustion products and airborne particulates that have been linked to a wide spectrum of adverse health outcomes. Acute inhalation of alkaline particulate matter provoked bronchial hyperreactivity, persistent cough and new-onset asthma among first responders and nearby residents. Over the long term, exposure has been associated with accelerated decline in lung function, chronic obstructive and restrictive changes on spirometry, and increased incidence of cardiovascular events such as myocardial infarction and stroke. Cancer incidence, particularly of the thyroid, prostate and haematolymphoid systems, appears modestly elevated above background rates in heavily exposed cohorts, though latency and surveillance bias present interpretative challenges. Emerging evidence also highlights epigenetic reprogramming—especially DNA methylation changes—in genes governing immune, endocrine and metabolic pathways, suggesting mechanisms for multisystem disease. Psychological sequelae, including post-traumatic stress disorder and depression, compound physical morbidities and underscore the need for integrated care. Continued longitudinal follow-up of responders, residents and volunteers remains essential to delineate late-emerging effects, guide screening protocols and inform preparedness for future environmental disasters.

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Health Effects of World Trade Center Exposure publication trend

The graph below shows the total number of articles in health effects of world trade center exposure across all publications each year (not limited to Nature Index journals).

Technical terms

Particulate matter (PM): A heterogeneous mix of solid and liquid particles suspended in air, classified by aerodynamic diameter (e.g. PM2.5 < 2.5 µm), capable of deep pulmonary penetration and systemic translocation.

DNA methylation: An epigenetic modification involving addition of methyl groups to cytosine bases in DNA, influencing gene expression without altering nucleotide sequence.

Transcriptomics: The global analysis of RNA transcripts expressed by a cell or tissue, used to identify differentially regulated genes and pathways in response to an exposure.

Bronchial hyperresponsiveness: An exaggerated airway constrictive response to stimuli such as methacholine, indicative of reactive airway disease.

References

1. Characterization of the dust/smoke aerosol that settled east of the World Trade Center (WTC) in lower Manhattan after the collapse of the WTC 11 September 2001.. Environmental Health Perspectives (2002).
2. The World Trade Center Disaster and the Health of Workers: Five-Year Assessment of a Unique Medical Screening Program. Environmental Health Perspectives (2006).
3. The World Trade Center Residents’ Respiratory Health Study: New-Onset Respiratory Symptoms and Pulmonary Function. Environmental Health Perspectives (2004).
4. Health and environmental consequences of the world trade center disaster.. Environmental Health Perspectives (2004).
5. Cancer Incidence in World Trade Center Rescue and Recovery Workers, 2001–2008. Environmental Health Perspectives (2013).
6. Transcriptomic analysis of World Trade Center particulate Matter-induced pulmonary inflammation and drug treatments. Environment International (2023).
7. World Trade Center Exposure, DNA Methylation Changes, and Cancer: A Review of Current Evidence. Epigenomes (2023).
8. Long-term Cardiovascular Disease Risk Among Firefighters After the World Trade Center Disaster. JAMA Network Open (2019).