Trending Clinical Topic: 9/11 Health Conditions

Ryan Syrek


September 10, 2021

Each week, we identify one top search term, speculate about what caused its popularity, and provide an infographic on a related condition. If you have thoughts about what's trending and why, share them with us on Twitter or Facebook.

Twenty years after the attacks on the World Trade Center (WTC) and Pentagon, health concerns among survivors and first responders remain a key focus. Through the WTC Health Program, the Centers for Disease Control and Prevention (CDC) continues to track diseases and conditions associated with 9/11. More than 80,000 first responders and more than 30,000 survivors have enrolled in the program as of June 30, 2021.

In addition to the commonly reported conditions shown in the Infographic below, a rise in liver disease has also been reported. The exposure to chemicals, dust, and airborne particulates found at the WTC site have been causally linked to hepatotoxicity. A recent study found that responders who arrived earlier have a significantly higher prevalence of hepatic steatosis compared with those who arrived in the days that followed. The study's author, Artit Jirapatnakul, PhD, said the findings suggest that arrival time to the disaster may prove an important factor for predicting the risk for liver disease in this population and directing treatment accordingly. Last year, a separate study on liver conditions in 9/11 first responders found an elevated risk for nonalcoholic fatty liver disease (NAFLD). The retrospective look at 236 first responders presenting with gastrointestinal symptoms found that 195 (82.6%) had NAFLD, compared with 24%–45% of the general population.

In regard to other health concerns, a study of 9/11 first responders with cognitive impairment found cortical thinning across multiple brain regions, including those commonly affected by Alzheimer's disease. The first structural neuroimaging study conducted in this population suggests that a neurodegenerative condition is present in those affected. In both cognitively impaired and cognitively unimpaired WTC responders, cortical thickness was reduced in the entorhinal and temporal cortices compared with normative data; reductions were greater among those with cognitive impairment. The level of reduction in the study was similar to that commonly found in patients with dementia and may reflect early-stage dementia occurring in midlife.

The 9/11 attacks have also continued to affect mental health, as the experience resulted in serious psychological issues for many of those directly affected and others. As EMT Guy Sanders recently told the Associated Press, "You get people telling you, 'Well, [9/11] happened so long ago. Get over it.' But it is a trauma." Like many others, Sanders says he joined a support group. "It's not something to be gotten over. It's something to be addressed."

Other survivors have seen parallels with the pandemic. John Feal, a construction worker whose foot was crushed by a steel beam in the WTC attack, was diagnosed with and survived COVID-19 last year. Feal sees a connection between 9/11 and the pandemic in that the response to both requires increased community and collective resilience. Twenty years ago, the eyes of the world were on the fallout of the 9/11 attacks. Although a completely different event has now seized global attention, comparisons are causing many to reflect and may have helped lead to this week's top trending clinical topic.

Read more information about the most common 9/11-related health condition, chronic rhinosinusitis.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.