Posttraumatic stress disorder (PTSD) has been linked with cardiovascular disease in several trauma affected populations; with elevated rates of PTSD in first responders that results from exposure in their work environments. Our previous work (2012-2016) with 9/11 World Trade Center responders demonstrated a robust association between a diagnosis of PTSD and subsequent cardiovascular events (e.g., myocardial infarction, stroke) in men and women while controlling for other recognized mental health and environmental risk factors such as depression and World Trade Center dust exposure. The World Trade Center Heart Study is a prospective cohort of 6481, diverse first responders drawn the from the larger World Trade Center Health Program in New York City. The cohort has 90% retention and about twice the prevalence of PTSD compared to the general population. Our analysis will link the cohort to new data from the New York State hospitalization registry. We propose an innovative measurement approach to assessing PTSD symptom load in a longitudinal sample focusing on (1) frequency; (2) duration; and (3) intensity of symptoms between 2012 and 2021. We estimate the relationship between PTSD symptom load across time and CVD risk stratifying by race and sex using longitudinal multilevel regressions with random intercepts. This work has implications for understanding the course of PTSD in emergency responders and the link with cardiovascular incidents. It has clinical implications for the treatment and management of PTSD and the prevention of cardiovascular diseases, and coverage implications for the first responders protected by the Zadroga Act.

Background: Throughout the COVID-19 pandemic, continuity of New York City (NYC) public transportation was maintained so that essential workers could continue to commute. The full impact of this policy on NYC transit workers is still being determined.

Objective: To compare temporal trends of COVID-19 incidence between NYC transit workers and NYC residents during March-April, 2020.

Methods: Weekly NYC transit worker case data were obtained from injury and Illness logs. NYC resident case data were obtained from the NYC Health Department. Cases per 100,000 were compared weekly.

Results: Cases of COVID-19 in NYC transit workers peaked one week earlier than in NYC residents. Both the increase and decrease in transit workers’ cases were steeper than in NYC residents’ cases. At their highest levels, NYC transit workers and NYC residents had roughly equivalent COVID-19 case rates (430 transit worker cases/100,000, 422 NYC resident cases/100,000). From March-April, 2020, tower operators, flaggers, and subway operators had the highest COVID-19 rates of any transit occupation.

Conclusion: These findings show that NYC transit workers were likely impacted by COVID-19 earlier than NYC residents. The steeper decline in cases in transit workers may indicate that decreased ridership, reduction in work hours, or other measures may have been effective in protecting transit workers. All necessary safeguards must be ready to implement at the first sign of an emerging disease in order to adequately protect transit workers and to ensure that essential transportation services are available during public health crises.

Background: Some epidemiological studies have reported elevated risk of cancer mortality, most notably lymphohematopoietic cancers, among styrene-exposed workers.

Objective: We aimed to evaluate whether a cohort of workers exposed to styrene between 1948 and 1977 across 30 U.S. reinforced plastics facilities experienced elevated risk of cancer mortality compared to the U.S. national population.

Methods: We performed a mortality update of a historical cohort of 15,826-workers with follow-up occurring from 1948 through 2019 (extended from 2008). Standardized mortality ratios (SMRs) and 95% confidence intervals were computed by comparing observed deaths to expected deaths based on U.S. national-level age-, race-, sex-, and time-specific rates. Exposure-response trends were examined based on cumulative styrene exposure (ppm-months). Additional comparisons incorporating a 10-year lag and a 15-year latency period were performed.

Results: This update added 104,648 person-years of observation and 2,604 deaths. No statistically significant elevations in lymphohematopoietic cancer mortality were observed. Statistically significant excesses in mortality due to respiratory system cancer (SMR=1.30; 95% CI=1.22-1.39), cancer of the bronchus, trachea, and lung (SMR=1.31; 95% CI=1.22-1.40) and bronchitis, emphysema, and asthma (SMR=1.36; 95% CI=1.23-1.49) were observed. No statistically significant exposure-response trends were identified. Lag analyses and statistical comparisons accounting for latency yielded consistent results.

Conclusion: This cohort of U.S. reinforced plastics and composite industry workers experienced higher rates of mortality due to smoking-associated causes compared to the general U.S. population. Exposure-response analyses suggest these elevations may not be associated with styrene exposure. Analyses to evaluate the potential confounding effects of cigarette smoking in this cohort are planned.

Background: Healthy worker survivor bias (HWSB) occurs when healthier individuals remain employed for longer durations than those who leave employment potentially due to occupational exposures, resulting in underestimation of the true effect of an exposure-outcome association. To our knowledge, g-estimation has only been used once to calculate counterfactual unexposed survival times to account for the impact of HWSB on survival time related to lung cancer mortality among styrene-exposed workers (Bertke, 2021).

Objectives: We evaluated the influence of HWSB on survival time (time from cohort entry to death) related to lung cancer mortality among a historical cohort of styrene-exposed workers employed across 30 U.S. reinforced plastics facilities between 1948 and 1977.

Methods: The impact of HWSB on survival time was assessed among a cohort of 15,826 styrene-exposed workers followed from 1948 through 2019. We used g-estimation of a structural nested model adjusting for past exposures, sex, age, and calendar period, conditioned on employment history. Using g-estimation, an exposure-response parameter that compared survival times among exposed versus counterfactually unexposed workers was calculated.

Results: We identified an exposure-response parameter of -0.56, indicating styrene exposure was not associated with a shorter time to lung cancer death after accounting for HWSB. Specifically, this result implies that 1 year of exposure greater than 25 ppm does not accelerate time to lung cancer death.

Conclusion: As the second study that has assessed HWSB among a cohort of styrene-exposed workers, this study suggests HWSB did not have an impact on survival times related to lung cancer mortality.