Health Conditions as Mediators of the Association Between World Trade Center Exposure and Health-Related Quality of Life in Firefighters and EMS Workers

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Studies have reported reduced health-related quality of life (HrQoL) in rescue/recovery workers for years postdisaster. Few have examined specific postdisaster physical and mental health conditions as mediators of the association between exposure to disaster and HrQoL.


We used the Short Form-12 to measure HrQoL in 7190 male World Trade Center (WTC)-exposed first responders. Potential mediators included physician diagnoses obtained from medical records and mental health conditions obtained from questionnaires.


Among moderately and highly WTC-exposed workers, health conditions fully mediated the observed relationship between WTC-exposure and physical health functioning of HrQoL, and substantially mediated the association between WTC-exposure and mental health functioning.


Because WTC-related health conditions explain the relationship between WTC-exposure and HrQoL, medical monitoring with treatment of affected populations is necessary to mitigate the adverse effects of WTC-exposure on HrQoL.

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