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Functional Health and Quality of Life Publications

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2026

  • Work Disability, Early Retirement, and Loss of a Loved One in the World Trade Center Health Registry Cohort.
    • A study looked at how 9/11 affected people’s work and finances. Researchers found that some people could no longer work, retired early, or lost someone close to them. People who could not work were more likely to have lower income, less education, and PTSD. They were also more likely to be older and rescue workers. The study shows that 9/11 had lasting effects on people’s ability to work and their financial well-being.
    • Brite, J., Di Vitto, M., & Metzler, J. (2026). Work Disability, Early Retirement, and Loss of a Loved One in the World Trade Center Health Registry Cohort. American Journal of Industrial Medicine, 69(5), 382–395. https://doi.org/10.1002/ajim.70069
  • Post-Traumatic Growth and Quality of Life among World Trade Center Health Registry Enrollees 16 Years after 9/11
    • This registry study investigate Post-Traumatic growth in Health and Quality of life. Results showed that those who were physically injured during 9/11 experienced better mental functioning than those who did not.
    • Alper, H. E., Feliciano, L., Millien, L., Pollari, C., & Locke, S. (2026). Post-Traumatic Growth and Quality of Life Among World Trade Center Health Registry Enrollees 16 Years After 9/11. International Journal of Environmental Research and Public Health, 23(3), 393. https://doi.org/10.3390/ijerph23030393

2024

  • Chronic and Acute Pain and Adverse Economic Outcomes in a 9/11-Exposed Cohort.
    • A study of WTC Health Registry enrollees exposed to the 9/11 World Trade Center disaster found that both acute and chronic pain are linked to financial struggles and lower quality of life. Those with severe pain were more likely to retire early, have lower incomes, and experience poor health. The study highlights the long-term impact of pain and the need for targeted support for affected individuals.
    • Brite, J., Maqsood, J., Yu, S., Alper, H. E., & Cone, J. E. (2024). Chronic and Acute Pain and Adverse Economic Outcomes in a 9/11-Exposed Cohort. International Journal of Environmental Research and Public Health, 21(11), 1490. https://doi.org/10.3390/ijerph21111490

2021

  • Associations of Embeddedness and Posttraumatic Stress Disorder among 9/11 Survivors
    • The study looked at the relationship between social and emotional embeddedness and posttraumatic stress disorder (PTSD). Social embeddedness refers to a group of friends that can provide a feeling of belonging. Emotional embeddedness refers to being emotionally connected to people around you. We found that people with PTSD had the smallest friend group. Those who reported little to no PTSD reported the most friendships. It may be helpful for clinicians to address the social needs of those experiencing PTSD.
    • Hamwey, M. K., Pollari, C. D., Osahan, S., Garrey, S. K., Ortega, F. M., Solomon, A., & Brackbill, R. M. (2021). Associations of Embeddedness and Posttraumatic Stress Disorder among 9/11 Survivors. Epidemiologia, 2(4), 608–620. https://doi.org/10.3390/epidemiologia2040041
  • Effects of 9/11‐related injury on retirement patterns among World Trade Center Health Registry enrollees
    • Many survivors of the 9/11 terrorist attacks in New York City were injured. This study looked to understand how 9/11-related injuries affected retirement plans of WTC Health Registry enrollees. Study results showed that injured enrollees were more likely of retiring at younger ages compared to non-injured enrollees. Enrollees who retired with less severe injuries, were much more likely to return to work. Our results suggested that being injured on 9/11 was associated with early retirement if the injuries had not occurred, the person may have continued working longer.
    • Seil, K., Yu, S., Brackbill, R., Alper, H., & Maqsood, J. (2021). Effects of 9/11‐related injury on retirement patterns among World Trade Center Health Registry enrollees. American Journal of Industrial Medicine, 64(10), 873–880. https://doi.org/10.1002/ajim.23288

2020

  • Injury severity and psychological distress sustained in the aftermath of the attacks of 11 September 2001 predict somatic symptoms in World Trade Center Health Registry enrollees sixteen years later
    • The World Trade Center attacks on September 11th, 2001 (9/11) have been associated with the subsequent development of chronic diseases such as asthma, Post Traumatic Stress Disorder, heart attack, stroke, cancer, and autoimmune disease. Few studies have investigated the burden of unexplained physical health issues, or “somatic symptoms,” on 9/11 victims, or the relationship of such symptoms to exposure to the 9/11 attacks. In this study, we found that twenty-one percent of subjects had a “very high” burden of somatic symptoms, which is a greater rate compared to those in the general population, or populations who were not exposed to mass disasters (2-7%). We found that the level of somatic symptoms increased as the severity of reported 9/11-injury and psychological distress increased. In conclusion, we determined that victims of the 9/11 attacks suffer from a substantial burden of somatic symptoms, which are associated with physical and psychological consequences of exposure to the attacks. When designing treatment protocols for individuals exposed to complex man-made disasters like 9/11, healthcare professionals should consider both physical and mental health treatment approaches.
    • Alper, H. E., Gargano, L. M., Cone, J. E., & Brackbill, R. M. (2020). Injury Severity and Psychological Distress Sustained in the Aftermath of the Attacks of 11 September 2001 Predict Somatic Symptoms in World Trade Center Health Registry Enrollees Sixteen Years Later. International Journal of Environmental Research and Public Health, 17(12), 4232. https://doi.org/10.3390/ijerph17124232

2019

  • Comparing Life Satisfaction and Functioning 15 years after September 11, 2001 among survivors with and without injuries: a mixed-method study
    • Exposure to disasters is associated with long-term outcomes that impact one’s quality of life in numerous ways. In epidemiological research, quality of life refers to a person or group of peoples’ general well-being and satisfaction with the various aspects of their lives including physical health, family, education, employment, and finances. Quality of life among survivors of the terrorist attacks on the World Trade Center (WTC) is poorly understood, even with numerous studies showing that both mental and physical health conditions, strong predictors of quality of life, associated with the disaster can persist for years. In this study, we tried to dig deeper into the is-sue of the quality of life among 9/11 survivors by comparing life satisfaction and limited activity days among WTC Health Registry enrollees who did and did not endure physical injuries on 9/11. We used a “mixed-methods” approach for our study’s methodology meaning we performed both a statistical, or “quantitative,” analysis and a “qualitative” analysis of free text response left by enrollees at the end of the W4 survey. For the quantitative portion of the analysis, we examined the differences in life satisfaction and number of limited activity days in the last 30 days (i.e. at the time the survey response were given) between those with and without injuries using a statistical method called a “multivariable logistic regression.” For the qualitative portion of the analysis, we used a multi-round textual analysis to determined several themes embedded in the free-text comments and compared themes left by those with and without injuries. Textual themes identified in this analysis included, “emotional trauma/depressed/anxious,” “fear of future,” and, “I have moved on.” Our key findings in the quantitative analysis were that, compared to those who were not injured, those who sustained injuries on 9/11 were more likely to report being unsatisfied with their life and have 14 or more limited activity days in the last 30 days. Among those who were injured, being partially or completely prevented from working increased the likelihood of being unsatisfied with life and having 14 or more limited activity days. In the qualitative analysis, the emotional trauma experienced on account of exposure to 9/11 was a major and common theme, irrespective of injury status. Those who were injured on 9/11 were more likely to leave comments that fell into the theme of “anger/lack of recognition/appreciation,” describe substance use or abuse, and write about financial or healthcare access issues. The use of quantitative and qualitative analysis provided a more nuanced picture of the long-term effect of being injured on 9/11 on the present-day quality of life for WTC Health Registry enrollees. Early treatment for disaster-related injuries, as well as the identification and treatment of mental health conditions among those exposed to disasters, may improve long-term quality of life-related outcomes.
    • Gargano, L. M., Mok, H. K., Jacobson, M. H., Frazier, P., Garrey, S. K., Petrsoric, L. J., & Brackbill, R. M. (2019). Comparing life satisfaction and functioning 15 years after September 11, 2001 among survivors with and without injuries: A mixed-method study. Quality of Life Research, 28(10), 2787–2797. https://doi.org/10.1007/s11136-019-02194-w
  • Impact of health on early retirement and post-retirement income loss among survivors of the September 11, 2001 World Trade Center disaster
    • The health consequences of the 9/11 World Trade Center (WTC) terrorist attacks are well documented, but few studies have assessed the disaster’s impact on employment among individuals exposed to the disaster. Early retirement is an important factor to consider for economic assessments, as it can strongly affect one’s well-being (such as post-retirement income) for the remainder of one’s life. This study examined the association between 9/11-related health conditions and early retirement among residents and workers (N=6,377) who resided and/or worked near the WTC site on 9/11. It also looked at the association between such conditions and post-retirement income loss. The study data were from the WTC Health Registry, longitudinal health surveys in 2003–2004 and 2006–2007, and the 2017–2018 Health and Employment Survey. We found that residents and area workers with more physical health conditions resulting from 9/11, especially when simultaneously present with posttraumatic stress disorder (PTSD), were more likely to retire before age 60 than those with no conditions. For retirees, having PTSD or PTSD in addition to any number of physical conditions increased the odds of reporting substantial post-retirement income loss. Disaster-related outcomes can negatively impact aging individuals in the form of early retirement and income loss. Long-term effects of major disasters must continue to be studied.
    • Yu, S., Seil, K., & Maqsood, J. (2019). Impact of Health on Early Retirement and Post-Retirement Income Loss among Survivors of the 11 September 2001 World Trade Center Disaster. International Journal of Environmental Research and Public Health, 16(7), 1177. https://doi.org/10.3390/ijerph16071177
  • An assessment of long-term physical and emotional quality of life of person injured on 9/11/2001
    • Fifteen years after the disaster, the World Trade Center Health Registry conducted The Health and Quality of Life Survey. The survey looked at the physical and mental health of those who reported being injured on 9/11. This information was compared to non-injured persons. The results suggested that traumatic injuries appear to have a lasting negative effect on physical functioning.
    • Brackbill, R. M., Alper, H. E., Frazier, P., Gargano, L. M., Jacobson, M. H., & Solomon, A. (2019). An Assessment of Long-Term Physical and Emotional Quality of Life of Persons Injured on 9/11/2001. International Journal of Environmental Research and Public Health, 16(6), 1054. https://doi.org/10.3390/ijerph16061054

2018

  • In-Depth Study of Long-Term Impacts among People Injured on 9/11
    • A study examined the long-term health of people injured during the September 11 attacks. Researchers first interviewed 34 people about their experiences, then surveyed more than 6,500 people to study their physical and mental health. Among those surveyed, 41% had been injured on 9/11. Only 39% of injured participants said they were satisfied with their lives, compared with 61% of those who were not injured. The study aims to better understand the lasting effects of injury.
    • Solomon, A., Gargano, L. M., Locke, S., & Brackbill, R. M. (2018). In-Depth Study of Long-Term Impacts among People Injured on 9/11. Annals of Epidemiology, 28(9), 664. https://doi.org/10.1016/j.annepidem.2018.06.043

2017

  • Comorbidity amplifies the effects of post-9/11 Posttraumatic Stress Disorder Trajectories on Health-Related Quality of Life
    • A study of 30,002 people exposed to 9/11 examined how PTSD and other health problems affected quality of life over 10 years. People with long-term PTSD were much more likely to report poor health, frequent unhealthy days, and limits on daily activities. These problems were even greater among people who also had physical or mental health conditions. The findings show that early treatment for PTSD and other health problems may improve long-term quality of life after a disaster.
    • Li, J., Zweig, K. C., Brackbill, R. M., Farfel, M. R., & Cone, J. E. (2018). Comorbidity amplifies the effects of post-9/11 posttraumatic stress disorder trajectories on health-related quality of life. Quality of Life Research, 27(3), 651–660. https://doi.org/10.1007/s11136-017-1764-5
  • Injury, Intense Dust Exposure and Chronic Disease among Survivors of the World Trade Center Terrorist Attacks of September 11, 2001
    • Many people exposed to the September 11, 2001 terrorist attacks developed chronic diseases years later, but little is known about the association between chronic disease and exposure to the 9/11 attacks (e.g. injury, dust cloud), among those exposed exclusively or mainly on the day of the attacks. This study investigated the association between heart disease and injury, and between asthma/other lung diseases and dust cloud exposure, among those whose exposure occurred on 9/11 and not afterwards. Heart disease exhibited a substantial and significant association with number of injury types sustained on 9/11, while asthma and other lung diseases were significantly associated with intense dust cloud exposure on 9/11. These results suggest the need for continued monitoring of 9/11 exposed persons by medical providers.
    • Alper, H. E., Yu, S., Stellman, S. D., & Brackbill, R. M. (2017). Injury, intense dust exposure, and chronic disease among survivors of the World Trade Center terrorist attacks of September 11, 2001. Injury Epidemiology, 4(1), 17. https://doi.org/10.1186/s40621-017-0115-x

2016

  • Quality of life of persons injured on 9/11: Qualitative analysis from the World Trade Center Health Registry
    • Interviews with person injured on 9/11 found that even after the injury has healed, injured disaster survivors continue to have long-term health impacts from their experience. Some injured disaster survivors report having serious physical and mental health problems, economic problems due to loss of livelihood, limited sources of social support. A few survivors reported profound social isolation. Strategies for addressing the long-term health problems of disaster survivors are needed in order to support recovery.
    • Gargano, L. M., Gershon, R., & Brackbill, R. (2016). Quality of Life of Persons Injured on 9/11: Qualitative Analysis from the World Trade Center Health Registry. PLoS Currents. https://doi.org/10.1371/currents.dis.7c70f66c1e6c5f41b43c797cb2a04793
  • Impact of 9/11-related chronic conditions and PTSD comorbidity on early retirement and job loss among World Trade Center disaster rescue and recovery workers
    • This study focused on the economic impact of the 9/11 terrorist attacks. We looked at the association between 9/11-related chronic health conditions with or without PTSD and early retirement and job loss. A total of 7,662 non-uniformed rescue/recovery workers, such as volunteers, construction workers, healthcare staff, finance, and environmental services workers were studied. We found that workers with chronic conditions were more likely to experience early retirement and job loss, and the likelihood increased considerably when the worker also had PTSD. Disasters like 9/11 terrorist attacks have a large ripple effect on one’s overall well-being through health, employment, and earnings. Future evaluation of disaster impact should extend beyond the direct and short-term health consequences and include its long-term impact on labor force.
    • Yu, S., Brackbill, R. M., Locke, S., Stellman, S. D., & Gargano, L. M. (2016). Impact of 9/11‐related chronic conditions and PTSD comorbidity on early retirement and job loss among World Trade Center disaster rescue and recovery workers. American Journal of Industrial Medicine, 59(9), 731–741. https://doi.org/10.1002/ajim.22640

2014

  • Chronic Physical Health Consequences of Being Injured during the Terrorist Attacks on World Trade Center on September 11, 2001
    • Enrollees with injuries as a result of 9/11, including broken bones, burns, and head trauma, were found to be at increased risk of chronic disease five to six years later. This study included more than 14,000 adult enrollees who reported no previous diagnosis of heart disease, respiratory dis-ease, diabetes or cancer. The nearly 2,000 enrollees who reported more than one type of injury were twice as likely to also report a respiratory illness as those who were not injured. Enrollees with multiple types of injuries and probable post-traumatic stress disorder (PTSD) were three times more likely to report heart disease than those without injuries and PTSD.
    • Brackbill, R. M., Cone, J. E., Farfel, M. R., & Stellman, S. D. (2014). Chronic Physical Health Consequences of Being Injured During the Terrorist Attacks on World Trade Center on September 11, 2001. American Journal of Epidemiology, 179(9), 1076–1085. https://doi.org/10.1093/aje/kwu022

2012

  • Nonfatal injuries 1 week after Hurricane Sandy – New York City Metropolitan Area, October 2012
    • The study looked at injuries sustained in the first week after Hurricane Sandy hit New York City area on October 29, 2012. The degree of flooding in the home or surrounding area was directly related to the occurrence of injury, with 39% of those who evacuated by walking through water or swimming being injured, and 25% of those whose homes were flooded with 3 or more feet of water, regardless of whether they did or did not evacuate. Additionally, the greatest number injuries occurred among persons who had a damaged or destroyed home and attempted to do clean-up or repair work.
    • Brackbill, R. M., Caramanica, K., Maliniak, M., Stellman, S. D., Fairclough, M. A., Farfel, M. R., Turner, L., Maslow, C. B., Moy, A. J., Wu, D., Yu, S., Welch, A. E., Cone, J. E., & Walker, D. J. (2014). Nonfatal injuries 1 week after hurricane sandy--New York city metropolitan area, October 2012. MMWR. Morbidity and Mortality Weekly Report, 63(42), 950–954.