Racial and Ethnic Disparities in Liver Disease in the WTC General Responder Cohort

Racial and Ethnic Disparities in Liver Disease in the WTC General Responder Cohort: People of color
experience persistent disparities in liver disease outcomes in the U.S. This project investigates how these dis-
parities may affect members of the Mount Sinai WTC General Responder Cohort. Currently, the WTC Healthcare
Program (WTCHP) covers liver cancer treatment, but it does not cover the diagnosis and treatment of other liver
diseases or liver cancer surveillance These policies may create holes in the healthcare safety net that could
disproportionately disadvantage African American Responders. Fortunately, WTC monitoring visits provide the
data needed to calculate the Fibrosis-4 (FIB-4) score, a well-validated instrument for liver disease screening. We
embedded a FIB-4 calculator in Mount Sinai’s EPIC electronic medical record (EMR). It is available to Mount
Sinai WTCHP providers. In this project, we will introduce the calculator to Mount Sinai WTCHP providers. We
will also analyze for disparities in mortality and study archived specimens to assess for toxins that were present
in the WTC dust cloud. Environmental and workplace exposures to toxins can cause liver injury and cancer and
they synergize with other sources of liver injury to magnify damage and liver cancer risk. The WTC dust cloud
contained tons of debris and hepatotoxins, including particulates, polychlorinated biphenyls (PCBs) and other
persistent organic pollutants (POPs). Adolescents exposed to WTC dust had elevated PCDD/F levels > 12 years
after the attack, establishing that toxins in WTC dust remain detectable for long periods. Our research is expected
to show that WTC exposure caused, aggravated, or contributed to liver disease (criteria for certification).
Aim I: Disparities in mortality. The goal of SubAim1 is to collaborate with the WTCHP General Responder
Data Center to rigorously identify all Mount Sinai WTC General Responders with cirrhosis and/or liver cancer.
The goal of SubAim 2 is to test the hypothesis that among responders with cirrhosis and/or liver cancer, African
American responders have higher all-cause and liver-related mortality than other responders.
Aim II: A FIB-4 calculator to screen for liver disease in Mount Sinai General Responders. The goal of Aim
II is to enable WTCHP providers to screen for liver disease. We will introduce the FIB-4 calculator to Mount Sinai
WTCHP providers at some clinics and not others and test the hypothesis that education increases use of the
calculator. We will also monitor for differences in rates of referral to hepatology between clinics in each arm.
Aim III: WTC toxins in plasma and liver. The goal of SubAim 1 is to test the hypothesis that plasma levels of
PCBs and other POPs are higher in GRC responders than in controls and are directly related to FIB-4 scores
and inversely related to platelet counts. The goal of SubAim 2 is to compare particulates and granulomas be-
tween archived liver specimens of WTC responders and controls matched for liver disease etiology.
Impact: The long-term goals are to provide data to inform CDC/NIOSH decisions about whether liver diseases
meet criteria for WTC certification and to address any disparities that may exist among General Responders.

Grant Number: 5U01OH012622-03
NIH Institute/Center: ALLCDC
Principal Investigator: Andrea Branch