# Disparities in Utilization of the World Trade Center Health Program Among World Trade Center Rescue and Recovery Workers and Volunteers

## TL;DR

Volunteers at the World Trade Center site after 9/11 used health services less than first responders, highlighting a need for better outreach.

## Contribution

Identifies disparities in health program use among different types of 9/11 responders and volunteers.

## Key findings

- Only 22.5% of volunteers used the WTC Health Program compared to 47.9% overall.
- First responders were 2.73 times more likely to use the program than volunteers.
- Sociodemographic factors influenced program use, but race/ethnicity did not consistently.

## Abstract

The 11 September 2001 World Trade Center (WTC) rescue and recovery workers (RRWs) included first responders (FDNY and NYPD), volunteers, and other workers. Volunteers were often more vulnerable than first responders to adverse health outcomes resulting from the exposure. It is not yet known whether there are differences in WTC Health Program (WTCHP) utilization by worker type. This is a cross-sectional study of 20,012 WTCHP-eligible RRWs to examine whether worker type was associated with WTCHP utilization based on self-reported data from four WTC Health Registry follow-up surveys (2006–2021), using multivariable log-binomial regression adjusted for sociodemographic factors and comorbidities. We also examined factors associated with WTCHP utilization by worker type. Overall, 9584 RRWs (47.9%) reported receiving WTCHP services, but only 22.5% of volunteers reported WTCHP utilization. After adjustment, first responders and other workers were, respectively, 2.73 (95% CI = 2.56, 2.92) and 1.69 (95% CI = 1.58, 1.80) times more likely to utilize WTCHP service than volunteers. Sociodemographic factors and comorbidities were consistently associated with WTCHP utilization across worker types, except for race/ethnicity. Among those eligible, the volunteer group reported the lowest utilization of WTCHP among worker types, suggesting that WTC volunteers should be a priority group for outreach regarding access and utilization of WTCHP.