Liu Ruiling, O'Reilly Michael, Rockhill Sarah, Fu Lillian, Smith Kendra C, Butturini Emma, Santiago-Colón Albeliz, L Shaw Rachael, Pressley Kevin, Calvert Geoffrey M
World Trade Center Health Program, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention, Atlanta, GA, USA.
Rollins School of Public Health, Emory University, Atlanta, GA, USA.
BMC Health Serv Res. 2025 Aug 5;25(1):1024. doi: 10.1186/s12913-025-13248-w.
The World Trade Center (WTC) Health Program, a limited federal healthcare program, provides medical monitoring and treatment for WTC-related conditions to eligible Responders and Survivors of the 9/11 terrorist attacks. Free initial health evaluations (IHE) represent the first step towards the Program's goal of providing equitable and timely member access to healthcare. This study aimed to evaluate equity in IHE utilization among Program members to inform the development of targeted interventions.
This surveillance study used administrative and surveillance data collected from January 2012 through February 2024. It included Program members newly enrolled during 2012-2022 who completed an IHE or were alive for ≥ 1 year after enrollment. We conducted descriptive and multivariable logistic regression analyses. Outcomes of interest included timely IHE utilization (proportion of members completing an IHE within 6 months of enrollment) and any IHE utilization (proportion completing an IHE by February 2024). Factors of interest included member type, sex, age, race/ethnicity, preferred language, and urban/rural residence.
27,379 Responders and 30,679 Survivors were included. Responders were 89% male, 70% 45-64 years old at enrollment and 76% non-Hispanic White. Survivors were 54% male, 54% 45-64 years old at enrollment and 57% non-Hispanic White. Timely IHE utilization remained stable (~ 65%) among Responders, while for Survivors, it increased from 16% among those enrolled in 2017 to 68% in 2021. Timely IHE utilization was lower for younger members (enrolled < 45 years old vs. ≥ 65 years old, adjusted odds ratio [aOR] = 0.71, p < 0.001), rural residents, female Survivors (44% vs. 47% males, aOR = 0.87, p < 0.001), and Survivors who preferred non-English languages (39% vs. 46% who preferred English, aOR = 0.70, p < 0.001). Compared to non-Hispanic White members, non-Hispanic Black members had higher timely/any IHE utilization, while non-Hispanic Asian/Pacific Islander/Native Hawaiian and Hispanic Survivors had lower timely IHE utilization.
This study highlights Program achievements (e.g. increased timely IHE utilization among Survivors over time and higher timely/any IHE utilization among non-Hispanic Black members compared to non-Hispanic White members) and gaps in providing equitable IHE services to its members. The Program can develop tailored strategies to further improve equity in IHE utilization (e.g. working with providers to adopt/expand flexible IHE scheduling and increase non-English language capacity).
世界贸易中心（WTC）健康计划是一项有限的联邦医疗保健计划，为9·11恐怖袭击的合格响应者和幸存者提供与世贸中心相关疾病的医疗监测和治疗。免费的初始健康评估（IHE）是该计划实现公平、及时地为成员提供医疗保健这一目标的第一步。本研究旨在评估计划成员中IHE使用情况的公平性，为制定有针对性的干预措施提供依据。
这项监测研究使用了2012年1月至2024年2月收集的行政和监测数据。研究对象包括2012年至2022年新加入该计划且完成了IHE或在入组后存活≥1年的成员。我们进行了描述性和多变量逻辑回归分析。感兴趣的结果包括及时使用IHE（成员在入组后6个月内完成IHE的比例）和任何IHE使用情况（到2024年2月完成IHE的比例）。感兴趣的因素包括成员类型、性别、年龄、种族/族裔、首选语言和城乡居住情况。
纳入了27379名响应者和30679名幸存者。响应者中89%为男性，入组时70%年龄在45 - 64岁，76%为非西班牙裔白人。幸存者中54%为男性，入组时54%年龄在45 - 64岁，57%为非西班牙裔白人。响应者中及时使用IHE的比例保持稳定（约65%），而对于幸存者，这一比例从2017年入组者的16%增加到2021年的68%。年轻成员（入组时年龄<45岁与≥65岁相比）、农村居民、女性幸存者（44%对男性的47%，调整后的优势比[aOR]=0.87，p<0.001）以及首选非英语语言的幸存者（39%对首选英语者的46%，aOR=0.70，p<0.001）的及时IHE使用率较低。与非西班牙裔白人成员相比，非西班牙裔黑人成员的及时/任何IHE使用率更高，而非西班牙裔亚裔/太平洋岛民/夏威夷原住民和西班牙裔幸存者的及时IHE使用率较低。
本研究突出了该计划的成就（如随着时间推移幸存者中及时IHE使用率增加，以及与非西班牙裔白人成员相比，非西班牙裔黑人成员的及时/任何IHE使用率更高）以及在为其成员提供公平IHE服务方面存在的差距。该计划可以制定针对性策略，以进一步提高IHE使用的公平性（如与提供者合作采用/扩大灵活的IHE安排并提高非英语语言服务能力）。
