After the September 11, 2001 World Trade Center (WTC) disaster, recovery and clean-up efforts were concentrated at the WTC site and the Staten Island (SI) Fresh Kills landfill and barges. Research is limited regarding the long-term health effects of human remains exposure during clean-up and recovery work at the SI landfill and barges. We studied 1,592 WTC Health Registry enrollees who worked at the SI landfill, loading piers and barges after the 9/11/01 attacks to assess the relationship

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... n human remains exposure and persistent posttraumatic stress disorder (PTSD) 10-11 years later. A dose-response relationship was found between frequency of human remains exposure and persistent PTSD (adjusted odds ratio (AOR): every day (AOR) = 4.77; 95% confidence interval (CI): 2.00-11.52, almost every day (AOR) = 4.35; 95% CI: 1.75-10.80), and some days (AOR) = 2.98; 95% CI: 1.43-6.22). When exposed to human remains, sanitation workers had higher odds of persistent PTSD, compared to firefighters and police. In addition, respondents who scored lower on a social support scale had higher odds of persistent PTSD. The findings highlight the need for strategies to reduce the risk of PTSD associated with exposure to human remains in future disasters. WHAT IS KNOWN • Clean-up and recovery workers at the Staten Island landfill and on barges after the attacks on 9/11were exposed to hazardous debris and human remains • Adverse mental health consequences have been associated with exposure to human remains during war time, and following natural disastersand plane crashes WHAT THIS PAPER ADDS • A 9/11 occupational exposure index that examines the unique cumulative effects of Staten Island landfill and barge-specific work exposures • Dose-response relationship between human remains exposure and PTSD • Sanitation workers were at higher risk of PTSD when exposed to human remains compared to firefighters and police