Comparing life satisfaction and functioning 15 years after September 11, 2001 among survivors with and without injuries: a mixed-method study

Purpose: This study compares life satisfaction and limited activity days among 9/11 survivors with and without physical injuries using quantitative and qualitative approaches. Methods: The study population included World Trade Center Health Registry enrollees who reported being injured on 9/11 in 2003–2004 and a sample of non-injured enrollees who participated in a cross-sectional substudy. We used multivariable logistic regression to examine differences in life satisfaction and number of limited activity days in the last 30 days between those with and without injuries. The free-response section of the survey was analyzed qualitatively to compare themes of those with and without injuries. Results: The final sample consisted of 2821 adult enrollees. Compared to those who were not injured, those who were injured on 9/11 were more likely to report being unsatisfied with their life (adjusted odds ratio (AOR): 1.5, 95% confidence intervals (CI) 1.1–2.0) and have 14 or more limited activity days in the last 30 days (AOR: 1.4, 95% CI 1.0–1.9). Among those who were injured, being partially or completely prevented from working increased the odds of being unsatisfied with life and having 14 or more limited activity days. In qualitative analysis, the emotional trauma experienced from 9/11 was a major and common theme, regardless of injury status. Those with injuries were more likely to express anger/lack of recognition/appreciation, describe substance use/abuse, and have financial/health care access issues. Conclusions: More than 15 years after 9/11, those who were injured continue to be impacted, reporting lower life satisfaction and more functional impairment.