Deaths in World Trade Center Terrorist Attacks --- New York City, 2001

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On September 11, 2001, terrorists flew two hijacked airplanes into the World Trade Center (WTC) in lower Manhattan in New York City (NYC), destroying both towers of the WTC. This report presents preliminary vital statistics on the deaths caused by the terrorist attacks and describes the procedures developed by the New York City Department of Health and Mental Hygiene (NYCDOHMH) to issue death certificates in response to the attacks. These data underscore the need for legal mechanisms to expedite the issuance of death certificates in the absence of human remains and the need for vital registration systems that can be relocated in case of emergency.

As of August 16, 2002, a total of 2,726 death certificates related to the WTC attacks had been filed. All but 13 persons died on September 11; of the 13 persons who were injured on September 11 and died subsequently, three persons died in other states, one each in Massachusetts, Missouri, and New Jersey. Of these 2,726 decedents, 2,103 (77%) were males and 623 (23%) were females. The median age for these decedents was 39 years (range: 2--85 years); the median age was 38 years for females (range: 2--81 years) and 39 years for males (range: 3--85 years). Three persons were aged <5 years, and three were aged >80 years. These data represent 97% of the estimated 2,819 WTC deaths; fewer death certificates have been issued than the estimated number of decedents because some families have not yet requested certificates, and investigations into several requests are still in progress.

Of these 2,726 decedents, 1,659 (61%) were non-Hispanic white males, 407 (15%) were non-Hispanic white females, 177 (6%) were Hispanic males, 81 (3%) were Hispanic females, 136 (5%) were non-Hispanic black males, 79 (3%) non-Hispanic black females, 122 (4%) were Asian/Pacific Islander (API) males, and 54 (2%) were API females. A total of 1,837 (67%) had graduated from college or had postgraduate education (males, 69%; females, 63%) (Table 1).

A total of 2,158 (79%) decedents were born in the 50 U.S. states, compared with 59% of the NYC population (1). A total of 568 (21%) decedents were born outside the 50 states, including the United Kingdom (n=56), India (n=36), Puerto Rico (n=34), the Dominican Republic (n=26), and Japan (n=25). By place of residence, as reported on the death certificates, 1,169 (43%) decedents were residents of NYC, 593 (22%) were residents elsewhere in New York (NY) state, and 674 (25%) were residents of New Jersey (Table 2). A total of 27 (1%) were residents of foreign countries. A total of 90 decedents were residents of Massachusetts, the origin of the two airplanes that struck the WTC, and 29 were residents of California, the destination of the flights.

NYCDOHMH processing of death certificates includes assignment of underlying cause-of-death codes. The NYC Office of Chief Medical Examiner (OCME) classified all reported deaths as homicides*. (Death certificates for the 10 terrorists on the two airplanes have not been issued and are not included in these data; these deaths might be classified as suicides.) As of August 22, 2002, OCME had issued 2,734 death certificates, including 1,373 for decedents whose remains had been found and 1,361 for decedents whose remains had not been found; the discrepancy might reflect the later date, and these data might contain some duplications. Methods used to identify decedents included DNA (645), dental radiographs (188), fingerprints (71), personal effects (19), and photographs (16). Multiple methods were used to identify 407 decedents, and 966 were identified by a single method (Shiya Ribowsky, OCME, personal communication, 2002). Death certificates listed the cause of death as "physical injuries (body not found)" for decedents whose remains were not found and were specific when remains were found (e.g., "blunt trauma to head, trunk, and extremities").

Reported by: SP Schwartz, PhD, W Li, PhD, L Berenson, MS, RD Williams, Office of Vital Statistics, New York City Dept of Health and Mental Hygiene, New York.

Editorial Note:

NYC is an independent vital registration jurisdiction; all of its vital statistics and vital records functions are concentrated in NYCDOHMH's headquarters building, which is 10 blocks (0.4 miles; 0.7 kilometers) from the WTC site. Following the attacks, the area was evacuated; within 6 hours, the Office of Vital Records (OVR) moved its death registration function to another location 7.9 miles (12.8 kilometers) away. All death certificate and burial permit services were resumed by 4:00 p.m. Telephone and computer communications were disrupted by the attacks; key-entry of death certificate data resumed September 17. However, use of the data for analysis and death certificate retrieval was not possible until October 3, when the system's connection to the mainframe computer in Brooklyn was restored.

The WTC attacks created an unprecedented need to issue thousands of death certificates in the absence of human remains. NY state law (Estates, Powers and Trusts Law §2-1.7) provides for the presumption of death because of absence related to exposure to specific peril. However, no procedure existed to receive, evaluate, adjudicate, file, and issue death certificates at the volume and speed that was required. By September 25, the NYC Law Department, the NY State Office of Court Administration, OCME, and NYCDOHMH had developed and implemented procedures for issuing a death certificate in the absence of human remains. OVR then provided 10 certified death certificates to each family within 24 hours of receipt from the medical examiner, waiving the usual fees.

To prevent fraudulent issuance of birth certificates of decedents, on October 23, NYCDOHMH began mailing copies of death certificates to states of birth and residence through the Interstate Transcript Exchange Program. NYCDOHMH also began sharing fact-of-death information with the regional Social Security Administration office to prevent fraudulent issuance of death benefits, and provided information to the NYC Police Department.

The findings in this report are subject to at least two limitations. First, the data are preliminary because some families have not yet requested death certificates, and investigations into certain requests for certificates are ongoing. Second, demographic information was collected from family members through special affidavits; this information is being revised as corrections are made by family members.

Other vital records agencies might find the emergency death certificate procedures developed by NYCDOHMH to be useful in preparing for and responding to similar disasters (2). States should develop procedures to issue death certificates in the absence of human remains, registration systems that can process both the normal volume of births and deaths and high volumes in emergencies, and systems and operations that can be relocated if power and communications systems fail.

References

*The new terrorism codes issued by CDC's National Center for Health Statistics (NCHS) did not exist when the WTC certificates were first received; to identify these deaths, a unique code was developed and used, which will be changed to conform to the new NCHS codes.

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