Incident chronic obstructive pulmonary disease associated with occupation, industry, and workplace exposures in the Health and Retirement Study

Our plain-English summary of Incident chronic obstructive pulmonary disease associated with occupation, industry, and workplace exposures in the Health and Retirement Study, by S.R. Silver, W.A. Alarcon, J. Li (American Journal of Industrial Medicine, 2021).

The study

• Authors: S.R. Silver, W.A. Alarcon, J. Li
• Journal: American Journal of Industrial Medicine
• Published: 2021;64(1):26-38
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Chronic health effects from accumulated occupational exposures manifest as the workforce ages. The Health and Retirement Study (HRS), a panel survey of U.S. adults nearing/in retirement, allows assessment of associations among industry and occupation (I/O), workplace exposures, and incident chronic obstructive pulmonary disease (COPD).

Methods: The study population comprised respondents from the 1992 HRS cohort employed in 1972 or later and not diagnosed with COPD as of initial interview. We examined associations with incident COPD through 2016 and: (1) broad and selected detailed I/O, (2) workplace exposures, and (3) exposures within I/O. Given the cohort's baseline age (50-62), we calculated subhazard ratios (SHRs) for COPD accounting for competing risk of death.

Results: SHRs for COPD were significantly elevated for several industries: mining; blast furnaces, steelworks, rolling and finishing mills; groceries and related products; and automotive repair shops. Occupations with significantly elevated SHRs were maids and housemen; farmworkers; vehicle/mobile equipment mechanics and repair workers; material moving equipment operators; and nonconstruction laborers. Significantly elevated COPD SHRs were observed for specific I/O-exposure pairs: blast furnace/steelworks/rolling/finishing mills and asbestos; automotive repair shops and aerosol paints; farmworkers and pesticide exposures; and both material moving equipment operators and nonconstruction laborers exposed to dust and ash.

Conclusions: Certain jobs and occupational exposures are associated with increased risk for developing COPD in late preretirement and during retirement. Given the disability and economic costs of COPD, these findings support focusing exposure prevention and medical monitoring resources on groups of workers at increased risk.

© 2020 Wiley Periodicals LLC.

In plain English

The authors analysed U.S. Health and Retirement Study survey data on 7907 people who were aged 50 to 62 in 1992, had worked in 1972 or later, and had not reported chronic obstructive pulmonary disease (COPD). COPD meant reporting that a doctor had diagnosed chronic lung disease other than asthma. By 2016, 1250 people reported this. The authors compared groups by longest-held industry or job and by self-reported workplace exposures. They adjusted for smoking, income, education and other factors, and accounted for deaths. People who reported asbestos exposure had a subhazard ratio (a measure of relative risk) of 1.79 (95% CI 1.38–2.31). In the blast furnace, steelworks, rolling and finishing mill industry, 5 of 8 workers who reported asbestos exposure reported COPD. Their ratio was 5.08 (95% CI 3.16–8.15), compared with workers who had neither that job nor that exposure. Mining and vehicle mechanic work also showed raised ratios. The authors concluded that some jobs carry increased COPD risk in late preretirement and retirement. They noted that exposures were not tied to a specific job and that pack-years of smoking could not be calculated.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Longitudinal cohort analysis of national panel survey data (respondents re-interviewed every 2 years), using competing-risk regression that treated death as a competing risk
• Who was studied: 7907 members of the 1992 U.S. Health and Retirement Study cohort, aged 50–62 at enrollment, who had worked in 1972 or later, had not reported COPD at the 1992 interview, and answered at least one follow-up survey. They were followed through 2016, and 1250 reported a COPD diagnosis during follow-up.
• Exposure: Longest-held industry and occupation, plus self-reported ever exposure (for at least 1 year) to workplace dusts, fumes, vapors, solvents or pesticides, recorded in 1992 as free-text answers and coded into more than 70 categories, including asbestos (298 respondents reported asbestos exposure)
• Main results:
  • Respondents who reported asbestos exposure (298 people, 71 incident COPD cases) had a subhazard ratio for COPD of 1.79 (95% CI 1.38–2.31), compared with those who never reported it, adjusted for smoking and other covariates.
  • Among workers in the blast furnaces, steelworks, rolling and finishing mills industry who reported asbestos exposure (8 workers, 5 COPD cases), the subhazard ratio was 5.08 (95% CI 3.16–8.15). The comparison group was workers who were neither in that industry nor exposed to asbestos.
  • Respondents who reported asbestos exposure but did not work in the blast furnace/steelworks industry (277 people, 63 COPD cases) had a subhazard ratio of 1.70 (95% CI 1.30–2.21).
  • Among material moving equipment operators, fewer than 5 reported asbestos exposure. Their subhazard ratio exceeded 4.0 and was statistically significant (exact figures not shown).
  • Workers whose longest-held industry was mining (48 workers, 12 COPD cases) had a subhazard ratio of 2.09 (95% CI 1.02–4.26). The comparison group was all other industries.
  • Vehicle and mobile equipment mechanics and repairers (133 workers, 30 COPD cases) had a subhazard ratio of 1.53 (95% CI 1.04–2.26).
  • Reported pesticide exposure was associated with a subhazard ratio of 1.31 (95% CI 0.97–1.76), which was not statistically significant.
• The authors' conclusion: The authors concluded that their results suggest working in some specific industries or occupations confers an increased risk of developing COPD in late preretirement and in retirement.
• Limitations the authors state:
  • COPD was self-reported. It is unknown whether some respondents included restrictive lung diseases such as pneumoconiosis in their answer.
  • Smoking information did not allow pack-years to be calculated.
  • Exposure history was ever-exposure and was not linked to any specific job, so the exposure may not have occurred in the longest-held job analysed.
  • Only two reported exposures per respondent were coded. The authors said this was particularly problematic for groups such as steelworkers.
  • There was no information on exposure timing, duration, frequency or intensity, and recall bias may apply.
  • Analysing only the longest-held job excludes shorter but possibly relevant work with pertinent exposures.
  • Many industry and occupation groups were too small to evaluate the effects of individual exposures.

Topics

Medical terms in this study, explained in our Lexicon: Occupational Exposure, COPD, Medical Monitoring.

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