Surveillance of respiratory diseases among construction and trade workers at Department of Energy nuclear sites

Our plain-English summary of Surveillance of respiratory diseases among construction and trade workers at Department of Energy nuclear sites, by J.M. Dement, L. Welch, E. Bingham, et al (American Journal of Industrial Medicine, 2003).

The study

• Authors: J.M. Dement, L. Welch, E. Bingham, B. Cameron, C. Rice, P. Quinn, K. Ringen
• Journal: American Journal of Industrial Medicine
• Published: 2003;43(6):559-73
• Cited by: 35 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Medical screening programs were begun in 1996 and 1997 at three Department of Energy (DOE) nuclear weapons facilities (Hanford Nuclear Reservation, Oak Ridge, and the Savannah River Site) to evaluate whether current and former construction workers are at significant risk for occupational illnesses. The focus of this report is pneumoconiosis associated with exposures to asbestos and silica among workers enrolled in the screening programs through September 30, 2001.

Methods: Workers provided a detailed work and exposure history and underwent a respiratory examination, which included a respiratory history and symptom questionnaire, a posterior-anterior (P-A) chest radiograph, and spirometry. Both stratified and multivariate logistic regression analyses were used to explore the risk of disease by duration of DOE employment and frequency of exposure, while controlling for potential confounders such as age, race, sex, and other work in the construction and building trades.

Results: Of the 2602 workers, 25.2% showed one or more chest X-ray changes by ILO criteria and 42.7% demonstrated one or more pulmonary function defects. The overall prevalence of parenchymal changes by ILO criteria (profusion 1/0 or greater) was 5.4%. In the logistic regression models, the odds ratio for parenchymal disease was 2.6 (95% confidence interval (CI) = 1.0-6.6) for workers employed 6 to 20 years at Hanford or Savannah River and increased to 3.6 (95% CI = 1.1-11.6) for workers employed more than 35 years, with additional incremental risks for workers reporting routine exposures to asbestos or silica.

Conclusions: Continued surveillance of workers is important given their increased risk of disease progression and their risk for asbestos related malignancies. Smoking cessation programs should also be high priority and continued abstinence for former smokers reinforced. Although the observed respiratory disease patterns are largely reflective of past exposures, these findings suggest that DOE needs to continue to review industrial hygiene control programs for work tasks involving maintenance, repair, renovation, and demolition.

Copyright 2003 Wiley-Liss, Inc.

In plain English

This cross-sectional analysis used medical screening data from construction and trade workers at three U.S. Department of Energy (DOE) nuclear weapons sites: Hanford, Oak Ridge and the Savannah River Site. It covered 2,602 workers who had completed both a chest X-ray and a breathing test (spirometry) through September 30, 2001. Workers also reported their own work tasks and exposures to asbestos, silica and welding. Overall, 25.2% had one or more chest X-ray changes and 42.7% had a pulmonary function defect. Lung-tissue (parenchymal) X-ray changes were found in 5.4% of all workers. One analysis was limited to Hanford and Savannah River workers aged 55 or older. In it, those with more than 35 years of DOE site work had higher odds of parenchymal changes than those with under five years (odds ratio 3.6, 95% CI 1.1 to 11.6). Workers reporting regular asbestos or silica exposure had higher estimates, but these did not reach statistical significance. The authors noted that participation was voluntary and that X-ray readers differed between sites. They concluded that the findings showed a clear pattern between duration of DOE work and respiratory disease risk.

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: Cross-sectional analysis of medical screening program data (work history interview, chest radiograph, spirometry), using stratified analyses and unconditional logistic regression
• Who was studied: 2,602 current and former construction and trade workers at the Hanford, Savannah River and Oak Ridge DOE sites who completed both chest X-ray and spirometry through September 30, 2001. 95.7% were male and the mean age was 58.2 years. The regression analyses were limited to Hanford and Savannah River workers.
• Exposure: Self-reported tasks and materials involving asbestos, silica, and welding/cutting fumes, rated by frequency from rarely to continuous. Duration of DOE site work was used as a stand-in for exposure duration. Asbestos fiber types were not specified.
• Main results:
  • All sites combined: 25.2% of workers had one or more chest X-ray changes by ILO criteria, and 42.7% had a pulmonary function defect.
  • Parenchymal changes (profusion 1/0 or greater) were found in 5.4% of all workers and in 7.3% at Oak Ridge.
  • Among workers with a profusion score of 1/0 or greater, 94% had irregular opacities, which the authors described as consistent with asbestos exposure.
  • Pleural-only changes were much more common at Hanford (36.6%) than at the other two sites (8.4 to 11.9%). The authors found that the Hanford X-ray reader reported more pleural disease than other readers.
  • In the stratified analysis, the prevalence of any parenchymal change was 4.0% in workers with less than 5 years at DOE sites and 9.7% in workers with 35 or more years.
  • Regression for Hanford and Savannah River workers aged 55 or older: the odds ratio for parenchymal changes was 3.6 (95% CI 1.1 to 11.6) for more than 35 years of DOE work, compared with under 5 years. It was 1.8 (95% CI 0.8 to 4.1) for 5 to 19 years and 2.6 (95% CI 1.0 to 6.6) for 20 to 34 years (Table XVI).
  • In the same model, regular asbestos exposure (OR 1.2, 95% CI 0.6 to 2.3) and regular silica exposure (OR 1.6, 95% CI 0.9 to 2.8) were associated with higher parenchymal disease risk, but these results were not statistically significant. Ever smoking had an OR of 2.0 (95% CI 1.1 to 3.7).
  • For pleural-only changes among workers aged 55 or older, the odds ratio was 2.2 (95% CI 1.2 to 4.2) for 35 or more years of DOE work and 2.1 (95% CI 1.3 to 3.5) for 35 or more years of non-DOE trade work.
  • Across all sites, 20.5% had restrictive, 12.2% obstructive and 10.0% mixed lung function defects. There was no consistent trend in lung function categories with duration of DOE work.
• The authors' conclusion: The authors concluded that the screening findings generally confirmed workers' concerns and showed a clear pattern between duration of DOE site work and respiratory disease risk. They also concluded that DOE should continue reviewing worker protection for maintenance, repair, renovation and demolition tasks.
• Limitations the authors state:
  • Participation was voluntary and workers could accept only parts of the protocol, so selection bias is possible.
  • Disease prevalence is likely underestimated because many workers, especially at Oak Ridge, had prior lung disease diagnoses and were not re-examined.
  • Different B-readers were used at each site, which likely explains some of the variation in pleural findings between sites.
  • Exposure information relied on worker recall, which the authors said is incomplete.
  • The comparison group (under five years of DOE work) was also exposed, so the regression models likely underestimate risk from DOE work.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis.

Medical terms in this study, explained in our Lexicon: Pneumoconiosis, Exposure History, Chest X-Ray, Spirometry, Odds Ratio, confidence interval, Disease Progression, Industrial Hygiene.

Related studies

• Airways obstruction among older construction and trade workers at Department of Energy nuclear sites — J.M. Dement, L. Welch, et al. (2010)
• Mortality of older construction and craft workers employed at Department of Energy (DOE) nuclear sites — J.M. Dement, K. Ringen, et al. (2009)
• Mortality of older construction and craft workers employed at department of energy (DOE) nuclear sites: follow-up through 2011 — K. Ringen, J. Dement, et al. (2015)
• Mortality of older construction and craft workers employed at department of energy nuclear sites: Follow-up through 2016 — K. Ringen, J. Dement, et al. (2019)
• Respiratory impairments due to dust exposure: a comparative study among workers exposed to silica, asbestos, and coalmine dust — X. Wang, E. Yano, et al. (1997)
• Variability in interpretation among B-readers in the U.S. Navy Asbestos Medical Surveillance Program — J.G. Muller, J.M. Lieske, et al. (2008)

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