Occupational exposures and 20-year incidence of COPD: The European Community Respiratory Health Survey
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Author(s)
Type
Journal Article
Abstract
Background: Occupational exposures have been associated with an increased risk of Chronic Obstructive Pulmonary Disease (COPD). However, few studies have related objectively-assessed occupational exposures to prospectively-assessed incidence of COPD, using post-bronchodilator lung function tests. Our objective was to examine the effect of occupational exposures on COPD incidence in the European Community Respiratory Health Survey (ECRHS).
Methods: General population samples aged 20-44 were randomly selected in 1991-1993, and followed up 20 years later (2010-2012). Spirometry was performed at baseline and at follow-up, with incident COPD defined using a Lower Limit of Normal (LLN) criterion for post-bronchodilator FEV1/FVC. Only participants without COPD and without current asthma at baseline were included. Coded job histories during follow-up were linked to a Job-Exposure Matrix, generating occupational exposure estimates to twelve categories of agents. Their association with COPD incidence was examined in log-binomial models fitted in a Bayesian framework.
Findings: 3,343 participants fulfilled the inclusion criteria; 89 of them had COPD at follow-up (1.4 cases/1000 person-years). Participants exposed to biological dust had a higher incidence of COPD compared to those unexposed (RR=1.6, 95% Credible Interval: 1.1 – 2.3), as did those exposed to gases & fumes (RR=1.5, 95%CrI: 1.0 – 2.2) and pesticides (RR=2.2, 95%CrI: 1.1 – 3.8). The combined Population Attributable Fraction for these exposures was 21.0%.
Interpretation: These results substantially strengthen the evidence base for occupational exposures as an important risk factor for COPD.
Methods: General population samples aged 20-44 were randomly selected in 1991-1993, and followed up 20 years later (2010-2012). Spirometry was performed at baseline and at follow-up, with incident COPD defined using a Lower Limit of Normal (LLN) criterion for post-bronchodilator FEV1/FVC. Only participants without COPD and without current asthma at baseline were included. Coded job histories during follow-up were linked to a Job-Exposure Matrix, generating occupational exposure estimates to twelve categories of agents. Their association with COPD incidence was examined in log-binomial models fitted in a Bayesian framework.
Findings: 3,343 participants fulfilled the inclusion criteria; 89 of them had COPD at follow-up (1.4 cases/1000 person-years). Participants exposed to biological dust had a higher incidence of COPD compared to those unexposed (RR=1.6, 95% Credible Interval: 1.1 – 2.3), as did those exposed to gases & fumes (RR=1.5, 95%CrI: 1.0 – 2.2) and pesticides (RR=2.2, 95%CrI: 1.1 – 3.8). The combined Population Attributable Fraction for these exposures was 21.0%.
Interpretation: These results substantially strengthen the evidence base for occupational exposures as an important risk factor for COPD.
Date Issued
2018-11-01
Date Acceptance
2018-02-26
Citation
Thorax, 2018, 73, pp.1008-1015
ISSN
1468-3296
Publisher
BMJ Publishing Group
Start Page
1008
End Page
1015
Journal / Book Title
Thorax
Volume
73
Copyright Statement
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Sponsor
Medical Research Council (MRC)
Commission of the European Communities
Grant Number
G0901214
633212
Subjects
copd epidemiology
occupational lung disease
1103 Clinical Sciences
Respiratory System
Publication Status
Published
Date Publish Online
2018-03-24