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Thorax. 2018 Nov;73(11):1008-1015. doi: 10.1136/thoraxjnl-2017-211158. Epub 2018 Mar 24.

Occupational exposures and 20-year incidence of COPD: the European Community Respiratory Health Survey.

Author information

1
Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.
2
Universitat Pompeu Fabra (UPF), Barcelona, Spain.
3
CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
4
Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
5
IRAS, University of Utrecht, Utrecht, The Netherlands.
6
Department of Epidemiology and Social Medicine (ESOC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
7
StatUA Statistics Centre, University of Antwerp, Antwerp, Belgium.
8
Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Ludwig Maximilians University, Comprehensive Pneumology Centre Munich, German Centre for Lung Research, Munich, Germany.
9
Pulmonology Department, Galdakao Hospital, Bizkaia, Spain.
10
Servicio de Neumología, Complejo Hospitalario Universitario, Albacete, Spain.
11
Facultad de Medicina Albacete, Universidad de Castilla-La Mancha, Ciudad Real, Spain.
12
Respiratory Department, Hospital Universitario San Agustín, Aviles, Spain.
13
Respiratory and Allergy Clinical Unit, Universitary Hospitalary Complex, Huelva, Spain.
14
Université de Bordeaux, Inserm, Bordeaux Population Health Research Center, team EPICENE, UMR 1219, Bordeaux, France.
15
Department of Pédiatrie, CHU de Grenoble Alpes, Grenoble, France.
16
Inserm, U1209, IAB, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Grenoble, France.
17
Université Grenoble Alpes, Grenoble, France.
18
University Hospital of Montpellier, Montpellier, France.
19
Sorbonne Universités, Paris, France.
20
Inserm UMR 1152-Equipe Epidémiologie, Université Paris Diderot, Paris, France.
21
Department of Health Sciences, Experimental and Forensic Medicine - Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy.
22
Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland.
23
Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
24
Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
25
Centre for International Health, University of Bergen, Bergen, Norway.
26
Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
27
Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
28
Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
29
Research and Evaluation Office, Boston Public Health Commission, Boston, Massachusetts, USA.
30
Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
31
University of Basel, Basel, Switzerland.
32
Monash Centre for Occupation and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
33
Lung Clinic, Tartu University Hospital, Tartu, Estonia.
34
Section of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
35
Department of Public Health, Section for Environment, Occupation and Health, Danish Ramazzini Center, Aarhus University, Aarhus, Denmark.
36
National Research Center for the Working Environment, Copenhagen, Denmark.
37
Unit of Occupational Medicine, University Hospital of Verona, Verona, Italy.
38
University of California San Francisco, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.
39
Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College London, London, UK.
40
MRC-PHE Centre for Environment and Health, Imperial College London, London, UK.

Abstract

BACKGROUND:

Occupational exposures have been associated with an increased risk of COPD. However, few studies have related objectively assessed occupational exposures to prospectively assessed incidence of COPD, using postbronchodilator lung function tests. Our objective was to examine the effect of occupational exposures on COPD incidence in the European Community Respiratory Health Survey.

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 criterion for postbronchodilator 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 12 categories of agents. Their association with COPD incidence was examined in log-binomial models fitted in a Bayesian framework.

FINDINGS:

3343 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 with those unexposed (relative risk (RR) 1.6, 95% CI 1.1 to 2.3), as did those exposed to gases and fumes (RR 1.5, 95% CI 1.0 to 2.2) and pesticides (RR 2.2, 95% CI 1.1 to 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.

KEYWORDS:

copd epidemiology; occupational lung disease

PMID:
29574416
DOI:
10.1136/thoraxjnl-2017-211158
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