Occupational Dermatitis in Welding: Does Nickel Exposure Account for Higher Rates in Women? Analysis of a Canadian Cohort.

OBJECTIVES: Women are reported to have higher rates of nickel sensitization than men, but there have been few studies of sex-related differences in dermatitis associated with occupational nickel exposure. This analysis examines dermatitis in a large cohort of women and men in welding and electrical occupations and considers how far differences in rates of dermatitis may be accounted for by nickel exposure.
METHODS: Women and men were recruited to cohorts of workers who had entered welding and electrical apprenticeships (the WHAT-ME and WHAT-MEN studies). Participants completed questionnaires at baseline and every 6 months for up to 5 years. At each contact, cohort members were asked about current dermatitis and whether it was made worse by work. From the first follow-up after recruitment, those working in their trade completed detailed subroutines about tasks in their trade including, for welders, the process, base metal, and consumables. Exposures were considered by trade and, within welding, by stainless or high alloy steel (SOHAS) as the base metal. Urinary nickel concentration was also examined. Using only report of dermatitis that began after entry to the trade, new-onset dermatitis, all episodes of dermatitis, and dermatitis made worse by work were examined against exposure by multilevel, multivariable logistic regression, allowing for potential confounding.
RESULTS: Among 1885 participants (welders; 447 women, 554 men: electrical trades; 438 women, 446 men), 200 reported dermatitis that started before they entered the trade, leaving 1685 for analysis. Women, but not men, who had entered the welding trades were more at risk of new onset [odds ratio (OR) = 1.54; 95% confidence interval (CI) 1.02-2.32] or dermatitis episodes (OR = 1.75; 95% CI 1.10-2.77) than those entering the electrical trades. Within welding, women were more at risk than men of new-onset dermatitis (OR = 1.85; 95% CI 1.15-2.96) and dermatitis episodes (2.14; 95% CI 1.24-3.68) but were not more likely to report these were made worse by work. Use of SOHAS as the base metal was associated with reports that dermatitis was made worse by work (3.54; 95% CI 1.04-12.03), but having adjusted for SOHAS use, women still remained at greater risk. A final analysis considered the effect on risk estimates of removing those welding SOHAS from the analysis. The risk for women of episodes of dermatitis was essentially unchanged, whether the comparison group was male welders or women in the electrical trades.
CONCLUSIONS: Welding is associated with risk of dermatitis in women. Although welding of SOHAS was associated with dermatitis that was made worse by work, it does not importantly explain the higher female rates in welding and other causes must be examined to support preventive measures.