Theodore Lytras1,2, Anna Beckmeyer-Borowko3,4, Manolis Kogevinas1,2,5,6, Hans Kromhout7, Anne-Elie Carsin1,2,5, Josep Maria Antó1,2,5,6, Hayat Bentouhami8, Joost Weyler8, Joachim Heinrich9,10, Dennis Nowak9,10, Isabel Urrutia11, Jesús Martínez-Moratalla12,13, José Antonio Gullón14, Antonio Pereira Vega15, Chantal Raherison Semjen16, Isabelle Pin17,18,19, Pascal Demoly20,21, Bénédicte Leynaert22, Simona Villani23, Thorarinn Gislason24,25, Øistein Svanes26, Mathias Holm27, Bertil Forsberg28, Dan Norbäck29, Amar J Mehta30, Dirk Keidel3,4, David Vernez31, Geza Benke32, Rain Jõgi33, Kjell Torén34, Torben Sigsgaard35, Vivi Schlünssen35,36, Mario Olivieri37, Paul D Blanc38,39, John Watkins40, Roberto Bono41, Giulia Squillacioti41, A Sonia Buist42, Roel Vermeulen7, Deborah Jarvis43,44, Nicole Probst-Hensch3,4, Jan-Paul Zock1,2,5. 1. Barcelona Institute of Global Health, Barcelona, Spain. 2. Universitat Pompeu Fabra, Barcelona, Spain. 3. Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland. 4. University of Basel, Basel, Switzerland. 5. CIBER Epidemiología y Salud Pública, Madrid, Spain. 6. Hospital del Mar Medical Research Institute, Barcelona, Spain. 7. IRAS, University of Utrecht, Utrecht, the Netherlands. 8. Social Epidemiology and Health Policy, Department of Epidemiology and Social Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium. 9. Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, University Hospital of Ludwig Maximilians University, Munich, Germany. 10. Comprehensive Pneumology Center Munich, German Center for Lung Research, Munich, Germany. 11. Pulmonology Department, Galdakao Hospital, Galdakao, Spain. 12. Servicio de Neumología, Complejo Hospitalario Universitario, Albacete, Spain. 13. Albacete Faculty of Medicine, University of Castilla-La Mancha, Ciudad Real, Spain. 14. Respiratory Department, San Agustín University Hospital, Avilés, Asturias, Spain. 15. Pulmonology and Allergy Clinical Unit, Juan Ramón Jiménez University Hospital, Huelva, Spain. 16. University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team EPICENE, UMR 1219, Bordeaux, France. 17. Département de Pédiatrie, CHU de Grenoble Alpes, Grenoble, France. 18. Inserm, U1209, IAB, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Grenoble, France. 19. Université Grenoble Alpes, Grenoble, France. 20. University Hospital of Montpellier, Montpellier, France. 21. INSERM UMR-S 1136-Sorbonne Université, Paris, France. 22. Inserm UMR 1152-Equipe Epidémiologie, Université Paris Diderot, Paris, France. 23. Department of Public Health, Experimental, and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy. 24. Department of Respiratory Medicine and Sleep, Landspitali University Hospital 108, Reykjavik, Iceland. 25. Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 26. Department of Clinical Science, University of Bergen, Bergen, Norway. 27. Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. 28. Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden. 29. Department of Medical Sciences, Uppsala University, Uppsala, Sweden. 30. Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark. 31. Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland. 32. Monash Centre for Occupation and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. 33. Tartu University Hospital, Lung Clinic, Tartu, Estonia. 34. Occupational and Environmental Medicine, School of Public Health and Community 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, Department of Diagnostics and Public Health, University of Verona, Verona, Italy. 38. University of California San Francisco, San Francisco, California. 39. San Francisco Veterans Affairs Health Care System, San Francisco, California. 40. School of Medicine, Cardiff University/Public Health Wales, Cardiff, United Kingdom. 41. Department of Public Health and Pediatrics, University of Turin, Turin, Italy. 42. Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, Oregon; and. 43. Population Health and Occupational Disease, National Heart and Lung Institute and. 44. MRC-PHE Center for Environment and Health, Imperial College London, London, United Kingdom.
Abstract
Rationale: Few longitudinal studies have assessed the relationship between occupational exposures and lung-function decline in the general population with a sufficiently long follow-up. Objectives: To examine the potential association in two large cohorts: the ECRHS (European Community Respiratory Health Survey) and the SAPALDIA (Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults). Methods: General-population samples of individuals aged 18 to 62 were randomly selected in 1991-1993 and followed up approximately 10 and 20 years later. Spirometry (without bronchodilation) was performed at each visit. Coded complete job histories during follow-up visits were linked to a job-exposure matrix, generating cumulative exposure estimates for 12 occupational exposures. Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were jointly modeled in linear mixed-effects models, fitted in a Bayesian framework, taking into account age and smoking. Results: A total of 40,024 lung-function measurements from 17,833 study participants were analyzed. We found accelerated declines in FEV1 and the FEV1/FVC ratio for exposure to biological dust, mineral dust, and metals (FEV1 = -15.1 ml, -14.4 ml, and -18.7 ml, respectively; and FEV1/FVC ratio = -0.52%, -0.43%, and -0.36%, respectively; per 25 intensity-years of exposure). These declines were comparable in magnitude with those associated with long-term smoking. No effect modification by sex or smoking status was identified. Findings were similar between the ECRHS and the SAPALDIA cohorts.Conclusions: Our results greatly strengthen the evidence base implicating occupation, independent of smoking, as a risk factor for lung-function decline. This highlights the need to prevent or control these exposures in the workplace.
Rationale: Few longitudinal studies have assessed the relationship between occupational exposures and lung-function decline in the general population with a sufficiently long follow-up. Objectives: To examine the potential association in two large cohorts: the ECRHS (European Community Respiratory Health Survey) and the SAPALDIA (Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults). Methods: General-population samples of individuals aged 18 to 62 were randomly selected in 1991-1993 and followed up approximately 10 and 20 years later. Spirometry (without bronchodilation) was performed at each visit. Coded complete job histories during follow-up visits were linked to a job-exposure matrix, generating cumulative exposure estimates for 12 occupational exposures. Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were jointly modeled in linear mixed-effects models, fitted in a Bayesian framework, taking into account age and smoking. Results: A total of 40,024 lung-function measurements from 17,833 study participants were analyzed. We found accelerated declines in FEV1 and the FEV1/FVC ratio for exposure to biological dust, mineral dust, and metals (FEV1 = -15.1 ml, -14.4 ml, and -18.7 ml, respectively; and FEV1/FVC ratio = -0.52%, -0.43%, and -0.36%, respectively; per 25 intensity-years of exposure). These declines were comparable in magnitude with those associated with long-term smoking. No effect modification by sex or smoking status was identified. Findings were similar between the ECRHS and the SAPALDIA cohorts.Conclusions: Our results greatly strengthen the evidence base implicating occupation, independent of smoking, as a risk factor for lung-function decline. This highlights the need to prevent or control these exposures in the workplace.
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