OCCUPATIONAL LUNG DISEASE

An international prospective general population-based study of respiratory work disability

K Torén^1,2, J-P Zock^3,4,5, M Kogevinas^3,4,5,6, E Plana^3,4,5, J Sunyer^3,5,7, K Radon⁸, D Jarvis⁹, H Kromhout¹⁰, A d’Errico¹¹, F Payo¹², J M Antó^3,4,5,7, P D Blanc¹³

¹ Occupational and Environmental Medicine, Sahlgrenska School of Public Health at University of Gothenburg, Göteborg, Sweden
² Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Göteborg, Sweden
³ Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
⁴ Muncipal Institute of Medical Research (IMIM-Hospital del mar), Barcleona, Spain
⁵ CIBER Epidemiologia y salud Pública (CIBERESP), Spain
⁶ Medical School, University of Crete, Heraklion, Greece
⁷ Department of Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
⁸ Institute for Occupational and Environmental Medicine, Ludwig-Maximilians-University, Munich, Germany
⁹ Department of Public Health Sciences, King’s College London, London, UK
¹⁰ Environmental and Occupational Health Division, Institute for Risk Assessment Sciences, Utrecht, The Netherlands
¹¹ Servizio regionale di Epidemiologia, ASL 5, Torino, Italy
¹² Department of Pneumology, Hospital de Galdakao, Euskadi, Spain
¹³ Division of Occupational and Environmental Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA

Dr K Torén, Dept of Occupational and Environmental Medicine, Sahlgrenska Academy at University of Gothenburg, Box 414, S-405 30 Göteborg, Sweden; kjell.toren{at}amm.gu.se

Background: Previous cross-sectional studies have shown that job change due to breathing problems at the workplace (respiratory work disability) is common among adults of working age. That research indicated that occupational exposure to gases, dust and fumes was associated with job change due to breathing problems, although causal inferences have been tempered by the cross-sectional nature of previously available data. There is a need for general population-based prospective studies to assess the incidence of respiratory work disability and to delineate better the roles of potential predictors of respiratory work disability.

Methods: A prospective general population cohort study was performed in 25 centres in 11 European countries and one centre in the USA. A longitudinal analysis was undertaken of the European Community Respiratory Health Survey including all participants employed at any point since the baseline survey, 6659 subjects randomly sampled and 779 subjects comprising all subjects reporting physician-diagnosed asthma. The main outcome measure was new-onset respiratory work disability, defined as a reported job change during follow-up attributed to breathing problems. Exposure to dusts (biological or mineral), gases or fumes during follow-up was recorded using a job-exposure matrix. Cox proportional hazard regression modelling was used to analyse such exposure as a predictor of time until job change due to breathing problems.

Results: The incidence rate of respiratory work disability was 1.2/1000 person-years of observation in the random sample (95% CI 1.0 to 1.5) and 5.7/1000 person-years in the asthma cohort (95% CI 4.1 to 7.8). In the random population sample, as well as in the asthma cohort, high occupational exposure to biological dust, mineral dust or gases or fumes predicted increased risk of respiratory work disability. In the random sample, sex was not associated with increased risk of work disability while, in the asthma cohort, female sex was associated with an increased disability risk (hazard ratio 2.8, 95% CI 1.3 to 5.9).

Conclusions: Respiratory work disability is common overall. It is associated with workplace exposures that could be controlled through preventive measures.

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