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Environmental exposure
Increased mortality from infectious pneumonia after occupational exposure to inorganic dust, metal fumes and chemicals
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  1. Kjell Torén1,2,
  2. Ingemar Qvarfordt2,
  3. Ingvar A Bergdahl3,
  4. Bengt Järvholm3
  1. 1Section of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  2. 2Section of Respiratory Medicine and Allergology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  3. 3Occupational Medicine, Department of Clinical Medicine and Public Health, Umeå University, Umeå, Sweden
  1. Correspondence to Professor Dr Kjell Torén, Section of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, SE-405 30 Gothenburg, Sweden; kjell.toren{at}amm.gu.se

Abstract

Objectives There are epidemiological studies indicating that exposure to metal fumes is a risk factor for infectious pneumonia. Whether occupational exposure to other agents, such as inorganic dust or chemicals, also increases the risk for infectious pneumonia is not clear. The aim of the present study was to elucidate whether occupational exposure to respiratory pollutants and irritants increases the risk for infectious pneumonia.

Design Prospective cohort study.

Setting Swedish male construction workers.

Participants 320 143 male construction workers exposed to inorganic dust (asbestos, man-made mineral fibres, dust from cement, concrete and quartz), wood dust, metal fumes and chemicals (organic solvents, diisocyanates and epoxi resins) or unexposed.

Main outcome measures The cohort was followed from 1971 to 2003 and the main outcome measures were mortality to infectious pneumonia, lobar pneumonia or pneumococcal pneumonia. RRs were obtained by the person-years method and from Poisson regression models, adjusting for baseline values of age and smoking habits.

Results Among men aged 20–64 years there was increased mortality from infectious pneumonias among construction workers exposed to metal fumes (RR 2.31, 95% CI 1.35 to 3.95), inorganic dust (RR 1.87, 95% CI 1.22 to 2.87) and chemicals (RR 1.91, 95% CI 1.37 to 3.22). The mortality was also increased from both lobar pneumonia and pneumococcal pneumonia. Among men aged 65–84 years the occupational exposure to inorganic dust and chemicals was associated with slightly increased mortality from infectious pneumonia. Among groups with mutually exclusive exposures there was increased mortality from infectious pneumonias among construction workers exposed to inorganic dust, but not among those exposed to wood dust or chemicals. There were no cases among workers exposed only to metal fumes.

Conclusions Our findings indicate that exposure to inorganic dust increases the mortality from infectious pneumonias, especially lobar pneumonia and pneumococcal pneumonia. The mechanism is unclear, but the effect may be mediated through induced airways inflammation.

  • Asthma
  • clinical epidemiology
  • exhaled airway markers
  • occupational lung disease

https://doi.org/10.1136/thoraxjnl-2011-200707

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    Footnotes

    • Funding Funding was provided by the Swedish Council for Worklife research and Social Science (FAS) and the Swedish Heart and Lung Foundation.

    • Competing interests All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare (1) no support from any company for the submitted work; (2) no relationships with any companies that might have an interest in the submitted work in the previous 3 years; (3) their spouses, partners, or children have no financial relationships that may be relevant to the submitted work; and (4) no non-financial interests that may be relevant to the submitted work.

    • Ethical approval The study was approved by the Committee of Ethics at Umeå University.

    • Provenance and peer review Not commissioned; externally peer reviewed.