Chronic obstructive pulmonary disease among residents of an historically industrialised area
- Anthony C Darby1,
- Judith C Waterhouse2,3,
- Vivien Stevens4,
- Clare G Billings3,
- Catherine G Billings2,3,
- Clare M Burton1,
- Charlotte Young5,
- Jeremy Wight6,
- Paul D Blanc7,
- David Fishwick1
- 1Centre for Workplace Health, Health and Safety Laboratory, Buxton, UK
- 2Centre for Workplace Health, University of Sheffield, UK
- 3Respiratory Function Unit, Royal Hallamshire Hospital, Sheffield, UK
- 4Scientific Computing and Informatics, Medical Imaging and Medical Physics, Royal Hallamshire Hospital, Sheffield, UK
- 5Mathematical Sciences Unit, Health and Safety Laboratory, Buxton, UK
- 6Sheffield NHS Primary Care Trust, Sheffield, UK
- 7Department of Medicine, University of California, San Francisco, USA
- Correspondence to Dr Anthony Darby, Centre for Workplace Health, Health and Safety Laboratory, Buxton SK17 9JN, UK;
Contributors AD performed data collection, entry and analysis, coded the job exposure matrix and wrote the manuscript. DF and PB designed the study and wrote the manuscript. DF is also the study guarantor. JW designed the study, stratified participants, performed the mail out and performed spirometry, data collection and data entry. JWight contributed to the design of the study, provided access to study participants and approved the final article. CB performed job exposure matrix coding and approved the final article. CY checked the statistical analysis. VS designed and managed the secure database and assisted with mail outs. CGB performed data entry and contributed to initial study design. CathGB recruited supplemental patients, performed some spirometry and contributed to questionnaire design. All authors had access to the data if required and read the final article.
- Received 30 June 2011
- Accepted 11 April 2012
- Published Online First 28 June 2012
Objective To assess the contribution of workplace exposures to chronic obstructive pulmonary disease (COPD) risk in a community with a heavy burden of past industrial employment.
Methods A random population sample of Sheffield, UK residents aged over 55 years (n=4000), enriched with a hospital-based supplemental sample (n=209), was approached for study. A comprehensive self-completed questionnaire elicited physician-made diagnoses, current symptoms, and past workplace exposures. The latter were defined in three ways: self-reported exposure to vapours, gases, dusts and fumes (VGDF); response to a specific exposure checklist; and through a job exposure matrix (JEM) assigning exposure risk likelihood based on job history independent of respondent-reported exposure. A subset of the study group underwent lung function testing. Population attributable risk fractions (PAR%), adjusted for age, sex and smoking, were calculated for association between workplace exposure and COPD.
Results 2001 (50%) questionnaires were returned from the general population sample and 60 (29%) by the hospital supplement. Among 1754 with complete occupational data, any past occupational exposure to VGDF carried an adjusted excess risk for report of a physician's diagnosis of COPD, emphysema, or chronic bronchitis (ORs 3.9; 95% CI 2.7 to 5.8), with a corresponding PAR% value of 58.7% (95% CI 45.6% to 68.7%). The PAR% estimate based on JEM exposure was 31%. From within the subgroup of 571 that underwent lung function testing, VGDF exposure was associated with a PAR% of 20.0% (95% CI −7.2 to 40.3%) for Global initiative for chronic Obstructive Lung Disease (GOLD) 1 (or greater) level of COPD.
Conclusion This heavy industrial community-based population study has confirmed significant associations between reported COPD and both generic VGDF and JEM-defined exposures. This study supports the predominantly international evidence-based notion that workplace conditions are important when considering the current and future respiratory health of the workforce.
- COPD epidemiology
- occupational lung disease
- allergic lung disease
- asbestos induced lung disease
- asthma epidemiology
- asthma guidelines
- clinical epidemiology
Funding The study was funded by internal research monies, and no external funding was obtained.
Competing interests None.
Ethics approval The study was approved by the Sheffield Research Ethics Committee, the Sheffield Health and Social Research Consortium and by the Sheffield Teaching Hospitals NHS Foundation Trust Research Department. All participants received written information concerning the study and gave informed consent.
Provenance and peer review Not commissioned; externally peer reviewed.