Background Occupational exposures have been associated with an increased risk of COPD. However, few studies have related objectively assessed occupational exposures to prospectively assessed incidence of COPD, using postbronchodilator lung function tests. Our objective was to examine the effect of occupational exposures on COPD incidence in the European Community Respiratory Health Survey.
Methods General population samples aged 20–44 were randomly selected in 1991–1993 and followed up 20 years later (2010–2012). Spirometry was performed at baseline and at follow-up, with incident COPD defined using a lower limit of normal criterion for postbronchodilator FEV1/FVC. Only participants without COPD and without current asthma at baseline were included. Coded job histories during follow-up were linked to a Job-Exposure Matrix, generating occupational exposure estimates to 12 categories of agents. Their association with COPD incidence was examined in log-binomial models fitted in a Bayesian framework.
Findings 3343 participants fulfilled the inclusion criteria; 89 of them had COPD at follow-up (1.4 cases/1000 person-years). Participants exposed to biological dust had a higher incidence of COPD compared with those unexposed (relative risk (RR) 1.6, 95% CI 1.1 to 2.3), as did those exposed to gases and fumes (RR 1.5, 95% CI 1.0 to 2.2) and pesticides (RR 2.2, 95% CI 1.1 to 3.8). The combined population attributable fraction for these exposures was 21.0%.
Interpretation These results substantially strengthen the evidence base for occupational exposures as an important risk factor for COPD.
- copd epidemiology
- occupational lung disease
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Contributors Study idea and design: TL, MK, JPZ, HK, JMA, KT, DJ. Data collection: MK, HK, AEC, JMA, HB, JW, JH, DN, IU, JMMR, JAG, APV, CRS, IP, PD, BL, SV, TG, CRS, MH, BF, DN, AJM, NPH, GB, RJ, KT, TS, VS, JGA, DJ, JPZ. Data analysis: TL, MK, JPZ. Data interpretation: all authors. Initial manuscript draft: TL, MK, JPZ. Critical revision of the manuscript for important intellectual content: all authors. Final approval of the manuscript for publication: all authors.
Funding Financial support for ECRHS I, for the localcentres included in this study: Australia: Asthma Foundation of Victoria, Allenand Hanbury’s, Belgium: Belgian Science Policy Office, National Fundfor Scientific Research, Estonia: Estonian Science Foundation, grantno 1088, France: Ministère de la Santé, Glaxo France, InsitutPneumologique d’Aquitaine, Contrat de Plan Etat-RégionLanguedoc-Rousillon, CNMATS, CNMRT (90MR/10, 91AF/6), Ministredelegué de la santé, RNSP, France; GSF, Germany: Bundesminister für Forschung und Technologie, Italy: Ministero dell’Università edella Ricerca Scientifica e Tecnologica, CNR, Regione Veneto grantRSF n. 381/05.93, Norway: Norwegian Research Council project no.101422/310; Spain: Fondo de Investigación Sanitaria(#91/0016-060-05/E, 92/0319 and #93/0393), Hospital General deAlbacete, Hospital General Juan Ramón Jiménez, DirecciónRegional de Salud Pública (Consejería de Sanidad del Principado deAsturias), CIRIT (1997 SGR 00079) and Servicio Andaluz de Salud; Sweden: The Swedish Medical Research Council, the Swedish Heart LungFoundation, the Swedish Association against Asthma and Allergy;Switzerland: Swiss national Science Foundation grant 4026-28099; UK:National Asthma Campaign, British Lung Foundation, Department ofHealth, South Thames Regional Health Authority. Financial Support for ECRHS III: Australia: National Health & Medical ResearchCouncil, Belgium: Antwerp South, Antwerp City: Research FoundationFlanders (FWO), grant code G.0.410.08.N.10 (both sites), Estonia:Tartu- SF0180060s09 from the Estonian Ministry of Education. France:(All) Ministère de la Santé. Programme Hospitalier de RechercheClinique (PHRC) national 2010. Bordeaux: INSERM U897 UniversitéBordeaux segalen, Grenoble: Comite Scientifique AGIRadom 2011. Paris:Agence Nationale de la Santé, Région Ile de France, domained’intérêt majeur (DIM) Germany : Erfurt: German ResearchFoundation HE 3294/10-1 Hamburg: German Research Foundation MA711/6-1, NO 262/7-1 Iceland: Reykjavik, The Landspitali UniversityHospital Research Fund, University of Iceland Research Fund, ResMedFoundation, California, USA, Orkuveita Reykjavikur (Geothermalplant), Vegagerðin (The Icelandic Road Administration (ICERA). Italy: All Italian centres were funded by the Italian Ministry ofHealth, Chiesi Farmaceutici SpA, in addition Verona was funded byCariverona foundation, Education Ministry (MIUR). Norway: NorwegianResearch council grant no 214123, Western Norway Regional HealthAuthorities grant no 911631, Bergen Medical Research Foundation. Spain: Fondo de Investigación Sanitaria (PS09/02457, PS09/0071609/01511) PS09/02185 PS09/03190), Servicio Andaluz de Salud, SociedadEspañola de Neumología y Cirurgía Torácica (SEPAR 1001/2010);Sweden: All centres were funded by The Swedish Heart and LungFoundation, The Swedish Asthma and Allergy Association, The SwedishAssociation against Lung and Heart Disease. Fondo de InvestigaciónSanitaria (PS09/02457 Barcelona: Fondo de Investigación Sanitaria(FIS PS09/00716) Galdakao: Fondo de Investigación Sanitaria (FIS09/01511) Huelva: Fondo de Investigación Sanitaria (FIS PS09/02185)and Servicio Andaluz de Salud Oviedo: Fondo de InvestigaciónSanitaria (FIS PS09/03190) Sweden: All centres were funded by TheSwedish Heart and Lung Foundation, The Swedish Asthma and AllergyAssociation, The Swedish Association against Lung and Heart Disease. Swedish Research Council for health, working life and welfare (FORTE)Göteborg : Also received further funding from the Swedish Council for Working life and Social Research. Umea also received funding fromVasterbotten Country Council ALF grant. Switzerland: The SwissNational Science Foundation (grants no 33CSCO-134276/1,33CSCO-108796, 3247BO-104283, 3247BO-104288, 3247BO-104284,3247-065896, 3100-059302, 3200-052720, 3200-042532, 4026-028099) TheFederal office for forest, environment and landscape, The FederalOffice of Public Health, The Federal Office of Roads and Transport, the canton’s government of Aargan, Basel-Stadt, Basel-Land, Geneva,Luzern, Ticino, Valais and Zürich, the Swiss Lung League, thecanton’s Lung League of Basel Stadt/ Basel, Landschaft, Geneva,Ticino, Valais and Zurich, SUVA, Freiwillige AkademischeGesellschaft, UBS Wealth Foundation, Talecris Biotherapeutics GmbH,Abbott Diagnostics, European Commission 018996 (GABRIEL), WellcomeTrust WT 084703MA, UK: Medical Research Council (Grant Number 92091).Support also provided by the National Institute for Health Researchthrough the Primary Care Research Network The coordination of the ECRHS III was fundedthrough the Medical Research Council (Grant Number 92091). ISGlobal is a member of the CERCA Programme /Generalitat de Catalunya. The present analyses are part of the Ageing Lungsin European Cohorts (ALEC) Study (www.alecstudy.org), which hasreceived funding from the European Union’s Horizon 2020 research andinnovation programme under grant agreement No. 633212.
Competing interests None declared.
Ethics approval Local committees for each study centre.
Provenance and peer review Not commissioned; externally peer reviewed.
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