Are welders more at risk of respiratory infections? Findings from a cross-sectional survey and analysis of medical records in shipyard workers: the WELSHIP project

Marongiu, Andrea; Hasan, Omar Sharif Ibne; Ali, Anila; Bakhsh, Sharoon; George, Bobby; Irfan, Nabeel; Minelli, Cosetta; Canova, Cristina; Schofield, Susan; Matteis, Sara De; Cullinan, Paul

doi:10.1136/thoraxjnl-2015-207912

Cited by 23 publications

(12 citation statements)

References 19 publications

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“…d'Errico, et al, Youlden, et al, and a meta‐analysis by Binazzi et al all provide evidence that the exposure to these industrial materials are significant risk factors for the development of sinonasal cancer . It is therefore important that more studies focus on this association, because, beside being a risk factor for cancer, occupational exposure to industrial materials are also strongly associated with significant respiratory morbidity …”

Section: Discussionmentioning

confidence: 99%

Comorbidity burden and nonclinical factors associated with sinonasal cancer all‐cause mortality

et al. 2019

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Objective: To describe comorbidity burden and nonclinical factors associated with all-cause mortality of sinonasal cancer in the United States.Methods: The National Cancer Database (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013) was queried for adult cases of sinonasal cancer (n = 10,518). Outcome of interest was all-cause mortality. Independent variables included comorbidity score and nonclinical factors such as age, gender, race, facility type, distance to facility, insurance, and income. Survival analysis was conducted via multivariable extended Cox regression with Heaviside adjustments.Results: Patients were mostly (79%), male (61%), and mean age of diagnosis was 63.5 years. Approximately one in five patients (18.7%) had a major comorbid condition (Charlson-Deyo score ≥ 1) at diagnosis. After adjusting for clinical factors, increasing comorbidity score was associated with a corresponding increase in hazard of mortality (aHR comorbidity score of 1 = 1.25; 95% CI, 1.16, 1.35), (aHR score of 2+ = 1.61; 95%, CI 1.41, 1.83). Hazard of mortality was also associated with being male (aHR = 1.11; 95% CI, 1.04, 1.17); black (aHR = 1.13, 95% CI, 1.03, 1.24); uninsured (aHR = 1.45; 95% CI, 1.25, 1.68) or on Medicaid (aHR = 1.50; 95% CI, 1.33, 1.69); residence in zip codes with lower median income quartile (aHR < $30,000 = 1.17; 95% CI, 1.06, 1.29); and treatment at community cancer programs (aHR = 1.14, 95% CI 1.01, 1.28).Conclusion: Comorbid disease is associated with all-cause sinonasal cancer mortality, and after accounting for known clinical factors, significant differences in mortality persist based on disparity-driven, nonclinical factors.

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Section: Discussionmentioning

confidence: 99%

Comorbidity burden and nonclinical factors associated with sinonasal cancer all‐cause mortality

et al. 2019

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“…Worker studies have indicated that welders are at increased risk of lobar pneumonia from Streptococcus pneumoniae infection as well as other lung infections (Coggon et al, 1994; Coggon and Palmer, 2016; Suri et al, 2016; Zeidler-Erdely et al, 2012). A cross-sectional study of shipyard workers in the Middle East found that those exposed to welding fumes had a higher prevalence of respiratory symptoms and were more likely to report to healthcare professionals concerning respiratory infections (Marongiu et al, 2016). Epidemiological studies have found that welders are at increased risk of developing and dying from pneumococcal and lobar pneumonia, suggesting a need for pneumococcal vaccination among welders (Coggon et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

Inhalation of iron-abundant gas metal arc welding-mild steel fume promotes lung tumors in mice

et al. 2018

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Welding fumes were reclassified as a Group 1 carcinogen by the International Agency for Research on Cancer in 2017. Gas metal arc welding (GMAW) is a process widely used in industry. Fume generated from GMAW-mild steel (MS) is abundant in iron with some manganese, while GMAW-stainless steel (SS) fume also contains significant amounts of chromium and nickel, known carcinogenic metals. It has been shown that exposure to GMAW-SS fume in A/J mice promotes lung tumors. The objective was to determine if GMAW-MS fume, which lacks known carcinogenic metals, also promotes lung tumors in mice. Male A/J mice received a single intraperitoneal injection of corn oil or the initiator 3-methylcholanthrene (MCA; 10 μg/g) and, one week later, were exposed by whole-body inhalation to GMAW-MS aerosols for 4 hours/day x 4 days/week x 8 weeks at a mean concentration of 34.5 mg/m. Lung nodules were enumerated by gross examination at 30 weeks post-initiation. GMAW-MS fume significantly increased lung tumor multiplicity in mice initiated with MCA (21.86 ± 1.50) compared to MCA/air-exposed mice (8.34 ± 0.59). Histopathological analysis confirmed these findings and also revealed an absence of inflammation. Bronchoalveolar lavage analysis also indicated a lack of lung inflammation and toxicity after short-term inhalation exposure to GMAW-MS fume. In conclusion, this study demonstrates that inhalation of GMAW-MS fume promotes lung tumors in vivo and aligns with epidemiologic evidence that shows MS welders, despite less exposure to carcinogenic metals, are at an increased risk for lung cancer.

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“…Epidemiological studies suggest that welders are at increased risk of respiratory infections in general and specifically pneumococcal pneumonia[ 1 ]. Originally reported in national analyses of occupational mortality, increased risk of pneumococcal pneumonia in welders was subsequently found in a large case–controlled study of men admitted to hospitals in the English West Midlands with community-acquired pneumonia, and recently confirmed in epidemiological studies in both the UK and other countries[ 2 – 5 ],[ 6 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

Pneumococcal infection of respiratory cells exposed to welding fumes; Role of oxidative stress and HIF-1 alpha

Grigg¹,

Miyashita²,

Suri³

2017

PLoS ONE

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Welders are more susceptible to pneumococcal pneumonia. The mechanisms are yet unclear. Pneumococci co-opt the platelet activating factor receptor (PAFR) to infect respiratory epithelial cells. We previously reported that exposure of respiratory cells to welding fumes (WF), upregulates PAFR–dependent pneumococcal infection. The signaling pathway for this response is unknown, however, in intestinal cells, hypoxia-inducible factor-1 α (HIF 1α) is reported to mediate PAFR-dependent infection. We sought to assess whether oxidative stress plays a role in susceptibility to pneumococcal infection via the platelet activating factor receptor. We also sought to evaluate the suitability of nasal epithelial PAFR expression in welders as a biomarker of susceptibility to infection. Finally, we investigated the generalisability of the effect of welding fumes on pneumococcal infection and growth using a variety of different welding fume samples. Nasal epithelial PAFR expression in welders and controls was analysed by flow cytometry. WF were collected using standard methodology. The effect of WF on respiratory cell reactive oxygen species production, HIF-1α expression, and pneumococcal infection was determined using flow cytometry, HIF-1α knockdown and overexpression, and pneumococcal infection assays. We found that nasal PAFR expression is significantly increased in welders compared with controls and that WF significantly increased reactive oxygen species production, HIF-1α and PAFR expression, and pneumococcal infection of respiratory cells. In unstimulated cells, HIF-1α knockdown decreased PAFR expression and HIF-1α overexpression increased PAFR expression. However, in knockdown cells pneumococcal infection was paradoxically increased and in overexpressing cells infection was unaffected. Nasal epithelial PAFR expression may be used as a biomarker of susceptibility to pneumococcal infection in order to target individuals, particularly those at high risk such as welders, for the pneumococcal vaccine. Expression of HIF-1α in unexposed respiratory cells inhibits basal pneumococcal infection via PAFR-independent mechanisms.

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Are welders more at risk of respiratory infections? Findings from a cross-sectional survey and analysis of medical records in shipyard workers: the WELSHIP project

Cited by 23 publications

References 19 publications

Comorbidity burden and nonclinical factors associated with sinonasal cancer all‐cause mortality

Comorbidity burden and nonclinical factors associated with sinonasal cancer all‐cause mortality

Inhalation of iron-abundant gas metal arc welding-mild steel fume promotes lung tumors in mice

Pneumococcal infection of respiratory cells exposed to welding fumes; Role of oxidative stress and HIF-1 alpha

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