COPD risk among older construction workers—Updated analyses 2020

Abstract

Background A 2010 study of construction workers participating in medical screening programs at the Department of Energy (DOE) nuclear facilities demonstrated increased chronic obstructive pulmonary disease (COPD) risk. The current study of a larger worker cohort allowed for a more nuanced analysis of COPD risk, including for employment beginning after the mid‐1990s. Methods Study participants included 17,941 workers with demographic and smoking data and spirometry with a minimum of three recorded expiratory efforts and reproducibility of forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) of 0.2 L or less. COPD was defined as a FEV1/FVC ratio below the lower limit of normal using established prediction equations without use of bronchodilation. Stratified analyses explored COPD prevalence by demographic variables and trade. Logistic regression analyses assessed risks by trade and time periods of trade and DOE site work, controlling for age, gender, race/ethnicity, body mass index, and smoking. Results Overall COPD prevalence was 13.4% and 67.4% of cases were classified as moderate to severe. Compared to nonconstruction workers, construction trade workers were at significantly increased risk of all COPD (OR = 1.34, 95% CI = 1.29–1.79) and even more so for severe COPD (OR = 1.61, 95% CI = 1.32–1.96). The highest risk trades were cement masons/bricklayers (OR = 2.36; 95% CI = 1.71–3.26) and roofers (OR = 2.22; 95% CI = 1.48–3.32). Risk among workers employed after 1995 was elevated but not statistically significant. Conclusions Construction workers are at increased COPD risk. Results support the prevention of both smoking and occupational exposures to reduce these risks. While the number of participants employed after 1995 was small, patterns of risk were consistent with findings in the overall cohort.

Identification of Modifiable Risk Factors of Exacerbations in Chronic Respiratory Diseases with Airways Obstruction in Vietnam

“…Many studies showed that occupational exposure is characterised by regular exposure to fumes, inorganic and organic fine dust, and many chemicals [ 18 , 19 , 20 ]. The industry, construction, and agriculture workers are the main occupations, associated with the risk of CRD [ 21 , 22 , 23 ]. In the present study, the most commonly exposed occupation among the patients were industry workers (22.1%), construction workers (10.6%), and drivers of vehicles using petrol (13.2%).…”

How much have adverse occupational health outcomes among construction workers improved over time? Evidence from 25 years of medical screening

“…Analyses focused on respiratory diseases (COPD and pneumoconiosis), lung cancer mortality, and hearing impairment, including risk of these outcomes by time period since first entry into construction work. Previous studies of the BTMed population have shown that construction trades workers are at significantly increased risk for all these adverse health conditions 3–6,40 …”

“…In clinical practice, COPD is diagnosed based on a combination of symptoms and pulmonary function, often including post‐bronchodilator spirometry. However, most prior epidemiologic studies of worker populations, including the BTMed cohort, have used an epidemiologic case definition for COPD based on spirometry without bronchodilation, and we have adopted this definition for the current study 2,5,42,43 . The ATS/ERS Task Force 44 recommends identification of airway obstruction based on an FEV 1 /FVC ratio below the lower limit of normal (LLN) to avoid age‐related misclassification associated with use of a fixed FEV 1 /FVC ratio 45–48 .…”

“…However, most prior epidemiologic studies of worker populations, including the BTMed cohort, have used an epidemiologic case definition for COPD based on spirometry without bronchodilation, and we have adopted this definition for the current study. 2,5,42,43 The ATS/ERS Task Force 44 recommends identification of airway obstruction based on an FEV 1 /FVC ratio below the lower limit of normal (LLN) to avoid age-related misclassification associated with use of a fixed FEV 1 /FVC ratio. [45][46][47][48] COPD was defined as a FEV 1 /FVC ratio below the LLN using the prediction equations of Hankinson et al 49 without use of bronchodilation.…”

“…Workers in construction trades experience a spectrum of workplace exposures in varying circumstances and are at significantly increased risk for chronic obstructive pulmonary disease (COPD), [1][2][3][4][5] pneumoconiosis, 6,7 and lung cancer. 4,[8][9][10] Construction trades workers also experience excessive noise exposure and are at significantly increased risk of noise-induced hearing impairment (NIHL).…”