Gender differences in the effect of occupational endotoxin exposure on impaired lung function and death: the Shanghai Textile Worker Study

Abstract

OBJECTIVE Airborne endotoxin exposure has both adverse and protective health effects. Studies show males have augmented acute inflammatory responses to endotoxin. In this longitudinal cohort study we investigated the effect of long-term exposure to endotoxin in cotton dust on health, and determined whether these effects differ by gender. METHODS In the Shanghai Textile Worker Study, 447 cotton and 472 control silk textile workers were followed from 1981 to 2011 with repeated measures of occupational endotoxin exposure, spirometry, and health questionnaires. Impaired lung function was defined as a decline in forced expiratory volume in one second to less than the 5th percentile of population predicted. Death was ascertained by death registries. We used Cox proportional hazards models to assess the effect of endotoxin exposure on the time to development of impaired lung function and death. RESULTS 128 deaths and 164 diagnoses of impaired lung function were ascertained between 1981 and 2011. Hazard ratios (HRs) for the composite endpoint of impaired lung function or death was 1.47 (95% CI 1.09-1.97) for cotton vs. silk workers and 1.04 (95% CI 1.01-1.07) per 10,000 endotoxin units (EU)/m3-years increase in exposure. HRs for all-cause mortality was 1.36 (95% CI 0.93-1.99) for cotton vs. silk workers and 1.04 (95% CI 0.99-1.08) per 10,000 EU/m3-years. The risk associated with occupational endotoxin exposure was elevated only in men. CONCLUSIONS Occupational endotoxin exposure is associated with an increase in the risk of impaired lung function and all-cause mortality in men.

Byssinosis and COPD rates among factory workers manufacturing hemp and jute

“…This significantly exceeds the recommended OELs of 50 EU/m 3 from the Netherlands. These findings support previous studies about the relation of endotoxins and byssinosis [22][23][24][25]38]. Our findings also suggest that advanced stage byssinosis may lead to development of chronic bronchitis and emphysema which are both components of COPD.…”

Industrial hygiene, occupational safety and respiratory symptoms in the Pakistani cotton industry

“…4 A specific respiratory syndrome in that industry was called byssinosis and Schilling 5 first classified byssinosis based on respiratory symptoms. Organic cotton dust contains endotoxins that are believed to cause most of the symptoms, 6 disturbed lung functions, 7 8 organic dust toxic syndrome 9 and obstructive pattern of lung diseases having features of asthma and chronic obstructive pulmonary disease. 10 There is still unprotected and persistent exposure to cotton dust, endotoxins and different ergonomic hazards in the Pakistani cotton industry, resulting in severe public health problems.…”

Endotoxin and gender modify lung function recovery after occupational organic dust exposure: a 30-year study

“…29 We have previously reported in our cohort that endotoxin-exposed men are at higher risk than women of developing reduced lung function and mortality due to all causes of death combined. 30 Animal studies demonstrating an augmented response to endotoxin related to male sex hormones 31 provide a potential biological explanation. However, gender differences in FEV 1 recovery were also noted among silk workers.…”