Systemic autoimmune disease mortality and occupational exposures

Abstract

Objective. To generate hypotheses regarding occupational exposures that may cause systemic autoimmune diseases.Methods. Based on examination of US death certificates, we identified deaths in 26 states for which a cause was listed as rheumatoid arthritis (RA) (n ‫؍‬ 36,178), systemic lupus erythematosus (SLE) (n ‫؍‬ 7,241), systemic sclerosis (n ‫؍‬ 5,642), or other systemic autoimmune disease (n ‫؍‬ 4,270). Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated to estimate associations between occupation and death from any systemic autoimmune disease, and from RA, SLE, and systemic sclerosis, specifically. Additionally, we estimated risks associated with occupational exposures, which were assigned using job-exposure matrices.Results. A broad array of occupations was associated with death from systemic autoimmune diseases, including several of a priori interest. Farming occupation was associated with death from any systemic autoimmune disease (OR 1.3 [95% CI 1.2-1.4]), and increased risk was also seen with occupational exposure to animals and pesticides. Several industrial occupations were associated with death from any systemic autoimmune disease, including mining machine operators (OR 1.3 [95% CI 1.1-1.5]), miscellaneous textile machine operators (OR 1.2 [95% CI 1.0-1.4]), and hand painting, coating, and decorating occupations (OR 1.8 [95% CI 1.0-2.9]). These occupations were also significantly associated with death from the specific autoimmune diseases examined. Certain occupations entailing exposure to the public, such as teachers, were associated with systemic autoimmune disease-related death, whereas others, such as waiters and waitresses, were not.Conclusion. Our results suggest that death from systemic autoimmune diseases may be associated with occupational exposures encountered in farming and industry. The hypotheses generated in this study provide leads for future research on determinants of these diseases.

Occupational silica exposure as a risk factor for scleroderma: a meta-analysis

“…Exposure categories were established in routine registries (Brown et al 1997; Brown et al (1997), Sweden Cohort (1965-19831977-1989; nationwide registry-based cohorts of patients hospitalized for silicosis Diagnoses of silicosis as proxy for silica exposure 37 11.9-86.3 Mehlhorn et al (1999), Germany Cohort; incidence 243,900 highly exposed and 50,000 low-exposed male uranium miners Assessment of level of exposure in uranium miners 7.41 6.14-8.93 Rosenman et al (1999), USA Cohort (1987, individuals with silicosis from state registry system Mehlhorn et al 1999;Ziegler et al 1997) or using job titles (Rodnan et al 1967;Walsh 1999;Calvert et al 2003;Gold et al 2007).…”

Wegener’s granulomatosis and environmental factors in Western Montana

“…Furthermore, a study of 52,277 cases and 260,632 controls obtained from death certificates identified that mortality risk from autoimmune diseases, specifically rheumatoid arthritis (OR=1.3, 95% CI: 1.1-1.5) and SLE (OR=1.2, 95% CI: 1.0-1.4), is increased in patients previously exposed to mining as determined by the occupational code "mining machine operator" on the subject's death certificate. 34,35 Most recently, a Swedish population-based case-control study of 2288 WG patients diagnosed by ICD#9 hospital discharge code and gender-, age-, regionmatched controls (10 per case) identified borderline risk (OR=1.6, 95% CI: 0.8-3.1) for miners after a validation step excluded cases not fulfilling ACR criteria. 36 We observed a positive association of exposure to rodenticides and a weakly positive association of exposure to insecticides with the development of WG.…”

Environmental risk factors of systemic sclerosis

“…Noonan et al [39] have, in fact, found that workers in an asbestos-contaminated vermiculite mining company were at twice the risk of either rheumatoid arthritis, systemic lupus erythematosus, or SSc compared with the unexposed population. Nevertheless, in this group of exposed patients, because asbestos was concurrent with crystalline silica exposure (contaminated vermiculite), it is difficult to assess the role of each material separately.…”