Airways obstruction among older construction and trade workers at Department of Energy nuclear sites

Mortality of older construction and craft workers employed at Department of Energy (DOE) nuclear sites: Follow-up through 2021

BACKGROUND

To determine if construction and trades workers formerly employed at US Department of Energy (DOE) nuclear weapons sites are at significant risk for occupational diseases, we studied the mortality experience of participants in the Building Trades National Medical Screening Program (BTMed).

METHODS

The cohort included 26,922 participants enrolled between 1998 and 2021 and 8367 deaths. Standardized mortality ratios were calculated based on US death rates. Cox models compared construction workers (n = 22,747; 7487 deaths) to two nonconstruction subpopulations: administrative, scientific and security workers (n = 1894; 330 deaths), and all other nonconstruction workers (n = 2218; 550 deaths).

RESULTS

Mortality was elevated for all causes, all cancers, cancers of the trachea, bronchus, lung, kidneys, and lymphatic and hematopoietic system, mesothelioma, chronic obstructive pulmonary disease (COPD), asbestosis, transportation injuries, and other injuries, particularly accidental poisonings. There were 167 deaths from coronavirus disease 2019 (COVID-19), which was lower than expected using US death rates. Overall cause-specific mortality was significantly higher among construction workers than for internal comparison groups.

CONCLUSIONS

Construction workers employed at DOE sites have a significantly increased risk for occupational illnesses. Apart from COVID-19 deaths, this update: (1) found that mortality among construction workers is significantly elevated compared to the US population and significantly higher than in the internal comparison populations, and (2) confirmed excess risk for these workers for first employment after 1990. Cancer mortality risks are similar to the cancers identified for DOE compensation from radiation exposures. The high lung cancer risk supports the value of early lung cancer detection. Continued medical surveillance is important.

Restrictive spirometry pattern among construction trade workers

BACKGROUND

Spirometry-based studies of occupational lung disease have mostly focused on obstructive or mixed obstructive/restrictive outcomes. We wanted to determine if restrictive spirometry pattern (RSP) is associated with occupation and increased mortality.

METHODS

Study participants included 18,145 workers with demographic and smoking data and repeatable spirometry. The mortality analysis cohort included 15,445 workers with known vital status and cause of death through December 31, 2016. Stratified analyses explored RSP prevalence by demographic and clinical variables and trade. Log-binomial regression models explored RSP risk factors while controlling for important confounders such as smoking, obesity, and comorbidities. Cox regression models explored mortality risk by spirometry category.

RESULTS

Prevalence of RSP was very high (28.6%). Mortality hazard ratios for RSP were 1.50 for all causes, 1.86 for cardiovascular diseases, 2.31 for respiratory diseases, and 1.66 for lung cancer. All construction trades except painters, machinists, and roofers had significantly elevated risk for RSP compared to our internal reference group. RSP was significantly associated with both parenchymal and pleural changes seen by chest X-ray.

CONCLUSIONS

Construction trade workers are at significantly increased risk for RSP independent of obesity. Individuals with RSP are at increased risk for all-cause mortality as well as mortality attributable to respiratory diseases, cardiovascular diseases, and lung cancer. RSP deserves greater attention in occupational medicine and epidemiology.

Occupational Exposure to Dust and the Relationship with the Respiratory Symptoms, Lung Function among Construction Workers of the University of Malaysia Sabah

BACKGROUND: The respiratory tract often becomes the site of injury from occupational exposure. All construction sites generate high levels of dust, typically from concrete, silica, asbestos, cement, wood, and stone, sand, and therefore, the workers are exposed to this airborne dust and increased their risk of developing respiratory disorders. Limited studies have been conducted to assess the relationship between respiratory symptoms, lung function, and occupational dust exposure among construction workers in Sabah. AIM: The objectives of this study are to determine the occupational exposure to dust and the relationship with the respiratory symptoms as well as lung function among construction workers in UMS Teaching Hospital. MATERIALS AND METHODS: This cross-sectional study consisted of construction workers working in all sections in the development of UMS Teaching Hospital. A standard respiratory questionnaire was distributed to construction workers and lung function measurement was performed using Spirometry and the results of their respiratory status were compared between workers who were exposed and unexposed to dust. Occupational dust exposure was determined by the gravimetric method using an air sampler. The total duration of the collection was 8 h and the filters with the dust samples were analyzed in the laboratory. RESULTS: The result showed three parameters that were significantly associated with respiratory symptoms, namely, age, marital status, and smoking status. Male workers had a higher prevalence (42.7%) of having respiratory symptoms compared to female workers (21.4%). Widow/widower/divorced (50.0%) had a higher prevalence of having respiratory symptoms compared to married (45.8%) or single workers (25.0%). Workers who smoke had a higher prevalence (51.2%) of having respiratory symptoms compared to non-smoker’s workers (22.7%). CONCLUSION: The highest dust exposure is the piping workstation, followed by the cement and plastering workstations. These warrant the compulsory use of personal protective equipment by construction workers during work, improving the quality of dust masks, and standardizing their usage. Effective engineering controls should also be promoted on construction sites.

Study protocol to determine the effects of solvents on lung function among paint industry workers in Mauritius: A cross-sectional study

Background

The effects of exposure to solvents in paints have been widely studied, but very little information is at hand with only a small number of studies carried out on pulmonary function of paint industry workers. The aim of this study is to determine the respiratory effects of exposure to solvents among workers of the paint industry in Mauritius.

Design and methods

A quantitative cross-sectional study will be conducted in three paint factories across Mauritius. 388 participants would be selected using simple random sampling and be subjected to a pre-designed questionnaire for data collection. Lung function test using a spirometer will also be conducted. Data analysis will be performed using Statistical Package for Social Sciences (SPSS v26.0). The exposed workers will be classified by shift duration, that is, individuals with weekly solvent exposure of ≤12 and >12 h respectively. Using multivariable regression analysis, odds ratio will be calculated to analyze the relationship between the dependent variable (hours of exposure to solvents) and independent variables while adjusting for socio-demographic factors. Independent t-test will also be used to identify any difference between the means of lung function tests and the two exposure groups. Based on pre-observation in the three paint industries, it is anticipated that male workers could be found less likely to be exposed to solvents as compared to female workers. Also, workers with a level of education below secondary and lower secondary categories could have a higher likelihood of being exposed ≤12 h/week shift. Those who are aware of occupational hazards and could indicate to have used personal protective equipment (PPE) could be less likely exposed to solvents.

Expected Impact of the study for Public Health

This study has been approved by the Ethics Committee of the Faculty of Health Sciences at the University of Johannesburg- ethics clearance number: REC-919-2021. The results of this study will be made available to all stakeholders involved in Health and Safety in the Mauritius. Meetings with professional in the field, especially the concerned paint factories, have been arranged to discuss the impact of solvent exposure and propose remedial actions to protect the workers.

COPD risk among older construction workers-Updated analyses 2020

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.

Mortality of older construction and craft workers employed at department of energy nuclear sites: Follow-up through 2016

BACKGROUND

To determine if construction and trades workers employed at U.S. Department of Energy (DOE) nuclear sites facilities are at significant risk for diseases associated with occupational exposures, we compared the mortality experience of participants in the Building Trades National Medical Screening Program (BTMed) to that of the US population.

METHODS

The cohort includes 24,086 BTMed participants enrolled between 1998 and 2016 and 5203 deaths. Cause-specific standardized mortality ratios were calculated based on US death rates.

RESULTS

Mortality was elevated for all causes, all cancers, cancers of the trachea, bronchus, and lung and lymphatic and hematopoietic system, mesothelioma, chronic obstructive pulmonary disease, asbestosis, transportation injuries, and other injuries, particularly those caused by accidental poisoning, suggesting a possible effect of the opioid epidemic.

CONCLUSIONS

Apart from other injuries, mortality patterns were very similar to those reported in the past in this population. Construction workers employed at DOE sites have a significantly increased risk for occupational illnesses. Risks are associated with employment during all time periods covered including possibly after 1990. The cancer risks closely match the cancers identified for DOE compensation from radiation exposures. The high risk of lung cancer supports the value of early lung cancer detection. Continued medical surveillance is important.

Systematic review: chronic obstructive pulmonary disease and construction workers

Background

Between 15 and 20% of prevalent cases of chronic obstructive pulmonary disease (COPD) have been attributed to occupational exposures to vapours, gases, dusts and fumes. Dust at construction sites is still a challenge, but no overview exists of COPD among construction workers.

Aims

To assess the occurrence of COPD among construction workers.

Methods

We performed a systematic search in PubMed and Embase between 1 January 1990 and 31 August 2016 in order to identify epidemiological studies with a risk estimate for either COPD morbidity/mortality or a spirometry-based definition of airway obstruction among workers in the construction industry. The authors independently assessed studies to determine their eligibility and performed a quality assessment of the included papers.

Results

Twelve studies were included. Nine studies found a statistically significant association between COPD and work in the construction industry, although only among never-smokers in one study and only for the period after 2000 in another study. One study found that the annual decline in forced expiratory volume in 1 s was significantly higher among construction workers compared with bus drivers.

Conclusions

This review suggests that COPD occurs more often among construction workers than among workers who are not exposed to construction dust. It is not possible to draw any conclusions on specific subgroups as most studies analysed construction workers as one united group. In addition, no potential exposure–effect relationship could be identified.

Respiratory Cancer and Non-Malignant Respiratory Disease-Related Mortality among Older Construction Workers-Findings from the Health and Retirement Study

OBJECTIVE

This study explored the risk of respiratory cancer and non-malignant respiratory disease (NMRD)-related mortality among older construction workers.

METHODS

Analyzed data from the 1992-2010 RAND Health and Retirement Study (HRS) and the HRS National Death Index - Cause of Death file. About 25,183 workers aged 50 years and older were examined, including 5,447 decedents and 19,736 survivors, of which 1,460 reported their longest job was in construction. Multinomial logistic regression assessed the differences in mortality between workers' longest occupations, controlling for confounders.

RESULTS

After adjusting for smoking and demographics, construction workers were almost twice as likely to die from respiratory cancer (OR = 1.65; CI: 1.10-2.47) or NMRD (OR = 1.73; CI: 1.16-2.58) compared to white-collar workers.

CONCLUSIONS

This study adds to the growing evidence that respiratory cancer and NMRD are frequently associated with construction exposure.

Lower limit of normal based spirometric abnormalities associated with radiographic abnormality in an elderly cohort at low risk for exposure

BACKGROUND

Although the relation between radiographic abnormalities and spirometric impairment in people with asbestosis has been studied extensively, the extent of spirometric impairment associated with milder radiographic abnormalities is not established.

OBJECTIVE

To test associations between mild radiographic abnormalities and Lower Limit of Normal (LLN)-based spirometry interpretation.

METHODS

Spirometry and CXRs were collected for 1,026 at low risk of exposure to pneumoconiotic agents participants in a medical screening program.

RESULTS

Individuals with each type of isolated or combined International Labour Organization (ILO) abnormalities had up to over sixfold statistically significant increase in odds of LLN-based restrictive pattern physiology (OR = 1.96, 95%CI 1.03-3.73 for parenchymal to OR = 6.09, 95%CI 1.94-19.10 for parenchymal and pleural) compared to those with normal films.

CONCLUSIONS

The findings from this study confirm the association of mild profusion abnormalities with clinically relevant, LLN-based lung function abnormalities.

A case-control study of airways obstruction among construction workers

BACKGROUND

While smoking is the major cause of chronic obstructive pulmonary disease (COPD), occupational exposures to vapors, gases, dusts, and fumes (VGDF) increase COPD risk. This case-control study estimated the risk of COPD attributable to occupational exposures among construction workers.

METHODS

The study population included 834 cases and 1243 controls participating in a national medical screening program for older construction workers between 1997 and 2013. Qualitative exposure indices were developed based on lifetime work and exposure histories.

RESULTS

Approximately 18% (95% CI = 2-24%) of COPD risk can be attributed to construction-related exposures, which are additive to the risk contributed by smoking. A measure of all VGDF exposures combined was a strong predictor of COPD risk.

CONCLUSIONS

Construction workers are at increased risk of COPD as a result of broad and complex effects of many exposures acting independently or interactively. Control methods should be implemented to prevent worker exposures, and smoking cessation should be promoted.

Chronic Obstructive Pulmonary Disease in Never-Smoking Bricklayers

Background: Chronic obstructive pulmonary disease (COPD) due to occupational exposures remains an important public health problem taking significant toll on the global burden of the disease.Aim: In order to assess chronic prevalence and characteristics of COPD in bricklaying we performed a cross-sectional study including 47 never-smoking male bricklayers (aged 34 to 57 years) and an equal number of never-smoking male office workers studied as a control.Methods: Evaluation of examined subjects consisted of completion of a questionnaire, baseline spirometry, and bronchodilator reversibility testing.Results: We found higher prevalence of respiratory symptoms in bricklayers with significant difference for cough and phlegm. Majority of the chronic respiratory symptoms in bricklayers were work-related. The mean values of all measured spirometric parameters in bricklayers were significantly lower than in office workers. The prevalence of COPD was significantly higher in bricklayers than in office workers (14.9% vs. 4.3%, P = 0.034). COPD in both examined groups was close related to age over 45 years, while in bricklayers significant association was registered for duration of occupational exposure longer than 20 years and work-related respiratory symptoms.Conclusion: Our findings support data about relationship between occupational exposure to inorganic dust and fumes in construction workers and persistent airflow limitation.

Time trend in hospitalised chronic lower respiratory diseases among Danish building and construction workers, 1981-2009: a cohort study

OBJECTIVES

To show trends in age-standardised hospital admission ratios (SHR) for chronic lower respiratory diseases, estimated for Danish construction workers over three time periods (1981-1990, 1991-2000, 2001-2009).

DESIGN

Within consecutive cohorts of all male building and construction workers in Denmark, selected occupations: bricklayers, carpenters, electricians, painters, plumbers and 'other construction workers' were followed up for hospitalisation due to chronic lower respiratory diseases. SHR was calculated for each occupation and time period. Time trend was calculated for construction workers at large using Poisson regression.

SETTING

Denmark.

PARTICIPANTS

All gainfully employed male building and construction workers aged 20 or more.

PRIMARY AND SECONDARY OUTCOME MEASURES

Age-standardised and gender-standardised hospitalisation ratios (SHR).

RESULTS

The number of hospitalised construction workers at large was reduced from 1134 in the first 10-year period to 699 in the last 9-year period. Among all Danish males, it was, however, even more reduced as reflected in the expected number that was down from 1172 to 617. Hence, SHR increased from 97 during 1981-1990, 100 during 1991-2000 to 113 during 2001-2009. It means that SHR increased with an average rate of 0.76% per year (95% CI 0.28 to 1.24) during the study period. A low SHR=72 (95% CI 60 to 87) was found among carpenters in 1981-1990. From 2001 to 2009, high SHRs were found among painters (SHR=147; 95% CI 111 to 192) and plumbers (SHR=132; 95% CI 101 to 171). In general, the selected groups of construction workers had, however, a low or average SHR due to chronic lower respiratory diseases.

CONCLUSIONS

The number of hospitalised workers, suffering from chronic lower respiratory diseases, was reduced over time for construction workers, but for all economically active men, it was reduced even more. Therefore, SHR due to chronic lower respiratory diseases increased over time in the construction industry at large.

Cement dust exposure-related emphysema in a construction worker

Although, smoking is considered the most important predisposing factor in development of emphysema; environmental exposures also play an important role. There have been several studies on work related respiratory symptoms and ventilatory disorders among employees of cement industry. We report a case of cement exposure related emphysema in 75 years old woman construction worker.

Lung function in asbestos-exposed workers, a systematic review and meta-analysis

BACKGROUND

A continuing controversy exists about whether, asbestos exposure is associated with significant lung function impairments when major radiological abnormalities are lacking. We conducted a systematic review and meta-analysis in order to assess whether asbestos exposure is related to impairment of lung function parameters independently of the radiological findings.

METHODS

MEDLINE was searched from its inception up to April 2010. We included studies that assessed lung function parameters in asbestos exposed workers and stratified subjects according to radiological findings. Estimates of VC, FEV1 and FEV1/VC with their dispersion measures were extracted and pooled.

RESULTS

Our meta-analysis with data from 9,921 workers exposed to asbestos demonstrates a statistically significant reduction in VC, FEV1 and FEV1/VC, even in those workers without radiological changes. Less severe lung function impairments are detected if the diagnoses are based on (high resolution) computed tomography rather than the less sensitive X-ray images. The degree of lung function impairment was partly related to the proportion of smokers included in the studies.

CONCLUSIONS

Asbestos exposure is related to restrictive and obstructive lung function impairment. Even in the absence of radiological evidence of parenchymal or pleural diseases there is a trend for functional impairment.