Change in prevalence of asbestos-related disease among sheet metal workers 1986 to 2016

Issue 3-The occupational burden of respiratory diseases, an update

INTRODUCTION AND AIMS

Workplace exposures are widely known to cause specific occupational diseases such as silicosis and asbestosis, but they also can contribute substantially to causation of common respiratory diseases. In 2019, the American Thoracic Society (ATS) and the European Respiratory Society (ERS) published a joint statement on the occupational burden of respiratory diseases. Our aim on this narrative review is to summarise the most recent evidence published after the ATS/ERS statement as well as to provide information on traditional occupational lung diseases that can be useful for clinicians and researchers.

RESULTS

Newer publications confirm the findings of the ATS/ERS statement on the role of workplace exposure in contributing to the aetiology of the respiratory diseases considered in this review (asthma, COPD, chronic bronchitis, idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, infectious pneumonia). Except for COPD, chronic bronchitis and infectious pneumonia, the number of publications in the last 5 years for the other diseases is limited. For traditional occupational lung diseases such as silicosis and asbestosis, there are old as well as novel sources of exposure and their burden continues to be relevant, especially in developing countries.

CONCLUSIONS

Occupational exposure remains an important risk factor for airways and interstitial lung diseases, causing occupational lung diseases and contributing substantially in the aetiology of common respiratory diseases. This information is critical for public health professionals formulating effective preventive strategies but also for clinicians in patient care. Effective action requires shared knowledge among clinicians, researchers, public health professionals, and policy makers.

Epidemiology of Asbestosis between 2010-2014 and 2015-2019 Periods in Colombia: Descriptive Study

Background

Asbestosis is a prevalent worldwide problem, but scarce data sourced from developing countries are available. We describe the sociodemographic characteristics and patterns in the occurrence of care provided for asbestosis in Colombia during the periods 2010-2014 and 2015-2019 to establish the behavior, trends, and variables associated with concentrations among people attended by asbestosis.

Methods

A retrospective descriptive study was carried out with data from the Integrated Social Protection Information System (SISPRO) for two 5-year periods. People attended by asbestosis (ICD-10: J61) were identified; the frequency of patient visits, sociodemographic characteristics, case distribution patterns, and trends in both five-year periods were described, as was the crude frequency (cFr, 95% CI) of asbestosis (1,000,000 people/year) in both five-year periods (cFr ratio, 95% CI).

Results

During the period 2010-2019, 765 people attended by asbestosis were identified; there were 308 people attended by asbestosis between 2010-2014 (cFr: 2.20, 1.96-2.47), and ther were 457 people attended by asbestos between 2015-2019 (cFr: 3.14, 2.92-3.50). In both periods, the estimated cFr in men was nine times the estimated cFr in women. The cFr increased in the 2015-2019 period (cFr_ratio: 1.23, 1.06-1.43). Compared with the 2010-2014 period, the cFr of asbestosis increased in women (cFr_ratio: 1.44, 1.03-2.01), in the Andean (cFr_ratio: 1.61, 1.35-1.95) and Caribbean regions (cFr_ratio: 1. 66, 1.21-2.30), in the urban area (cFr_ratio: 1.24, 1.05-1.48), and in the age groups 45-59 years (cFr_ratio: 1.34, 1.001-1.79) and ≥60 years (cFr_ratio: 1.43, 1.13-1.83).

Discussion

During two five-year periods, the cFr of asbestosis was higher in men; between the first and second five-year periods, it increased significantly, especially in urbanized geographic areas and in populations aged ≥45 years. The estimates possibly reflect the effect of disease latency or the expected impact of public health policies to monitor asbestos exposure and complications.

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

BACKGROUND

Construction workers have always had a high risk of occupational illnesses. We used 25 years of data from a medical screening program serving older construction workers to determine how much health outcomes have improved over the past 60 years.

METHODS

We investigated changes in relative risk for chest radiographs consistent with pneumoconiosis, COPD by spirometry, lung cancer mortality, and audiometry-assessed hearing impairment among workers participating in a medical screening program. Results were stratified by decade of first construction employment: before 1960, 1960-1969, 1970-1979, 1980-1989, and after 1990. Poisson and Cox regression analyses assessed relative risk by decade adjusted for age, sex, smoking, and years of construction trade work.

RESULTS

Subjects were 94% male and, on average, 60 years old with 25 years of construction work. When compared to workers employed before 1960, those first employed after 1990 experienced the following reductions in model-adjusted relative risks: chronic obstructive pulmonary disease, 32%; all pneumoconiosis, 68%; parenchymal abnormalities, 35%; pleural abnormalities, 71%; hearing impairment, 20%; and lung cancer mortality, 48%. Risks started to decline in the 1960s with greatest reductions among workers first employed after 1970.

CONCLUSIONS

This study demonstrates the positive impact that adoption of occupational health protections have had over the past 60 years. The greatest risk reductions were observed for outcomes with strong regulatory and legal incentives to reduce exposures and associated risks, such as those associated with inhalation hazards (asbestos and silica), while lowest improvement was for hearing impairment, for which little regulatory enforcement and few prevention incentives have been adopted.

Characteristics and factors associated with morbidity of migrant workers with pneumoconiosis: a cross-sectional study

OBJECTIVES

To better understand the characteristics of migrant workers with pneumoconiosis in China, and the factors that contribute to their morbidity.

DESIGN

A cross-sectional study.

SETTING

This study was conducted in Shanghai, Nanning and Shenzhen, China, between December 2020 and December 2021.

PARTICIPANTS

There were 601 questionnaires that were analysed involving 198 migrant workers with pneumoconiosis, 205 workers with pneumoconiosis in state-owned enterprises (SOEs) and 198 other migrant workers with non-pulmonary occupational diseases.

OUTCOME MEASURES

Epidemiological characteristics of pneumoconiosis among migrant workers were determined. Using logistic regression, we examined the factors related to the morbidity of pneumoconiosis in migrant workers.

RESULTS

The response rate was 93.27%. In comparison with pneumoconiosis among SOE workers, the number of migrant workers with pneumoconiosis who first encountered dust exposure between the ages of 30 and 44 years and had an accumulated dust exposure of 1-10 years was proportionately greater. Migrant workers who developed pneumoconiosis between 18 and 32 years and those who had stage III pneumoconiosis were proportionately greater (p<0.05). Compared with migrant workers with non-pulmonary occupational diseases, six factors were associated with the morbidity of pneumoconiosis in migrant workers. Risk factors were dust exposure (OR=499.25, 95% CI: 68.33 to 3647.59) and someone smoking in the workplace (OR=5.67, 95% CI: 2.18 to 14.78). Protective factors were regular sleeping hours per night, (OR=0.23, 95% CI: 0.09 to 0.60), excellent ventilation (OR=0.09, 95% CI: 0.01 to 0.65), rules and regulations (OR=0.22, 95% CI: 0.07 to 0.66) and post-departure medical examinations (OR=0.24, 95% CI: 0.09 to 0.63).

CONCLUSIONS

Compared with SOE workers with pneumoconiosis, migrant workers are exposed to dust at an earlier age, but for shorter duration, display morbidity at an earlier age and have a higher proportion of tertiary pneumoconiosis. They are predominantly male and have inadequate employment stability and medical insurance. Occupational health check-ups and management systems are inadequate.

Incident chronic obstructive pulmonary disease associated with occupation, industry, and workplace exposures in the Health and Retirement Study

BACKGROUND

Chronic health effects from accumulated occupational exposures manifest as the workforce ages. The Health and Retirement Study (HRS), a panel survey of U.S. adults nearing/in retirement, allows assessment of associations among industry and occupation (I/O), workplace exposures, and incident chronic obstructive pulmonary disease (COPD).

METHODS

The study population comprised respondents from the 1992 HRS cohort employed in 1972 or later and not diagnosed with COPD as of initial interview. We examined associations with incident COPD through 2016 and: (1) broad and selected detailed I/O, (2) workplace exposures, and (3) exposures within I/O. Given the cohort's baseline age (50-62), we calculated subhazard ratios (SHRs) for COPD accounting for competing risk of death.

RESULTS

SHRs for COPD were significantly elevated for several industries: mining; blast furnaces, steelworks, rolling and finishing mills; groceries and related products; and automotive repair shops. Occupations with significantly elevated SHRs were maids and housemen; farmworkers; vehicle/mobile equipment mechanics and repair workers; material moving equipment operators; and nonconstruction laborers. Significantly elevated COPD SHRs were observed for specific I/O-exposure pairs: blast furnace/steelworks/rolling/finishing mills and asbestos; automotive repair shops and aerosol paints; farmworkers and pesticide exposures; and both material moving equipment operators and nonconstruction laborers exposed to dust and ash.

CONCLUSIONS

Certain jobs and occupational exposures are associated with increased risk for developing COPD in late preretirement and during retirement. Given the disability and economic costs of COPD, these findings support focusing exposure prevention and medical monitoring resources on groups of workers at increased risk.