Prevalence of chronic obstructive pulmonary disease in the U.S. working population: an analysis of data from the 1997-2004 National Health Interview Survey

Chronic bronchitis and emphysema among workers exposed to dust, vapors, or fumes by industry and occupation

Exposures to dust, vapors, or fumes (DVF) are associated with chronic bronchitis (CB) and emphysema. The 2007-2012 National Health and Nutrition Examination Survey data were used to estimate age-standardized prevalence of CB and emphysema among ever-employed adults by exposure status and industry and occupation groups. Age-standardized CB and emphysema prevalence were 2.3% and 1.9%, respectively. Of the estimated 111 million U.S. workers exposed to DVF, 2.7% reported CB and 2.8% reported emphysema. Workers in the "accommodation, food services" industry and "food preparation, serving related" occupations were more likely to report CB and emphysema. Current findings indicate that workplace exposures may be associated with high prevalence of CB and emphysema in certain industry and occupational groups. Early diagnosis and identifying associated workplace exposures are important steps in CB and emphysema prevention efforts.

Latent Health Risk Classes Associated with Poor Physical and Mental Outcomes in Workers with COPD from Central Appalachian U.S. States

Adults who work in the Central Appalachian region of the United States (U.S.) are disproportionately affected by Chronic Obstructive Pulmonary Disease (COPD). While there is a socio-demographic profile of adults with COPD who are at increased risk for physical and mental distress, the risk factors that uniquely affect the health-related quality of life (HRQoL) of Central Appalachian workers with COPD are unknown. Therefore, we conducted a latent class analysis of 2016 and 2017 Behavioral Risk Factor Surveillance System data from 1326 currently employed adults with COPD living in four U.S. states (KY, NC, TN, and WV) within the Central Appalachian Region. Drawing from the social ecological model, we identified associations between theoretically informed risk indicators-comorbid health conditions, substance use and abuse, and limited access to healthcare-on three HRQoL variables, including infrequent (0-13 days) or frequent (≥14 days) physical distress, mental distress, and limited activity due to poor health over the past 30 days. Workers at high risk for comorbid conditions reported more frequent physical distress, mental distress, and activity limitations as compared to those at low risk. Workers reporting difficulty accessing healthcare were no more likely to report physical or mental distress when compared to workers with adequate access to healthcare; however, those with limited healthcare access did report more frequent activity limitation due to poor health. Interestingly, workers with COPD at high risk for substance use and abuse were no more likely to report poor HRQoL outcomes compared to those at low risk. Our findings have important implications for addressing indicators of poor health among Central Appalachian workers with COPD, especially those living with multiple comorbidities.

The Occupational Burden of Nonmalignant Respiratory Diseases. An Official American Thoracic Society and European Respiratory Society Statement

Rationale: Workplace inhalational hazards remain common worldwide, even though they are ameliorable. Previous American Thoracic Society documents have assessed the contribution of workplace exposures to asthma and chronic obstructive pulmonary disease on a population level, but not to other chronic respiratory diseases. The goal of this document is to report an in-depth literature review and data synthesis of the occupational contribution to the burden of the major nonmalignant respiratory diseases, including airway diseases; interstitial fibrosis; hypersensitivity pneumonitis; other noninfectious granulomatous lung diseases, including sarcoidosis; and selected respiratory infections. Methods: Relevant literature was identified for each respiratory condition. The occupational population attributable fraction (PAF) was estimated for those conditions for which there were sufficient population-based studies to allow pooled estimates. For the other conditions, the occupational burden of disease was estimated on the basis of attribution in case series, incidence rate ratios, or attributable fraction within an exposed group. Results: Workplace exposures contribute substantially to the burden of multiple chronic respiratory diseases, including asthma (PAF, 16%); chronic obstructive pulmonary disease (PAF, 14%); chronic bronchitis (PAF, 13%); idiopathic pulmonary fibrosis (PAF, 26%); hypersensitivity pneumonitis (occupational burden, 19%); other granulomatous diseases, including sarcoidosis (occupational burden, 30%); pulmonary alveolar proteinosis (occupational burden, 29%); tuberculosis (occupational burden, 2.3% in silica-exposed workers and 1% in healthcare workers); and community-acquired pneumonia in working-age adults (PAF, 10%). Conclusions: Workplace exposures contribute to the burden of disease across a range of nonmalignant lung conditions in adults (in addition to the 100% burden for the classic occupational pneumoconioses). This burden has important clinical, research, and policy implications. There is a pressing need to improve clinical recognition and public health awareness of the contribution of occupational factors across a range of nonmalignant respiratory diseases.

High exposure mining occupations are associated with obstructive lung disease, National Health Interview Survey (NHIS), 2006-2015

BACKGROUND

The association between mining occupation categories and obstructive lung disease (OLD) has not been well explored in the United States.

METHODS

National Health Interview Survey (NHIS) data from 2006 to 2015 was used to determine the relationship between mining occupations and diagnosis of chronic bronchitis, emphysema, chronic obstructive pulmonary disease (COPD), and asthma. We classified occupations into low, moderate, high, and very high dust exposure groups. Extraction workers were categorized as very high dust exposure.

RESULTS

We found 4.5% of miners had chronic bronchitis, 3.3% had emphysema, 6.2% had COPD, and 9.9% had asthma. In fully adjusted models, extraction workers had significantly increased odds of having chronic bronchitis (OR = 2.18 [95%CI: 1.02, 4.64]), emphysema (OR = 7.85 [95%CI: 1.70, 36.27]), and COPD (OR = 2.56 [95%CI: 1.29, 5.12]) compared to lower exposure occupations.

CONCLUSIONS

Occupation is an important predictor of OLD in the mining industry.

[Chronic cerebral ischemia in obstructive pulmonary diseases]

Chronic obstructive pulmonary disease (COPD) is one of the main causes of disease and death incidences worldwide. Different organs and systems are involved in COPD activating tissue hypoxia. It affects especially tissue functioning with the high level of intensity of metabolic processes, and the nervous system suffers first. Neuroimaging studies show white and grey matter damage and cerebral atrophy, which may clinically manifest themselves in different neurological symptoms depended on vascular system lesions, and cognitive and affective impairments. Despite of its potential importance, encephalopathy in COPD remains a little-studied concomitant pathology. Application of cytoprotective drugs is pathogenetically justified in this case and must be included in COPD complex therapy. In particular, the inclusion of mexicor in the treatment of patients with chronic pulmonary heart increases the efficacy of treatment of the main and associated diseases (chronic cerebral ischemia, cardiac insufficiency and arrhythmia).

Prevalence of chronic obstructive pulmonary disease among US working adults aged 40 to 70 years. National Health Interview Survey data 2004 to 2011

OBJECTIVE

To estimate the prevalence and prevalence odds ratios of chronic obstructive pulmonary disease (COPD) among US workers by major occupational groups.

METHODS

The 2004 to 2011 National Health Interview Survey data for working adults 40 to 70 years old was analyzed to estimate the prevalence of COPD by major occupational groups. Logistic regression models were used to evaluate the associations between COPD (chronic bronchitis or emphysema) and occupations.

RESULTS

The estimated overall COPD prevalence was 4.2% (95% CI, 4.0 to 4.3). The odds of COPD were highest among workers in health care support occupations (prevalence odds ratio, 1.64; 95% CI, 1.25 to 2.14) followed by food preparation and serving-related occupations (prevalence odds ratio, 1.57; 95% CI, 1.20 to 2.06).

CONCLUSIONS

Prevalence varied by occupations, suggesting workplace exposures may contribute to COPD. Preventive measures such as interventions to reduce smoking may reduce the prevalence of COPD.

Temporal trends in hospitalization rates for older adults with chronic obstructive pulmonary disease

BACKGROUND

Over the last 15 years, substantial advances have been made in the treatment of chronic obstructive pulmonary disease (COPD). Little information is available, however, on whether these treatments have resulted in reduced rates of hospitalization and acute exacerbations among COPD patients. This retrospective cohort study examined changes in hospitalization rates among Medicare beneficiaries with COPD from 1999 to 2008.

METHODS

We analyzed data from 424,418 fee-for-service Medicare beneficiaries enrolled between 1999 and 2008 who were diagnosed with COPD. We examined temporal changes in the frequency of hospitalization and acute exacerbations among Medicare beneficiaries with COPD.

RESULTS

Over the 10-year study period, the hospitalization rates for COPD patients--adjusted for age, sex, race, socioeconomic status, region, and number of comorbidities--decreased: from 131 to 107 per 100 person-years for all causes (P <.001); from 58 to 44 per 100 person-years for all respiratory causes (P <.001); and from 73 to 63 per 100 person-years for nonrespiratory causes (P <.001). There was no change in prevalence of COPD in the Medicare population over this time. Additionally, the percentage of COPD patients hospitalized with 2 or more acute exacerbations decreased from 5.5% to 4.3% over the 10-year study period (P <.001).

CONCLUSION

Between 1999 and 2008, hospitalization rates decreased substantially among Medicare beneficiaries diagnosed with COPD.

Risk factors, health behaviors, and injury among adults employed in the transportation, warehousing, and utilities super sector

BACKGROUND

The TWU super sector is engaged in the movement of passengers and cargo, warehousing of goods, and the delivery of services. The purpose of this study is to describe employee self-reported personal risk factors, health behaviors and habits, disease and chronic conditions, and employer-reported nonfatal injury experiences of workers in the TWU super sector.

METHODS

National Health Interview Survey (NHIS) data for 1997-2007, grouped into six morbidity and disability categories and three age groups, were reviewed. Demographic characteristics and prevalence estimates are reported for workers in the TWU super sector and the entire U.S. workforce, and compared with national adult population data from the NHIS. Bureau of Labor Statistics employer-reported TWU injury data from 2003 to 2007 was also reviewed.

RESULTS

An average of 8.3 million workers were employed annually in the TWU super sector. TWU workers 65 or older reported the highest prevalence of hypertension (49%) across all industry sectors, but the 20% prevalence is notable among middle age workers (25-64). TWU workers had the highest prevalence of obesity (28%), compared to workers in all other industry sectors. Female TWU workers experienced the highest number of lost workdays (6.5) in the past year across all TWU demographic groups.

CONCLUSIONS

Self-reported high proportions of chronic conditions including hypertension and heart disease combined with elevated levels of being overweight and obese, and lack of physical activity-particularly among TWUs oldest workers-can meaningfully inform wellness strategies and interventions focused on this demographic group. Am. J. Ind. Med. 56:556-568, 2013. © 2012 Wiley Periodicals, Inc.

Epidemiology of chronic obstructive pulmonary disease: a literature review

The aim of this study is to quantify the burden of chronic obstructive pulmonary disease (COPD) – incidence, prevalence, and mortality – and identify trends in Australia, Canada, France, Germany, Italy, Japan, The Netherlands, Spain, Sweden, the United Kingdom, and the United States of America. A structured literature search was performed (January 2000 to September 2010) of PubMed and EMBASE, identifying English-language articles reporting COPD prevalence, incidence, or mortality. Of 2838 articles identified, 299 full-text articles were reviewed, and data were extracted from 133 publications. Prevalence data were extracted from 80 articles, incidence data from 15 articles, and mortality data from 58 articles. Prevalence ranged from 0.2%–37%, but varied widely across countries and populations, and by COPD diagnosis and classification methods. Prevalence and incidence were greatest in men and those aged 75 years and older. Mortality ranged from 3–111 deaths per 100,000 population. Mortality increased in the last 30–40 years; more recently, mortality decreased in men in several countries, while increasing or stabilizing in women. Although COPD mortality increased over time, rates declined more recently, likely indicating improvements in COPD management. In many countries, COPD mortality has increased in women but decreased in men. This may be explained by differences in smoking patterns and a greater vulnerability in women to the adverse effects of smoking.

Geographic disparities in chronic obstructive pulmonary disease (COPD) hospitalization among Medicare beneficiaries in the United States

Background:

Hospitalizations for persons with chronic obstructive pulmonary disease (COPD) result in significant health care resource use and excess expenditures. Despite well-documented sociodemographic disparities in COPD outcomes, no study has characterized geographic variations in COPD hospitalization across the US.

Methods:

Almost 3.8 million COPD hospitalization records were extracted from Medicare claims for 1995–2006, and the total population of eligible Medicare beneficiaries was extracted from the Medicare enrollment records to calculate COPD hospitalization rates by Health Service Area (HSA), (n = 949). Spatial cluster analysis and Bayesian hierarchical spatial modeling were used to characterize the geography of COPD hospitalizations.

Results:

The overall COPD hospitalization rate was 11.30 per 1,000 beneficiaries for the aggregated period 1995–2006. HSA-level COPD hospitalization rates had a median of 11.7 and a range of 3.0 (Cache, UT) to 76.3 (Pike, KY). Excessive hospitalization risk was concentrated in Appalachia, the southern Great Lakes, the Mississippi Delta, the Deep South, and west Texas. In the Bayesian spatial mixture model, 73% of variability of COPD hospitalization relative risk was attributed to unidentified regional social and physical environments shared by HSAs rather than to unique local HSA factors (27%).

Conclusion:

We discovered distinct geographic patterns in COPD hospitalization rates and risks attributed to both regionally-shared environmental risk factors and HSA-unique environmental contexts. The correlates of these geographic patterns remain to be determined. Geographic comparisons of COPD hospitalization risk provide insights for better public health practice, policies, and programs for COPD prevention.