Cumulative Occupational Exposures and Lung-Function Decline in Two Large General-Population Cohorts

Rationale: Few longitudinal studies have assessed the relationship between occupational exposures and lung-function decline in the general population with a sufficiently long follow-up.Objectives: To examine the potential association in two large cohorts: the ECRHS (European Community Respiratory Health Survey) and the SAPALDIA (Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults).Methods: General-population samples of individuals aged 18 to 62 were randomly selected in 1991-1993 and followed up approximately 10 and 20 years later. Spirometry (without bronchodilation) was performed at each visit. Coded complete job histories during follow-up visits were linked to a job-exposure matrix, generating cumulative exposure estimates for 12 occupational exposures. Forced expiratory volume in 1 second (FEV(1)) and forced vital capacity (FVC) were jointly modeled in linear mixed-effects models, fitted in a Bayesian framework, taking into account age and smoking.Results: A total of 40,024 lung-function measurements from 17,833 study participants were analyzed. We found accelerated declines in FEV(1) and the FEV(1)/FVC ratio for exposure to biological dust, mineral dust, and metals (FEV(1) = -15.1 ml, -14.4 ml, and -18.7 ml, respectively; and FEV(1)/FVC ratio = -0.52%, -0.43%, and -0.36%, respectively; per 25 intensity-years of exposure). These declines were comparable in magnitude with those associated with long-term smoking. No effect modification by sex or smoking status was identified. Findings were similar between the ECRHS and the SAPALDIA cohorts.Conclusions: Our results greatly strengthen the evidence base implicating occupation, independent of smoking, as a risk factor for lung-function decline. This highlights the need to prevent or control these exposures in the workplace.

• Lytras, T.
• Beckmeyer-Borowko, A.
• Kogevinas, M.
• Kromhout, H.
• Carsin, A. E.
• Antó, J. M.
• Bentouhami, H.
• Weyler, J.
• Heinrich, J.
• Nowak, D.
• Urrutia, I.
• Martínez-Moratalla, J.
• Gullón, J. A.
• Pereira Vega, A.
• Raherison Semjen, C.
• Pin, I.
• Demoly, P.
• Leynaert, B.
• Villani, S.
• Gislason, T.
• Svanes, Ø
• Holm, M.
• Forsberg, B.
• Norbäck, D.
• Mehta, A. J.
• Keidel, D.
• Vernez, D.
• Benke, G.
• Jõgi, R.
• Torén, K.
• Sigsgaard, T.
• Schlünssen, V.
• Olivieri, M.
• Blanc, P. D.
• Watkins, J.
• Bono, R.
• Squillacioti, G.
• Buist, A. S.
• Vermeulen, R.
• Jarvis, D.
• Probst-Hensch, N.
• Zock, J. P.