Blanc P D, Menezes A M B, Plana E, Mannino D M, Hallal P C, Toren K, Eisner M D, Zock J-P
Division of Occupational and Environmental Medicine, University of California San Francisco, 350 Parnassus Ave., Suite 609, San Francisco, CA 94117, USA.
Eur Respir J. 2009 Feb;33(2):298-304. doi: 10.1183/09031936.00118808. Epub 2008 Nov 14.
The occupational contribution to chronic obstructive pulmonary disease (COPD) has yet to be put in a global perspective. In the present study, an ecological approach to this question was used, analysing group-level data from 90 sex-specific strata from 45 sites of the Burden of Obstructive Lung Disease study, the Latin American Project for the Investigation of Obstructive Lung Disease and the European Community Respiratory Health Survey follow-up. These data were used to study the association between occupational exposures and COPD Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage II or above. Regression analysis of the sex-specific group-level prevalence rates of COPD at each site against the prevalence of occupational exposure and ever-smoking was performed, taking into account mean smoking pack-yrs and mean age by site, sex, study cohort and sample size. For the entire data set, the prevalence of exposures predicted COPD prevalence (0.8% increase in COPD prevalence per 10% increase in exposure prevalence). By comparison, for every 10% increase in the proportion of the ever-smoking population, the prevalence of COPD GOLD stage II or above increased by 1.3%. Given the observed median population COPD prevalence of 3.4%, the model predicted that a 20% relative reduction in the disease burden (i.e. to a COPD prevalence of 2.7%) could be achieved by a 5.4% reduction in overall smoking rates or an 8.8% reduction in the prevalence of occupational exposures. When the data set was analysed by sex-specific site data, among males, the occupational effect was a 0.8% COPD prevalence increase per 10% change in exposure prevalence; among females, a 1.0% increase in COPD per 10% change in exposure prevalence was observed. Within the limitations of an ecological analysis, these findings support a worldwide association between dusty trades and chronic obstructive pulmonary disease for both females and males, placing this within the context of the dominant role of cigarette smoking in chronic obstructive pulmonary disease causation.
职业因素对慢性阻塞性肺疾病（COPD）的影响尚未从全球角度进行审视。在本研究中，采用了一种生态学方法来探讨这个问题，分析了来自慢性阻塞性肺疾病负担研究、拉丁美洲阻塞性肺疾病调查项目和欧洲共同体呼吸健康调查随访的45个地点90个性别特异性分层的群体水平数据。这些数据用于研究职业暴露与慢性阻塞性肺疾病全球倡议（GOLD）II期及以上之间的关联。针对每个地点的COPD性别特异性群体患病率与职业暴露患病率和曾经吸烟率进行回归分析，同时考虑按地点、性别、研究队列和样本量划分的平均吸烟包年数和平均年龄。对于整个数据集，暴露患病率可预测COPD患病率（暴露患病率每增加10%，COPD患病率增加0.8%）。相比之下，曾经吸烟人群比例每增加10%，GOLD II期及以上COPD的患病率增加1.3%。鉴于观察到的人群COPD患病率中位数为3.4%，该模型预测，总体吸烟率降低5.4%或职业暴露患病率降低8.8%，可使疾病负担相对降低20%（即COPD患病率降至2.7%）。当按性别特异性地点数据对数据集进行分析时，在男性中，职业暴露患病率每变化10%，COPD患病率增加0.8%；在女性中，职业暴露患病率每变化10%，COPD患病率增加1.0%。在生态学分析的局限性范围内，这些发现支持了无论是男性还是女性，从事粉尘作业与慢性阻塞性肺疾病之间存在全球关联，并将此置于吸烟在慢性阻塞性肺疾病病因中占主导地位的背景下。
