Centre for Workplace Health, Health and Safety Laboratory, Buxton SK17 9JN, UK.
Thorax. 2012 Oct;67(10):901-7. doi: 10.1136/thoraxjnl-2011-200543. Epub 2012 Jun 28.
To assess the contribution of workplace exposures to chronic obstructive pulmonary disease (COPD) risk in a community with a heavy burden of past industrial employment.
A random population sample of Sheffield, U.K. residents aged over 55 years (n=4000), enriched with a hospital-based supplemental sample (n=209), was approached for study. A comprehensive self-completed questionnaire elicited physician-made diagnoses, current symptoms, and past workplace exposures. The latter were defined in three ways: self-reported exposure to vapours, gases, dusts and fumes (VGDF); response to a specific exposure checklist; and through a job exposure matrix (JEM) assigning exposure risk likelihood based on job history independent of respondent-reported exposure. A subset of the study group underwent lung function testing. Population attributable risk fractions (PAR%), adjusted for age, sex and smoking, were calculated for association between workplace exposure and COPD.
2001 (50%) questionnaires were returned from the general population sample and 60 (29%) by the hospital supplement. Among 1754 with complete occupational data, any past occupational exposure to VGDF carried an adjusted excess risk for report of a physician's diagnosis of COPD, emphysema, or chronic bronchitis (ORs 3.9; 95% CI 2.7 to 5.8), with a corresponding PAR% value of 58.7% (95% CI 45.6% to 68.7%). The PAR% estimate based on JEM exposure was 31%. From within the subgroup of 571 that underwent lung function testing, VGDF exposure was associated with a PAR% of 20.0% (95% CI -7.2 to 40.3%) for Global initiative for chronic obstructive lung disease (GOLD) 1 (or greater) level of COPD.
This heavy industrial community-based population study has confirmed significant associations between reported COPD and both generic VGDF and JEM-defined exposures. This study supports the predominantly international evidence-based notion that workplace conditions are important when considering the current and future respiratory health of the workforce.
在一个过去工业就业负担沉重的社区，评估工作场所暴露对慢性阻塞性肺疾病（COPD）风险的贡献。
对英国谢菲尔德的一个年龄在 55 岁以上的随机人群样本（n=4000）进行了研究，并通过医院补充样本（n=209）进行了补充。通过一份全面的自我完成问卷，调查了医生做出的诊断、当前症状和过去的工作场所暴露情况。后者以三种方式定义：自我报告的蒸气、气体、粉尘和烟雾（VGDF）暴露；对特定暴露检查表的回应；以及通过工作场所暴露矩阵（JEM），根据与受访者报告的暴露无关的工作历史分配暴露风险可能性。研究小组的一部分人接受了肺功能测试。根据年龄、性别和吸烟情况，计算了工作场所暴露与 COPD 之间的人群归因风险分数（PAR%）。
从普通人群样本中返回了 2001 份（50%）问卷，从医院补充样本中返回了 60 份（29%）。在有完整职业数据的 1754 人中，任何过去职业性 VGDF 暴露都与医生诊断 COPD、肺气肿或慢性支气管炎的报告存在调整后过量风险（OR 3.9；95%CI 2.7 至 5.8），相应的 PAR%值为 58.7%（95%CI 45.6%至 68.7%）。基于 JEM 暴露的 PAR%估计值为 31%。在接受肺功能测试的 571 名亚组中，VGDF 暴露与全球倡议慢性阻塞性肺疾病（GOLD）1 级（或更高）COPD 的 PAR%为 20.0%（95%CI-7.2 至 40.3%）相关。
这项基于重工业社区的人群研究证实，报告的 COPD 与通用 VGDF 和 JEM 定义的暴露之间存在显著关联。这项研究支持了主要的国际循证观点，即当考虑劳动力当前和未来的呼吸道健康时，工作场所条件很重要。
