De Matteis Sara, Jarvis Deborah, Hutchings Sally, Darnton Andy, Fishwick David, Sadhra Steven, Rushton Lesley, Cullinan Paul
Department of Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK.
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
Occup Environ Med. 2016 Jun;73(6):378-84. doi: 10.1136/oemed-2015-103406. Epub 2016 Mar 21.
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Exposure to occupational hazards is an important preventable risk factor but the contribution of specific occupations to COPD risk in a general population is uncertain. Our aim was to investigate the association of COPD with occupation in the UK population.
In 2006-2010, the UK Biobank cohort recruited 502 649 adults aged 40-69 years. COPD cases were identified by prebronchodilator forced expiratory volume in 1 s/forced vital capacity<lower limit of normal according to American Thoracic Society (ATS)/ European Respiratory Society (ERS) guidelines. Current occupations were coded using the Standard Occupational Classification (SOC) 2000. Prevalence ratios (PRs) and 95% CIs of COPD for each SOC-coded job were estimated using a robust Poisson model adjusted for sex, age, recruitment centre and lifetime tobacco smoking. Analyses restricted to never-smokers and non-asthmatics were also performed.
Of the 353 occupations reported by 228 614 current working participants, several showed significantly increased COPD risk. Those at highest COPD risk were seafarers (PR=2.64; 95% CI 1.59 to 4.38), coal mine operatives (PR=2.30; 95% CI 1.00 to 5.31), cleaners (industrial: PR=1.96; 95% CI 1.16 to 3.31 and domestic: PR=1.43; 95% CI 1.28 to 1.59), roofers/tilers (PR=1.86; 95% CI 1.29 to 2.67), packers/bottlers/canners/fillers (PR=1.60; 95% CI 1.15 to 2.22), horticultural trades (PR=1.55; 95% CI 0.97 to 2.50), food/drink/tobacco process operatives (PR=1.46; 95% CI 1.11 to 1.93), floorers/wall tilers (PR=1.41; 95% CI 1.00 to 2.00), chemical/related process operatives (PR=1.39; 95% CI 0.98 to 1.97), postal workers/couriers (PR=1.35; 95% CI 1.15 to 1.59), labourers in building/woodworking trades (PR=1.32; 95% CI 1.04 to 1.68), school mid-day assistants (PR=1.32; 95% CI 1.01 to 1.74) and kitchen/catering assistants (PR=1.30; 95% CI 1.10 to 1.53). Associations were similar in analyses restricted to never-smokers and non-asthmatics.
Selected occupations are associated with increased COPD risk in a large cross-sectional population-based UK study. Further analyses should confirm the extent to which these associations reflect exposures still of concern and where strengthened preventive action may be needed.
慢性阻塞性肺疾病（COPD）是全球发病和死亡的主要原因。接触职业危害是一个重要的可预防风险因素，但特定职业对普通人群COPD风险的影响尚不确定。我们的目的是调查英国人群中COPD与职业的关联。
2006 - 2010年，英国生物银行队列招募了502649名40 - 69岁的成年人。根据美国胸科学会（ATS）/欧洲呼吸学会（ERS）指南，通过支气管扩张剂前1秒用力呼气量/用力肺活量低于正常下限来确定COPD病例。当前职业使用2000年标准职业分类（SOC）进行编码。使用稳健泊松模型估计每个SOC编码职业的COPD患病率比（PRs）和95%置信区间（CIs），并对性别、年龄、招募中心和终生吸烟情况进行调整。还进行了仅限于从不吸烟者和非哮喘患者的分析。
在228614名当前在职参与者报告的353种职业中，有几种职业的COPD风险显著增加。COPD风险最高的是海员（PR = 2.64；95% CI 1.59至4.38）、煤矿工人（PR = 2.30；95% CI 1.00至5.31）、清洁工（工业：PR = 1.96；95% CI 1.16至3.31；家庭：PR = 1.43；95% CI 1.28至1.59）、屋顶工/瓦工（PR = 1.86；95% CI 1.29至2.67）、包装工/装瓶工/罐头工/灌装机操作工（PR = 1.60；95% CI 1.15至2.22）、园艺行业（PR = 1.55；95% CI 0.97至2.50）、食品/饮料/烟草加工操作工（PR = 1.46；95% CI 1.11至1.93）、地板工/墙面瓦工（PR = 1.41；95% CI 1.00至2.00）、化学/相关工艺操作工（PR = 1.39；95% CI 0.98至1.97）、邮政工人/快递员（PR = 1.35；95% CI 1.15至1.59）、建筑/木工行业工人（PR = 1.32；95% CI 1.04至1.68）、学校午餐助理（PR = 1.32；95% CI 1.01至1.74）和厨房/餐饮助理（PR = 1.30；95% CI 1.10至1.53）。在仅限于从不吸烟者和非哮喘患者的分析中，关联相似。
在一项基于英国大型横断面人群的研究中，特定职业与COPD风险增加有关。进一步分析应确定这些关联在多大程度上反映了仍令人担忧的暴露情况以及可能需要加强预防行动的方面。
