Occupational and Environmental Medicine, University of Birmingham, Birmingham, UK
Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, West Midlands, UK.
Thorax. 2020 Jun;75(6):468-475. doi: 10.1136/thoraxjnl-2019-213407. Epub 2020 May 6.
Although around 10% to 15% of COPD burden can be attributed to workplace exposures, little is known about the role of different airborne occupational pollutants (AOP). The main aim of the study was to assess the effect size of the relationship between various AOP, their level and duration of exposure with airflow obstruction (AFO).
A cross-sectional analysis was conducted in 228 614 participants from the UK Biobank study who were assigned occupational exposure using a job exposure matrix blinded to health outcome. Adjusted prevalence ratios (PRs) and 95% CI for the risk of AFO for ever and years of exposure to AOPs were estimated using robust Poisson model. Sensitivity analyses were conducted for never-smokers, non-asthmatic and bi-pollutant model.
Of 228 614 participants, 77 027 (33.7%) were exposed to at least one AOP form. 35.5% of the AFO cases were exposed to vapours, gases, dusts or fumes (VGDF) and 28.3% to dusts. High exposure to vapours increased the risk of occupational AFO by 26%. Exposure to dusts (adjusted PR=1.05; 95% CI 1.01 to 1.08), biological dusts (1.05; 1.01 to 1.10) and VGDF (1.04; 1.01 to 1.07) showed a significantly increased risk of AFO, however, statistically not significant following multiple testing. There was no significant increase in risk of AFO by duration (years) of exposure in current job. The results were null when restricted to never-smokers and when a bi-pollutant model was used. However, when data was analysed based on the level of exposure (low, medium and high) compared with no exposure, directionally there was increase in risk for those with high exposure to vapours, gases, fumes, mists and VGDF but statistically significant only for vapours.
High exposure (in current job) to airborne occupational pollutants was suggestive of higher risk of AFO. Future studies should investigate the relationship between lifetime occupational exposures and COPD.
虽然大约 10%至 15%的 COPD 负担可归因于工作场所暴露，但对于不同的空气传播职业污染物 (AOP) 的作用知之甚少。该研究的主要目的是评估各种 AOP、其暴露水平和暴露时间与气流阻塞 (AFO) 之间关系的效应大小。
在英国生物库研究中，对 228614 名参与者进行了横断面分析，他们使用职业暴露矩阵分配职业暴露，该矩阵对健康结果是盲目的。使用稳健泊松模型估计 AFO 风险的调整患病率比 (PR) 和 95%CI 对于 AOP 的终身暴露和暴露年限。还对从不吸烟、非哮喘和双污染物模型进行了敏感性分析。
在 228614 名参与者中，77027 人 (33.7%) 接触过至少一种 AOP 形式。35.5%的 AFO 病例接触过蒸气、气体、粉尘或烟雾 (VGDF)，28.3%接触过粉尘。高浓度蒸气暴露使职业性 AFO 的风险增加了 26%。暴露于粉尘 (调整 PR=1.05；95%CI 1.01 至 1.08)、生物粉尘 (1.05；1.01 至 1.10) 和 VGDF (1.04；1.01 至 1.07) 显示出 AFO 风险显著增加，但经多次测试后无统计学意义。目前工作中暴露年限 (年) 与 AFO 风险无显著增加。当限制在从不吸烟者时，当使用双污染物模型时，结果为零。然而，当根据暴露水平 (低、中、高) 而不是无暴露来分析数据时，与无暴露相比，高暴露于蒸气、气体、烟雾和 VGDF 的人风险呈上升趋势，但仅蒸气有统计学意义。
高浓度 (目前工作中) 空气传播职业污染物提示 AFO 风险较高。未来的研究应调查终生职业暴露与 COPD 之间的关系。
