School of Public Health, Qingdao University, Qingdao, Shandong Province, China.
Shandong Academy of Occupational Health and Occupational Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong Province, China.
Medicine (Baltimore). 2023 Feb 10;102(6):e32908. doi: 10.1097/MD.0000000000032908.
Chronic obstructive pulmonary disease (COPD) results from a complex interaction between genes and the environment, and occupational exposures are an underappreciated risk factor. Until now, little research attention has been paid to the potential impact of occupational risk factor exposure on the COPD in China. The aim of this retrospective study was to analyze the role of occupational risk factor exposure on the severity and progression of COPD for exploring new prevention strategies for this disease. This study adopted a random cluster-sampling method. Five grade-A tertiary hospitals that met the inclusion criteria were selected as the survey sites, and patients with COPD hospitalized in these hospitals from January 1, 2019, to December 31, 2019, were selected as the research subjects. Data of the patients diagnosed with COPD met the Global Initiative for Chronic Obstructive Lung Disease (2019) criteria and were collected from the computerized medical record databases. Among 4082 investigated COPD patients, 1063 (26%) were found to have occupational risk factor exposure history. The top 3 industries with a large COPD case number and a history of occupational risk factor exposure ranked in the order of agriculture (including farming, forestry, animal husbandry, and fishery), manufacturing, and mining. Further multivariate logistic regression analysis indicated that when setting a low exposure level as a reference, medium and high exposure levels were correlated with the severity of COPD (odds ratio values were 2.837 and 6.201, respectively, P < .05). Linear regression analysis showed that cumulative exposure to occupational risk factors was negatively correlated with the forced expiratory volume in 1-second percentage of COPD patients, with a correlation coefficient of 0.68. Our results indicated that occupational risk factor exposure levels were related to the severity of COPD significantly. The incubation period of COPD in the exposure group was significantly shorter than that in the non-exposure group. To prevent worked-related COPD, special attention and control efforts should be taken to reduce the level of occupational risk factors such as organic dust, irritating chemicals, etc in the work environments, especially in the industries of agriculture, forestry, animal husbandry and fishery, manufacturing, and mining.
慢性阻塞性肺疾病（COPD）是由基因和环境复杂相互作用引起的，职业暴露是一个被低估的危险因素。到目前为止，人们对职业危险因素暴露对中国 COPD 的潜在影响关注甚少。本回顾性研究旨在分析职业危险因素暴露对 COPD 严重程度和进展的作用，探索该疾病的新预防策略。本研究采用随机整群抽样方法，选取符合纳入标准的 5 家甲级三级医院作为调查点，选取 2019 年 1 月 1 日至 2019 年 12 月 31 日在这些医院住院的 COPD 患者作为研究对象。符合全球慢性阻塞性肺疾病倡议（2019）标准的患者数据来自计算机化病历数据库。在 4082 例调查的 COPD 患者中，有 1063 例（26%）有职业危险因素暴露史。患有 COPD 且有职业危险因素暴露史的前 3 大行业按农业（包括农业、林业、畜牧业和渔业）、制造业和采矿业排序。进一步的多变量逻辑回归分析表明，当以低暴露水平为参考时，中、高暴露水平与 COPD 的严重程度相关（比值比分别为 2.837 和 6.201，P<0.05）。线性回归分析表明，职业危险因素暴露的累积量与 COPD 患者 1 秒用力呼气量的百分比呈负相关，相关系数为 0.68。我们的结果表明，职业危险因素暴露水平与 COPD 的严重程度显著相关。暴露组 COPD 的潜伏期明显短于非暴露组。为了预防与工作相关的 COPD，应特别注意和控制工作环境中的职业危险因素（如有机粉尘、刺激性化学物质等）水平，特别是在农业、林业、畜牧业和渔业、制造业和采矿业等行业。
