Occupational exposures associated with work-related asthma and work-related wheezing among U.S. workers

BACKGROUND: National estimates of occupational asthma (OA) in the United States are sparse. METHODS: Using data from the Third National Health and Nutrition Examination Survey (NHANES III) 1988-1994, we analyzed associations between occupation and work-related asthma and work-related wheezing among U.S. workers. RESULTS: This study identified several occupations that were at risk of developing work-related asthma and/or wheezing, with cleaners and equipment cleaners showing the highest risks. Other major occupations identified were farm and agriculture; entertainment; protective services; construction; mechanics and repairers; textile; fabricators and assemblers; other transportation and material moving occupations; freight, stock, and material movers; and motor vehicle operators. The population attributable risks for work-related asthma and work-related wheezing were 26% and 27%, respectively. CONCLUSIONS: This study adds evidence to the literature that identifies work-related asthma as an important public health problem. Several occupations are targeted for additional evaluation and study. Of particular interest are cleaners, which are being increasingly reported as a risk group for asthma. Future intervention strategies need to be developed for effective control and prevention of asthma in the workplace.     

Retrospective mortality cohort study of Italian workers compensated for silicosis

Objectives

To estimate cause specific mortality in a large cohort of Italian workers compensated for silicosis.

Methods

The cohort included 14 929 subjects (14 098 men and 831 women) compensated for silicosis between 1946 and 1979, alive on 1 January 1980, and resident in Tuscany (a region of central Italy with 3 547 000 inhabitants). Mortality follow up ranged from 1980 to 1999. Vital status and the causes of death were determined by linkage with the regional mortality registry and with the national mortality database. The cohort mortality rates were compared to the rates of the local reference population. SMRs and their 95% confidence intervals were computed assuming a Poisson distribution of the observed deaths. Specific SMR analyses were performed according to the level of disability, the year of compensation assignment, and the job type.

Results

A significant excess mortality was observed in male silicotics for cancer of the lung, trachea, and bronchus and cancer of the liver, respiratory diseases (silicosis, asbestosis, antracosilicosis, and other pneumoconiosis), and for tubercolosis. Statistically significant mortality excess was observed in female silicotics for respiratory diseases (specifically silicosis and other pneumoconiosis) and tuberculosis. Analyses for period of compensation assignment showed a twofold increased SMR for biliary tract cancer among female workers and for liver cancer among male workers compensated before 1970.

Conclusions

The excess mortality from respiratory tract cancers and respiratory tract diseases detected in Italian compensated silicotics are in agreement with previous epidemiological studies. Although the twofold increased risk for liver cancer among males is suggestive of a possible association with silica dust exposure, the finding needs to be confirmed.     

Endemic work-related febrile respiratory illness among construction workers

Construction workers building Denver International Airport (DIA) reported work-related respiratory and flulike symptoms of several months duration. We performed a cross-sectional interview study of 495 randomly selected DIA workers from six contractors in comparison with preplacement workers. We defined cases as workers with two work-attributed lower respiratory symptoms and one work-attributed systemic symptom. Case rates were significantly higher among DIA workers (34%) compared with those who had never worked at DIA (2%). Risk factors for illness included exposure to fireproofing (OR, 4.21; 95% CI, 1.95–9.08), work in tunnels and adjoining areas (OR, 3.07; 95% CI, 1.84–5.12), length of DIA employment (OR, 0.65; 95% CI, 0.46–0.92), and preexisting bronchitis (OR, 2.43; 95% CI, 1.17–5.05). Our industrial hygiene investigation revealed alkaline dust (pH 11) present at a worksite associated with elevated risk of illness, and we identified airborne Penicillium mold widely distributed indoors at DIA. Clinical evaluation of 26 self-identified symptomatic DIA employees, including bronchoalveolar lavage and biopsy in 10, revealed work-related asthma in three workers and histologic evidence of chronic bronehitis in four who had never smoked. We concluded that future investigations of endemic work-related febrile respiratory illness among construction workers should evaluate its association with indoor exposure to dusts from alkaline fireproofing, Penicillium mold, mycotoxins, and bacterial bioaerosols.     

Upper airway symptoms among workers with work-related respiratory complaints

Background Work-related rhinitis and asthma symptoms frequently co-exist. Aims To determine the prevalence and nature of nasal, pharyngeal, laryngeal and sinus symptoms among individuals with work-related respiratory symptoms. Methods Individuals referred to a tertiary occupational asthma clinic for investigations with specific inhalation challenges were evaluated using the RHINASTHMA quality of life questionnaire and a questionnaire that assessed the nature and frequency of upper airway symptoms, their relationship to the workplace and their temporal relationship with the onset of asthma symptoms. Results There were 83 study participants. At least one upper airway symptom was reported by all of these individuals: nasal in 92%; pharyngeal in 82%; laryngeal in 65% and sinus in 53% of participants. Overall, there were no significant differences in the frequencies of nasal, pharyngeal, laryngeal and sinus symptoms when comparing these with occupational asthma (OA), work-exacerbated asthma (WEA) and work-related respiratory symptoms (WRS), except that nasal bleeding was most frequent among those with WRS. The presence of laryngeal symptoms was significantly associated with rhinitis-specific quality of life impairment. Individuals with workplace exposures to high molecular weight agents had greater impaired quality of life than those who were exposed to low molecular weight agents (RHINASTMA Upper Airway sub-scores: 24.0±10.4 versus 19.8±6.8; P < 0.05). Conclusions Individuals who were referred for work-related respiratory symptoms experienced high rates of work-related nasal, pharyngeal, laryngeal and sinus symptoms, regardless of having OA, WEA or WRS.     

Organic dust exposure and work-related effects among recycling workers

OBJECTIVE: Organic dust exposure and work-related symptoms and effects among household waste recycling workers in Materials Recovery Facilities (MRFs) are a concern. MRFs are a central operation where source-segregated, dry, recyclable materials (paper, plastics, cans, etc.) are sorted, mechanically or manually, to market specifications for processing into secondary materials. METHODS: One hundred and fifty-nine MRF workers (91%) from nine MRFs participated. Measurements of airborne total dust, endotoxin, (1-->3)-beta-D-glucan, and a questionnaire survey were carried out. Blood data was restricted to MRFs 3, 6, and 9 (45 workers). Blood sampling investigated differential cell counts, erythrocyte sedimentation rate (ESR), and immunoglobulin (Ig)E. RESULTS: Workers exposed to higher amounts of endotoxin and (1-->3)-beta-D-glucan had an increased risk for respiratory symptoms as compared to those with lower exposure. Stomach problems was associated to higher (1-->3)-beta-D-glucan exposure. MRF 3 had a higher (1-->3)-beta-d-glucan exposure compared to 6 and 9, and respiratory symptoms, unusual tiredness, and vomiting were reported more often in MRF 3. Monocyte numbers and ESR were significantly decreased in MRF 3 compared to MRF 6 and 9, but all measured values were within normal ranges. CONCLUSIONS: The results suggest that MRF workers exposed to higher levels of endotoxin and (1-->3)-beta-D-glucan at their work sites exhibit various work-related symptoms, and that the longer a worker is in the MRF environment, the more likely he is to become affected by various respiratory and gastrointestinal symptoms.     

Cancer mortality among jewelry workers

Mortality was investigated for the years 1950–1980 for 1,009 male members of a New York jewelry workers union, and for the years 1984–1989 among 919 men and 605 women identified as jewelry workers on death certificates from 24 states. Malignant neoplasms were excessive for male union members (proportional mortality ratio [PMR] = 1.17; 95% confidence interval [CI]: 1.02–1.33) and female jeweler deaths from the 24 states (PMR = 1.24; 95% CI: 1.07–1.42). Deaths due to nonmalignant causes were not unusual, except for excesses, in union males, of the circulatory system (PMR = 1.10; 95% CI: 1.02–1.19), including arteriosclerotic heart disease (PMR = 1.25; 95% CI: 1.14–1.37) and rheumatic heart disease (PMR = 3.02; 95% CI: 1.94–4.50). Cancers of the digestive tract were proportionally elevated among union males (proportional cancer mortality rate [PMR] = 1.13; 95% CI: 0.89–1.41) and among deaths from the 24 states (PCMR = 1.22; 95% CI: 1.01–1.47). For the 24 states, excesses for digestive cancer were found for both males (PCMR = 1.19; 95% CI: 0.90–1.54) and females (PCMR = 1.26; 95% CI: 0.96–1.62). Regarding specific sites in the digestive tract, colon cancer excesses were found in union males (PCMR = 1.53: 95% CI: 1.05–2.15), and for men (PCMR = 1.27; 95% CI: 0.82–1.88) and women (PCMR = 1.36; 95% CI: 0.92–3.27) in 24 states. Also, in the 24 states, excesses were noted for esophageal cancer (PMR = 2.03; 95% CI: 1.08–3.47) and stomach cancer (PCMR = 1.66; 95% CI: 0.95–2.69), due to excess stomach cancer in women (PCMR = 2.50; 95% CI: 1.20–4.61). Marginal proportional excesses were found for malignancies of the hematolymphopoietic system in union males (PCMR = 1.12; 95% CI: 0.72–1.67) and among deaths from 24 states (PCMR = 1.23; 95% CI: 0.90–1.66), particularly due to non-Hodgkin's lymphoma deaths (PCMR = 1.39; 95% CI: 0.93–2.00). The wide variety of exposures in this industry, particularly to metals and solvents, could possibly involve excess risk for malignancy at these sites. © 1993 Wiley-Liss, Inc.

1 This article is a US Government work and, as such, is in the public domain in the United States of America.

     

Leukemia mortality among radiation-exposed workers

The qualitative leukemogenicity of ionizing radiation was firmly established by studies of medical workers and patients exposed to high radiation levels in the mid-1900s. Quantitative relationships were evaluated through extensive studies of atomic bomb survivors and patients who received therapeutic radiation, for whom the duration of exposure was brief. Although many studies have been conducted of nuclear workers and others exposed occupationally, uncertainty remains about quantitative aspects of the leukemia-radiation exposure relation for low dose-rate, fractionated exposures. Some studies have shown dose-related increases in leukemia risks for certain nuclear workers in the U.S. and Europe, although these findings are inconsistent across populations. Despite limitations in low-dose epidemiology, well-designed studies among nuclear workers should inform some controversial aspects of the relation between ionizing radiation exposure and leukemia risk.     

Incidence of asthma among aluminum workers

Exposures to respiratory irritants encountered in aluminum smelters in Europe, Australia, and New Zealand have been suggested as the cause of "potroom asthma." However, there remains disagreement in North America regarding the existence of this entity. This study was designed to assess whether asthma occurs excessively among potroom workers and if so, delineate dose-response relationships for possible causal risk factors. The asthma incidence ratio between potroom and nonpotroom workers after adjusting for smoking was 1.40. Although bivariate analyses showed a relationship between asthma incidence and exposure to total fluoride, gaseous fluoride, particulate fluoride, sulfur dioxide, and smoking, only the effects of gaseous fluoride (relative risk [RR] = 5.1) and smoking (RR = 7.7) remained significant in a multivariate model. Potroom asthma appears to occur at the studied U.S. aluminum smelters at doses within regulatory guidelines.     

Medical costs and sources of payment for work-related injuries among Hispanic construction workers

OBJECTIVE: To assess medical costs of occupational injuries and sources of payment among Hispanic and non-Hispanic construction workers. METHODS: More than 7000 construction workers, including 1833 Hispanic workers were examined using the Medical Expenditure Panel Survey, 1996 to 2002. Univariate and multivariate analyses were conducted using SUDAAN. RESULTS: Annually, work-related injuries in construction cost $1.36 billion (2002 dollars), with 46% paid by workers' compensation. Compared with non-Hispanic workers, Hispanic workers were 53% more likely to have medical conditions resulting from work-related injuries, but 48% less likely to receive payment for medical costs from workers' compensation (P < 0.05). CONCLUSIONS: This study suggests an urgent need to reform the current workers' compensation system to reduce the burden shifted to injured workers and society. Such reforms should include easier access and more assistance for Hispanic and other immigrant workers.     

Skin and respiratory symptoms among workers with suspected work-related disease

Background Many workers are exposed to chemicals that can cause both respiratory and skin responses. Although there has been much work on respiratory and skin outcomes individually, there are few published studies examining lung and skin outcomes together. Aims To identify predictors of reporting concurrent skin and respiratory symptoms in a clinical population. Methods Patients with possible work-related skin or respiratory disease were recruited. An interviewer- administered questionnaire collected data on skin and respiratory symptoms, health history, smoking habits, workplace characteristics and occupational exposures. Predictors of concurrent skin and respiratory symptoms were identified using multiple logistic regression models adjusted for age, sex and atopy. Results In total, 204 subjects participated; 46% of the subjects were female and the mean age was 45.4 years (SD = 10.5). Most subjects (n = 167, 82%) had possible work-related skin disease, compared with 37 (18%) subjects with possible work-related respiratory disease. Subjects with a history of eczema (OR 3.68, 95% CI 1.7-7.8), those from larger workplaces (OR 2.82, 95% CI 1.8-7.4) and those reporting respirator use at work (OR 2.44, 95% CI 1.2-4.8) had significantly greater odds of reporting both work-related skin and respiratory symptoms. Current smoking was also associated with reporting concurrent skin and respiratory symptoms (OR 2.57, 95% CI 1.2-5.8). Conclusions Workers reported symptoms in both systems, and this may be under-recognised both in the workplace and the clinic. The association between history of eczema and concurrent skin and respiratory symptoms suggests a role for impaired barrier function but needs further investigation.     

某家具制造企业工人职业性肌肉骨骼疾患调查分析

目的 调查某家具制造企业工人肌肉骨骼疾患(work-related musculoskeletal disorders, WMSDs)的患病情况和特征。
方法 选取某家具制造企业437名工人为研究对象, 采用横断面调查方法调查工人肌肉骨骼疾患患病情况。
结果 WMSDs年患病率为32.27%, 以下背(腰)部、颈部和肩部为主, 年患病率分别为11.21%、9.84%和7.78%。男性以下背(腰)部疾患年患病率最高(10.27%), 女性以颈部和下背(腰)部疾患年患病率最高(均为16.42%)。女性颈部和手腕/手疾患年患病率均高于男性, 差异有统计学意义(P < 0.05)。颈部疾患的年患病率在各段工龄之间比较, 差异有统计学意义(P < 0.05), 且患病率有随工龄增加而升高的趋势(P < 0.05)。手工搬举重物者颈部WMSDs年患病率(17.95%)高于不搬举重物者(8.08%)(P < 0.01), 工作台座椅与个人尺寸不相符者颈部WMSDs年患病率高于工作台座椅与个人尺寸相符者(P < 0.01)。
结论 该家具制造企业工人肌肉骨骼疾患较为严重, 以下背(腰)部、颈部和肩部发生较多, 可能与性别、年龄、工龄以及工效学等因素有关。
     

Individual and work-related risk factors for musculoskeletal pain among computer workers in Nigeria

We investigated the prevalence of musculoskeletal pain (MSP) and the association of 1-month prevalence with individual and work-related factors among commercial typists in Enugu. Participants responded to a questionnaire about occurrences of MSP and a 75.6% (242/320) response rate was achieved. Prevalence was summarized in frequencies and percentages while associations between MSPs and risk factors were explored using chi-square. MSP was most common in the low back (58.3%), and low back pain limited 51.7% from activities between 1 and 30 days. Advancing age was significantly associated with MSP in the low back (x² = 19.885; p = .001), neck (x² = 28.309; p < .001), shoulder (x² = 13.122; p = .011), but not wrist/hand (p = .075). Working 1–5 years in this job was associated with increasing prevalence of MSP in all body regions studied. Lesser job control was associated with increased prevalence of wrist/hand pain. Prevalence of MSDs among computer operators in Enugu, Nigeria, is high and highlights the importance of workplace intervention.     

建筑工人下背部工作相关肌肉骨骼疾患影响因素分析

目的  分析建筑工人下背部工作相关肌肉骨骼疾患(work-related musculoskeletal disorders, WMSDs)的患病现状和影响因素。方法  选择北京市、辽宁省、山东省和广东省等地共8家建筑公司的453名建筑工人为研究对象,采用《肌肉骨骼疾患调查问卷》收集研究对象各部位WMSDs的患病情况,应用多因素logistic回归分析模型分析建筑工人下背部WMSDs的影响因素。结果  研究对象WMSDs总患病率为43.7%,其中患病率从高到低排序为下背部24.1%、肩部18.3%、颈部14.6%、上背部12.4%、手腕部12.1%、足踝部6.0%、腿部5.5%、膝部5.1%及肘部5.1%。研究对象的多部位WMSDs患病率为28.9%。多因素logistic回归分析模型分析结果显示,以初中及以下组为参考组,高中及中专文化程度是建筑工人罹患WMSDs的保护因素(OR=0.390, 95% CI: 0.179~0.849, P=0.018);长时间蹲或跪姿(OR=1.818, 95% CI: 1.053~3.138, P=0.032)、搬运重物(每次>20 kg)(OR=2.876, 95% CI: 1.629~5.077, P＜0.001)、以不舒服姿势工作(OR=2.619, 95% CI: 1.455~4.714, P=0.001)、下背部长时间保持同一姿势(OR=2.913, 95% CI: 1.640~5.177, P＜0.001)和长时间屈膝(OR=2.958, 95% CI: 1.659~5.274, P＜0.001)是研究对象罹患WMSDs的独立危险因素。结论  建筑工人WMSDs患病风险较高,其中最常见的是下背部WMSDs。其影响因素主要包括个体特征、劳动类型和不良工效学因素。     

Effects of bioaerosol exposure on work-related symptoms among Swiss sawmill workers

Objective Exposure to bioaerosols in the occupational environment of sawmills could be associated with a wide range of health effects, in particular respiratory impairment, allergy and organic dust toxic syndrome. The objective of the study was to assess the frequency of medical respiratory and general symptoms and their relation to bioaerosol exposure. Method Twelve sawmills in the French part of Switzerland were investigated and the relationship between levels of bioaerosols (wood dust, airborne bacteria, airborne fungi and endotoxins), medical symptoms and impaired lung function was explored. A health questionnaire was distributed to 111 sawmill workers. Results The concentration of airborne fungi exceeded the limit recommended by the Swiss National Insurance (SUVA) in the twelve sawmills. This elevated fungi level significantly influenced the occurrence of bronchial syndrome (defined by cough and expectorations). No other health effects (irritations or respiratory effects) could be associated to the measured exposures. We observed that junior workers showed significantly more irritation syndrome (defined by itching/running nose, snoring and itching/red eyes) than senior workers. Lung function tests were not influenced by bioaerosol levels nor dust exposure levels. Conclusion Results suggest that occupational exposure to wood dust in a Swiss sawmill does not promote a clinically relevant decline in lung function. However, the occurrence of bronchial syndrome is strongly influenced by airborne fungi levels.