The occupations at increased risk of COPD: analysis of lifetime job-histories in the population-based UK Biobank Cohort
The occupations at increased risk of COPD: analysis of lifetime job-histories in the population-based UK Biobank Cohort
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DOI：
10.1183/13993003.00186-2019
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发表时间：
2019-07-01
影响因子：
24.3
通讯作者：
Cullinan, Paul
中科院分区：
文献类型：
--
作者：
De Matteis, Sara;Jarvis, Deborah;Cullinan, Paul
职业暴露是慢性阻塞性肺疾病(COPD)的重要、可预防的原因。识别COPD高危工作是重点预防策略的关键，但没有明确的工作列表。我们通过评估基于人口的英国生物库队列中终身工作历史和肺功能数据的相关性来解决这个问题，其前所未有的样本量使得分析仅限于从不吸烟的人，以排除最重要的混杂因素--吸烟。肺活量测定：1 S用力呼气量/用力肺活量比值低于正常值下限。终身工作记录是通过OSCAR(职业自我编码自动记录)收集的，这是一个新的经过验证的在线工具，可以自动将工作编码到英国标准职业分类v2000中。通过对年龄、性别、中心和吸烟进行调整后，使用稳健的泊松回归估计了每个工作岗位的COPD患病率与终生办公室员工相比的患病率。在116375名有完整工作历史的参与者中，94551人有可接受/可重复的肺活量测量数据和吸烟信息，并被纳入分析。六种职业表明，从不吸烟和从不哮喘的人患慢性阻塞性肺疾病的风险增加；其中大多数职业也有积极的暴露反应趋势。有趣的新发现包括雕塑家、园丁和仓库工人。慢性阻塞性肺病患者，特别是从不吸烟的人，应该被问及他们的工作历史，以便更好地管理疾病。有必要在COPD高危工作岗位采取有针对性的预防策略。
Occupational exposures are important, preventable causes of chronic obstructive pulmonary disease (COPD). Identification of COPD high-risk jobs is key to focus preventive strategies, but a definitive job-list is unavailable.We addressed this issue by evaluating the association of lifetime job-histories and lung function data in the population-based UK Biobank cohort, whose unprecedented sample size allowed analyses restricted to never-smokers to rule out the most important confounder, tobacco smoking. COPD was spirometrically defined as forced expiratory volume in 1 s/forced vital capacity ratio below the lower limit of normal. Lifetime job-histories were collected via OSCAR (Occupations Self-Coding Automatic Recording), a new validated online tool that automatically codes jobs into the UK Standard Occupational Classification v. 2000. Prevalence ratios for COPD by employment duration in each job compared to lifetime office workers were estimated using robust Poisson regression adjusted for age, sex, centre and smoking. Only associations confirmed among never-smokers and never-asthmatics were considered reliable.From the 116375 participants with complete job-histories, 94 551 had acceptable/repeatable spirometry data and smoking information and were included in the analysis. Six occupations showed an increased COPD risk among never-smokers and never-asthmatics; most of these also with positive exposure-response trends. Interesting new findings included sculptors, gardeners and warehouse workers.COPD patients, especially never-smokers, should be asked about their job-history for better disease management. Focussed preventive strategies in COPD high-risk jobs are warranted.