The association between occupational factors and adverse health outcomes in chronic obstructive pulmonary disease
The association between occupational factors and adverse health outcomes in chronic obstructive pulmonary disease
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DOI：
10.1136/oem.2003.010058
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发表时间：
2004-08-01
影响因子：
4.9
通讯作者：
Balmes, JR
中科院分区：
文献类型：
--
作者：
Blanc, PD;Eisner, MD;Balmes, JR
背景和目标：尽管认识到，职业暴露可能会作出实质性贡献的COPD的病因学，鲜为人知的是，在COPD相关的健康outcome.Methods：前瞻性队列研究中使用结构化的电话采访随机抽样的成年人年龄在55-75岁之间的慢性阻塞性肺病的条件（肺气肿，慢性支气管炎，或COPD）的潜在作用的工作相关因素。使用调整吸烟和人口统计学因素的多变量模型，估计职业暴露于蒸汽、气体、粉尘或烟雾（VGDF）和因肺部疾病而离开工作之间的单独和联合关联（呼吸相关的工作残疾）与健康结果和利用确定在一年的后续行动。结果：在234名受试者中，128名（55%）报告在其最长时间的工作中暴露于VGDF，58名（25%）报告呼吸相关工作残疾，38名（16%）受试者报告两者。VGDF和呼吸相关工作残疾的组合暴露（而不是单独的任何一个因素）与随访时的最大风险相关，（每天）由于呼吸或肺部疾病而限制活动的天数（OR 3.8; 95% CI 1.4 - 10.1），急诊科（艾德）访视（OR 3.9; 95% CI 1.4 - 10.5）和住院（OR 7.6; 95% CI 1.8至32）。在COPD患者中，既往职业暴露和肺病所致的工作残疾，特别是合并，似乎是不良健康相关结果的风险因素。
Background and Aims: Despite recognition that occupational exposures may make a substantive contribution to the aetiology of COPD, little is known about the potential role of work related factors in COPD related health outcomes.Methods: Prospective cohort study using structured telephone interviews among a random sample of adults aged 55-75 reporting a COPD condition (emphysema, chronic bronchitis, or COPD). Using multivariate models adjusting for smoking and demographic factors, the separate and combined associations were estimated between occupational exposure to vapours, gas, dust, or fumes (VGDF) and leaving work due to lung disease (respiratory related work disability) with health outcomes and utilisation ascertained at one year follow up.Results: Of 234 subjects, 128 (55%) reported exposure to VGDF on their longest held jobs, 58 (25%) reported respiratory related work disability, and 38 (16%) subjects reported both. Combined exposure to VGDF and respiratory related work disability ( rather than either factor alone) was associated with the greatest risk at follow up of frequent ( everyday) restricted activity days attributed to a breathing or lung condition (OR 3.8; 95% CI 1.4 to 10.1), emergency department (ED) visit (OR 3.9; 95% CI 1.4 to 10.5), and hospitalisation (OR 7.6; 95% CI 1.8 to 32).Conclusions: Among persons with COPD, past occupational exposures and work disability attributed to lung disease, particularly in combination, appear to be risk factors for adverse health related outcomes.