Increased mortality from infectious pneumonia after occupational exposure to inorganic dust, metal fumes and chemicals
Increased mortality from infectious pneumonia after occupational exposure to inorganic dust, metal fumes and chemicals
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DOI：
10.1136/thoraxjnl-2011-200707
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发表时间：
2011-11-01
期刊：
影响因子：
10
通讯作者：
Jarvholm, Bengt
中科院分区：
文献类型：
--
作者：
Toren, Kjell;Qvarfordt, Ingemar;Jarvholm, Bengt
目的有流行病学研究表明，接触金属烟雾是感染性肺炎的一个危险因素。是否职业暴露于其他因素，如无机粉尘或化学品，也增加感染性肺炎的风险尚不清楚。本研究的目的是阐明职业性接触呼吸道污染物和刺激物是否会增加感染性肺炎的风险。设计前瞻性队列研究。设定瑞典男性建筑工人。参与者320 143名男性建筑工人暴露于无机粉尘（石棉、人造矿物纤维、水泥、混凝土和石英粉尘）、木尘、金属烟雾和化学品（有机溶剂、二异氰酸酯和环氧树脂）或未暴露的环境中。该队列从1971年随访至2003年，主要结局指标为感染性肺炎、大叶性肺炎或肺炎球菌性肺炎的死亡率。rr通过人年法和泊松回归模型获得，调整了年龄和吸烟习惯的基线值。结果在20 ~ 64岁男性中，暴露于金属烟雾（RR 2.31, 95% CI 1.35 ~ 3.95）、无机粉尘（RR 1.87, 95% CI 1.22 ~ 2.87）和化学品（RR 1.91, 95% CI 1.37 ~ 3.22）的建筑工人感染性肺炎死亡率增加。大叶性肺炎和肺炎球菌性肺炎的死亡率也有所增加。在65-84岁的男性中，职业性接触无机粉尘和化学品与感染性肺炎死亡率略有增加有关。在相互排斥暴露组中，接触无机粉尘的建筑工人感染性肺炎死亡率增加，而接触木屑或化学品的工人则没有增加。仅接触金属烟雾的工人中没有病例。结论接触无机粉尘可增加感染性肺炎的死亡率，尤其是大叶性肺炎和肺炎球菌性肺炎。其机制尚不清楚，但可能是通过诱导气道炎症介导的。
Objectives There are epidemiological studies indicating that exposure to metal fumes is a risk factor for infectious pneumonia. Whether occupational exposure to other agents, such as inorganic dust or chemicals, also increases the risk for infectious pneumonia is not clear. The aim of the present study was to elucidate whether occupational exposure to respiratory pollutants and irritants increases the risk for infectious pneumonia.Design Prospective cohort study.Setting Swedish male construction workers.Participants 320 143 male construction workers exposed to inorganic dust (asbestos, man-made mineral fibres, dust from cement, concrete and quartz), wood dust, metal fumes and chemicals (organic solvents, diisocyanates and epoxi resins) or unexposed.Main outcome measures The cohort was followed from 1971 to 2003 and the main outcome measures were mortality to infectious pneumonia, lobar pneumonia or pneumococcal pneumonia. RRs were obtained by the person-years method and from Poisson regression models, adjusting for baseline values of age and smoking habits.Results Among men aged 20e64 years there was increased mortality from infectious pneumonias among construction workers exposed to metal fumes (RR 2.31, 95% CI 1.35 to 3.95), inorganic dust (RR 1.87, 95% CI 1.22 to 2.87) and chemicals (RR 1.91, 95% CI 1.37 to 3.22). The mortality was also increased from both lobar pneumonia and pneumococcal pneumonia. Among men aged 65-84 years the occupational exposure to inorganic dust and chemicals was associated with slightly increased mortality from infectious pneumonia. Among groups with mutually exclusive exposures there was increased mortality from infectious pneumonias among construction workers exposed to inorganic dust, but not among those exposed to wood dust or chemicals. There were no cases among workers exposed only to metal fumes.Conclusions Our findings indicate that exposure to inorganic dust increases the mortality from infectious pneumonias, especially lobar pneumonia and pneumococcal pneumonia. The mechanism is unclear, but the effect may be mediated through induced airways inflammation.