Certain occupations, nonworking status may increase asthma-COPD mortality risk

Adults working in certain industries and occupations, and those currently not working, have higher risk for asthma-COPD overlap mortality, according to new data published in Morbidity and Mortality Weekly Report.

Researchers with the CDC assessed National Vital Statistics multiple-cause-of-death mortality data from the National Occupational Mortality System, which included information on industry and occupation collected from 26 states. From 1999 to 2016, among U.S. adults aged 25 years and older, 4,689,828 had COPD and 164,731 had asthma as their underlying or contributing cause of death, and 18,766 (6,738 men, 12,028 women) had asthma and COPD listed as the cause of death. The overall death rate for asthma-COPD overlap was 5.03 per million persons (4.3 for men, 5.59 for women). Annual age-adjusted death rate among those with asthma-COPD overlap declined from 6.7 in 1999 to 3.01 in 2016 (P < .05) for men and from 7.71 to 4.01 (P < .05) for women.

Among adults 25 to 64 years, asthma-COPD overlap proportionate mortality ratios by industry were significantly higher for male food, beverage and tobacco workers (2.64; 95% CI, 1.27-4.86) and nonpaid workers, nonworkers and those working at home (men: 1.72; 95% CI, 1.22-2.36; women: 1.4; 95% CI, 1.22-1.62).

In this age group, asthma-COPD overlap proportionate mortality ratios by occupation were significantly higher among women bartenders (3.28; 95% CI, 1.2-7.15), unemployed, nonworking or disabled men (1.98; 95% CI, 1.39-2.75) and women (1.79; 95% CI, 1.29-2.42), and women homemakers (1.34; 95% CI, 1.14-1.58).

Katelynn E. Dodd

“The association between asthma-COPD overlap mortality and nonworking status among adults of working age (25-64 years) suggests that asthma-COPD overlap might be associated with substantial morbidity resulting in loss of employment,” Katelynn E. Dodd, MPH, with the respiratory health division at the National Institute for Occupational Safety and Health at the CDC, told Healio Pulmonology. “Increased risk for asthma-COPD overlap mortality was observed among adults in certain industries and occupation, suggesting targets for public health interventions to prevent asthma and COPD in and out of the workplace.”

Among adults aged 64 years and older, asthma-COPD overlap proportionate mortality ratios by industry were significantly higher among:

• women working in unspecified food industries (3.72; 95% CI, 1.2-8.68)
• women working in furniture and home furnishing stores (2.99; 95% CI, 1.1-6.52)
• women working in private households (1.69; 95% CI, 1.08-2.51)
• men in beverage manufacturing (3.15; 95% CI, 1.02-7.37)
• men in computer and electronic products (2.58; 95% CI, 1.24-4.74)
• men in agriculture, forestry, fishing and hunting (1.82; 95% CI, 1.42-2.33); and
• men working in miscellaneous manufacturing (1.39; 95% CI, 1-1.89).

Among adults aged 64 years and older, asthma-COPD overlap proportionate mortality ratios by occupation were significantly higher among:

• waitresses (1.7; 95% CI, 1.07-2.55)
• women production workers (1.66; 95% CI, 1.04-2.52)
• men in fishing, hunting and forestry (3.78; 95% CI, 1.82-6.95)
• male industrial production managers (2.23; 95% CI, 1.07-4.1)
• male carpenters (1.68; 95% CI, 1.02-2.59)
• male farmers and farm managers (1.62; 95% CI, 1.17-2.18); and
• male laborers and material movers (1.54; 95% CI, 1.07-2.14).

Dodd told Healio Pulmonology that continued surveillance for asthma-COPD overlap morbidity and mortality is essential to inform policy and intervention activities.

“Workplace exposures should be considered during the diagnosis and management of asthma-COPD overlap, particularly among workers employed in industries and occupations with elevated mortality,” Dodd said.