Jobs with highest COPD mortality include mining, food services, construction
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COPD mortality varied by industry and occupation among ever-employed persons, according to data from the CDC published in Morbidity and Mortality Weekly Report.
Workers in the top three industries with the highest COPD mortality ratio were mining, accommodation and food services, and construction, and the top three occupations most affected included food preparation and serving-related jobs, health care support, and construction and extraction.
“Findings from this report might help physicians identify workers who should be evaluated for COPD in the industries and occupations with a higher proportion of COPD deaths,” Girija Syamlal, MBBS, MPH, a research epidemiologist in the respiratory health division at the National Institute for Occupational Safety and Health, told Healio. “The elevated COPD mortality among ever-employed persons in certain industries and occupations underscores the importance of targeted interventions to prevent COPD from developing and intervening before it becomes symptomatic or severe.”
Syamlal and colleagues analyzed 2020 data of 3.1 million decedents from 46 states and New York City who were ever employed; of them,10.3% had COPD listed on their death certificate.
To determine industries and occupations with the highest proportionate mortality ratios (PMRs) for COPD, researchers identified the number of COPD deaths in a specific industry/occupation and divided it by the expected number of COPD deaths.
According to analysis, individuals aged 75 years or older had the highest age-specific COPD death rate with 855.8 deaths per 100,000 ever-employed persons. After adjusting for age, researchers reported the highest adjusted death rates were among women (101.3; 95% CI, 100.3-101.8), white individuals (116.9; 95% CI, 116.1-117.7) and non-Hispanic individuals (115.8; 95% CI, 115-116.6).
Among ever-employed persons, COPD PMRs increased significantly in 10 out of the 23 studied industries and 11 out of the 26 studied occupations.
By industry, the highest PMRs were for mining (1.33; 95% CI, 1.28-1.38), accommodation and food services (1.28; 95% CI, 1.25-1.3) and construction (1.23; 95% CI, 1.21-1.24). Similarly, occupations most affected were food preparation and serving (1.3; 95% CI, 1.27-1.33), health care support (1.29; 95% CI, 1.25-1.32) and construction and extraction (1.29; 95% CI, 1.27-1.31).
“These findings are consistent with previous reports of high COPD prevalence among these worker groups,” Syamlal told Healio. “These worker groups tend to have elevated rates of COPD and report higher tobacco use and are frequently exposed to secondhand smoke, vapors, gas, dust and fumes in the workplace.”
According to Syamlal, these insights could prompt preventive measures for employees in these work environments.
“Identification of workplace hazards could assist with early identification of and implementation of public health programs — workplace smoke-free policies and cessation programs, elimination or substitution of exposures, removing workers from exposures and engineering controls such as ventilation or enclosure of exposure-generating processes — that promote healthy behaviors, early interventions and better access to health care services,” she said.
Future studies should consider COPD deaths over a range of years, Syamlal noted, to better understand occupational and workplace risks.
“COPD mortality varied across occupation and industry groups in 2020,” Syamlal told Healio. “Using additional years of data will allow to assess trends in COPD mortality and conduct more detailed analyses. Continued surveillance, including collection of detailed industry and occupational history and etiologic research to further characterize occupational risk factors for COPD, is essential to guide interventions and policies to improve workers’ health.”
For more information:
Girija Syamlal, MBBS, MPH, can be reached at gos2@cdc.gov.
Perspective
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The contribution of occupational exposures to the population burden of COPD has become increasingly well recognized, but there is still a long way to go in getting this fully on the prevention agenda. This report contributes positively to furthering that process.
The authors report that for certain industrial sectors and occupational groups, deaths from COPD are proportionally higher. Moreover, for key industries characterized by “dusty trades” such as mining and construction, the excess is in the 20% to 30% range.
As the authors acknowledge, interpretation of their findings is constrained by the inability to take cigarette smoking into account. This is important because many occupations with likely exposures to vapors, gas, dust or fumes also have higher direct smoking rates. Still, it is unlikely that differential smoking rates account for all of the excess. Moreover, other studies that have shown that occupational exposures do carry COPD risk even when smoking is taken into account, with findings indicating that the risks are additive.
A key observation in the paper goes unmentioned in its discussion: A greater than 20% excess COPD mortality among the 30,000 military personnel included in the analysis. The study methods (“usual” industry and occupation as noted on death certificates) accounts for the relatively small number in this category, but also suggests that these persons experienced long-term military service and any associated exposures.
There is an important need to approach military service from an occupational health perspective. It not only is a job, but one that can entail a wide range of hazardous inhalant exposures, from combustion byproducts (burn pits are only one source) to dusts to various toxic substances.
Importantly, this study, in addition to highlighting traditional industry and occupational groups, also provides further impetus to add military service to the workplace factors we access for job-related disease outcomes.
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