Industries, occupations with high IPF mortality in 2020 to 2022 differ by sex

Key takeaways:

• Within the studied cohort, males had a higher IPF death rate than females.
• Researchers observed eight industries with substantially elevated proportionate mortality ratios in males and three in females.

Jobs with high IPF mortality ratios differed by sex, but notable categories for both included the public administration industry and health care practitioners and technical occupations, according to study findings.

“Clinicians should be aware that some types of work are associated with increased risk for IPF and look for potentially modifiable work-related risk factors when appropriate in patients with IPF, such as exposures to wood and metal dust and secondhand smoke,” Jacek M. Mazurek, MD, of the respiratory health division at the National Institute for Occupational Safety and Health, CDC, told Healio.

In an exploratory, cross-sectional study published in Morbidity and Mortality Weekly Report, Mazurek and colleagues evaluated 67,843 U.S. patients (67.3% at least 75 years old; 58.5% male; 90.4% white; 89.6% non-Hispanic) who met three criteria — aged at least 15 years, ever employed and died between 2020 and 2022 with IPF mentioned in the cause of death — to determine how IPF-related mortality differs across industries and occupations.

Following adjustment for age, researchers found 7.1 deaths by IPF per 100,000 persons in 2020 to 2022. Mazurek told Healio this means the IPF death rate grew since it was 5.3 per 100,000 persons in 2017 per a previous report by other investigators.

“This increased rate occurred despite a decrease in cigarette smoking in the U.S, which is a risk factor for IPF,” Mazurek said. “This unexpected finding might be partially explained by differences in research methodologies between the studies, improved precision in diagnostic criteria and increasing implementation of recommendations for diagnosing IPF.”

Within the studied cohort, males had a higher IPF death rate than females (7.7 vs. 6.2 per 100,000 persons). In terms of age, individuals aged at least 75 years had the greatest death rate of the six assessed age groups at 67.6 per 100,000 persons, according to the study.

Researchers also reported that white individuals had a greater IPF death rate per 100,000 persons (8.2) vs. Black/African American individuals (2.5), Asian/other Pacific Islander individuals (2.4) and American Indian/Alaska Native individuals (3.8).

For non-Hispanic individuals, the rate was 7.7 deaths by IPF per 100,000 persons, and this was higher than the rate of 3.4 deaths by IPF per 100,000 persons in the group of Hispanic/Latino individuals.

To calculate the number of IPF deaths potentially linked to occupational exposure in their 2020 to 2022 cohort, researchers used an estimate of 21%. In this analysis, the study noted that more IPF deaths “might have resulted from occupational exposures” in males vs. females (8,340 vs. 5,908).

When divided into males and females, the industry with the most IPF deaths differed between the sexes. For males, the manufacturing industry came out on top with 7,525 deaths (18.9% of male IPF deaths), whereas the health care and social assistance industry came out on top for females with 4,277 deaths (15.2% of female IPF deaths), according to the study.

Switching to proportionate mortality ratios (PMRs), researchers observed eight industries with substantially elevated PMRs, defined as “a 95% CI lower level [less than] 1,” in the group of males:

• utilities (1.15; 95% CI, 1.08-1.24);
• public administration (1.15; 95% CI, 1.11-1.19);
• professional, scientific and technical services (1.12; 95% CI, 1.07-1.17);
• health care and social assistance (1.11; 95% CI, 1.05-1.17);
• finance and insurance (1.1; 95% CI, 1.04-1.16);
• real estate and rental and leasing (1.08; 95% CI, 1-1.18);
• education services (1.07; 95% CI, 1.02-1.12); and
• manufacturing (1.05; 95% CI, 1.03-1.08).

In the group of females, three industries had substantially elevated PMRs: public administration (1.12; 95% CI, 1.06-1.18), health care and social assistance (1.1; 95% CI, 1.07-1.13) and education services (1.09; 95% CI, 1.05-1.13).

Similar to above, the occupation with the most IPF deaths differed based on sex. According to the study, management came out on top for males with 5,715 deaths (14.4% of male IPF deaths), whereas office and administrative support came out on top for females with 4,521 deaths (16.1% of female IPF deaths).

Researchers reported that community and social service workers had the greatest substantially elevated PMR in the group of males at 1.23 (95% CI, 1.14-1.32), whereas farming, fishing and forestry workers held this rank in the group of females at 1.24 (95% CI, 1.01-1.53).

Further, health care practitioners and technical occupations was another notable occupation category, as researchers observed substantially elevated PMRs in males (1.13; 95% CI, 1.06-1.21) and females (1.21; 95% CI, 1.16-1.27) working in this category.

“Among both male and female workers, the highest significantly elevated PMRs were found in the public administration, health care and social assistance, and educational services industries, as well as in the health care practitioners and technical occupations,” Mazurek told Healio. “Workers in some of these industries and occupations would be anticipated to have frequent exposure to secondhand smoke; vapors, gas, dust and fumes; biologic (eg, bioaerosols in indoor environments); chemical (eg, pesticides); and other hazards in the workplace.

“However, for some industries and occupations at increased risk, potential sources of increased risk are unclear and might be related to either work exposures or factors not directly related to work that were not fully addressed by the study design,” Mazurek said.

When interpreting these study findings, Mazurek told Healio they should be viewed as “hypothesis-generating” and noted several limitations: “lack of detailed information on IPF diagnosis, temporal relationship between IPF death and work, smoking status and workplace exposures, and work histories.”

“Subsequent analytic studies documenting the role of workplace exposures in the development of IPF could build on this work by addressing these limitations,” Mazurek said.

“Continued research to confirm findings in this report, and surveillance including collection of detailed industry and occupational history and etiologic research to further characterize occupational risk factors for IPF, are essential to guide development and implementation of evidence-based interventions and policies to improve workers’ health,” Mazurek added.