Prevention of the chronic obstructive pulmonary disease (COPD) – minimization of occupational factors

Status:

completed 09/2022

Aims:

Obstructive respiratory diseases are among the most frequently suspected occupational diseases in Germany. In occupational medicine research and practice, there are still unanswered questions, especially about the development of chronic obstructive pulmonary disease (COPD) due to work-related influences. In view of demographic change and longer working lives, it is expected that more and more workers will be affected in the future. However, if COPD is detected at an early stage by those affected themselves or by company physicians, the course of the disease can be significantly slowed down or even stopped with medication. The development or worsening of the disease can be prevented by targeted preventive measures such as increased training in respiratory protection or other targeted, activity-related protective measures, a change of workplace or, in the case of smokers, by smoking cessation measures.

Using the industry- and occupation-specific results of the projects research questions, we aim to provide targeted information to employees and improve COPD health literacy. In addition, the attributable share of occupational exposure in the overall incidence of COPD will be estimated. We determine the prevalence of occupational hazards separately for various industries and occupations.

Activities/Methods:

The survey and examinations were conducted by the "Epidemiological Study Center" at the University Medical Center Hamburg-Eppendorf (UKE) as part of the cohort study "Hamburg City Health Study" (HCHS). For the HCHS, a population-representative random sample of the Hamburg population was drawn from the residents' registration office. The data analyses in this final report are based on the so-called 15,000 cohort, derived from the first 15,000 participants of HCHS. For this cohort, full information is available from questionnaire and examination data. This includes the coding of free-text items according to national and international classification schemes of occupations (KldB, ISCO-08, and SOC2000) and the quality-assessed spirometry results.

The survey period for the first 10,000 subject cohort was between February 2016 and November 2018 and the second 5,000 subject cohort was recruited between November 2018 and December 2022.

Results:

For 9,125 subjects, sufficient pulmonary function data were available to determine pulmonary obstruction according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criterion and for 7,546 subjects according to the Global Lung Initiative (GLI) reference values. The prevalence of obstruction was 16.4% according to GOLD and 7.4% according to GLI. According to GOLD, men were slightly more likely to have pulmonary obstruction than women (16.4% vs. 15.0%) and according to GLI, women had a slightly higher prevalence (8.8% vs. 7.6%). According to GOLD, the prevalence of obstruction increased with older age, whereas it fell with GLI reference values.

When asked if they were exposed to inhalant noxious agents at work, 22.1% answered "yes" in the questionnaire (women 14.0%; men 30.2%). The Job-Exposure-Matrix (JEM) rated 31.5% of employees as occupationally exposed (women 23.9%; men 38.8%). Occupational groups with a high discrepancy between self-assessment and the JEM were: "Textile and leather occupations" (Difference 66%), "Food manufacturing and processing" (60.8%), and "Cleaning occupations" (59.6%). In multiple logistic regression models, workplace exposure was a higher risk factor for pulmonary obstruction according to self-report (GOLD OR = 1.20; 95% CI: 1.02 - 1.41; GLI OR = 1.32; 95% CI: 1.03 - 1.68) than according to the JEM (GOLD OR = 1.06; 95% CI: 0.91 - 1.24; GLI OR = 0.94; 95% CI: 0.74 - 1.20). Neither according to self-report in the questionnaire, nor according to the JEM, the individual workplace contaminants (chemical, gas, dust, smoke) were a statistically significant risk factor. Two occupational groups at increased risk could be identified that have not been within the focus of COPD prevention up to now: "software development and programming" occupations (GOLD: OR = 2.56; 95% CI: 1.45 - 4.33; GLI: OR = 2.78; 95% CI: 1.18 - 5.78) and "general education school teachers" (GOLD: OR = 1.25; 95% CI: 0.85 - 1.81; GLI: OR = 2.11; 95% CI: 1.22 - 3.50).

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