Occupational exposure, socio-economic status and mortality in asthma and chronic obstructive pulmonary disease (copd) in the Helsinki region, Finland

After musculoskeletal and mental disorders, chronic obstructive lower airway diseases are highly prevalent worldwide and are a leading cause of disability. They are also a major cause of premature death, surpassed by only cardiovascular diseases and neoplasms. Asthma and chronic obstructive pulmonary disease (COPD) are the most common types of chronic lower airways diseases and are frequently encountered by doctors throughout their careers. This study aimed to investigate the association between these two diseases and socioeconomic status, and their impact on mortality both alone and in conjunction with estimated occupational exposure to vapours, gases, dusts, or fumes (VGDF). The study was based on the earlier FinEsS (Finland, Estonia, Sweden) postal questionnaire study of airway health. It consisted of two parts: the first part focused on data collected from five different centres in the three countries. A total of 1498 participants underwent a clinical interview that elicited detailed information on tobacco smoking of any type, spirometry measurements, and fractions of exhaled nitric oxide (FENO). The pooled results, adjusted for tobacco smoking, revealed that manual work was associated with self-reported physician-diagnosed COPD, and that non-manual workers with intermediate education (4–6 years) were more likely to report asthma. Manufacturing and plant operating were associated with COPD, but service work in which workers had the lowest level of education was associated with both asthma and COPDtype symptoms, but not with asthma or COPD diagnoses. Healthcare workers were more likely to have asthma but less likely to report a COPD diagnosis. FENO levels did not differ among occupations, except among lower-educated (maximum 4 years) non-manual workers, who significantly more seldom had high FENO levels (>25 parts per billion). The second part of the study focused on data from just one centre, Helsinki, and consisted of cause of death registry data from a 24-year follow-up. This part of the study had 6062 participants, and 1014 cause of death registry entries were collected during the follow-up period, making it a large general population cohort with deaths collected over an extended period. We found that those who reported physician-diagnosed asthma and COPD had the lowest survival rate, and excess deaths were associated with cardiovascular or respiratory causes. Estimated exposure was also associated with mortality, and together with self-reported physician-made diagnoses, lowered the survival rate in both the COPD only and the joint asthma and COPD groups. High estimated occupational exposure to VGDF was linked to higher mortality and certain specific causes of cardiovascular and respiratory diseases. As a novel finding, among men, dementia-caused death was associated with high occupational exposure. In conclusion, this study shows that manual work and occupational exposures to VGDF are associated with COPD. It also found that coughing, wheezing and sputum production are more common among those with manual occupations, and that having both asthma and COPD diagnoses leads to poorer disease prognosis and earlier mortality in a general population cohort. High occupational exposure to VGDF was associated with higher mortality and certain specific causes of cardiovascular and respiratory diseases. Thus, it is important to reduce workers’ exposure in their jobs and to pay particular attention to highly exposed workers who already have a chronic lower airway tract disease.

Grantor dc:publisher

Helsingin yliopisto

Year dc:date.issued

2023

Author dc:creator

• Jalasto, Juuso

• lääketiede

Statement dc:rights

• Julkaisu on tekijänoikeussäännösten alainen. Teosta voi lukea ja tulostaa henkilökohtaista käyttöä varten. Käyttö kaupallisiin tarkoituksiin on kielletty.
• This publication is copyrighted. You may download, display and print it for Your own personal use. Commercial use is prohibited.
• Publikationen är skyddad av upphovsrätten. Den får läsas och skrivas ut för personligt bruk. Användning i kommersiellt syfte är förbjuden.

Language dc:language.iso

eng

Handle dc:identifier.uri

http://hdl.handle.net/10138/566883

OAI record oai:identifier

https://helda.helsinki.fi/server/oai/request?verb=GetRecord&metadataPrefix=dim&identifier=oai%3Ahelda.helsinki.fi%3A10138%2F566883