{"id":{"repo_id":"helsinki","oai_identifier":"oai:helda.helsinki.fi:10138/566883"},"canonical_url":"https://search.dev.ndltd.org/etd/helsinki/oai:helda.helsinki.fi:10138/566883","repository":{"repo_id":"helsinki","name":"University of Helsinki","base_url":"https://helda.helsinki.fi/server/oai/request"},"display":{"title":"Occupational exposure, socio-economic status and mortality in asthma and chronic obstructive pulmonary disease (copd) in the Helsinki region, Finland","abstract":"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.","abstract_html":"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.","abstract_has_math":false,"creators":["Jalasto, Juuso"],"institution":"Helsingin yliopisto","degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2023,"date_issued":"2023-11-24","date_published":"2023-11-24","updated_at":"2026-08-21T22:21:56Z","subjects":["lääketiede"],"languages":["eng"],"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."],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"http://hdl.handle.net/10138/566883","outbound_label":"Handle","outbound_source":"dc:identifier.uri"},"source_record":{"url":"https://helda.helsinki.fi/server/oai/request?verb=GetRecord&metadataPrefix=dim&identifier=oai%3Ahelda.helsinki.fi%3A10138%2F566883","prefix":"dim"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:creator","label":"Author","values":["Jalasto, Juuso"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.accessioned","label":"Dc Date Accessioned","values":["2023-11-07T14:34:15Z"]},{"key":"dc:date.available","label":"Dc Date Available","values":["2023-11-14","2023-11-07T14:34:15Z"]},{"key":"dc:date.issued","label":"Date","values":["2023-11-24"]},{"key":"dc:publisher","label":"Institution","values":["Helsingin yliopisto","Helsingfors universitet","University of Helsinki"]},{"key":"dc:type.dcmitype","label":"Dc Type Dcmitype","values":["Text"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["lääketiede"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language.iso","label":"Language (ISO)","values":["eng"]},{"key":"dc:rights","label":"Dc Rights","values":["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."]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier.uri","label":"Identifier URI","values":["http://hdl.handle.net/10138/566883"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["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.","Krooniset ahtauttavat alahengitystiesairaudet ovat tuki- ja liikuntaelinsairauksien ja mielenterveyssyiden jälkeen merkittävimpiä työkyvyttömyyteen johtavia tauteja länsimaissa. Ne ovat myös merkittäviä kuolleisuuteen vaikuttavia tauteja, syöpätautien ja sydän- ja verisuonitautien jälkeen. Näistä taudeista yleisempiä ovat astma ja keuhkoahtaumatauti (COPD), joita lääkärit kohtaavat työssään usein. Tämä tutkimus perustuu aiempaan vuonna 1996 toteutettuun FinEsS (Suomi, Viro, Ruotsi) postikyselytutkimukseen, joka keskittyi osallistuneiden hengityselinterveyden selvittämiseen. Nykyisessä tutkimuksessa oli kaksi osiota, joista ensimmäinen oli poikittaistutkimus, jossa tutkittiin yhteensä viidestä keskuksesta, kolmesta eri maasta, peräisin olevaa dataa. Ensimmäisessä osiossa 1498 osallistujalle tehtiin haastattelu, spirometria sekä uloshengitysilman typpioksidimittaus (FENO). Tässä vertailussa COPD:tä oli enemmän ruumiillisen työn tekijöillä, jotka myös tupakoivat enemmän kuin ei-ruumiillista työtä tekevät. Astmaa oli enemmän korkeammin koulutetuilla ja ei-ruumiillista työtä tekevillä, joilla myös nähtiin useammin viitettä eosinofiilisestä tulehduksesta. Eroa oli nähtävissä myös maakohtaisesti, siten, että COPD diagnooseja sekä vähän koulutusta vaativia töitä oli enemmän Virossa. FENO-mittausten perusteella ei eroa juuri ollut töiden välillä, ainoastaan keskitasoisesti kouluttautuneilla toimistotyöntekijöillä oli vähemmän koholla olevaa FENO-arvoa (FENO > 25 parts per billion). Toisessa osiossa tarkasteltiin Helsingin alueen kyselytutkimukseen (n =6062) osallistujien kuolleisuutta, liittämällä aineistoon kuolinsyyrekisteristä kaikki tapahtuneet kuolemat 24 vuoden ajalta. Löydöksenä oli suurin kuolleisuus astman ja COPD:n samanaikaisten diagnoosien ryhmässä (astma-COPD overlap, ACO). Kuolleisuus, joka liittyi sydänverisuoni- tai keuhkosairauksiin, oli myös merkitsevästi suurempaa niillä, jotka ilmoittivat sairastavansa sekä astmaa että COPD:tä. Tarkasteltaessa kuolleisuutta suhteessa työperäiseen, ammattinimikkeen perusteella arvioituun altistumiseen, korkea-asteinen altistuminen kaasuille, pölyille ja höyryille (VGDF) lisäsi kuolleisuutta sekä yleisesti että hengityselinsairauskuolleisuutta astman ja COPD:n yhteismuodossa. Kun analysoimme kuolleisuutta suhteessa ammatin perusteella arvioituun työperäiseen altistumiseen, tuloksena oli, että työperäinen altistuminen pölyille, kaasuille ja höyryille lisäsi kuolleisuutta sekä sydänperäisiin että hengityselinsairauksiin. Lisäksi uutena löydöksenä todettiin dementiaan liittyvän kuolleisuuden lisääntyminen miehillä, joilla oli työssään korkea-asteinen altistuminen pölyille, kaasuille ja höyryille. Tutkimuksen perusteella nähdään vähäaltisteinen ei-ruumiillinen ja korkeasti koulutettu työ astman suhteen jonkin verran assosioituneena tekijänä, ja altisteinen ruumiillinen työ sekä tupakointi COPD:n esiintymiseen assosioituvana. Oireiden määrä on myös korkeampi ruumiillista työtä tekevillä. Sekä astmaa että COPD:tä sairastavilla oli enemmän hengitystieoireita (yskää, hengityksen vinkumista ja ysköksiä) ja suurempi kuolleisuus kuin muilla ryhmillä. Työperäisillä tekijöillä on selkeä yhteys lisääntyneeseen kuolleisuuteen, minkä vuoksi on tärkeää vähentää työperäistä altistumista kaikilta ja erityisesti kiinnittää huomiota niihin, joilla on jo diagnosoitu keuhkoahtaumatauti."]},{"key":"dc:format.mimetype","label":"Dc Format Mimetype","values":["application/pdf"]},{"key":"dc:title","label":"Title","values":["Occupational exposure, socio-economic status and mortality in asthma and chronic obstructive pulmonary disease (copd) in the Helsinki region, Finland"]}]}],"canonical_facts":{"dc:creator":["Jalasto, Juuso"],"dc:date.accessioned":["2023-11-07T14:34:15Z"],"dc:date.available":["2023-11-14","2023-11-07T14:34:15Z"],"dc:date.issued":["2023-11-24"],"dc:description.abstract":["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.","Krooniset ahtauttavat alahengitystiesairaudet ovat tuki- ja liikuntaelinsairauksien ja mielenterveyssyiden jälkeen merkittävimpiä työkyvyttömyyteen johtavia tauteja länsimaissa. Ne ovat myös merkittäviä kuolleisuuteen vaikuttavia tauteja, syöpätautien ja sydän- ja verisuonitautien jälkeen. Näistä taudeista yleisempiä ovat astma ja keuhkoahtaumatauti (COPD), joita lääkärit kohtaavat työssään usein. Tämä tutkimus perustuu aiempaan vuonna 1996 toteutettuun FinEsS (Suomi, Viro, Ruotsi) postikyselytutkimukseen, joka keskittyi osallistuneiden hengityselinterveyden selvittämiseen. Nykyisessä tutkimuksessa oli kaksi osiota, joista ensimmäinen oli poikittaistutkimus, jossa tutkittiin yhteensä viidestä keskuksesta, kolmesta eri maasta, peräisin olevaa dataa. Ensimmäisessä osiossa 1498 osallistujalle tehtiin haastattelu, spirometria sekä uloshengitysilman typpioksidimittaus (FENO). Tässä vertailussa COPD:tä oli enemmän ruumiillisen työn tekijöillä, jotka myös tupakoivat enemmän kuin ei-ruumiillista työtä tekevät. Astmaa oli enemmän korkeammin koulutetuilla ja ei-ruumiillista työtä tekevillä, joilla myös nähtiin useammin viitettä eosinofiilisestä tulehduksesta. Eroa oli nähtävissä myös maakohtaisesti, siten, että COPD diagnooseja sekä vähän koulutusta vaativia töitä oli enemmän Virossa. FENO-mittausten perusteella ei eroa juuri ollut töiden välillä, ainoastaan keskitasoisesti kouluttautuneilla toimistotyöntekijöillä oli vähemmän koholla olevaa FENO-arvoa (FENO > 25 parts per billion). Toisessa osiossa tarkasteltiin Helsingin alueen kyselytutkimukseen (n =6062) osallistujien kuolleisuutta, liittämällä aineistoon kuolinsyyrekisteristä kaikki tapahtuneet kuolemat 24 vuoden ajalta. Löydöksenä oli suurin kuolleisuus astman ja COPD:n samanaikaisten diagnoosien ryhmässä (astma-COPD overlap, ACO). Kuolleisuus, joka liittyi sydänverisuoni- tai keuhkosairauksiin, oli myös merkitsevästi suurempaa niillä, jotka ilmoittivat sairastavansa sekä astmaa että COPD:tä. Tarkasteltaessa kuolleisuutta suhteessa työperäiseen, ammattinimikkeen perusteella arvioituun altistumiseen, korkea-asteinen altistuminen kaasuille, pölyille ja höyryille (VGDF) lisäsi kuolleisuutta sekä yleisesti että hengityselinsairauskuolleisuutta astman ja COPD:n yhteismuodossa. Kun analysoimme kuolleisuutta suhteessa ammatin perusteella arvioituun työperäiseen altistumiseen, tuloksena oli, että työperäinen altistuminen pölyille, kaasuille ja höyryille lisäsi kuolleisuutta sekä sydänperäisiin että hengityselinsairauksiin. Lisäksi uutena löydöksenä todettiin dementiaan liittyvän kuolleisuuden lisääntyminen miehillä, joilla oli työssään korkea-asteinen altistuminen pölyille, kaasuille ja höyryille. Tutkimuksen perusteella nähdään vähäaltisteinen ei-ruumiillinen ja korkeasti koulutettu työ astman suhteen jonkin verran assosioituneena tekijänä, ja altisteinen ruumiillinen työ sekä tupakointi COPD:n esiintymiseen assosioituvana. Oireiden määrä on myös korkeampi ruumiillista työtä tekevillä. Sekä astmaa että COPD:tä sairastavilla oli enemmän hengitystieoireita (yskää, hengityksen vinkumista ja ysköksiä) ja suurempi kuolleisuus kuin muilla ryhmillä. Työperäisillä tekijöillä on selkeä yhteys lisääntyneeseen kuolleisuuteen, minkä vuoksi on tärkeää vähentää työperäistä altistumista kaikilta ja erityisesti kiinnittää huomiota niihin, joilla on jo diagnosoitu keuhkoahtaumatauti."],"dc:format.mimetype":["application/pdf"],"dc:identifier.uri":["http://hdl.handle.net/10138/566883"],"dc:language.iso":["eng"],"dc:publisher":["Helsingin yliopisto","Helsingfors universitet","University of Helsinki"],"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."],"dc:subject":["lääketiede"],"dc:title":["Occupational exposure, socio-economic status and mortality in asthma and chronic obstructive pulmonary disease (copd) in the Helsinki region, Finland"],"dc:type.dcmitype":["Text"]},"updated_at":"2026-08-21T22:21:56Z"}