title: Who should not go high: chronic disease and work at altitude during construction of the Qinghai-Tibet railroad.
abstract: From 2001 to 2005, a new railroad linking Beijing with Lhasa was built by more than 100,000 workers, of whom 80% traveled from their lowland habitat to altitudes up to 5000 m to work on the railroad. We report on the medical conditions of 14,050 of these altitude workers, specifically with regard to preexisting illness. All subjects were seen at low and high altitude. Average age was 29.5 +/- 7.4 (SD) yr, range 20 to 62 yr; 98.8% of the subjects were men and 1.2% were women. Overall incidence of AMS upon first-time exposure was 51%, that of HACE 0.28%, and that of HAPE 0.49%. About 1% of the subjects were hypertensive before altitude exposure. Those with blood pressure >or=160/95 were excluded from employment at altitude. Altitude exposure led to a greater increase of blood pressure in hypertensives compared to normotensives. On prealtitude screening prevalence of cardiac arrhythmias was 0.33%. Since the majority of these were rather benign and occurring in young and otherwise healthy subjects, we allowed altitude employment. Follow-up at altitude was uneventful. Subjects with coronary heart disease and diabetes were excluded from altitude employment. Obesity was a risk factor for acute mountain sickness and for reduced work performance at altitude. Overweight subjects lost more weight during their altitude stay than subjects with normal weight. Altitude exposure was a risk factor for upper gastrointestinal tract bleeding, especially in combination with alcohol, aspirin, and dexamethasone intake. Asthmatic subjects generally did better at altitude compared to low altitude, with the exception of one subject who experienced an asthma episode from pollen exposure. In conclusion, careful evaluation of preexisting chronic illness and risk factors allowed prevention of altitude deterioration of a preexisting health condition, all the while allowing subjects with some specific conditions to work and live at altitude without problems.
authors.affiliation: Physiological Research Group of the Ministry of Railroad, P. R. China. wutianyiqh@hotmail.com
authors.forename: Tian-Yi
authors.initials: TY
authors.lastname: Wu
authors.forename: Shou Quan
authors.initials: SQ
authors.lastname: Ding
authors.forename: Jin Liang
authors.initials: JL
authors.lastname: Liu
authors.forename: Man Tang
authors.initials: MT
authors.lastname: Yu
authors.forename: Jian Hou
authors.initials: JH
authors.lastname: Jia
authors.forename: Zuo Chuan
authors.initials: ZC
authors.lastname: Chai
authors.forename: Rui Chen
authors.initials: RC
authors.lastname: Dai
authors.forename: Sheng Lin
authors.initials: SL
authors.lastname: Zhang
authors.forename: Bao Yu
authors.initials: BY
authors.lastname: Li
authors.forename: Lei
authors.initials: L
authors.lastname: Pan
authors.forename: Bao Zhu
authors.initials: BZ
authors.lastname: Liang
authors.forename: Ji Zhui
authors.initials: JZ
authors.lastname: Zhao
authors.forename: De Tang
authors.initials: de T
authors.lastname: Qi
authors.forename: Yong Fu
authors.initials: YF
authors.lastname: Sun
authors.forename: Bengt
authors.initials: B
authors.lastname: Kayser
mesh_terms: D000064:Acclimatization; D000328:Adult; D000531:Altitude; D000532:Altitude Sickness / Q000175:diagnosis / Q000453:epidemiology*; D002681:China / Q000453:epidemiology; D002908:Chronic Disease; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology; D000860:Hypoxia / Q000453:epidemiology; D008297:Male; D009784:Occupational Diseases / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D011654:Pulmonary Edema / Q000453:epidemiology; D011890:Railroads; D011795:Surveys and Questionnaires; D018609:Tibet