title: Unexpected excessive chronic obstructive pulmonary disease mortality among female silk textile workers in Shanghai, China.
abstract: OBJECTIVE
  To investigate chronic obstructive pulmonary disease (COPD) mortality among textile workers.
  
  
  METHODS
  A total of 267,400 Chinese female textile employees were monitored for COPD mortality from 1989 to 2000. Textile factories in the cohort were classified into 10 industrial sectors. Age-adjusted mortality, standardized mortality ratios (SMRs) and 95% CIs were calculated by sector. In addition, RRs (HRs) adjusted for smoking and age were calculated for exposure to cotton and silk textile work compared with the other sectors in the cohort.
  
  
  RESULTS
  A majority of textile sectors had lower or similar COPD mortality (age-adjusted SMRs=0.58-1.15) compared with the general female population in the city of Nanjing, China. SMRs for cotton and silk workers were, respectively, 1.02 (95% CI: 0.81 to 1.28) and 2.03 (95% CI: 1.13 to 3.34). Compared with all other textile sectors in the cohort, there was greater COPD mortality among cotton workers (HR=1.40, 95% CI: 1.03 to 1.89) and silk workers (HR=2.54, 95% CI: 1.47 to 4.39).
  
  
  CONCLUSIONS
  Elevated COPD mortality among cotton workers is consistent with previous reports of adverse respiratory effects of cotton dust. The higher rate of COPD deaths among silk workers was unexpected.
authors.affiliation: Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Seattle, WA 98105, USA. cuiling@u.washington.edu
authors.forename: Ling
authors.initials: L
authors.lastname: Cui
authors.forename: Lisa G
authors.initials: LG
authors.lastname: Gallagher
authors.forename: Roberta M
authors.initials: RM
authors.lastname: Ray
authors.forename: Wenjin
authors.initials: W
authors.lastname: Li
authors.forename: Daoli
authors.initials: D
authors.lastname: Gao
authors.forename: Yingzhe
authors.initials: Y
authors.lastname: Zhang
authors.forename: Sverre
authors.initials: S
authors.lastname: Vedal
authors.forename: David B
authors.initials: DB
authors.lastname: Thomas
authors.forename: Harvey
authors.initials: H
authors.lastname: Checkoway
mesh_terms: D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D032561:Cotton Fiber; D004391:Dust; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009784:Occupational Diseases / Q000401:mortality*; D016273:Occupational Exposure / Q000009:adverse effects*; D029424:Pulmonary Disease, Chronic Obstructive / Q000209:etiology / Q000401:mortality*; D012307:Risk Factors; D047011:Silk / Q000009:adverse effects*; D013783:Textile Industry
chemical_list: D004391:Dust; D047011:Silk