title: Chronic obstructive pulmonary disease among residents of an historically industrialised area.
abstract: OBJECTIVE
  To assess the contribution of workplace exposures to chronic obstructive pulmonary disease (COPD) risk in a community with a heavy burden of past industrial employment.
  
  
  METHODS
  A random population sample of Sheffield, U.K. residents aged over 55 years (n=4000), enriched with a hospital-based supplemental sample (n=209), was approached for study. A comprehensive self-completed questionnaire elicited physician-made diagnoses, current symptoms, and past workplace exposures. The latter were defined in three ways: self-reported exposure to vapours, gases, dusts and fumes (VGDF); response to a specific exposure checklist; and through a job exposure matrix (JEM) assigning exposure risk likelihood based on job history independent of respondent-reported exposure. A subset of the study group underwent lung function testing. Population attributable risk fractions (PAR%), adjusted for age, sex and smoking, were calculated for association between workplace exposure and COPD.
  
  
  RESULTS
  2001 (50%) questionnaires were returned from the general population sample and 60 (29%) by the hospital supplement. Among 1754 with complete occupational data, any past occupational exposure to VGDF carried an adjusted excess risk for report of a physician's diagnosis of COPD, emphysema, or chronic bronchitis (ORs 3.9; 95% CI 2.7 to 5.8), with a corresponding PAR% value of 58.7% (95% CI 45.6% to 68.7%). The PAR% estimate based on JEM exposure was 31%. From within the subgroup of 571 that underwent lung function testing, VGDF exposure was associated with a PAR% of 20.0% (95% CI -7.2 to 40.3%) for Global initiative for chronic obstructive lung disease (GOLD) 1 (or greater) level of COPD.
  
  
  CONCLUSIONS
  This heavy industrial community-based population study has confirmed significant associations between reported COPD and both generic VGDF and JEM-defined exposures. This study supports the predominantly international evidence-based notion that workplace conditions are important when considering the current and future respiratory health of the workforce.
authors: Centre for Workplace Health, Health and Safety Laboratory, Buxton SK17 9JN, UK. anthony.darby@nhs.net
authors: Anthony C
authors: AC
authors: Darby
authors: Judith C
authors: JC
authors: Waterhouse
authors: Vivien
authors: V
authors: Stevens
authors: Clare G
authors: CG
authors: Billings
authors: Catherine G
authors: CG
authors: Billings
authors: Clare M
authors: CM
authors: Burton
authors: Charlotte
authors: C
authors: Young
authors: Jeremy
authors: J
authors: Wight
authors: Paul D
authors: PD
authors: Blanc
authors: David
authors: D
authors: Fishwick
mesh_terms: D000368:Aged; D000395:Air Pollutants, Occupational / Q000009:adverse effects*; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D007221:Industry; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*; D012129:Respiratory Function Tests; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D011795:Surveys and Questionnaires; D017132:Workplace
chemical_list: D000395:Air Pollutants, Occupational