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Lytras, Theodore; Beckmeyer-Borowko, Anna; Kogevinas, Manolis; Kromhout, Hans; Carsin, Anne-Elie; Anto, Josep Maria; Bentouhami, Hayat; Weyler, Joost; Heinrich, Joachim; Nowak, Dennis ORCID logoORCID: https://orcid.org/0000-0001-7871-8686; Urrutia, Isabel; Martinez-Moratalla, Jesus; Gullon, Jose Antonio; Vega, Antonio Pereira; Semjen, Chantal Raherison; Pin, Isabelle; Demoly, Pascal; Leynaert, Benedicte; Villani, Simona; Gislason, Thorarinn; Svanes, Oistein; Holm, Mathias; Forsberg, Bertil; Norback, Dan; Mehta, Amar J.; Keidel, Dirk; Vernez, David; Benke, Geza; Jogi, Rain; Toren, Kjell; Sigsgaard, Torben; Schlünssen, Vivi; Olivieri, Mario; Blanc, Paul D.; Watkins, John; Bono, Roberto; Squillacioti, Giulia; Buist, A. Sonia; Vermeulen, Roel; Jarvis, Deborah; Probst-Hensch, Nicole and Zock, Jan-Paul (2021): Cumulative Occupational Exposures and Lung-Function Decline in Two Large General-Population Cohorts. In: Annals of the American Thoracic Society, Vol. 18, No. 2: pp. 238-246

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Abstract

Rationale: Few longitudinal studies have assessed the relationship between occupational exposures and lung-function decline in the general population with a sufficiently long follow-up. Objectives: To examine the potential association in two large cohorts: the ECRHS (European Community Respiratory Health Survey) and the SAPALDIA (Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults). Methods: General-population samples of individuals aged 18 to 62 were randomly selected in 1991-1993 and followed up approximately 10 and 20 years later. Spirometry (without bronchodilation) was performed at each visit. Coded complete job histories during follow-up visits were linked to a job-exposure matrix, generating cumulative exposure estimates for 12 occupational exposures. Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were jointly modeled in linear mixed-effects models, fitted in a Bayesian framework, taking into account age and smoking. Results: A total of 40,024 lung-function measurements from 17,833 study participants were analyzed. We found accelerated declines in FEV1 and the FEV1/FVC ratio for exposure to biological dust, mineral dust, and metals (FEV1 = -15.1 ml, -14.4 ml, and -18.7 ml, respectively;and FEV1/FVC ratio = -0.52%, -0.43%, and -0.36%, respectively;per 25 intensity-years of exposure). These declines were comparable in magnitude with those associated with long-term smoking. No effect modification by sex or smoking status was identified. Findings were similar between the ECRHS and the SAPALDIA cohorts. Conclusions: Our results greatly strengthen the evidence base implicating occupation, independent of smoking, as a risk factor for lung-function decline. This highlights the need to prevent or control these exposures in the workplace.

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