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The Global Burden of Non-Malignant Respiratory Disease Due to Occupational Airborne Exposures

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The Global Burden of Non-Malignant Respiratory Disease Due to Occupational Airborne Exposures Driscoll T et al - The global burden of non-malignant respiratory disease due to occupational airborne exposures This is a preprint of an article accepted for publication in the American Journal of Industrial Medicine © copyright 2005, copyright owner: Wiley-Liss, Inc. The global burden of non-malignant respiratory disease due to occupational airborne exposures Timothy Driscoll, M.B. B.S., Ph.D.,1,2 Deborah Imel Nelson,Ph.D.,3,4 Kyle Steenland, Ph.D.,5 James Leigh, M.D., Ph.D,6 Marisol Concha-Barrientos, M.D., Dr.P.H.,7 Marilyn Fingerhut, Ph.D.8 Annette Prüss-Üstün, Ph.D.4 1School of Public Health, University of Sydney, NSW 2006Australia; Tel: +61-2-9351-4372; Fax: +61-2-9351-5049; E-mail: [email protected] ; 2ELMATOM Pty Ltd, Sydney, Australia, 3Geological Society of America, Boulder, CO, U.S.A, Occupational and Environmental Health Unit, Protection of the Human Environment , World Health Organization, Geneva, Switzerland, 5Rollins School of Public Health, Emory University, Atlanta, Georgia, U.S.A., 6School of Public Health, University of Sydney, NSW, Australia, 7Gerencia de Salud, Asociación Chilena de Seguridad, Santiago, Chile, 8National Institute for Occupational Safety and Health, Washington, D.C., U.S.A. Background This paper describes the worldwide mortality lining of the chest), malignant conditions of the peritoneum and morbidity from asthma, COPD and pneumoconioses (the inside lining of the abdomen) and non-malignant arising from occupational exposures to airborne conditions of the lungs (asbestosis and, probably, chronic particulates, focusing on cases in the year 2000 resulting obstructive pulmonary disease (COPD) [Churg 1988, Ohar, from relevant past and current exposures. et al. 2004]). Other exposures have not been well Methods The proportions of workers exposed to the characterized, but the condition they cause is well defined agents, and their levels of exposure, were estimated using (such as some forms of occupational asthma). workforce data and the CAREX (CARcinogen EXposure) database. These were combined with relative risk measures This paper describes the worldwide impact of work in (for asthma and chronic obstructive pulmonary disease causing non-malignant respiratory disease, in terms of (COPD)) or absolute risk measures (for the mortality and morbidity (disability), focusing on the year pneumoconioses) to develop estimates of deaths, disability- 2000 and resulting from relevant past and current adjusted life years (DALYs) and attributable fraction (for exposures. There are a vast number of respiratory asthma and COPD). conditions that can arise directly, or indirectly, from work. Results There were an estimated 386 000 deaths (asthma: However, estimating exposures, risks and attributable 38 000; COPD: 318 000; pneumoconioses: 30 000) and proportions is not possible for many of these on an nearly 6.6 million DALYS (asthma: 1 621 000; COPD: international (or even national) scale, because of lack of 3 733 000, pneumoconioses: 1 288 000) due to exposure to appropriate data sources. Therefore, only the more occupational airborne particulates. important of the work-related respiratory conditions, in Conclusions Occupational airborne particulates are an terms of the total number of cases or the risks arising from important cause of death and disability worldwide. exposure, are included here. These are asthma, chronic Keywords Asthma, COPD, pneumoconiosis, occupation, obstructive pulmonary disease (COPD) and the three main work, deaths, DALYs, global burden pneumoconioses (asbestosis, silicosis and coal workers' pneumoconiosis). Malignant respiratory disease is not INTRODUCTION included here as it is described elsewhere [Driscoll, et al. Occupational non-malignant respiratory disease arises as a 2004]. Infectious respiratory conditions related to work, result of the exposure of workers to airborne agents, mostly hypersensitivity pneumonitis and beryllium disease are also in the form of particulates or dusts.1 The primary route of not included. exposure is inhalation, whereby these agents gain access to the respiratory system and are either deposited (in the case of dusts) or enter the circulatory system. For some Address correspondence to: Timothy Driscoll, School of exposures, there is a very clear connection between the Public Health, University of Sydney, NSW exposure and the disease (for example, silicosis is only 2006Australia,Tel: +61-2-9351-4372; Fax: +61-2-9351- caused by exposure to silica). Some exposures cause more 5049; E-mail: [email protected] than one type of disease, and even more than one type of respiratory disease. For example, asbestos can result in malignant conditions of the lung and the pleura (the inside 1 Dusts are technically defined as dry particle aerosols produced by mechanical processes such as breaking, grinding and pulverizing Johnson D, Swift D. 1997. Sampling and sizing particles. In: Di Nardi S editor. The occupational environment-its evaluation and control Fairfax, VA: The American Industrial Hygiene Association.. Particle sizes range from less than 1 µm to over 100 µm. The smaller particles present a greater hazard, as they remain airborne longer and are more likely to enter the respiratory tract. Dusts may be organic (e.g. grain dust) or inorganic (e.g. silica, asbestos and coal mine dust). 1 Driscoll T et al - The global burden of non-malignant respiratory disease due to occupational airborne exposures This is a preprint of an article accepted for publication in the American Journal of Industrial Medicine © copyright 2005, copyright owner: Wiley-Liss, Inc. MATERIALS AND METHODS wood. Chemical agents include chlorofluorocarbons, The general methodology used in this study is described in alcohols, metals and their salts, and welding fumes detail elsewhere [Nelson, et al. 2005]. In summary, the [CCOHS 1997]. These agents are found in a variety of methods used to determine appropriate exposure-risk workplaces, including food and natural products processing, relationships varied depending on the condition in question. animal handling facilities, manufacturing, and construction. Asthma and COPD can be caused by occupational and non- occupational factors. For these two diseases, the approach It would not be possible to conduct exposure assessments was to estimate the proportion of the population exposed and to obtain relative risk data for all the factors (and thus at risk), and determine the relative risks of contributing to this important occupational disease, developing the condition of interest in response to a certain especially since they often occur in combination. Therefore, level of exposure (or a surrogate of exposure - occupation occupation was used as a proxy for exposure to agents that for asthma, and economic sub-sector for COPD). From this are associated with occupational asthma. The basis for this information, the population attributable fraction (AF) (the approach was the work of Karjalainen and co-workers fraction of disease or death due to occupation) was [Karjalainen, et al. 2002, Karjalainen, et al. 2001], who calculated, which in turn, allowed the determination of conducted extensive epidemiological studies of the entire population burden. To calculate the attributable fraction of Finnish workforce and developed relative risk estimates for deaths or DALYs due to exposure to a specific health risk specific occupations. A similar but less extensive study factor, the estimates of the proportion of a population (fi) based in 12 industrialized countries was also used for exposed to the risk factor at k levels of exposure,2 and the agricultural occupations [Kogevinas, et al. 1999]. relative risks of morbidity and/or mortality from a specific adverse health effect due to that exposure (RRi) were The proportion of the total population with occupational combined in the following equation: exposure to asthmagens was estimated by determining the proportion of the population working in occupations that k k matched as closely as possible those identified by AF = ( ∑ fi RRi - 1) / ( ∑ fi RRi ) Karjalainen and co-workers [Karjalainen, et al. 2002, i=0 i=0 Karjalainen, et al. 2001] and for which relative risk values were provided. These calculations were done separately for The population attributable fractions were determined in men and women for each subregion (termed "region" for two ways. The mortality attributable fraction (the fraction the rest of this paper for simplicity – see [Nelson, et al. of deaths due to work) was determined on the basis of 2005]) of the world. Population workforce participation mortality. The overall attributable fraction was based on [ILO 2002] and occupation [ILO 1995] data came from the DALYs (disability-adjusted life years), which take into International Labour Organisation (ILO). The best estimate account both mortality and morbidity. of the proportion of persons considered at risk is difficult to determine. Not all workers in each occupation would have A different approach was taken for the pneumoconioses, been exposed to asthmagens, and persons who were which are fibrotic lung diseases caused only by exposed in the past but not currently are assumed to remain occupational exposure to specific mineral dusts. In the case at risk, at least for a number of years. Therefore, as for of specific pneumoconioses, the burden is best estimated by COPD (described below) it was assumed that the number of using absolute risk rather than relative risk, since there is persons currently employed in specific occupations virtually no
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