Year of Publication

2017

College

Public Health

Date Available

5-9-2017

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Wayne Sanderson, PhD, MS, CIH

Committee Member

Svetla Slavova, PhD

Committee Member

Steven Browning, PhD, MSPH

Abstract

Background

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States. Occupational exposure to vapors, gases, dusts, or fumes (VGDFs), in combination with smoking, significantly increases the risk of developing COPD. Amongst agricultural workers, exposure to pesticides has been found to cause significantly elevated rates of annual decline in lung function, ultimately leading to a clinical diagnosis of pulmonary obstruction if the period of exposure is sufficient.

Purpose

It is hypothesized that, when compared to the standard population, workers in “dusty” occupations (where VGDF workplace exposure is significant) die at significantly elevated rates from certain cardiac and pulmonary pathologies (AMI, stroke, COPD, chronic lower respiratory disease), due to the pulmonary obstruction caused by workplace VGDF exposure.

Methods

Using death certificate data provided by the Kentucky Office of Vital Statistics, Cabinet for Health & Family Services, proportionate mortality ratios of dusty occupations versus non-dusty occupations were calculated for select pulmonary and cardiovascular causes of death. These calculations were done for both winter months (December, January, and February) and non-winter months (March through November).

A logistic model was created with following covariates: age, race, gender, occupation type (dusty vs. non-dusty), and time of death (winter month versus non-winter month). The outcome of interest was a death due to stroke, cardiac pathology, chronic respiratory pathology, or acute respiratory pathology.

Results

PMR values for those above the median age (75 years) were significantly elevated for myocardial infarction in both winter and non-winter deaths. PMR values for those of the 25th percentile in age and older were significantly elevated for COPD in non-winter months. PMR values for all age groups in non-winter deaths were significantly elevated for respiratory illness from occupational agent exposure. PMR values were significantly elevated for those of the 25th percentile age group and older in non-winter deaths from respiratory cancer. In both winter and non-winter deaths, the PMR for chronic lower respiratory disease was significantly higher only for those above the 75th percentile in age group. For winter deaths, only those in the 25th-50th percentile age group and those above the 75th percentile had significantly elevated PMR values for COPD. For winter deaths, significantly elevated PMR values existed for at least one age group for deaths from respiratory cancer and respiratory illness from an occupational agent.

Being older than the median value of age more than doubles one’s odds of death from stroke (OR 2.23 (1.479, 3.541) for 50th to 75th percentiles, OR 2.959 (1.913, 4.575) for 75th percentile and older). Dusty occupation was associated with increased odds of death from a cardiac pathology only in female workers above the median age (OR 1.139 (1.056, 1.228) for ages from 50th to 75th percentile, OR 1.161 for ages from 75th percentile onward). Male workers are 1.5 (OR 1.504 (1.429, 1.583)) times as likely to die from chronic respiratory diseases as their female colleagues. As age increases, the odds of dying from acute respiratory pathologies increase dramatically (ages from 25th to 50th percentile: OR 1.976 (1.637, 2.384), ages from 50th to 75th percentile OR 3.908 (3.292, 4.640), ages from 75th percentile onward OR 6.209 (5.244, 7.352)). OR for winter time and acute respiratory pathology is 1.204 (1.094, 1.326)

Discussion

A higher proportion of the deaths in workers from dusty occupations are due to COPD, myocardial infarction, chronic lower respiratory disease, respiratory illness caused by an occupational agent, and respiratory cancers when compared to workers of similar socio-economic status in non-dusty occupations. Furthermore, working in a dusty occupation is not a significant predictor of increased risk of death from stroke. Dusty occupation is a significant predictor of increased death from a cardiac pathology only in women between the 25th and 75th percentiles of the age distribution. Male workers in the study were 1.5 times as likely to die from a chronic respiratory pathology as female workers. Non-Caucasian workers were 0.73 times as likely to die from chronic respiratory pathologies as their Caucasian colleagues. Winter time increases ones odds of dying from an acute respiratory disease by 1.2 times. Furthermore, as age increases, the odds of dying from an acute respiratory pathology or stroke increase dramatically, regardless of one’s industry type.

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