Chronic Obstructive Pulmonary Disease Mortality by Industry…

Discussion

In 2020, 10% of deaths among ever-employed persons aged ≥15 years in 47 jurisdictions were associated with COPD. Elevated age-adjusted COPD death rates among White and non-Hispanic persons^††† are consistent with previous findings of increased COPD morbidity and mortality among these groups (3,5). During 2012–2018, an estimated 5.8 million (annual average) currently employed U.S. workers had COPD (3). An estimated 40% of adults with COPD have never smoked, and an estimated 24% of all COPD cases among never-smokers were attributed to workplace exposures (2–4), including dust, fumes, gases, vapors, and secondhand smoke (2). To reduce the prevalence of COPD among workers, the COPD National Action Plan^§§§ emphasizes that occupational risk factors and interventions should be included in messaging and communication campaigns. In addition, COPD should be incorporated into prevention programs that address occupational risk factors.^¶¶¶ Higher proportions of COPD deaths were observed for ever-employed persons whose usual industry was mining, accommodation and food services, construction, or transportation and material moving, and among workers whose usual occupation was healthcare support, food preparation and serving related, construction and extraction, or transportation and material moving. National survey data indicates that workers in these industries and occupations have elevated prevalence of COPD, higher tobacco use, and are frequently exposed to secondhand smoke, vapors, gas, dust, and fumes in the workplace (2,3,6–8). For example, approximately one third of the workers in mining, construction, accommodation and food services, and transportation and warehousing industries, and healthcare support, construction and extraction, food preparation and serving related occupations are combustible tobacco users and are often exposed to secondhand smoke, diesel exhaust, and byproducts of machinery combustion, as well as dusts (e.g., wood and silica dusts), vapors, and fumes (6–8). In addition, a previous study among nurses and healthcare support workers found that exposure to cleaners and disinfectants (i.e., glutaraldehyde, bleach, hydrogen peroxide, alcohol, and ammonium compounds) was associated with increased (25%–38%) risk for COPD (9).

Although the exact reason for the differences in high COPD death rates among certain groups is unknown, differences could be partly explained by preventable workplace exposures including secondhand smoke, vapors, dusts, and fumes (2,6,8). Identification of hazards in the workplace could assist with early identification and implementation of public health programs (e.g., workplace smoke-free policies and cessation programs, elimination or substitution of exposures, removing workers from exposures, and engineering controls such as ventilation or enclosure of exposure-generating processes) that support comprehensive approaches to prevention through control of workplace hazards and promotion of healthy behaviors, early interventions, and better access to health care services (8).

The findings in this report are subject to at least six limitations. First, COPD-related deaths were not validated using medical records. Second, no information on workplace exposures is available on death certificates. Therefore, whether workplace exposures could have led directly to the COPD death is unknown. Third, if COPD was caused by workplace exposures, the industry and occupation information reported on the death certificate might not be the industry and occupation in which workplace exposures occurred. Fourth, 38,264 decedents (1.2% of total deaths) for whom employment history was not available on the death certificate were excluded from the current study. Fifth, information on smoking status of decedents was not available; smoking is known to cause or worsen COPD. Finally, results are limited to 47 jurisdictions and might not be representative of nonparticipating jurisdictions.

Findings from this report might help physicians identify workers who should be evaluated for COPD in the industries and occupations with a higher proportion of COPD deaths. The elevated COPD mortality among ever-employed persons in certain industries and occupations underscores the importance of targeted interventions to prevent COPD from developing and intervening before it becomes symptomatic or severe. Continued surveillance, including collection of detailed industry and occupational history and etiologic research to further characterize occupational risk factors for COPD, is essential to guide interventions and policies to improve workers’ health.