Prospective Risk of Rheumatologic Disease Associated with Occupational Exposure in a Cohort of Male Construction Workers

被引:60
作者
Blanc, Paul D. [1 ]
Jarvholm, Bengt [2 ]
Toren, Kjell [3 ,4 ]
机构
[1] Univ Calif San Francisco, Div Occupat & Environm Med, Dept Med, San Francisco, CA 94117 USA
[2] Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden
[3] Univ Gothenburg, Sahlgrenska Acad, Sect Occupat & Environm Med, Gothenburg, Sweden
[4] Sahlgrens Univ Hosp, Gothenburg, Sweden
基金
瑞典研究理事会;
关键词
Autoimmune disease; Dust; Occupation; Rheumatoid arthritis; Silica; SYSTEMIC-LUPUS-ERYTHEMATOSUS; SILICA EXPOSURE; INCREASED MORTALITY; INORGANIC DUST; ARTHRITIS; DETERMINANTS; CHEMICALS; SWEDEN;
D O I
10.1016/j.amjmed.2015.05.001
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: The association between occupational exposure and autoimmune disease is well recognized for silica, and suspected for other inhalants. We used a large cohort to estimate the risks of rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, and dermatomyositis associated with silica and other occupational exposures. METHODS: We analyzed data for male Swedish construction industry employees. Exposure was defined by a job-exposure matrix for silica and for other inorganic dusts; those with other job-exposure matrix exposures but not to either of the 2 inorganic dust categories were excluded. National hospital treatment data were linked for International Classification of Diseases, 10th Revision-coded diagnoses of rheumatoid arthritis (seronegative and positive), systemic lupus erythematosus, systemic sclerosis, and dermatomyositis. The 2 occupational exposures were tested as independent predictors of prospective hospital-based treatment for these diagnoses using age-adjusted Poisson multivariable regression analyses to calculate relative risk (RR). RESULTS: We analyzed hospital-based treatment data (1997 through 2010) for 240,983 men aged 30 to 84 years. There were 713 incident cases of rheumatoid arthritis (467 seropositive, 195 seronegative, 51 not classified) and 128 cases combined for systemic lupus erythematosus, systemic sclerosis, and dermatomyositis. Adjusted for smoking and age, the 2 occupational exposures (silica and other inorganic dusts) were each associated with increased risk of rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, and dermatomyositis combined: RR 1.39 (95% confidence interval [CI], 1.17-1.64) and RR 1.31 (95% CI, 1.11-1.53), respectively. Among ever smokers, both silica and other inorganic dust exposure were associated with increased risk of rheumatoid arthritis (RRs 1.36; 95% CI, 1.11-1.68 and 1.42; 95% CI, 1.17-1.73, respectively), while among never smokers, neither exposure was associated with statistically significant increased risk of rheumatoid arthritis. CONCLUSION: This analysis reaffirms the link between occupational silica and a range of autoimmune diseases, while also suggesting that other inorganic dusts may also impart excess risk of such disease. (C) 2015 Elsevier Inc. All rights reserved.
引用
收藏
页码:1094 / 1101
页数:8
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