Cumulative occupational exposures and lung-function decline in two large general-population cohorts

Theodore Lytras, Anna Beckmeyer-Borowko, Manolis Kogevinas, Hans Kromhout, Anne Elie Carsin, Josep Maria Antó, Hayat Bentouhami, Joost Weyler, Joachim Heinrich, Dennis Nowak, Isabel Urrutia, Jesús Martínez-Moratalla, José Antonio Gullón, Antonio Pereira Vega, Chantal Raherison Semjen, Isabelle Pin, Pascal Demoly, Bénédicte Leynaert, Simona Villani, Thorarinn GislasonØistein Svanes, Mathias Holm, Bertil Forsberg, Dan Norbäck, Amar J. Mehta, Dirk Keidel, David Vernez, Geza Benke, Rain Jogi, Kjell Torén, Torben Sigsgaard, Vivi Schlünssen, Mario Olivieri, Paul D. Blanc, John Watkins, Roberto Bono, Giulia Squillacioti, A. Sonia Buist, Roel Vermeulen, Deborah Jarvis, Nicole Probst-Hensch, Jan Paul Zock

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)238-246
Number of pages9
JournalAnnals of the American Thoracic Society
Issue number2
StatePublished - Feb 1 2021


  • Longitudinal studies
  • Lung function
  • Occupational disease
  • Occupational exposure
  • Spirometry

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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