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

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Abstract

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.

Section snippets

Overview

This analysis exploited an existing national cohort of male employees in the Swedish construction industry that has had extensive follow-up with well-characterized health outcomes. The cohort includes subjects with a range of work-related exposures to vapors, gas, dust, and fumes, but also includes a large segment without appreciable likelihood of substantive respiratory inhalant exposure on the job. We wished to use this cohort to assess the risk of rheumatologic diseases associated with

Results

Among the 240,983 male participants in the Swedish construction health examinations analyzed here, the mean age at baseline was 32.1 ± 11.6 years and, although altogether 43% were never smokers, more than a third were still actively smoking at study entry. Details of smoking status by job-exposure matrix occupational inhalant exposure category are presented in Table 1. The differences in smoking status by exposure category were statistically significant (P < .01). Although silica exposure was

Discussion

Our findings are consistent with the known association between silica exposure and autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, and dermatomyositis), showing that this can be observed in a large industrial sector cohort with prospective follow-up. As importantly, our findings also extend the association of these diseases to other exposures, in particular to nonsilica inorganic dusts. Indeed, in the other inorganic dust-exposed group, the estimated

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  • Cited by (0)

    Funding: This work was supported in part by a visiting professorship (PDB) at the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden and the Swedish Research Council for Health, Working Life and Welfare (Forte). Funding was also provided to allow presentation of this research at an international colloquium silicosis held at Sciences Po, Paris, France, November 2014.

    Conflict of Interest: None.

    Authorship: All authors had access to the data and a role in writing the manuscript.

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