Hypersensitivity Pneumonitis Mortality by Industry and Occupation

Details

• Personal Author:
  Blackley DJ ; Hall NB ; Laney AS ; Wood JM
• Description:
  We read with interest the research letter by Fernández Pérez et al, and agree that population-level mortality from hypersensitivity pneumonitis (HP) has not been well-characterized in the United States. However, the role of occupation in the development and severity of HP is well established. Occupational exposures are responsible for a substantial portion of HP cases, and it is important to monitor trends in morbidity and mortality so that prevention activities can be prioritized. To that end, we conducted a similar analysis of HP mortality data from 2003-2017 (ICD-10 code J67.x), while also taking available employment history into account. We identified a similar demographic risk profile: 58% of decedents were male, 93% were White, and a high proportion lived in the Midwest or Northeast. Using data from 21 states during 2003, 2004, and 2007-2013, we calculated proportionate mortality ratios (PMRs) by usual industry and occupation, while adjusting for age, sex, and race. Among industries, the PMR was highest for animal production (PMR 9.9; 95% CI 5.1, 17.3) and crop production (PMR 5.2; 95% CI 2.9, 8.7), and among occupations, it was highest among farmers and ranchers (PMR 7.9; 95% CI 5.0, 11.8). Fernández Pérez and colleagues acknowledge that exposure information was not available in these data, however, because HP is often caused by workplace exposures, a decedent's work history is a significant factor that should be considered. The authors suggest that genetic differences between racial groups could play a role in determining the susceptibility to HP. We think it is unlikely that the racial differences observed are the result of genetic factors. It is far more likely that this observation is confounded by associations with geographical clustering of agricultural industries and occupations which are associated with race, which are in turn associated with exposure to antigens primarily found in organic substances. We applaud the authors for highlighting the public health importance of HP, especially because mortality has been increasing and the root cause of this increase is unknown. Collecting a thorough clinical and occupational history is key to diagnosing HP and identifying an inciting antigen. If an occupational cause is identified, the individual worker might benefit from exposure reduction or avoidance, and a workplace evaluation could be conducted to identify additional cases and assess exposure controls. [Description provided by NIOSH]
• Subjects:
  Aging Agriculture Demography Environmental Exposure Farmers Hypersensitivity Men Mortality Occupational Health Preventive Medicine Race Factors Respiratory Tract Diseases Risk Assessment Risk Factors Safety Women

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• Keywords:
  Age Groups Agricultural Workers Animal Husbandry Workers Demographic Characteristics Exposure Levels Farm Workers Humans Mortality Rates Pneumonitis Preventive Medicine Racial Factors Risk Factors Statistical Analysis Surveillance Workers

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• ISSN:
  1073-449X
• Document Type:
  Text
• Genre:
  Journal Article
• Place as Subject:
  OSHA Region 3 ; West Virginia
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  RHD - Respiratory Health Division
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  200
• Issue:
  4
• NIOSHTIC Number:
  nn:20055918
• Citation:
  Am J Respir Crit Care Med 2019 Aug; 200(4):518
• Contact Point Address:
  Noemi B. Hall, PhD, Surveillance Branch, Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1095 Willowdale Road, Mail Stop HG900.2, Morgantown, WV 26505-2888
• Email:
  nhall@cdc.gov
• Federal Fiscal Year:
  2019
• Peer Reviewed:
  False
• Source Full Name:
  American Journal of Respiratory and Critical Care Medicine
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:77738848afda9895320115893c7b630608f684264c3354f224e0e30f440379e867250a50d96e586b73f7ee4ed223dafaadc96263dc880d5e3777300240ebc1c6
• Download URL:
  https://stacks.cdc.gov/view/cdc/213671/cdc_213671_DS1.pdf
• File Type:
  [PDF - 469.77 KB ]