Abstract
BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory lung disease that reduces lung function and primarily affects older adults. Evidence suggests that occupational exposures like diesel exhaust, cadmium, welding fumes, and silica increase the risk of COPD. Some United States Department of Energy (DOE) workers may be exposed to these noxious substances as they execute their job responsibilities. Assessment of the burden of COPD among these workers and identification of the potential associations between the condition and the above occupational exposures is important for guiding screening, prevention, and control programs. Therefore, the objectives of this study are to: (a) estimate the burden of COPD among former workers of the DOE in the United States and (b) investigate the association between occupational exposures and COPD occurrence and severity among these workers while controlling for environmental, behavioral, and socio-demographic factors. METHODS: Retrospective data containing health screening records of former DOE workers, covering the time period 2006-2019, were obtained from the National Supplemental Screening Program. Multivariate imputation by chained equation was used to impute missing values. Binary and multinomial logistic regression models were used to investigate predictors of COPD occurrence and severity, respectively. RESULTS: Of the 17,376 participants included in the study, 20.8% had COPD. History of asthma, age at exam, body mass index, and smoking were significant predictors of both COPD occurrence and severity. Individuals exposed to silica had higher odds of COPD compared to those that were not exposed to silica. Similarly, diesel exhaust exposure was significantly associated with risk of more severe COPD. CONCLUSIONS: The findings of this study demonstrate the importance of considering occupational experience in the assessment of both COPD occurrence and severity. This information may be important for occupational screening programs as well as aiding in identifying modifiable risk factors to guide prevention and control efforts.