Industry and Occupation-Specific COPD Prevalence Among Nonsmokers

On April 5, 2019, the CDC published a report that found that between 2013 and 2017, an estimated 2.4 million (2.2%) U.S. working adults eighteen and older who never smoked had COPD. The highest COPD prevalences among persons who never smoked were in the information (3.3%) and mining (3.1%) industries and office and administrative support occupation workers (3.3%). Women had higher COPD prevalences than did men.


Tobacco smoking is a major risk factor for chronic obstructive pulmonary disease (COPD), a debilitating respiratory condition with high mortality and morbidity. However, an estimated 24% of adults with COPD have never smoked. Among these persons, 26%–53% of COPD can be attributed to workplace exposures, including dust, fumes, gases, vapors, and secondhand smoke exposure. To assess industry-specific and occupation-specific COPD prevalence among adults 18 and older who have never smoked and who were employed any time during the past 12 months, the CDC analyzed 2013–2017 National Health Interview Survey (NHIS) data.


Sex differences in COPD prevalence were observed by industry and occupation. Among women, the highest prevalences were among those employed in the information industry (5.1%) and in the transportation and material moving occupation (4.5%). Among men, the highest prevalences were among those employed in the agriculture, forestry, fishing, and hunting industry (2.3%) and the administrative and support, waste management, and remediation services industry (2.3%). High COPD prevalences in certain industries and occupations among persons who have never smoked underscore the importance of continued surveillance, early identification of COPD, and reduction or elimination of COPD-associated risk factors, such as the reduction of workplace exposures to dust, vapors, fumes, chemicals, and exposure to indoor and outdoor air pollutants.


Among workers who never smoked, the highest COPD prevalences were among women (3.0%), adults sixty-five and older (4.6%), and those reporting fair/poor health (6.7%), more than three physician office visits in past 12 months (4.2%), more than three ED visits in past 12 months (10.3%), and more than seven days of work lost because of any illness or injury (6.6%). By sex, race, and ethnicity, COPD prevalences were highest among non-Hispanic white men (1.7%) and non-Hispanic black women (3.7%). Among persons who never smoked, those with COPD missed an average of 14.9 work days (15.6 days for women and 13.6 days for men) because of any illness or injury compared with persons who did not have COPD, who missed an average of 5.4 work days (6.4 days for women and 4.4 days for men).


Previous studies have shown that occupational exposures to dust and toxins, biologic and social differences, and genetic factors were associated with increased risk for COPD among persons who never smoked. Therefore, identifying occupational risk factors is needed for preventing and reducing COPD among workers. This study, which provides industry- and occupation-specific COPD prevalence estimates among 106 million persons who never smoked and were employed any time in the past 12 months, found that two thirds of those with COPD were women. Women who had never smoked had higher COPD prevalences than did men regardless of their sociodemographic characteristics. Within-group variations were observed among sex, race, and ethnicity, with the highest prevalences among non-Hispanic black women and non-Hispanic white men.


National surveys have shown that exposure to vapors, gas, dust, fumes, grain dust, organic dust, inorganic dust, ammonia, hydrogen sulfide, diesel exhaust, environmental tobacco smoke, and chemicals increases the risk for COPD morbidity and mortality among persons who have never smoked. For example, exposure to coal mine dust or respirable crystalline silica among workers in the mining industry has been associated with COPD and other pulmonary diseases. In this study, office and administrative support workers (including secretaries, administrative and dental assistants, and clerks), protective service workers, and information industry workers (including publishing, telecommunications, broadcasting, and data processing workers) had the highest COPD prevalences. Workers in these industries can be exposed to organic and inorganic dusts, isocyanates, irritant gases, paper dust and fumes from photocopiers, chemicals, oil-based ink, paints, glues, toxic metals, and solvents, all of which are known respiratory irritants and have been associated with bronchitis, emphysema, and COPD. In addition, workplace exposures to environmental tobacco smoke can be associated with COPD.


The proportions of workers who reported an emphysema, chronic bronchitis, or COPD diagnosis were 1.1%, 3.8%, 2.5%, respectively for those who ever smoked (35% of workers), and 0.1%, 1.9%, and 0.4%, respectively for those who never smoked (65% of workers). In this report, although the pattern of responses to all three COPD-related questions among those who ever smoked and those who never smoked was similar (i.e., highest proportions with COPD were among those who were diagnosed with chronic bronchitis), chronic bronchitis was 19 times more frequently reported than emphysema among those who never smoked, compared with 3.5 times among those who ever smoked. These results are similar to those previously reported that a substantial proportion of COPD among the nonsmoker population might be explained by chronic bronchitis.


The findings of high COPD prevalences among workers who never smoked corroborates findings that occupational exposures, in addition to smoking, might be associated with development of COPD. Higher COPD prevalences in certain industries and occupations underscore the importance of continued surveillance, identification of potential workplace exposures, collection of detailed occupational history, performance of pulmonary function testing, and assessment of environmental tobacco smoke exposure for early diagnosis and treatment of COPD among workers. Efforts to reduce adverse workplace exposures (including exposure to dust, vapors, fumes, chemicals, and indoor and outdoor air pollutants) and promote research to characterize the many contributing risk factors in COPD are needed to reduce the prevalence of COPD.


See the CDC Report


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