Occupational Exposures and Subclinical Interstitial Lung Disease. The MESA (Multi-Ethnic Study of Atherosclerosis) Air and Lung Studies

Abstract

Rationale: The impact of a broad range of occupational exposures on subclinical interstitial lung disease (ILD) has not been studied.

Objectives: To determine whether occupational exposures to vapors, gas, dust, and fumes (VGDF) are associated with high-attenuation areas (HAA) and interstitial lung abnormalities (ILA), which are quantitative and qualitative computed tomography (CT)-based measurements of subclinical ILD, respectively.

Methods: We performed analyses of participants enrolled in MESA (Multi-Ethnic Study of Atherosclerosis), a population-based cohort aged 45-84 years at recruitment. HAA was measured at baseline and on serial cardiac CT scans in 5,702 participants. ILA was ascertained in a subset of 2,312 participants who underwent full-lung CT scanning at 10-year follow-up. Occupational exposures were assessed by self-reported VGDF exposure and by job-exposure matrix (JEM). Linear mixed models and logistic regression were used to determine whether occupational exposures were associated with log-transformed HAA and ILA. Models were adjusted for age, sex, race/ethnicity, education, employment status, tobacco use, and scanner technology.

Measurements and main results: Each JEM score increment in VGDF exposure was associated with 2.64% greater HAA (95% confidence interval [CI], 1.23-4.19%). Self-reported vapors/gas exposure was associated with an increased odds of ILA among those currently employed (1.76-fold; 95% CI, 1.09-2.84) and those less than 65 years old (1.97-fold; 95% CI, 1.16-3.35). There was no consistent evidence that occupational exposures were associated with progression of HAA over the follow-up period.

Conclusions: JEM-assigned and self-reported exposures to VGDF were associated with measurements of subclinical ILD in community-dwelling adults.

Keywords: community-based study; epidemiology; interstitial lung disease; occupational exposures; subclinical.

Figure 1.

Forest plot of multivariable-adjusted associations between job-exposure matrix–assigned exposures and high-attenuation areas (HAA), stratified on selected clinical and demographic variables. Boxes represent point estimates; whiskers are 95% confidence intervals. P values for stratified analyses are shown. P values for interactions are less than 0.001, 0.96, 0.88, 0.87, and 0.77 for sex, smoking status, baseline age, ethnicity, and employment status, respectively.