Association of occupational exposures with cardiovascular disease among US Hispanics/Latinos

Abstract

Objective: Cardiovascular disease (CVD) is a leading cause of mortality and morbidity in the USA. The role of occupational exposures to chemicals in the development of CVD has rarely been studied even though many agents possess cardiotoxic properties. We therefore evaluated associations of self-reported exposures to organic solvents, metals and pesticides in relation to CVD prevalence among diverse Hispanic/Latino workers.

Methods: Cross-sectional data from 7404 employed individuals, aged 18-74 years, enrolled in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) were analysed. Participants from four US cities provided questionnaire data and underwent clinical examinations, including ECGs. CVD was defined as the presence of at least one of the following: coronary heart disease, atrial fibrillation, heart failure or cerebrovascular disease. Prevalence ratios reflecting the relationship between each occupational exposure and CVD as well as CVD subtypes were calculated using Poisson regression models.

Results: Hispanic/Latino workers reported exposures to organic solvents (6.5%), metals (8.5%) and pesticides (4.7%) at their current jobs. Overall, 6.1% of participants had some form of CVD, with coronary heart disease as the most common (4.3%) followed by cerebrovascular disease (1.0%), heart failure (0.8%) and atrial fibrillation (0.7%). For individuals who reported working with pesticides, the prevalence ratios for any CVD were 2.18 (95% CI 1.34 to 3.55), coronary heart disease 2.20 (95% CI 1.31 to 3.71), cerebrovascular disease 1.38 (95% CI 0.62 3.03), heart failure 0.91 (95% CI 0.23 to 3.54) and atrial fibrillation 5.92 (95% CI 1.89 to 18.61) after adjustment for sociodemographic, acculturation, lifestyle and occupational characteristics. Metal exposures were associated with an almost fourfold (3.78, 95% CI 1.24 to 11.46) greater prevalence of atrial fibrillation. Null associations were observed for organic solvent exposures.

Conclusions: Our results suggest that working with metals and pesticides could be risk factors for CVD among Hispanic/Latino workers. Further work is needed to evaluate these relationships prospectively.

Keywords: cardiac risk factors and prevention; epidemiology.

Figure 1

PRs with 95% CI for current occupational exposure to solvents and cardiovascular disease after adjustment for age, gender, field centre, Hispanic/Latino background, current health insurance status, cigarette use, alcohol use level, years of residential duration in the USA, employment status, physical activity level, alternative healthy eating index, Short Acculturation Scale for Hispanics – language subscale, hypertension, hypercholesterolaemia, body mass index and diabetes mellitus. LCL, lower confidence limit; PR, prevalence ratio; UCL, upper confidence limit.

Figure 2

PRs with 95% CI for current occupational exposure to metals and cardiovascular disease after adjustment for age, gender, field centre, Hispanic/Latino background, current health insurance status, cigarette use, alcohol use level, years of residential duration in the USA, employment status, physical activity level, alternative healthy eating index, Short Acculturation Scale for Hispanics – language subscale, hypertension, hypercholesterolaemia, body mass index and diabetes mellitus. LCL, lower confidence limit; PR, prevalence ratio; UCL, upper confidence limit.

Figure 3

PRs with 95% CI for current occupational exposure to pesticides and cardiovascular disease after adjustment for age, gender, field centre, Hispanic/Latino background, current health insurance status, cigarette use, alcohol use level, years of residential duration in the USA, employment status, physical activity level, alternative healthy eating index, Short Acculturation Scale for Hispanics – language subscale, hypertension, hypercholesterolaemia, body mass index and diabetes mellitus. LCL, lower confidence limit; PR, prevalence ratio; UCL, upper confidence limit.