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. 2021 Oct 9;3(6):100385.
doi: 10.1016/j.jhepr.2021.100385. eCollection 2021 Dec.

Blue-collar work is a risk factor for developing IgG4-related disease of the biliary tract and pancreas

Lowiek M Hubers  1 , Alex R Schuurman  1 , Jorie Buijs  2 , Nahid Mostafavi  1 , Marco J Bruno  2 , Roel C H Vermeulen  3 , Anke Huss  3 , Henk R van Buuren  2 , Ulrich Beuers  1
Affiliations

Blue-collar work is a risk factor for developing IgG4-related disease of the biliary tract and pancreas

Lowiek M Hubers et al. JHEP Rep. .

Abstract

Background & aims: Immunoglobulin G4-related disease (IgG4-RD) of the biliary tract and pancreas is a fibroinflammatory disease of unknown origin with striking male predominance. We aimed to investigate whether blue-collar work and occupational contaminant exposure are risk factors for IgG4-RD of the biliary tract and pancreas.

Method: We performed an age-/sex-matched case-control study in the largest academic medical centers of the Netherlands. Occupational history was surveyed by questionnaires. The International Standard Classification of Occupations (ISCO88) was used to classify jobs. Job exposure matrices ALOHA and DOM were utilized to assess the years individuals were exposed to compounds. The disease control cohort consisted of patients from 6 equally sized groups. Conditional logistic regression was used to assess effects of blue-collar work and exposure to occupational contaminants on developing IgG4-RD of the biliary tract and pancreas.

Results: Overall, 101 patients with IgG4-RD of the biliary tract and pancreas were matched 1:3 to 303 controls. Patients with IgG4-RD had a lower level of education (p = 0.001). Individuals who at least once performed blue-collar work (>1 year), had higher odds of developing IgG4-RD than individuals that only performed white-collar work (odds ratio [OR] 3.66; CI 2.18-6.13; p <0.0001). Being ever exposed (>1 year) to industrial ALOHA (e.g. mineral dust; vapors-dust-gases-fumes) and DOM compounds (e.g. asbestos) resulted in higher odds of IgG4-RD (OR 2.14; 95% CI 1.26-3.16; p <0.001 and OR 2.95; 95% CI 1.78-4.90; p <0.001, respectively).

Conclusion: Blue-collar work is a risk factor for developing IgG4-RD of the biliary tract and pancreas putatively driven by exposure to selected industrial compounds; this may explain the striking male predominance among patients.

Lay summary: Immunoglobulin G4-related disease (IgG4-RD) causes tumor-like lesions and typically affects middle-aged to elderly men. The background and cause of this disease remain relatively unknown. In this study, we identified blue-collar work as a risk factor for developing IgG4-RD of the biliary tract and pancreas, which may explain the striking male predominance among patients. Furthermore, these results suggest that toxic exposure to occupational contaminants may drive autoimmunity in IgG4-RD of the biliary tract and pancreas.

Keywords: AIP, autoimmune pancreatitis type 1; AUMC, Amsterdam University Medical Centers; EMC, Erasmus Medical Center; IRC, IgG4-related cholangitis; ISCO, International Standard Classification of Occupations; IgG4-RD, immunoglobulin G4-related disease; IgG4-related cholangitis; JEM, job exposure matrix; OR, odds ratio; VDGF, vapors, dusts, gases, and fumes; asbestos; autoimmune pancreatitis; occupational.

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Conflict of interest statement

The authors have declared that no conflict of interest exists related to this work. Please refer to the accompanying ICMJE disclosure forms for further details.

Figures

None
Graphical abstract
Fig. 1
Fig. 1
Flow chart of inclusions.
Fig. 2
Fig. 2
Blue-collar and white-collar work across cases and controls. Proportion of patients performing blue-collar and white-collar work across cases with IgG4-RD of biliary tract and pancreas (n = 101) and disease controls (n = 303) suggesting that blue-collar work (>1 year) is a strong risk factor for IgG4-RD of the biliary tract and pancreas (OR 3.66, 95% CI 2.18–6.13). IgG4-RD, immunoglobulin G4-related disease; OR, odds ratio.
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