Abstract Rationale Previously, self-reported occupational exposure (OE) to dust and fumes have been associated with increased mortality but are potentially susceptible to recall bias. Job Exposure Matrices (JEM) are less prone to recall bias; associations between JEM-based risk categories with all-cause mortality have been incompletely explored. Methods Current and former smokers, aged 45-80, ≥10 pack-years of smoking were enrolled in COPDGene, a multicenter study. All subjects underwent structured questionnaires and spirometry at enrollment, and were followed prospectively up to 15 years. OE category (low, medium, high) was determined by a COPD-specific JEM, which assessed participants’ OE to vapor, gas, dust and fumes (VGDF) using their main occupation. Vital status was assessed through 07/31/2023. Cox-proportional hazard models adjusted for age, sex, race, BMI, smoking status, smoking pack-years and % FEV1 predicted at enrollment were used to assess associations between all-cause mortality and exposure group. Subgroup analyses were also performed by sex and lung function category at baseline, including normal spirometry (GOLD0), preserved ratio impaired spirometry (PRISm), and COPD (defined by FEV1/FVC 0.7). Results A total of 9,905 participants were included in the final analysis. Mean age was 59.6 years, 54.1 % and 67.4 % of participants were male and non-Hispanic white, respectively. The prevalence and baseline characteristics of low (54.8%), medium (33.0%), and high exposure groups (12.1%) are shown in Figure 1 (Panel A). An increased proportion of males were observed in medium and high exposure groups (Figure 1, Panel A). Subjects in the medium and high exposure categories had increased all-cause mortality (aHR 1.22 1.12 - 1.33 and aHR 1.27 1.12 - 1.43, respectively) (Figure 1, Panel B) relative to the low exposure group. In subgroup analyses by sex, increased all-mortality was consistently observed in both males and females except in females with high exposure (likely due to the small number of females in this category). Similarly, increased all-cause mortality in the medium and high exposure groups was observed in all lung function categories (GOLD0, PRISm and COPD). Conclusion Occupational exposure to VGDF, assessed by JEM, was significantly associated with increased all-cause mortality among current and former smokers. These findings are consistent with self-reported OE to dust and fumes and mortality, previously described in COPDGene and suggest that a COPD-specific JEM may have utility in risk stratification while minimizing recall bias. Future studies are warranted to determine the underlying mechanisms which contribute to the association between OE to VGDF and mortality. This abstract is funded by: NHLBI grants U01 HL089897 and U01 HL089856 and by NIH contract 75N92023D00011.
Xanthavanij et al. (Fri,) studied this question.