A57-05 Self-Reported and Job Exposure Matrix-Assessed Occupational Exposures Are Associated With Increased Respiratory Mortality in Smokers in COPDGene

Rationale Occupational exposure (OE) to dust and fumes assessed by self-report and job-exposure matrices (JEMs) have demonstrated associations with the development of chronic lung disease and all-cause mortality. However, associations with cause-specific mortality among tobacco-exposed individuals have not been fully explored. Methods Data from COPDGene, a multicenter cohort study of current and former smokers, aged 45 - 80, were analyzed. Participants underwent structured questionnaires and spirometry at enrollment. Self-reported OE categories (No Exposure, Dust-Only, Fumes-Only and Dust-and-Fumes Exposed) were created based on responses to two questions: “Have you ever worked for a year or more in any dusty job?” and “Have you ever been exposed to gas, smoke, chemical vapors, or fumes in your work?” Separately, a JEM utilized an individual’s main occupation to categorize a participants’ dust and fumes exposure into three exposure categories (Low, Medium, and High risk). Vital status was assessed through 12/31/2018, with cause of death adjudicated by a Mortality Adjudication Core. Competing risk analysis for cause-specific (respiratory-, cardiovascular-, and cancer-related) mortality was performed separately for self-reported OE and JEM exposure categories using Fine and Gray Models adjusted for age, sex, race, BMI, smoking status, pack-years and COPD status (defined as FEV1/FVC < 0.7) at enrollment. Participants with missing covariate and exposure data were excluded from the analyses. Results A total of 10,127 participants were included in the self-reported OE analysis (mean age 59.5 years, 53.4% males, 66.8% non-Hispanic white, mean follow-up 7.2 years) and 9,839 participants in JEM analysis (mean age 59.6 years, 54.1% males, 67.6% non-Hispanic white, mean follow-up 7.2 years). A higher proportion of males were observed in the self-reported dust-and-fumes (males 73.2%, females 26.8%), and JEM-assessed medium- (66.7%) and high-risk (91.3%) categories. Leading causes of death in the total population of the cohort were respiratory- (6.8-6.9%), cancer- (4.8%) and cardiovascular-related (3.7-3.8%). Self-report OE to dust-and fumes-exposure and the JEM medium- and high-risk categories were associated with increased respiratory-related mortality (Figure 1, Panels A and B, respectively). The JEM medium- and high-risk categories were also associated with increased risk of cardiovascular mortality. There were no significant associations with self-reported OE categories and cardiovascular mortality, but self-reported OE to fumes-only was associated with a protective effect for cancer-related mortality. Conclusion Self-reported OE to dust-and-fumes and JEM-assessed medium- and high-risk categories were consistently associated with increased respiratory-related mortality among tobacco-exposed individuals. This abstract is funded by: NHLBI grants U01 HL089897 and U01 HL089856 and by NIH contract 75N92023D00011.