Occupational Risk Factors for COPD Phenotypes in the Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study

Figures & data

Figure 1.  Algorithm of recruitment and exclusions for the MESA Lung Study occupational analysis.

Table 1.  Characteristics of participants in the MESA Lung Study and occupational exposure as ascertained by questionnaire and NIOSH job-exposure matrix (JEM)

Characteristic	All	Males	Females	Never-smokers
	n = 3667	n = 1878	n = 1789	n = 1605
Age, mean (SD)	61.1 (9.8)	61.4 (9.9)	60.7 (9.7)	60.5 (9.9)
Race/ethnicity,%
White	36.1	36.2	36.0	31.9
Chinese	15.5	16.7	14.2	23.1
Black	26.4	25.2	27.6	22.7
Hispanic	22.1	22.0	22.2	22.3
Smoking status,%
Never	45.1	34.0	56.6	100.0
Former	45.2	55.8	34.2	–
Current	9.8	10.2	9.3	–
Cigarette pack-years, mean (SD)	12.5 (22.6)	16.1 (25.5)	8.8 (18.4)	–
Pipe-years, mean (SD)	3.8 (26.1)	7.4 (36.1)	0.0 (0.6)	–
Cigar-years, mean (SD)	3.1 (23.7)	5.7 (31.8)	0.3 (8.6)	–
Height (cm), mean (SD)	166.3 (9.9)	172.9 (7.5)	159.5 (7.2)	164.3 (9.9)
Weight (kg), mean (SD)	78.7 (17.1)	83.6 (15.7)	73.4 (17.1)	75.7 (16.6)
Body mass index,%
<25	30.2	28.5	31.9	34.5
25−<30	39.5	45.6	33.1	37.9
30−<35	20.3	20.3	20.4	18.9
≥35	10.0	5.6	14.7	8.7
Environmental Tobacco Smoke
Do not live with adult smoker	57.8	66.7	48.5	66.6
Live <21 years with adult smoker	30.1	25.7	34.6	22.1
Live ≥21 years with adult smoker	12.1	7.6	16.9	11.3
Education,%
Less than high school diploma	15.4	14.8	16.2	15.3
High school diploma	17.9	15.5	20.5	18.0
Some college/tech school	28.3	26.6	30.0	25.4
Bachelor's degree or higher	38.4	43.2	33.4	41.4
Occupational group,%
Management/professional	44.3	46.9	41.6	46.0
Service	15.5	12.9	18.3	16.2
Sales and office	20.8	14.0	28.0	21.4
Blue-collar	19.3	26.2	12.2	16.4
Moderate airflow limitation,%	5.7	6.7	4.7	2.1
Asthma, self-report,%	11.6	9.1	14.2	11.3
COPD, self-report doctor diagnosed (emphysema or COPD),%	2.9	3.3	2.5	0.8
Chronic bronchitis,^†%	8.0	8.1	7.9	5.7
Wheeze in last year, self-report,%	13.9	12.4	15.5	9.9
Dust,%	37.9	41.9	33.8	32.7
Vapor-gas,%	19.4	26.1	12.3	15.3
Fumes,%	24.2	30.5	17.7	18.4
Severity,%
None	55.7	51.5	60.0	61.4
Mild	25.5	28.5	22.3	23.1
Moderate	13.7	14.3	13.1	11.7
Severe	5.2	5.7	4.6	3.8
No. of VGDF agents^‡
0	55.6	51.5	60.0	61.3
1	21.0	18.4	23.8	20.8
2	10.0	10.8	9.1	8.4
3	13.4	19.4	7.0	9.5
Years exposure VGDF,%
None	56.2	51.8	60.7	62.0
≤15	21.9	22.6	21.1	19.1
>15	22.0	25.6	18.2	18.9
Dust JEM,%  Low	88.0	83.2	93.1	90.6
Medium	9.2	11.9	6.3	7.4
High	2.8	4.9	0.6	2.1
VGDF JEM,%
Low	85.0	78.3	91.9	87.7
Medium	9.8	14.0	5.4	8.5
High	5.3	7.7	2.7	3.8

^†Medical Research Council (MRC) defined chronic bronchitis. ^‡The number of VGDF agent was determined by exposure to gas/vapor, dust, and/or fumes.

Table 2.  Adjusted Odds Ratios (OR) for the association of airflow limitation^† with occupational exposures ascertained using questionnaire and NIOSH job-exposure matrix (JEM)

Exposure	All	Males	Females	Never-smokers
	n = 3508; airflow limitation = 196	n = 1782; airflow limitation = 115	n = 1726; airflow limitation = 81	n = 1581; airflow limitation = 32
	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)
Dust	1.23 (0.88–1.72)	1.21 (0.77–1.90)	1.23 (0.74–2.06)	1.98 (0.88–4.49)
Vapor-gas	1.55 (1.06–2.26)	1.55 (0.97–2.47)	1.36 (0.70–2.65)	2.71 (1.09–6.71)
Fumes	1.39 (0.97–1.99)	1.47 (0.93–2.32)	1.28 (0.71–2.33)	4.15 (1.74–9.87)
Severity of VGDF
None	1.0	1.0	1.0	1.0
Mild	1.18 (0.79–1.75)	1.24 (0.74–2.08)	1.09 (0.58–2.06) 1	1.64 (0.57–4.72)
Moderate	1.48 (0.94–2.34)	1.22 (0.65–2.31)	.82 (0.92–3.61)	2.64 (0.85–8.20)
Severe	2.13 (1.21–3.74)	1.57 (0.72–3.46)	2.99 (1.29–6.93)	14.75 (4.06–53.63)
X^2-trend, p-value	7.5, p < 0.01	1.3, p = 0.25	7.0, p < 0.01	13.9, p < 0.001
Years exposure VGDF,%
None
≤15	1.31 (0.88–1.94)	1.60 (0.95–2.71)	0.98 (0.51–1.86)	2.42 (0.90–6.52)
>15	1.31 (0.88–1.94)	1.10 (0.64–1.91)	1.63 (0.91–2.95)	3.31 (1.26–8.69)
X^2-trend, p-value	2.0, p = 0.16	0.3, p = 0.60	2.3, p = 0.13	6.2, p < 0.05
No. of VGDF agents^‡
0	1.0	1.0	1.0	1.0
1	1.40 (0.93–2.11)	1.28 (0.71–2.32)	1.54 (0.87–2.73)	1.82 (0.63–5.22)
2	1.40 (0.81–2.40)	1.45 (0.71–2.98)	1.35 (0.57–3.19)	3.64 (1.12–11.92)
3	1.69 (1.06–2.70)	1.62 (0.91–2.88)	1.53 (0.63–3.68)	5.07 (1.54–16.69)
X^2-trend, p-value	5.1, p < 0.05	2.9, p = 0.09	1.4, p = 0.23	8.8, p < 0.01
Dust JEM
Low	1.0	1.0	1.0	1.0
Med	1.08 (0.60–1.94)	0.85 (0.40–1.81)	1.80 (0.69–4.74)	1.99 (0.49–8.11)
High	2.35 (1.10–5.04)	2.28 (1.03–5.07)	–	1.87 (0.16–21.66)
X^2- trend, p-value	3.3, p = 0.07	2.3, p = 0.13	1.0, p = 0.32	0.89, p = 0.34
Organic dust JEM
Low	1.0	1.0	1.0	1.0
Medium	1.39 (0.70–2.77)	0.83 (0.31–2.20)	2.87 (1.05–7.87	3.04 (0.67–13.69)
High	2.31 (0.93–5.74)	2.23 (0.87–5.76)	) –	–
X^2-trend, p-value	3.8, p = 0.05	1.5, p = 0.21	3.3, p = 0.07	0.4, p = 0.53

^†Odds ratios for airflow limitation adjusted for age, race/ethnicity, gender, BMI, smoking status, cigarette pack-years, pipe-years, cigar-years, environmental tobacco smoke, asthma, and education.

^‡The number of VGDF agent was determined by exposure to gas/vapor, dust, and/or fumes.

Figure 2.  Adjusted Odds Ratios for airflow limitation, chronic bronchitis, wheeze and self-reported exposures. ^†Severity is the most severe exposure to VGDF.

Table 3.  Adjusted Odds Ratios (OR) for association of airflow limitation^† with the interaction of smoking and occupational exposures from questionnaire and NIOSH job-exposure matrix (JEM).

Interaction association	All	Males	Females
	n = 3511; airflow limitation = 196	n = 1785; airflow limitation = 115	n = 1726; airflow limitation = 81
	OR (95% CI)	OR (95% CI)	OR (95% CI)
Smoking/dust^‡
Never/no	1.0	1.0	1.0
Never/yes Ever/no	1.73 (0.84–3.56)	1.40 (0.43–4.59)	2.12 (0.84–5.34)
Ever/yes	4.57 (2.62–7.96)	4.65 (1.91–11.28)	5.08 (2.39–10.81)
	5.47 (3.07–9.76)	5.97 (2.42–14.68)	5.15 (2.28–11.66)
Smoking/vapor-gas
Never/no	1.0	1.0	1.0
Never/yes	2.14 (0.97–4.72)	2.07 (0.62–6.98)	2.33 (0.78–6.94)
Ever/no Ever/yes	4.37 (2.71–7.05)	5.03 (2.23–11.34)	4.36 (2.33–8.15)
	6.10 (3.46–10.77)	7.43 (3.10–17.82)	4.52 (1.83–11.15)
Smoking/fumes
Never/no	1.0	1.0	1.0
Never/yes Ever/no	3.00 (1.44–6.27)	2.82 (0.86–9.31)	3.58 (1.35–9.49)
Ever/yes	5.30 (3.15–8.92)	5.99 (2.50–14.34)	5.54 (2.77–11.08)
	6.30 (3.52–11.30)	8.00 (3.19–20.04)	5.02 (2.09–12.08)
Smoking/any VGDF*
	1.0	1.0	1.0
Never/no	2.47 (1.20–5.12)	2.63 (0.78–8.86)	2.59 (1.02–6.60)
Never/yes Ever/no	5.09 (2.70–9.61)	5.92 (2.04–17.17)	5.31 (2.28–12.33)
Ever/yes	6.97 (3.68–13.20)	8.21 (2.83–23.85)	6.71 (2.86–15.78)
Smoking/JEM-dust
Never/no	1.0	1.0	1.0
Never/yes Ever/no	1.39 (0.39–4.88)	–	3.33 (0.85–12.98)
Ever/yes	3.94 (2.57–6.03)	4.16 (2.14–8.08)	4.00 (2.23–7.15)
	4.83 (2.61–8.96)	5.13 (2.26–11.64)	3.77 (0.99–14.30)
Smoking/JEM-
vapor-gas	1.0	1.0	1.0
Never/no	0.46 (0.11–2.03)	0.48 (0.06–3.93)	0.54 (0.07–4.40)
Never/yes Ever/no	3.44 (2.26–5.23)	3.94 (2.01–7.73)	3.47 (1.98–6.09)
Ever/yes	3.15 (1.76–5.64)	3.78 (1.69–8.46)	1.81 (0.54–6.02)

^†Odds ratios for airflow limitation adjusted for age, race/ethnicity, BMI, asthma, and education.

^‡Smoking was ever (former or current) or never.

*Exposure was dichotomized into any of the agents (Vapor-gas, Dust and/or Fumes).

Table 4.  Adjusted Odds Ratios for Self-reported Physician Diagnosis of COPD,^† with occupational exposure from questionnaire

Characteristic	All		Males		Females		Never-smokers
	n = 3508; COPD = 98		n = 1758; COPD = 55		n = 1701; COPD = 42	n = 1581; COPD = 12
	OR	95% CI	OR	95% CI	OR	95% CI	OR	95% CI
Dust	1.65	1.04–2.63	1.63	0.87–3.07	1.81	0.88–3.72	4.61	1.17–18.17
Vapor-gas	1.96	1.18–3.27	1.36	0.72–2.58	3.36	1.41–8.01	2.90	0.70–12.07
Fumes	1.44	0.87–2.36	0.93	0.49–1.78	2.92	1.31–6.50	6.25	1.37–28.57
Severity of VGDF
None	1.0	1.15–3.33	1.0	0.69–2.91	1.0	1.39–7.26	1.0	0.44–10.32
Mild	1.96	1.01–3.67	1.42	0.47–2.94	3.18	1.37–9.36	2.14	0.17–14.95
Moderate	1.93	1.29–6.09	1.17	1.22–7.61	3.58	0.23–6.74	1.60	1.92–120.5
Severe	2.80		3.05		1.25		15.19
X^2-trend, p-value	8.8, p < 0.01		3.7, p = 0.05		4.1, p < 0.05	4.7, p = 0.03
Years exposure VGDF
None	1.0	1.26–3.74	1.0	0.79–3.40	1.0	1.37–7.83	1.0	0.85–14.07
≤15	2.17	1.06–3.17	1.64	0.74–3.18	3.27	1.00–5.65	3.46	0.31–10.97
>15	1.84		1.54		2.38		1.86
X^2-trend, p-value	5.6, p < 0.05		1.5, p = 0.22		5.0, p < 0.05	1.3, p = 0.26
No. of VGDF agents^‡
0	1.0		1.0		1.0		1.0
1	2.31	1.34–3.96	2.04	0.96–4.32	2.73	1.21–6.17	1.38	0.25–7.66
2	1.31	0.59–2.90	0.951.68	0.33–2.75	2.116.00	0.61–7.32	2.9014.22	0.28–29.98
3	2.59	1.35–4.98		0.75–3.79		1.88–19.20		2.13–94.88
X^2-trend, p-value	7.0, p < 0.01		0.9, p = 0.34		9.1, p < 0.01		6.5, p = 0.01

^†Odds ratios for self-reported physician diagnosis of COPD or emphysema adjusted for age, race/ethnicity, BMI, smoking status, cigarette pack-years, pipe-years, cigar-years, environmental tobacco smoke, asthma, and education.

^‡The number of VGDF agent was determined by exposure to vapor-gas, dust, and/or fumes.

Table 5.  Adjusted Odds Ratios for chronic bronchitis^† and wheeze^‡ with occupational exposure from questionnaire

Characteristic	All		Males		Females		Never smokers
Chronic bronchitis	n = 3508;chronic bronchitis = 280		n = 1782; chronicbronchitis = 143		n = 1726; chronicbronchitis = 137		n = 1581; chronicbronchitis = 91
	OR	95% CI	OR	95% CI	OR	95% CI	OR	95% CI
Dust	1.95	1.49–2.55	2.45	1.66–3.61	1.60	1.09–2.33	1.96	1.23–3.12
Vapor-gas	1.54	1.13–2.09	1.87	1.28–2.75	1.11	0.65–1.91	1.33	0.75–2.38
Fumes	1.66	1.25–2.20	1.81	1.24–2.65	1.46	0.95–2.26	1.39	0.82–2.38
Severity of VGDF
None	1.0		1.0		1.0		1.0
Mild	1.83	1.35–2.48	2.14	1.38–3.30	1.58	1.02–2.44	1.12	0.63–1.98
Moderate	2.04	1.42–2.93	2.73	1.65–4.53	1.48	0.87–2.54	2.25	1.23–4.13
Severe	1.70	1.00–2.88	1.25	0.54–2.89	2.38	1.17–4.84	3.38	1.43–7.97
X^2-trend, p-value	14.7, p < 0.001		8.1, p < 0.01		6.8, < 0.01		10.8, p = 0.001
Years exposure VGDF
None	1.0		1.0		1.0		1.0
≤15	1.57	1.13–2.17	1.77	1.11–2.82	1.36	0.86–2.16	1.23	0.69–2.19
>15	2.23	1.63–3.03	2.52	1.61–3.94	2.05	1.32–3.19	1.81	1.04–3.13
X^2-trend, p-value	22.9, p < 0.0001		16.6, p < 0.0001		10.1, p < 0.01		5.4, p < 0.05
No. of VGDF agents*
	1.0	1.14–	1.0	0.81–	1.0	1.11–	1.0	0.85–2.60
0	1.58	2.20	1.38	2.35	1.71	2.63	1.48
1	2.41	1.64–3.56	2.85	1.67–4.87	1.91	1.07–3.41	1.56	0.73–3.30
2	2.15	1.47–3.15	2.53	1.57–4.08	1.57	0.79–3.14	2.09
3								1.04–4.18
X^2-trend, p-value	22.9, p < 0.0001		18.6, p < 0.001		5.1, p < 0.05		4.8, p < 0.05
Wheeze	n = 3508; wheeze = 488		n = 1783; wheeze = 219		n = 1726; wheeze = 269		n = 1564; wheeze = 156
	OR	95% CI	OR	(95% CI)	OR	(95% CI)	OR	(95% CI)
Dust	1.76	1.43–2.18	2.13	1.54–2.95	1.56	1.17–2.08	1.83	1.28–2.63
Vapor-gas	1.62	1.26–2.07	1.65	1.20–2.28	1.52	1.03–2.23	1.32	0.84–2.08
Fumes	1.53	1.21–1.92	1.60	1.16–2.21	1.43	1.02–2.01	1.64	1.09–2.47
Severity of VGDF
None	1.0	1.30–2.14	1.0	1.37–2.90	1.0	1.04–2.04	1.0	0.90–2.13
Mild	1.67	1.45–	2.0	1.69–	1.46	1.02–	1.3	1.20–
Moderate	1.95	2.61	2.61	4.03	1.54	2.32	91.98	3.27
Severe	3.15	2.16–4.60	3.03	1.75–5.26	3.52	2.04–6.07	4.55	2.35–8.81
X^2-trend, p-value	44.6, p < 0.0001		25.5, p < 0.0001		18.9, p < 0.0001		20.6, p < 0.0001
Years exposure VGDF
None	1.0	1.54–2.53	1.0	1.79–3.79	1.0	1.07–2.13	1.0	1.09–2.70
≤15	1.97	1.48–	2.60	1.31–	1.51	1.44–		0.97–
>15	1.92	2.48	1.93	2.85	2.04	2.90	1.72	2.48
X^2-trend, p-value	28.9, p < 0.0001		12.5, p < 0.0001		16.9, p< 0.0001		8.2, p < 0.01
No. of VGDF agents*
0	1.0		1.0		1.0		1.0
1	1.84	1.42–2.37	2.23	1.47–3.37	1.62	1.16–2.25	1.72	1.12–2.63
2	1.75	1.25–2.45	2.09	1.28–3.41	1.52	0.95–2.45	1.66	0.92–2.97
3	2.14	1.57–2.90	2.41	1.60–3.63	1.92	1.17–3.16	2.11	1.22–3.67
X^2-trend, p-value	27.2, p < 0.0001		17.3, p < 0.0001		9.5, p < 0.01		8.8, p < 0.01

^†Odds ratios for MRC defined chronic bronchitis adjusted for age, race/ethnicity, BMI, smoking status, cigarette pack-years, pipe-years, cigar-years, environmental tobacco smoke, and education.

^‡Odds ratios for wheeze in last 12 months adjusted for age, race/ethnicity, BMI, smoking status, cigarette pack-years, pipe-years, cigar-years, environmental tobacco smoke, and education.

*The number of VGDF agent was determined by exposure to vapor-gas, dust, and/or fumes.