Occupational and Environmental Medicine

Ball, M Alexander; Amick, Benjamin C; Nembhard, Wendy N; Joshua, Christina C; Delhey, Leanna M; Schach, Samuel L; Allen, Jaimi L

doi: 10.1136/oemed-2025-110495pmid: 41813116

ObjectivesSeveral industry-specific hazards are present in the poultry working environment. It is not well known whether risk factors unique to poultry working increase all-cause and cancer mortality relative to other industry types. The study objective was to compare all-cause and cancer mortality among poultry workers to non-poultry food workers.MethodsOccupational data for 30 411 poultry and 16 405 non-poultry workers were obtained from United Food and Commercial Workers union records and matched to the National Death Index up to 31 December 2019 to conduct a retrospective cohort study. Unadjusted and adjusted hazard ratios (aHR) and their 95% CIs from time-stratified Cox proportional hazard regression models were run to compare all-cause and cancer mortality among poultry and non-poultry workers.ResultsAcross the full cohort, no statistically significant elevation in all-cause or cancer mortality among poultry workers was observed (all-cause: aHR 0.98, 95% CI 0.95 to 1.01; cancer: aHR 1.05, 95% CI 0.97 to 1.13); however, time-period sensitivity was evident. After accounting for calendar time, poultry workers hired before 1960 had a 62% greater cancer mortality hazard compared with non-poultry workers (aHR 1.62, 95% CI 1.25 to 2.11). Poultry workers hired between 1980 and 1989 had a 59% (aHR 1.59, 95% CI 1.40 to 1.79) and 86% (aHR 1.86, 95% CI 1.39 to 2.48) greater all-cause and cancer mortality risk, respectively.ConclusionsUnion poultry workers hired in the United States during the 20th century faced greater all-cause and cancer mortality compared with non-poultry workers; however, this elevation was period-sensitive, varying by employment start date.

Agarwal, Isha; Frankenfeld, Cara; Schernhammer, Eva; Strohmaier, Susanne; Fleisch, Abby F; Rich-Edwards, Janet; Tobias, Deirdre K

doi: 10.1136/oemed-2025-110594pmid: 41605642

ObjectivesWe sought to evaluate whether rotating night shift work increases the risk of type 2 diabetes, particularly among women with a history of gestational diabetes mellitus (GDM).MethodsWe included 50 122 Nurses’ Health Study II participants who were parous at baseline in 1989 or at any time during follow-up through 2019. Using multivariable-adjusted Cox proportional hazards models, we estimated the HRs and 95% CIs for the associations between cumulative years of rotating night shift work and incident type 2 diabetes, overall, and by history of GDM.ResultsCompared with participants who never engaged in rotating night shift work, we observed a graded increase in the risk of type 2 diabetes with cumulative years of rotating night shift work: HR (95% CI) 1.14 (1.04 to 1.24) for <5 years, 1.32 (1.17 to 1.49) for 5–10 years and 1.32 (1.16 to 1.50) for >10 years (p-linear trend <0.001). Stratifying by history of GDM, we observed a similar pattern of associations among participants without a history of GDM, but not among those with a history of GDM (p-interaction=0.02). History of GDM was strongly associated with risk of incident type 2 diabetes in all women, including those who never worked rotating night shifts: HR (95% CI) 4.76 (3.90 to 5.81).Conclusions/interpretationCumulative years of rotating night shift work were modestly associated with a higher risk of type 2 diabetes, overall, and among nurses without a history of GDM. Rotating night shift work was not associated with risk of type 2 diabetes among individuals with a history of GDM, an exceptionally high-risk subgroup for type 2 diabetes.

Elling, Devy L; Almroth, Melody; Berglund, Kristina; Hammarberg, Anders; Mangot-Sala, Lluís; Taipale, Heidi; Tiihonen, Jari; Thern, Emelie

doi: 10.1136/oemed-2025-110613pmid: 41927469

ObjectiveAlcohol use disorders (AUDs) can lead to unemployment, yet they remain undertreated. Pharmacotherapies may strengthen labour market attachment but are underused. This study investigates the association between AUD pharmacotherapy use and the risk of becoming unemployed among individuals with an AUD diagnosis in Sweden.MethodsA longitudinal register-based study was conducted, using the Swedish Work, Illness and labour market Participation (SWIP) cohort, restricted to gainfully employed individuals between 16 and 60 years with a first-time AUD diagnosis in Sweden between 2006 and 2019 (n=77 503). The exposure was AUD pharmacotherapy use. The outcome was the first unemployment spell (≥90 consecutive days) that occurred after the first-time AUD diagnosis (2006–2020). Covariates included sociodemographic characteristics, comorbidities and unemployment history. The association between pharmacotherapy use and unemployment was examined using Cox regression models.ResultsOf the cohort, 42.8% used AUD pharmacotherapy and 15 098 individuals became unemployed during the observation period (median 7.1 years, IQR 3.3–10.6 years). Relative to those with AUD who did not use any pharmacotherapy, an inverse association between the use of AUD pharmacotherapy and unemployment incidence was observed (adjusted HR (aHR): 0.86; 95% CIs 0.82 to 0.89).ConclusionsAUD pharmacotherapy may decrease the risk of long-term unemployment. The findings further underscore the importance of pharmacotherapy treatment to sustain work ability and promote a healthy workforce.

Yang, Ting-An; Lin, Jhe-Ping; Fan, Hao-Yi; Chang, Chia-Cheng; Chen, Jau-Yuan; Tsao, Yu-Chung

doi: 10.1136/oemed-2025-110642pmid: 41856511

ObjectivesTo investigate the relationships between indium exposure biomarkers and pulmonary injury markers among indium-exposed workers, and to evaluate the exploratory diagnostic utility of indium levels for identifying subclinical ventilatory abnormalities.MethodsThis cross-sectional study recruited 30 workers from a Taiwanese indium–tin oxide (ITO) facility. Participants completed standardised questionnaires, spirometry, diffusing capacity (diffusing capacity of the lungs for carbon monoxide) testing and chest radiography. Serum indium (In-S) and urinary indium (In-U) concentrations were quantified alongside pulmonary biomarkers (Krebs von den Lungen-6 (KL-6), Surfactant Protein A (SP-A), Surfactant Protein D (SP-D)) and systemic inflammatory and oxidative stress markers (Lactate Dehydrogenase (LDH), Malondialdehyde, C-Reactive Protein, 8-hydroxy-2-deoxyguanosine). Group comparisons were stratified by In-S level and workstation. Associations were assessed using Spearman’s correlation. Receiver operating characteristic (ROC) analyses were performed to explore the diagnostic performance of indium biomarkers.ResultsProduction workers had significantly higher In-S and In-U levels than administrative staff (p<0.001). KL-6 and LDH were elevated in the high In-S group (p<0.01). In-S and In-U correlated moderately with KL-6 (ρ=0.556 and 0.536, respectively; p<0.001), and with SP-D (ρ=0.388 and 0.384; p=0.013 and 0.014). In-U showed negative correlation with SP-A (ρ=–0.329, p=0.038) and positive correlation with LDH (ρ=0.317, p=0.046). ROC analysis demonstrated exploratory diagnostic performance within this cohort of In-S for identifying reduced maximal mid-expiratory flow and reduced FEV₁/FVC ratio.ConclusionsIn-S and In-U levels are associated with biological markers of alveolar epithelial injury and functional parameters related to airway physiology. These findings support the potential role of indium biomonitoring in occupational surveillance, while underscoring the need for cautious interpretation given the cross-sectional design and limited sample size.

Consonni, Dario; Fustinoni, Silvia; Aarts, Daan Joris

doi: 10.1136/oemed-2025-110490pmid: 41748321

ObjectiveWithin a multicentre cohort study, mortality (1960–2008) had been evaluated of workers exposed to tetrafluoroethylene (TFE) and perfluorooctanoic acid (PFOA) employed (1960–1999) in a plant producing fluoropolymers in Piedmont, North-West Italy. Follow-up of this cohort was updated through 2024.MethodsWorkers’ job histories were merged with a semiquantitative job-exposure matrix to calculate cumulative exposure to TFE (still used) and PFOA (phased out in 2013). We calculated standardised mortality ratios (SMRs) and 95% CIs.ResultsAmong 505 male workers, there was high correlation between cumulative exposure to TFE and PFOA (Spearman’s rho 0.57). SMRs (reference: regional rates) were elevated for lung cancer (SMR 1.43, 95% CI 0.95 to 2.16, 23 deaths) and non-Hodgkin’s lymphoma (NHL, SMR 2.73, 95% CI 1.23 to 6.07, 6 deaths). Pleural cancer was also in excess (SMR 3.18 using national rates, 95% CI 1.02 to 9.84, 3 deaths). Mortality from leukaemia (three deaths) was not elevated. Lung cancer was not associated with length of employment or exposure. Three workers who died from liver, kidney and testis cancer had been exposed to TFE and unexposed to PFOA. NHL was positively associated with length of employment, time since first employment and exposure to TFE (all 6 deaths exposed, SMR 3.38, 95% CI 1.52 to 7.51 in unlagged analysis, excess confirmed in lagged analyses), while 3 were unexposed to PFOA. The NHL excess occurred among workers aged 65+ years last employed before 2000.ConclusionsThis study found elevated mortality from NHL. The available evidence suggests an association with TFE rather than PFOA exposure, although exposure misclassification cannot be ruled out.

Wan, Wenxin; Vermeulen, Roel; Portengen, Lützen; Olsson, Ann; Schüz, Joachim; Bijoux, Wendy; Ahrens, Wolfgang; Barul, Christine; Behrens, Thomas; Brüning, Thomas; Caporaso, Neil E; Consonni, Dario; Demers, Paul A; Fabianova, Eleonora; Fernández-Tardón, Guillermo;

Kromhout, Hans; Heederik, Dick J J

doi: 10.1136/oemed-2025-110290pmid: 41698712

IntroductionJob-exposure matrices (JEMs) are being used to assign (quantitative levels of) exposure to individuals based on their job history. In human observational studies, a group-based approach in which every individual with a similar job will be assigned similar exposure will not bias exposure–response associations but will result in loss of precision. However, since JEMs do not consider between-worker differences in average exposure, some individual workers’ cumulative exposures will be underestimated. This may affect their chances of compensation when a minimal (cumulative) exposure threshold is applied.MethodsWe analysed more than 80 000 repeated exposure measurements from a variety of industries and consequently combined variance components of location and worker (within a location within a job) to estimate the bandwidth of individual average exposures within a job. This allowed estimating percentiles one and two standard deviations (SD) above the median of workers’ exposure distribution within a job (across locations/companies).ResultsThe bandwidth factor appeared to be larger for exposures to particulates than for gases. It was also larger for biological agents. For exposure to particulate matter, the bandwidth factor varied slightly between industries (84BWfactor range 1–4) with a median 2.5.ConclusionBy applying a default bandwidth factor to an average exposure estimate resulting from a quantitative JEM, the Dutch occupational disease compensation scheme has chosen for an approach that recognises between-worker differences in exposure. This approach, in addition to considering uncertainty in exposure–response associations, addresses another important factor of uncertainty in ascertaining occupational disease based on the ‘presumably plausible’ principle.