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Occupational categories and chronic degenerative diseases in elderly workers
International Congress Series 1280 (2005) 161 – 165
www.ics-elsevier.com
Occupational categories and chronic degenerative diseases in elderly workers U. CarboneT, E. Della Valle, B. Boggia, G. Mancusi, S. Stranges, V. Pizzorusso, E. Farinaro Department of Preventive Medical Sciences, Unit of Occupational Medicine, bFederico II Q University of Naples, Italy
Abstract. The current delay in retirement age and the changing job opportunities have led to a progressive aging of the working population with a subsequent increase in work related and chronic degenerative diseases. To assess the relationship between occupational categories and chronic degenerative diseases, the prevalence of respiratory, cardiovascular and musculo-skeletal diseases was evaluated in a sample of 7199 male workers. The results indicate that compared to the general population there is a greater prevalence of chronic degenerative diseases among blue-collar workers, porters, and drivers while the prevalence in white-collar workers was not different. The higher prevalence of chronic degenerative diseases in drivers, porters and in blue-collar workers, already at younger ages, suggests that these occupations are wearing jobs and could accelerate the aging process. This should be taken into account in assessing working ability and in defining programs focused on control of welfare expenses. D 2005 Elsevier B.V. All rights reserved. Keywords: Aging; Chronic degenerative disease; Occupational category
1. Introduction Recent advances in Occupational Medicine have contributed to the development of broader evaluation criteria for work-related diseases.
T Corresponding author. Dipartimento di Scienze Mediche Preventive, Sezione di Medicina del Lavoro, Policlinico Federico II, Edificio 13, Via Sergio Pansini 5, 80131, Napoli, Italy. Tel.: +39 817462049; fax: +39 817462124. E-mail address: [email protected] (U. Carbone). 0531-5131/ D 2005 Elsevier B.V. All rights reserved. doi:10.1016/j.ics.2005.02.091
162
U. Carbone et al. / International Congress Series 1280 (2005) 161–165
Research utilizing these more sophisticated criteria has demonstrated relationships between chronic diseases, working conditions and associated risk factors. For example, there is evidence indicating that biomechanical column overload, inadequate posture, and whole body vibration predispose to lower-back injuries and related disorders [1,2]. In addition, stressful occupations, such as truck driving or manual weight handling, can affect the integrity of intervertebral discs [3–5] and may be associated with the development of cardiovascular diseases [6–10]. As to respiratory conditions, particularly chronic obstructive pulmonary disease (COPD), many specific risks may be involved [11,12], together with environmental conditions [13,14]. Recently low dose pollution, smoking habits and passive smoking have been confirmed as specific risk factors [15–17]. The delayed retirement age and the progressive aging of the active population have increased the prevalence of chronic degenerative diseases among workers, generating social conflicts and raising welfare expenses. The aim of the present study was to evaluate the interaction between health and occupation among different categories and detect a possible influence on the onset and progression of chronic degenerative diseases. 2. Material and methods The prevalence of respiratory, cardiovascular and musculo-skeletal diseases was evaluated analyzing the health surveillance data collected between 1998 and 2002 in a sample of 7199 male workers of the Campania Region. The distribution of the study population comprised 53.9% white-collar workers, 30% blue-collar workers, 3.7% porters and cleaners, 4.4% truck drivers, 7.7% other categories (technicians, craftsmen, teachers, policemen, sailors, nurses). Health status was assessed by medical history, physical and laboratory or instrumental examinations. The chronic respiratory diseases considered were: COPD defined by positive medical history and diagnostic spirometry; cardiovascular disease—specifically myocardial infarction, defined by a positive medical history and diagnostic electrocardiogram; musculo-skeletal diseases—specifically lumbar spondylopathy, defined by history of back pain in the previous year and partially impaired movement at the dynamic examination. Statistical analysis was performed using SPSS 10.0. Differences between occupational groups were analyzed by the Chi-square test. Significance was set at p b 0.05. Given its heterogeneity, the data from the bothersQ was not included in the calculations. The effects of non-occupational variables (i.e. age, smoking habit, BMI, serum cholesterol levels) were also evaluated dividing the sample into two subsets for each variable (age: V 45/N 45 years; smoke: no/yes-ex; BMI b 25/N 29.9, serum cholesterol levels V 220/N 220 mg/dl). 3. Results The overall prevalence of heart disease was 2%, respiratory diseases 13.4%, and musculo-skeletal diseases 11.5%. Table 1 displays the prevalence rates stratified by activity.
U. Carbone et al. / International Congress Series 1280 (2005) 161–165
163
Table 1 Chronic degenerative disease prevalence in different work activities Cardiovascular Respiratory Musculo-skeletal
White collars
Blue collars
Porters
Drivers
Others
1.4 6.2 5.6
2.6 20.4 17
2.2 34.8 23.6
5.4 29.3 36.6
2.5 16.8 10.3
Across occupational groups, the most prevalent chronic degenerative disease was COPD, except among truck drivers who reported a greater prevalence of musculo-skeletal disease. Table 2 displays the prevalence among occupational groups stratified by age categories. Disease prevalence was significantly higher in the older age group, except for cardiovascular disease in drivers and musculo-skeletal disease in porters, where the increased prevalence was not statistically significant. The prevalence of COPD and lumbar spondylopathy was significantly lower among white-collar workers than among the other groups. Cardiovascular disease was not significantly lower among white-collars than among porters, but was significantly lower compared to blue-collar workers and drivers. Comparing older workers only, the differences between white-collar workers and any other category were significant for all pathologies. In order to evaluate the effects of lifestyle, non-occupational risk factors were also taken into account, i.e. hypercholesterolemia, hypertension, smoking habit and obesity (BMI N 29.9) for cardiovascular diseases, smoking habit for respiratory diseases, and obesity for musculo-skeletal diseases. Significant differences in the prevalence of myocardial infarction were found between white-collar workers and truck drivers independently of the risk factors (respectively, p b 0.05, p b 0.01). When age was considered, a significant difference in prevalence of myocardial infarction was found only in younger age groups without individual risk factors. Smoking was a risk factor for respiratory disease. Significant differences in prevalence of COPD were found between smokers and non-smokers among white-collar workers, blue-collar workers, and drivers ( p b 0.05). The prevalence of musculo-skeletal disease was significantly higher only in obese white-collar workers. When age was considered, there was a significant difference between younger and older individuals only in white and blue-collar workers, whereas a weaker significance was found only in obese porters; no significant
Table 2 Prevalence of chronic degenerative disease in work activities by age groups
CVS Resp. M.Sk.
White collars
Blue collars
Porters
V 45
N 45
V 45
N 45
V 45
N 45
Drivers V 45
N 45
Others V 45
N 45
0.2 2.3 1.8
2.3 9.1 8.6
0.4 15.8 12.5
4.8 25.1 21.5
0.6 28.5 20.1
5.7 47.7 35.3
2.1 15.6 28.1
6.9 35.3 40.4
0 11.2 8.3
5.6 23.6 12.8
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U. Carbone et al. / International Congress Series 1280 (2005) 161–165
difference was found in truck drivers. This finding confirms that jobs with occupational risk factors, such as being a porter or driving a truck, may be strongly associated with an increased prevalence of musculo-skeletal diseases. 4. Discussion The present study analyses a wide sample of male workers engaged in different occupations, to detect a possible influence of the type of activity on the development of chronic degenerative diseases. Some limitations of our study have to be taken into account in the evaluation of the results. Firstly, the number of participants in the subgroups of occupations is not homogeneous, which reduces the statistical power of the analysis. Another important limitation is the cross sectional study design, which prevents us from drawing any conclusion about cause–effect relationship. The strong differences in the prevalence of chronic degenerative diseases among the different groups of workers are one of the main outputs of the study. While similar values have been found in white-collar workers compared to the general Italian population [18], the higher differences among porters and truck drivers could be considered a non-specific indicator of the pathogenicity of these occupations. The lack of any age effect on the prevalence of ischemic heart diseases in truck drivers and the prevalence of lumbar diseases in porters seems to suggest that the specificity of occupation has an important role in the premature development of damage. As a matter of fact, we found a large number of cases already in younger groups. The influence of truck driving on ischemic heart diseases is demonstrated by the higher prevalence of these pathologies in drivers than in white-collar workers, irrespectively of the presence of any individual risk. The differences between drivers and white-collar workers without individual risks and in younger ages are much more significant. Therefore in drivers, a considerable number of cases of ischemic heart diseases is present also without the well-known risk factors for cardiovascular diseases. This result could be influenced by some occupational risks. The prevalence of respiratory diseases is significantly higher among blue collars, porters and drivers than white-collar workers. This finding suggests that specific occupational risks (i.e. dusts, welding smog, chemical vapors, cold and damp) have an important role in the development of respiratory diseases. As expected, the smoking habit influences these pathologies among white collars, but its role in bluecollar workers and drivers is not at all negligible. The lack of influences of BMI on the prevalence of musculo-skeletal pathologies in drivers and porters could suggest a predominant role of occupational risk factors. We might speculate that in both activities there are some occupational risk factors that may have greater influence then individual variables such as age and BMI. In conclusion, our findings, if confirmed by other longitudinal studies, could suggest that occupations like driving trucks and being a porter increase the prevalence of the chronic degenerative diseases already at younger ages, and could accelerate the aging processes. This should be taken into account in assessing working ability and in deciding welfare expense control plans.
U. Carbone et al. / International Congress Series 1280 (2005) 161–165
165
References [1] L. Bordini, et al., The epidemiology of musculoskeletal changes due to biomechanical overload of the spine in the manual lifting of patients, Med. Lav. 90 (2) (1999) 103 – 116. [2] W.M. Keyserling, Workplace risk factors and occupational musculoskeletal disorders: Part 1. A review of biomechanical and psychophysical research on risk factors associated with low-back pain, AIHAJ 61 (1) (2000) 39 – 50. [3] M.C. Battie, et al., Occupational driving and lumbar disc degeneration: a case-control study, Lancet 360 (9343) (2002) 1369 – 1374. [4] K. Luoma, et al., Lumbar disc degeneration in relation to occupation, Scand. J. Work, Environ. & Health 24 (5) (1998) 358 – 366. [5] T. Videman, M.C. Battie, The influence of occupation on lumbar degeneration, Spine 24 (11) (1999) 1164 – 1168. [6] A. Kostrzewa, et al., Air pollution and cardiovascular toxicity: known risks, Ann. Cardiol. Angeiol. 53 (2) (2004) 71 – 78. [7] G. Costa, Cardiopathy and stress-inducing factors, Med. Lav. 95 (2) (2004) 133 – 139. [8] G. Muzi, et al., Evaluation of the effects of occupational noxae on the cardiovascular system, Med. Lav. 95 (2) (2004) 145 – 157. [9] G. Costa, The problem: shiftwork, Chronobiol. Int. 14 (2) (1997) 89 – 98. [10] R.G. Bursey, A cardiovascular study of shift workers with respect to coronary artery disease risk factor prevalence, J. Soc. Occup. Med. 40 (2) (1990) 65 – 67. [11] P.D. Blanc, et al., The association between occupational factors and adverse health outcomes in chronic obstructive pulmonary disease, Occup. Environ. Med. 61 (8) (2004) 661 – 667. [12] G. Viegi, et al., Respiratory effects of occupational exposure in a general population sample in north Italy, Am. Rev. Respir. Dis. 143 (3) (1991) 510 – 515. [13] M.D. Lebowitz, Epidemiological studies of the respiratory effects of air pollution, Eur. Respir. J. 9 (5) (1996) 1029 – 1054. [14] P. Avino, et al., Influence of air pollution on chronic obstructive respiratory diseases: comparison between city (Rome) and hillcountry environments and climates, Ann. Chim. 94 (9–10) (2004) 629 – 635. [15] P.S. Burge, Sick building syndrome, Occup. Environ. Med. 61 (2) (2004) 185 – 190. [16] G. Mastrangelo, et al., Ascertaining the risk of chronic obstructive pulmonary disease in relation to occupation using a case-control design, Occup. Med. (Lond.) 53 (3) (2003) 165 – 172. [17] J. He, P.K. Whelton, Passive cigarette smoking increases risk of coronary heart disease in work place, Eur. Heart J. 20 (24) (1999) 1764 – 1765. [18] ISTAT, National Statistical Yearbook, 2001.
www.ics-elsevier.com
Occupational categories and chronic degenerative diseases in elderly workers U. CarboneT, E. Della Valle, B. Boggia, G. Mancusi, S. Stranges, V. Pizzorusso, E. Farinaro Department of Preventive Medical Sciences, Unit of Occupational Medicine, bFederico II Q University of Naples, Italy
Abstract. The current delay in retirement age and the changing job opportunities have led to a progressive aging of the working population with a subsequent increase in work related and chronic degenerative diseases. To assess the relationship between occupational categories and chronic degenerative diseases, the prevalence of respiratory, cardiovascular and musculo-skeletal diseases was evaluated in a sample of 7199 male workers. The results indicate that compared to the general population there is a greater prevalence of chronic degenerative diseases among blue-collar workers, porters, and drivers while the prevalence in white-collar workers was not different. The higher prevalence of chronic degenerative diseases in drivers, porters and in blue-collar workers, already at younger ages, suggests that these occupations are wearing jobs and could accelerate the aging process. This should be taken into account in assessing working ability and in defining programs focused on control of welfare expenses. D 2005 Elsevier B.V. All rights reserved. Keywords: Aging; Chronic degenerative disease; Occupational category
1. Introduction Recent advances in Occupational Medicine have contributed to the development of broader evaluation criteria for work-related diseases.
T Corresponding author. Dipartimento di Scienze Mediche Preventive, Sezione di Medicina del Lavoro, Policlinico Federico II, Edificio 13, Via Sergio Pansini 5, 80131, Napoli, Italy. Tel.: +39 817462049; fax: +39 817462124. E-mail address: [email protected] (U. Carbone). 0531-5131/ D 2005 Elsevier B.V. All rights reserved. doi:10.1016/j.ics.2005.02.091
162
U. Carbone et al. / International Congress Series 1280 (2005) 161–165
Research utilizing these more sophisticated criteria has demonstrated relationships between chronic diseases, working conditions and associated risk factors. For example, there is evidence indicating that biomechanical column overload, inadequate posture, and whole body vibration predispose to lower-back injuries and related disorders [1,2]. In addition, stressful occupations, such as truck driving or manual weight handling, can affect the integrity of intervertebral discs [3–5] and may be associated with the development of cardiovascular diseases [6–10]. As to respiratory conditions, particularly chronic obstructive pulmonary disease (COPD), many specific risks may be involved [11,12], together with environmental conditions [13,14]. Recently low dose pollution, smoking habits and passive smoking have been confirmed as specific risk factors [15–17]. The delayed retirement age and the progressive aging of the active population have increased the prevalence of chronic degenerative diseases among workers, generating social conflicts and raising welfare expenses. The aim of the present study was to evaluate the interaction between health and occupation among different categories and detect a possible influence on the onset and progression of chronic degenerative diseases. 2. Material and methods The prevalence of respiratory, cardiovascular and musculo-skeletal diseases was evaluated analyzing the health surveillance data collected between 1998 and 2002 in a sample of 7199 male workers of the Campania Region. The distribution of the study population comprised 53.9% white-collar workers, 30% blue-collar workers, 3.7% porters and cleaners, 4.4% truck drivers, 7.7% other categories (technicians, craftsmen, teachers, policemen, sailors, nurses). Health status was assessed by medical history, physical and laboratory or instrumental examinations. The chronic respiratory diseases considered were: COPD defined by positive medical history and diagnostic spirometry; cardiovascular disease—specifically myocardial infarction, defined by a positive medical history and diagnostic electrocardiogram; musculo-skeletal diseases—specifically lumbar spondylopathy, defined by history of back pain in the previous year and partially impaired movement at the dynamic examination. Statistical analysis was performed using SPSS 10.0. Differences between occupational groups were analyzed by the Chi-square test. Significance was set at p b 0.05. Given its heterogeneity, the data from the bothersQ was not included in the calculations. The effects of non-occupational variables (i.e. age, smoking habit, BMI, serum cholesterol levels) were also evaluated dividing the sample into two subsets for each variable (age: V 45/N 45 years; smoke: no/yes-ex; BMI b 25/N 29.9, serum cholesterol levels V 220/N 220 mg/dl). 3. Results The overall prevalence of heart disease was 2%, respiratory diseases 13.4%, and musculo-skeletal diseases 11.5%. Table 1 displays the prevalence rates stratified by activity.
U. Carbone et al. / International Congress Series 1280 (2005) 161–165
163
Table 1 Chronic degenerative disease prevalence in different work activities Cardiovascular Respiratory Musculo-skeletal
White collars
Blue collars
Porters
Drivers
Others
1.4 6.2 5.6
2.6 20.4 17
2.2 34.8 23.6
5.4 29.3 36.6
2.5 16.8 10.3
Across occupational groups, the most prevalent chronic degenerative disease was COPD, except among truck drivers who reported a greater prevalence of musculo-skeletal disease. Table 2 displays the prevalence among occupational groups stratified by age categories. Disease prevalence was significantly higher in the older age group, except for cardiovascular disease in drivers and musculo-skeletal disease in porters, where the increased prevalence was not statistically significant. The prevalence of COPD and lumbar spondylopathy was significantly lower among white-collar workers than among the other groups. Cardiovascular disease was not significantly lower among white-collars than among porters, but was significantly lower compared to blue-collar workers and drivers. Comparing older workers only, the differences between white-collar workers and any other category were significant for all pathologies. In order to evaluate the effects of lifestyle, non-occupational risk factors were also taken into account, i.e. hypercholesterolemia, hypertension, smoking habit and obesity (BMI N 29.9) for cardiovascular diseases, smoking habit for respiratory diseases, and obesity for musculo-skeletal diseases. Significant differences in the prevalence of myocardial infarction were found between white-collar workers and truck drivers independently of the risk factors (respectively, p b 0.05, p b 0.01). When age was considered, a significant difference in prevalence of myocardial infarction was found only in younger age groups without individual risk factors. Smoking was a risk factor for respiratory disease. Significant differences in prevalence of COPD were found between smokers and non-smokers among white-collar workers, blue-collar workers, and drivers ( p b 0.05). The prevalence of musculo-skeletal disease was significantly higher only in obese white-collar workers. When age was considered, there was a significant difference between younger and older individuals only in white and blue-collar workers, whereas a weaker significance was found only in obese porters; no significant
Table 2 Prevalence of chronic degenerative disease in work activities by age groups
CVS Resp. M.Sk.
White collars
Blue collars
Porters
V 45
N 45
V 45
N 45
V 45
N 45
Drivers V 45
N 45
Others V 45
N 45
0.2 2.3 1.8
2.3 9.1 8.6
0.4 15.8 12.5
4.8 25.1 21.5
0.6 28.5 20.1
5.7 47.7 35.3
2.1 15.6 28.1
6.9 35.3 40.4
0 11.2 8.3
5.6 23.6 12.8
164
U. Carbone et al. / International Congress Series 1280 (2005) 161–165
difference was found in truck drivers. This finding confirms that jobs with occupational risk factors, such as being a porter or driving a truck, may be strongly associated with an increased prevalence of musculo-skeletal diseases. 4. Discussion The present study analyses a wide sample of male workers engaged in different occupations, to detect a possible influence of the type of activity on the development of chronic degenerative diseases. Some limitations of our study have to be taken into account in the evaluation of the results. Firstly, the number of participants in the subgroups of occupations is not homogeneous, which reduces the statistical power of the analysis. Another important limitation is the cross sectional study design, which prevents us from drawing any conclusion about cause–effect relationship. The strong differences in the prevalence of chronic degenerative diseases among the different groups of workers are one of the main outputs of the study. While similar values have been found in white-collar workers compared to the general Italian population [18], the higher differences among porters and truck drivers could be considered a non-specific indicator of the pathogenicity of these occupations. The lack of any age effect on the prevalence of ischemic heart diseases in truck drivers and the prevalence of lumbar diseases in porters seems to suggest that the specificity of occupation has an important role in the premature development of damage. As a matter of fact, we found a large number of cases already in younger groups. The influence of truck driving on ischemic heart diseases is demonstrated by the higher prevalence of these pathologies in drivers than in white-collar workers, irrespectively of the presence of any individual risk. The differences between drivers and white-collar workers without individual risks and in younger ages are much more significant. Therefore in drivers, a considerable number of cases of ischemic heart diseases is present also without the well-known risk factors for cardiovascular diseases. This result could be influenced by some occupational risks. The prevalence of respiratory diseases is significantly higher among blue collars, porters and drivers than white-collar workers. This finding suggests that specific occupational risks (i.e. dusts, welding smog, chemical vapors, cold and damp) have an important role in the development of respiratory diseases. As expected, the smoking habit influences these pathologies among white collars, but its role in bluecollar workers and drivers is not at all negligible. The lack of influences of BMI on the prevalence of musculo-skeletal pathologies in drivers and porters could suggest a predominant role of occupational risk factors. We might speculate that in both activities there are some occupational risk factors that may have greater influence then individual variables such as age and BMI. In conclusion, our findings, if confirmed by other longitudinal studies, could suggest that occupations like driving trucks and being a porter increase the prevalence of the chronic degenerative diseases already at younger ages, and could accelerate the aging processes. This should be taken into account in assessing working ability and in deciding welfare expense control plans.
U. Carbone et al. / International Congress Series 1280 (2005) 161–165
165
References [1] L. Bordini, et al., The epidemiology of musculoskeletal changes due to biomechanical overload of the spine in the manual lifting of patients, Med. Lav. 90 (2) (1999) 103 – 116. [2] W.M. Keyserling, Workplace risk factors and occupational musculoskeletal disorders: Part 1. A review of biomechanical and psychophysical research on risk factors associated with low-back pain, AIHAJ 61 (1) (2000) 39 – 50. [3] M.C. Battie, et al., Occupational driving and lumbar disc degeneration: a case-control study, Lancet 360 (9343) (2002) 1369 – 1374. [4] K. Luoma, et al., Lumbar disc degeneration in relation to occupation, Scand. J. Work, Environ. & Health 24 (5) (1998) 358 – 366. [5] T. Videman, M.C. Battie, The influence of occupation on lumbar degeneration, Spine 24 (11) (1999) 1164 – 1168. [6] A. Kostrzewa, et al., Air pollution and cardiovascular toxicity: known risks, Ann. Cardiol. Angeiol. 53 (2) (2004) 71 – 78. [7] G. Costa, Cardiopathy and stress-inducing factors, Med. Lav. 95 (2) (2004) 133 – 139. [8] G. Muzi, et al., Evaluation of the effects of occupational noxae on the cardiovascular system, Med. Lav. 95 (2) (2004) 145 – 157. [9] G. Costa, The problem: shiftwork, Chronobiol. Int. 14 (2) (1997) 89 – 98. [10] R.G. Bursey, A cardiovascular study of shift workers with respect to coronary artery disease risk factor prevalence, J. Soc. Occup. Med. 40 (2) (1990) 65 – 67. [11] P.D. Blanc, et al., The association between occupational factors and adverse health outcomes in chronic obstructive pulmonary disease, Occup. Environ. Med. 61 (8) (2004) 661 – 667. [12] G. Viegi, et al., Respiratory effects of occupational exposure in a general population sample in north Italy, Am. Rev. Respir. Dis. 143 (3) (1991) 510 – 515. [13] M.D. Lebowitz, Epidemiological studies of the respiratory effects of air pollution, Eur. Respir. J. 9 (5) (1996) 1029 – 1054. [14] P. Avino, et al., Influence of air pollution on chronic obstructive respiratory diseases: comparison between city (Rome) and hillcountry environments and climates, Ann. Chim. 94 (9–10) (2004) 629 – 635. [15] P.S. Burge, Sick building syndrome, Occup. Environ. Med. 61 (2) (2004) 185 – 190. [16] G. Mastrangelo, et al., Ascertaining the risk of chronic obstructive pulmonary disease in relation to occupation using a case-control design, Occup. Med. (Lond.) 53 (3) (2003) 165 – 172. [17] J. He, P.K. Whelton, Passive cigarette smoking increases risk of coronary heart disease in work place, Eur. Heart J. 20 (24) (1999) 1764 – 1765. [18] ISTAT, National Statistical Yearbook, 2001.