Table 11.
Studies Used to Calculate the Occupational Population Attributable Fraction and Attributable Fraction in Community-acquired Pneumonia
| First Author, Year, Location (Reference) | Type of Study | Population/Cases/Control Subjects | Pneumonia Type/Definition | Exposure Information | PAF or AF (%)* |
|---|---|---|---|---|---|
| Occupational PAF of pneumonia | |||||
| Farr, 2000, UK (227) | Case–control | 175 cases from British Thoracic Society study of patients with community-acquired pneumonia; 385 control subjects | Acute respiratory infiltrate; Mycoplasma excluded; 70% with streptococcal pneumonia confirmation | Self-reported dusty occupation (OR, 1.71) | 16 |
| Palmer, 2003, UK (228) | Case–control | 525 cases, 1,222 referents aged 20–64 yr; 158 lobar; 142 segmental; 225 bronchopneumonia | New/worse respiratory infection, new chest radiograph opacity, hospital admission | Self-reported metal fumes in prior year; OR, 1.6, all; OR, 1.8, lobar pneumonia | 3, 4 |
| Neupane, 2010, Canada (230) | Case–control | 365 cases of pneumonia; 494 control subjects | Admission to hospital for pneumonia, temperature >38°C, new opacity | Self-reported exposure to VGDF (OR, 5.78) | 45 |
| Almirall, 2015, Spain (229) | Case–control | 1,336 cases of pneumonia; 1,326 control subjects | Acute respiratory illness, new radiographic findings, antibiotics | Self-reported exposure to dust (OR, 1.7) | 3 |
| Occupational AF of pneumonia in specific cohorts | |||||
| Beaumont, 1980, USA (235) | Cohort mortality | 8,679 metal trades union; 3,247 welders | All pneumonia | Job classification based on union records | 41 |
| Newhouse, 1985, UK (236) | Cohort mortality | 1,027 welders at a shipyard | All pneumonia | Personnel records from shipyard: job title, tasks; SMR for pneumonia, 269 | 46 |
| Coggon, 1994, UK (237) | Cohort mortality | Male welders England and Wales, 1979–1980 and 1982–1999; 55 pneumonia deaths | Lobar pneumonia | OPCS; welders PMR, 255 | 62 |
| Graham, 2004, USA (233) | Cohort mortality | 5,408 Vermont granite workers; 2,539 deceased, determined by death certificates | All pneumonia, ICD codes | Employment records SMR, <100 | 0 |
| Veiga, 2006, Brazil (234) | Cohort mortality | 2,856 coal miners | All pneumonia | Employment records SMR for pneumonia in miners, 263 | 62 |
| Palmer, 2009, UK (238) | Population mortality | Occupations with exposure to metal fumes, aged 18–64 yr | Lobar pneumonia, ICD-9 codes | OPCS; welders PMR, 242 (166–342) | 59 |
| Wong, 2010 Canada (239) | Retrospective chart review | 1,768 cases of pneumococcal disease; 863 cases aged 18–65 yr; 18 cases in welders | Invasive pneumococcal disease, positive culture results (blood, CSF, other) | Self-reported current occupation OR for welders, 2.7 | 63 |
| Koh, 2011, Korea (231) | Retrospective cohort | Mineral dust– and metal fume–exposed workers: 365 cases (59 in foundry workers); control group (noise-only exposure), 927 cases | All pneumonia (viral, bacterial, fungal), >1-d hospitalization; SAR for pneumonia | National Health Insurance claims, employer, SIC codes; foundry workers SAR, 1.64 (men) | 38 |
| Torén, 2011, Sweden (232) | Prospective cohort of construction workers | 183,194 construction workers aged 20–64 yr; followed for 32 yr; 145 deaths resulting from pneumonia, 62 deaths resulting from lobar pneumonia | Mortality of all infectious pneumonia, lobar pneumonia, pneumococcal pneumonia; viral and fungal pneumonia excluded; Swedish Cause of Death Register | Self-reported job title, JEM | |
| Relative risk for all and lobar pneumonias | |||||
| Inorganic dusts | |||||
| All pneumonia, 1.87 | 47 | ||||
| Lobar pneumonia, 3.37 | 70 | ||||
| Metal fumes | |||||
| All pneumonia, 2.31 | 57 | ||||
| Lobar pneumonia, 3.67 | 73 |
Definition of abbreviations: AF = attributable fraction; CSF = cerebrospinal fluid; ICD = International Classification of Diseases; JEM = job exposure matrix; OPCS = Office of Population Censuses and Surveys; OR = odds ratio; PAF = population attributable fraction; PMR = proportionate mortality ratio; SAR = standardized admission ratio; SIC = Standard Industrial Classification; SMR = standardized mortality ratio; UK = United Kingdom; USA = United States; VGDF = vapors, gas, dust, or fumes.
The median PAF among four population-based studies (top rows) is 10% (range, 3–45%); the median AF within cohorts is 52.5% (range, 38–73%).
PAF for “Occupational PAF of pneumonia” and AF for “Occupational AF of pneumonia in specific cohorts”.