Occupation, socioeconomic status and chronic obstructive respiratory diseases - The EpiLung study in Finland, Estonia and Sweden

Juuso Jalasto, Paul Lassmann-Klee, Christian Schyllert, Ritva Luukkonen, Mari Meren, Matz Larsson, Jaak Põlluste, Britt-Marie Sundblad, Ari Lindqvist, Steinar Krokstad, Hannu Kankaanranta, Paula Kauppi, Anssi Sovijärvi, Tari Markku Kallevi Haahtela, Helena Backman, Bo Lundbäck, Päivi Piirilä

Research output: Contribution to journalArticleScientificpeer-review


Objective: To study occupational groups and occupational exposure in association with chronic obstructive respiratory diseases. Methods: In early 2000s, structured interviews on chronic respiratory diseases and measurements of lung function as well as fractional expiratory nitric oxide (FENO) were performed in adult random population samples of Finland, Sweden and Estonia. Occupations were categorized according to three classification systems. Occupational exposure to vapours, gases, dusts and fumes (VGDF) was assessed by a Job-Exposure Matrix (JEM). The data from the countries were combined. Results: COPD, smoking and occupational exposure were most common in Estonia, while asthma and occupations requiring higher educational levels in Sweden and Finland. In an adjusted regression model, non-manual workers had a three-fold risk for physician-diagnosed asthma (OR 3.18, 95%CI 1.07-9.47) compared to professionals and executives, and the risk was two-fold for healthcare & social workers (OR 2.28, 95%CI 1.14-4.59) compared to administration and sales. An increased risk for physician-diagnosed COPD was seen in manual workers, regardless of classification system, but in contrast to asthma, the risk was mostly explained by smoking and less by occupational exposure to VGDF. For FENO, no associations with occupation were observed. Conclusions: In this multicenter study from Finland, Sweden and Estonia, COPD was consistently associated with manual occupations with high smoking prevalence, highlighting the need to control for tobacco smoking in studies on occupational associations. In contrast, asthma tended to associate with non-manual occupations requiring higher educational levels. The occupational associations with asthma were not driven by eosinophilic inflammation presented by increased FENO. Keywords: Asthma; COPD; Fraction of exhaled nitric oxide (FENO); Occupational exposure; Smoking; Socioeconomic status.
Original languageEnglish
Article number106403
JournalRespiratory Medicine
Number of pages8
Publication statusPublished - Jan 2022
MoE publication typeA1 Journal article-refereed

Fields of Science

  • 3121 General medicine, internal medicine and other clinical medicine
  • Asthma
  • COPD
  • Fraction of exhaled nitric oxide (FENO)
  • Occupational exposure
  • Smoking
  • Socioeconomic status

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