Respiratory diseases among union carpenters: cohort and case-control analyses.
Lung diseases, defined by ICD-9 diagnoses on medical insurance claims, were studied through the combined use of administrative records, private health insurance, and workers' compensation claims for a cohort of 10,938 active union carpenters between 1989 and 1992. The cohort defined the study base for a nested case-control study, in which cases (n = 220) were initially identified by an ICD-9 code for asthma in private health insurance or workers' compensation files. A questionnaire was used to collect information on respiratory history and potential home and workplace exposures. Questions used by Burney et al. to define a discriminant function predictor (DFP) of a bronchial response to histamine were used to reclassify cases and controls for further exploratory analyses. Bronchitis accounted for over 50% of the lung disease cases among this cohort followed by asthma, chronic obstructive airway disease, and chronic bronchitis. Incidence density rates of asthma, chronic bronchitis, and chronic obstructive airway disease adjusted for age, sex, and time in the union increased with increasing age. Using Surveillance, Epidemiology, and End Results (SEER) Program data to estimate expected lung cancer cases in our cohort, an elevated standardized incidence rate (SIR) was seen among male carpenters between the ages of 45-54. Smoking history was not available for the entire cohort. Using the ICD-9 or Burney case definition of asthma, odds ratios were significantly elevated for exposure to hay, epoxy paints, enzymes, animals, and molds. Additional exposures associated with asthma using Burney's definition, are ones to which a majority of these carpenters were exposed including cement, drywall, and demolition dusts.
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