Civilian Work May Impact Veterans’ Lung Health

TOPLINE: Civilian occupational exposure to vapors, gas, dust, or fumes (VGDF) is common among previously deployed veterans, with nearly one-third reporting such exposures. Exposures based on a work-related exposure assessment were associated with > 70% increased odds of chronic bronchitis (CB), while self-reported exposures showed weaker associations.

METHODOLOGY:

• Analysis of data from 1868 veterans (mean [SD] age 37.8 [13.1] years, 89% male) who were previously deployed to Southwest Asia, Afghanistan, Kyrgyzstan, or Djibouti between October 2001 and February 2017.

• Primary outcomes included dyspnea, CB (defined as cough and phlegm for ≥ 3 consecutive months in the last 2 years), and wheeze, assessed using American Thoracic Society and National Health and Nutrition Examination Survey respiratory health questionnaires.

• Multivariate logistic regression models tested associations between VGDF exposure and respiratory outcomes, adjusting for body mass index, sex, age, cigarette smoking, race, education, and military branch.

• Sensitivity analyses examined participants with ≥ 5 years of civilian employment and evaluated combined associations of self-reported and those determined by a job-exposure matrix risk assessment.

TAKEAWAY:

• VGDF exposure determined by the job-exposure matrix risk assessment was associated with increased odds of CB (odds ratio [OR], 1.75; 95% CI, 1.05-2.20), with highly likely VGDF showing stronger association (OR, 1.94; 95% CI, 1.27-2.37).

• Self-reported VGDF exposure demonstrated weaker associations with CB (OR, 1.18; 95% CI, 0.85-1.86) compared to job-exposure matrix risk assessment though the subcategory of combustion byproducts showed increased odds (OR, 1.74; 95% CI, 1.34-3.00).

• Among participants with ≥ 5 years of civilian employment, any job-exposure matrix determined VGDF likelihood was associated with increased odds of CB (OR, 1.72; 95% CI, 1.04-2.49) and wheeze (OR, 1.54; 95% CI, 1.09-2.70).

• Agreement between job-associated and self-reported VGDF exposure was modest (κ, 0.48; 95% CI, 0.44-0.52), with job-exposure matrix job-exposure matrix risk assessment alone demonstrating statistically significant association with CB (OR, 1.77; 95% CI, 1.31-2.68).

IN PRACTICE: “Our findings support the value of using combined methods to assess occupational exposure risk,” the authors wrote. “Relying on a single global measure may obscure specific exposure components resulting in weaker associations.”  

SOURCE:The study was led by Sahra Mohazzab-Hosseinian, PhD, Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Veterans Affairs Puget Sound Health Care System Seattle Division, and Paul D. Blanc, MD, MSPH, San Francisco Veterans Affairs Health Care System. It was published online in American Journal of Industrial Medicine.

LIMITATIONS: Self-reported exposure may be prone to recall bias if participants with respiratory symptoms are more likely to report such exposure. Only those who first reported overall VGDF exposure were asked individual exposure items, potentially leading to underreporting of subcategories and pushing associations toward the null. The job exposure matrix developed for this study, while consistent with earlier applications, did not have certified industrial hygienist validation of assignments. The study focused on civilian occupational VGDF in a cohort that also experienced military inhalational exposures during deployment and nondeployment service, without assessing potential confounding or modifying effects of combined military and civilian occupational exposures. Multiple comparisons were conducted, and reported CIs and statistical significance should be viewed as exploratory with consideration of increased chance of Type I error.

DISCLOSURES: This study received support from the VA Office of Research and Development Cooperative Studies Program (CSP) #595 and Promise to Address Comprehensive Toxics Act Toxic Exposure Funds through the VA Office of Research and Development Military Exposures Research Program. No conflicts of interest were disclosed by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.