Chronic Obstructive Pulmonary Disease Prevalence Among Adults Who Have Never Smoked, by Industry and Occupation — United States, 2013–2017

Girija Syamlal, MBBS; Brent Doney, PhD; Jacek M. Mazurek, MD

Disclosures

Morbidity and Mortality Weekly Report. 2019;68(13):303-307. 

In This Article

Abstract and Introduction

Introduction

Tobacco smoking is a major risk factor for chronic obstructive pulmonary disease (COPD), a debilitating respiratory condition with high mortality and morbidity.[1,2] However, an estimated 24% of adults with COPD have never smoked.[3,4] Among these persons, 26%–53% of COPD can be attributed to workplace exposures, including dust, fumes, gases, vapors, and secondhand smoke exposure.[4–6] To assess industry-specific and occupation-specific COPD prevalence among adults aged ≥18 years who have never smoked and who were employed any time during the past 12 months, CDC analyzed 2013–2017 National Health Interview Survey (NHIS) data. Among an estimated 106 million workers who had never smoked, 2.2% (2.4 million) have COPD. Highest prevalences were among workers aged ≥65 years (4.6%), women (3.0%), and those reporting fair/poor health (6.7%). Among industries and occupations, the highest COPD prevalences were among workers in the information industry (3.3%) and office and administrative support occupations (3.3%). Among women, the highest prevalences were among those employed in the information industry (5.1%) and in the transportation and material moving occupation (4.5%), and among men, among those employed in the agriculture, forestry, fishing, and hunting industry (2.3%) and the administrative and support, waste management, and remediation services industry (2.3%). High COPD prevalences in certain industries and occupations among persons who have never smoked underscore the importance of continued surveillance, early identification of COPD, and reduction or elimination of COPD-associated risk factors, such as the reduction of workplace exposures to dust, vapors, fumes, chemicals, and exposure to indoor and outdoor air pollutants.

NHIS data are collected annually from a nationally representative sample of the civilian noninstitutionalized U.S. population through a personal interview. To improve the precision and reliability of estimates, data collected during 2013–2017 were combined. Survey response rates ranged from 61.2% in 2013 to 53.0% in 2017.* Respondents were considered to be employed if they were "working for pay at a job or business," or "with a job or business but not at work," or "working, but not for pay, at a family-owned job or business" any time during the 12 months preceding the interview. Information on participants' current industry and occupation was categorized into 21 industry groups and 23 occupation groups.Participants with COPD were identified by a positive response to any of the following three questions: 1) "Have you ever been told by a doctor or other health professional that you had chronic obstructive pulmonary disease, also called COPD?"; 2) "Have you ever been told by a doctor or other health professional that you had emphysema?"; or 3) "During the past 12 months, have you been told by a doctor or other health professional that you had chronic bronchitis?" Persons were considered to have never smoked if they had never smoked or smoked <100 cigarettes during their lifetime. Persons were considered to have ever smoked if they had smoked >100 cigarettes during their lifetime and includes both current cigarette smokers and former cigarette smokers. Respondent self-reported health status at the time of interview and the number of physician office visits, emergency department (ED) visits, and lost work days in the past 12 months resulting from any illness or injury were assessed.§

Data were analyzed using SAS (version 9.4; SAS Institute) and were adjusted for nonresponse and weighted to be nationally representative, and variance estimates were calculated to account for the clustered survey design. The proportions of workers who reported emphysema, chronic bronchitis, and COPD diagnosis were assessed separately among those who never smoked and those who ever smoked. Prevalence estimates with relative standard error (standard error of the estimate divided by the estimate) ≥30% were not reported. Participants with unknown or missing information for COPD were excluded from the analysis. Two-sided t-tests were used to determine statistically significant (p<0.05) differences between point estimates.

During 2013–2017, among an estimated 164 million U.S. adults aged ≥18 years who were working any time during the 12 months preceding the interview, COPD prevalences were 6.0% (3.4 million) among those who ever smoked and 2.2% (2.4 million) among those who never smoked. The proportions of workers who reported an emphysema, chronic bronchitis, or COPD diagnosis were 1.1%, 3.8%, 2.5%, respectively for those who ever smoked (35% of workers), and 0.1%, 1.9%, and 0.4%, respectively for those who never smoked (65% of workers).

Among workers who never smoked, the highest COPD prevalences were among women (3.0%), adults aged ≥65 years (4.6%), and those reporting fair/poor health (6.7%), more than three physician office visits in past 12 months (4.2%), more than three ED visits in past 12 months (10.3%), and >7 days of work lost because of any illness or injury (6.6%). By sex, race, and ethnicity, COPD prevalences were highest among non-Hispanic white men (1.7%) and non-Hispanic black women (3.7%) (Table 1). Among persons who never smoked, those with COPD missed an average of 14.9 work days (15.6 days for women and 13.6 days for men) because of any illness or injury compared with persons who did not have COPD, who missed an average of 5.4 work days (6.4 days for women and 4.4 days for men).

Among workers who never smoked, COPD prevalences exceeded 3.0% among those in the information (3.3%) and mining (3.1%) industries and in the office and administrative support occupation (3.3%) (Table 2). Sex differences in COPD prevalence were observed by industry and occupation. Among men, the highest COPD prevalences were among those employed in agriculture, forestry, fishing, and hunting (2.3%), the administrative and support, waste management, and remediation services (2.3%), the arts, entertainment, and recreation (2.3%) industries, and protective services occupation (2.3%); among women, the highest prevalences were among those employed in the information industry (5.1%) and transportation and material moving occupation (4.5%).

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