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A study published in the October issue of Arthritis & Rheumatism
examined the associations between occupation and the risk of dying
from systemic autoimmune diseases and found that occupational
exposures in farming and industry are linked to higher death rates
from these diseases.
Researchers L.S. Gold and A.J. De Roos, of the Fred Hutchinson
Cancer Research Center in Seattle, WA, examined death
certificate data from 26 states from 1984 to 1998. Any cases that
listed a systemic autoimmune disease (for example, rheumatoid
arthritis) as a cause of death, were included, as were disease types
with a suspected systemic autoimmune disease origin (such as
unspecified connective tissue disorder).
Five control subjects matched by age, sex, race, year of death and
geographic region were also selected. The researchers established
each person's longest-held occupation from the "usual occupation"
listed on the death certificate. In addition, they examined specific
exposures based on occupation and industry. These included asbestos,
solvents, benzene, pesticides and other substances. Occupations
involving significant exposure to the public (such as teachers, and
waiters/waitresses) or animals were also tracked.
The results showed that some occupations involving exposure to the
public (such as nurses and teachers) were associated with an
increased risk of dying from a systemic autoimmune disease but this
was not the case with all jobs involving public exposure (for
example food service jobs). Farmers showed increased risk of death
from systemic autoimmune disease, particularly for those who worked
with crops versus livestock. In addition, several industrial
occupations such as mining and textile machine operators, as well as
timber cutting and logging had an increased risk of death from this
group of diseases.
Further analysis showed that the same occupations and exposures were
present in those who were older than the typical retirement age when
they died, "implying that the occupational exposures were involved
in a chronic pathogenic process leading to either disease incidence
or slow progression of existing autoimmunity," according to the
authors. They suggest that the higher risk associated with jobs
involving public contact may be due to exposure to multiple
infectious agents leading to an autoimmune response.
The authors note that autoimmune diseases tend to be underreported
on death certificates, and that the increased risk seen with certain
occupations, such as teachers, may be due to the fact that these
individuals have extensive health benefits even after retirement,
and therefore better access to care. This would also help explain
why other occupations that involve public contact but lower health
insurance coverage, such as waiter/waitress, seemed to have a lower
risk of death from autoimmune disease. However, not all the
occupational associations they found are expected to be affected by
insurance status.
"The size of our study allowed us to estimate associations between
specific occupations and death from autoimmune diseases and to
generate hypotheses that will be useful as starting points for
future studies in this area," the authors conclude. They note that
future studies should focus on obtaining more detailed occupational
histories from the groups found to be at increased risk.
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