Occupational exposure to respirable crystalline silica and incident idiopathic interstitial pneumonias and pulmonary sarcoidosis: a national prospective follow-up study

• Published in: Occupational and environmental medicine (London, England) Vol. 81; no. 6; pp. 279 - 286
• Main Authors: Iversen, Inge Brosbøl, Vestergaard, Jesper Medom, Ohlander, Johan, Peters, Susan, Bendstrup, Elisabeth, Bonde, Jens Peter Ellekilde, Schlünssen, Vivi, Bønløkke, Jakob Hjort, Rasmussen, Finn, Stokholm, Zara Ann, Andersen, Michael Brun, Kromhout, Hans, Kolstad, Henrik Albert
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.06.2024
• Subjects: Adult; Aged; Denmark - epidemiology; Female; Follow-Up Studies; Humans; Idiopathic Interstitial Pneumonias - epidemiology; Idiopathic Interstitial Pneumonias - etiology; Incidence; Lung Diseases, Interstitial; Male; Middle Aged; Occupational Diseases - epidemiology; Occupational Diseases - etiology; Occupational Exposure - adverse effects; Occupational Exposure - statistics & numerical data; Occupational Health; Prospective Studies; Sarcoidosis, Pulmonary - epidemiology; Sarcoidosis, Pulmonary - etiology; Silicon Dioxide - adverse effects; Silicosis; Silicosis - epidemiology; Silicosis - etiology; Workplace; Denmark; Occupational Health; Lung Diseases, Interstitial; Silicosis
• ISSN: 1351-0711; 1470-7926
• DOI: 10.1136/oemed-2023-108964

BackgroundRespirable crystalline silica is a well-known cause of silicosis but may also be associated with other types of interstitial lung disease. We examined the associations between occupational exposure to respirable crystalline silica and the risk of idiopathic interstitial pneumonias, pulmonary sarcoidosis and silicosis.MethodsThe total Danish working population was followed 1977–2015. Annual individual exposure to respirable crystalline silica was estimated using a quantitative job exposure matrix. Cases were identified in the Danish National Patient Register. We conducted adjusted analyses of exposure–response relations between cumulative silica exposure and other exposure metrics and idiopathic interstitial pneumonias, pulmonary sarcoidosis and silicosis.ResultsMean cumulative exposure was 125 µg/m3-years among exposed workers. We observed increasing incidence rate ratios with increasing cumulative silica exposure for idiopathic interstitial pneumonias, pulmonary sarcoidosis and silicosis. For idiopathic interstitial pneumonias and pulmonary sarcoidosis, trends per 50 µg/m3-years were 1.03 (95% CI 1.02 to 1.03) and 1.06 (95% CI 1.04 to 1.07), respectively. For silicosis, we observed the well-known exposure–response relation with a trend per 50 µg/m3-years of 1.20 (95% CI 1.17 to 1.23).ConclusionThis study suggests that silica inhalation may be related to pulmonary sarcoidosis and idiopathic interstitial pneumonias, though these findings may to some extent be explained by diagnostic misclassification. The observed exposure–response relations for silicosis at lower cumulative exposure levels than previously reported need to be corroborated in analyses that address the limitations of this study.