ADVANCEMENT OF THE SCIENCE
Open Access
The Impact of Aging on Occupational Lung Disease
ease, diabetes mellitus, osteoporosis, muscle weakness) that put older adults in a unique situation regarding disease outcomes (Chatila et al., 2008). As more older adults remain in the workforce longer, they have an increased chance of occupational exposure, with result- ing potential adverse health outcomes (De Matteis et al., 2017). A majority of occupa- tional lung diseases have lung fibrosis as a clinical outcome, and aged lung tissue aug- ments the profibrotic response to injury by increasing the recruitment of circulating plu- ripotent mesenchymal progenitor cells called fibrocytes. Age-associated changes in the com- position and function of lung epithelial cells increase the susceptibility to the development and progression of lung disease (Cho & Stout- Delgado, 2020), adding evidence that suggests age plays a role in the severity and outcome of occupational lung diseases. In support of the influence of age on occupational lung diseases, data from The Work-Related Lung Disease Surveillance Report by the National Institute for Occu- pational Health and Safety (NIOSH, 2008) indicated that the number of deaths from major occupational lung diseases is highest in individuals 75–84 years, then individuals 65–74 years, closely followed by individu- als ≥85 years for 1995–2004 and 2005–2014 (NIOSH, n.d., 2008; Table 1; Figure 1). Fur- thermore, the report showed that the num- ber of deaths from work-related respiratory diseases is highest with all pneumoconiosis and related exposure, followed in order by asbestosis and related exposure, malignant mesothelioma, coal workers’ pneumoco- niosis and related exposure, and silicosis and related exposure (NIOSH, n.d., 2008; Table 1; Figures 2 and 3). These occupa- tional lung diseases have long latency peri- ods in common, and therefore the diseases Alexander C. Ufelle, MBBS, MPH, PhD Department of Public Health Sciences, Slippery Rock University Adelle Williams, MBA, PhD Department of Public Health Sciences, Slippery Rock University Angela Mattis Bernardo, PhD Department of Safety Management, Slippery Rock University
b:;r)+; The majority of occupational lung diseases have long latency periods, with disease manifesting at an older age. We conducted an extensive literature review and analyzed data for age-related mortality, the impact of age on the lungs and occupational lung diseases, changes in the workforce, and considerations for surveillance to maintain a healthy workforce. Age is a major factor in occupational lung diseases, which in turn predisposes older adults to other health conditions and reduces their quality of life and life expectancy. More specifically, age-related changes in the lungs increase the susceptibility to environmental exposure-induced lung injuries and are linked to poor prognosis. Data from the Work-Related Lung Disease Surveillance Report published by the National Institute for Occupational Safety and Health (NIOSH, 2008) indicated that death from occupational lung diseases among U.S. residents peaked in the age group 75–84 years. Interestingly, the age group 65–74 years recorded a substantial number of deaths, second to the age group 75–84 years. This trend represents a shift in U.S. mortality for all diseases, which peaks at ≥85 years. Improved surveillance and early detection will be instrumental in reducing the burden of occupational lung injury in older adults, many of whom are staying in the workforce longer. Keywords: aging, latency period, mortality, occupational lung disease, surveillance
I ntroduction Advanced age is the major risk factor for death for all age-related adult chronic diseases (Schneider et al., 2021) and for developing chronic lung conditions such as chronic obstructive pulmonary disease (COPD) and lung cancer. Changes that occur in the respiratory system during aging show a striking resemblance to the pathophysiologi- cal changes that occur in younger patients who have been a ected by lung parenchy- mal disease (Mercado et al., 2015). Although exposure to environmental hazards promotes
the development of chronic pulmonary con- ditions, it is unclear why it takes several decades for the disease to manifest and if age- related cellular changes underlie and poten- tiate these disease phenotypes. Occupational lung diseases have been shown to have severe disease outcomes in patients infected with COVID-19 (Lohia et al., 2021), highlighting the challenges, including the e ects of age, faced by these individuals years after leaving the workforce. Occupational lung diseases such as COPD have comorbidities (e.g., coronary artery dis-
16
Volume 87 • Number 3
Powered by FlippingBook