Identification of Occupations Susceptible to High Exposure and Risk Associated With Multiple Toxicants: National Health and Nutrition Examination Survey 1999-2014

Abstract

Background: According to the World Health Organization, occupational exposures to hazardous chemicals are estimated to cause over 370,000 premature annual deaths. The risks due to multiple workplace chemical exposures, and those occupations most susceptible to the resulting health effects, remain poorly characterized. The aim of this study is to identify occupations with elevated toxicant biomarker concentrations and increased health risk associated with exposure to combinations of toxicants in a working US population from diverse categories of occupation. Methods: For this observational study of 51,008 participants, we used data from the 1999-2014 National Health and Nutrition Examination Survey. We characterized differences in chemical exposures by occupational group for 129 chemicals by applying a series of generalized linear models with the outcome as biomarker concentrations and the main predictor as the occupational groups, adjusting for age, sex, race/ethnicity, poverty income ratio, study period, and biomarker of tobacco use. We identified groups of occupations with similar chemical exposure profiles via hierarchical clustering. For each occupational group, we calculated percentages of participants with chemical biomarker levels exceeding acceptable health-based guidelines. Findings: Blue collar workers from “Construction”, “Other Services”, “Professional, Scientific, Technical Services”, “Real Estate, Rental, Leasing”, “Manufacturing”, and “Wholesale Trade” along with several unemployed groups have higher biomarker levels of toxic chemicals such as lead, cadmium, arsenic, mercury, acrylamide, glycideamide, xylenes, 1,4-dichlorobenzene, tetrachloroethane, methyl tert-butyl ether, and benzene compared to their white-collar counterparts. For these toxicants, 1-58% of blue collar workers from these industries have chemical biomarker concentrations exceeding acceptable levels. Interpretation: Blue collar workers and several unemployed groups have toxicant levels higher relative to their white-collar counterparts, often exceeding acceptable levels associated with noncancer effects. Our findings identify multiple occupations to prioritize for targeted interventions and health policies to monitor and reduce high toxicant exposures in susceptible individuals. Funding Information: Ravitz Family Foundation, University of Michigan Forbes Institute for Cancer Discovery, Harvard Data Science Initiative, University of Michigan Center for Occupational Health and Safety Engineering, and National Institutes of Health (R01 ES028802, P30 ES017885, P30 CA046592, UG3 CA267907). Declaration of Interests: Drs. Nguyen, Colacino, Sartor, and Jolliet has nothing to disclose. At the time of the writing of the manuscript, Dr. Patel was a consultant and shareholder of XY.health. Dr. Patel is also paid by J&J.