Association between spirometry results and ILO abnormalities in a cohort of former nuclear weapons workers

Nuclear weapons industry workers are recognized as being at risk for a variety of exposures, including various radionuclides, beryllium, asbestos, high explosives and barium, all of which have been implicated in the pathogenesis of occupational lung disease. Limited epidemiological data is available on the association between pulmonary physiology and radiologic evidence of occupational lung disease in this population. Former DoE nuclear weapons workers from a nuclear weapons assembly site received spirometry and chest x-ray as part of the DOE Former Worker Medical Screening Program. Of the 757 screened workers, we found 45 (5.9%) with parenchymal abnormalities defined as ILO small opacities median profusion score =>1/0. We found 37 (4.9%) workers with isolated pleural and 19 (2.5%) with coincident parenchymal and pleural abnormalities. No statistically significant association was found between ILO abnormalities and exposures under study but in logistic regression models controlling for age,sex,race and smoking, isolated pleural abnormalities were statistically significantly associated (p<0.05) with abnormal spirometry defined based on NHANES III lower limit of normal (LLN) values. Workers with pleural abnormalities had over six-fold statistically significant increase in odds of testing below 60% of FVC%predicted, when compared to those with normal spirometry results. Coincident parenchymal and pleural abnormalities were also associated with abnormal spirometry results (p=0.05) and had a six-fold increase in odds of testing below 60% FVC%predicted. These results confirm the association of spirometric abnormality with ILO readings consistent with pneumoconiosis in medical screening programs of nuclear weapons workers