Grantee Research Project Results
2000 Progress Report: Interstitial Lung Disease: Moisture, Molds, and Mycotoxins
EPA Grant Number: R825251Title: Interstitial Lung Disease: Moisture, Molds, and Mycotoxins
Investigators: Storey, Eileen , Hodgson, Michael J , Jarvis, Bruce , Yang, Chin , Turner, William
Institution: University of Connecticut , University of Maryland - College Park
EPA Project Officer: Chung, Serena
Project Period: December 2, 1996 through December 1, 1999 (Extended to October 1, 2001)
Project Period Covered by this Report: December 2, 1999 through December 1, 2000
Project Amount: $572,710
RFA: Air Quality (1996) RFA Text | Recipients Lists
Research Category: Air Quality and Air Toxics , Air
Objective:
The grant consists of five related projects. These include a case-control study of ILD, a case-control study of sarcoidosis, an exposure assessment of sources among metalworkers, a study of lung disease among school teachers with an assessment of schools for the presence of moisture and bioaerosols, and a mortality study.Progress Summary:
Case-Control Study of Interstitial Lung Disease. A pathology registry was used to identify all biopsy-confirmed ILD cases from 1992 to 1998. One control was matched to each case based on sex, age (+ 5 years with the exception of one pair that was + 7 years apart) and ethnicity (white and non-white). All study subjects were asked to complete a self-administered questionnaire. Cases biopsied on or after January 1, 1997 were asked to participate in the home site visit portion of the study once their questionnaire was returned. The questionnaire addresses moisture and aerosolization in buildings; including the home and work environment. During the home site visit physical and bioaerosol measurements were taken by trained field personnel to assess moisture risk factors within the home. An engineer, from Turner Building Science LLC, blinded to case/control status, has evaluated sketches of each home, which include geography. These sketches are a part of each home exposure assessment. Three separate analyses have resulted from this work.Study One: This methodological analysis explores the relationship between the data from the self-administered questionnaires and the home site visit checklist. Dwelling structural questions and moisture indicator variable questions (e.g., Is there a history of leaks or flooding in the home? or Is there an external exhaust fan in the bathroom?) were compared using responses to the questionnaire and the home site visit checklist. Such comparisons will allow us to predict the ability of home, apartment and condominium dwellers to predict the level of moisture in their home. The ability of physical and bioaerosol measurements to predict moisture also has been examined. Sixty-four study subjects are included in this analysis.
Study Two: This part of the study includes the twenty-nine matched case-control pairs in which home site visits were performed. It examines the differences in the homes of ILD case and control subjects using the descriptions of moisture risk factors, physical measurements and bioaerosol measurements. Although thirty cases agreed to participate in the study, only twenty-nine controls were matched to them.
Study Three: This study is based on the questionnaires from fifty matched case control pairs. It explores the occupational, home, family and personal medical history factors in the development of ILD.
Case-Control Study of Sarcoidosis. A case-control study of sarcoidosis was conducted to explore potential association with occupational and environmental exposure. All 59 patients seen between 1992 and 1997 in a pulmonary division, and unmatched controls from orthopedic surgeons, received two copies of a self-administered questionnaire inquiring about occupational and environmental histories. 52.2 percent of the patients and 32.4 percent of the controls responded. Patients were significantly more likely to have been exposed to inorganic dusts (odds ratio [OR] 3.48; 95 percent confidence interval [95 percent CI]: 1.02 - 11.80), molds (OR 9.8; 95 percent CI: (0.98 - 98.40) and solvents or oils in the work place (OR: 9.8; 95 percent CI: (1.60 - 48.0) than controls. They described exposure at home through moldy basements (OR: 2.37; 95 percent CI: 0.97, 5.8) or mold on bathroom walls (OR: 5.69; 95 percent CI 1.3-25.6) more frequently than controls. Sarcoidosis may represent a disease at least in part attributable to occupational and environmental exposures. These results led to sampling in the homes of some of the study subjects. Thirty-six of the 51 identified subjects participated. Only one subject still worked for the same employer. This employer refused participation. Occupational exposures for one patient with sarcoidosis were identified. This patient worked for the metalworking facility described in section III.
Exposure Assessment in a Metal Working Facility. The Division continued research on the causes of a substantial outbreak of hypersensitivity pneumonitis (HP) first recognized at a metal working plant in the autumn of 1997. Activities focused on immunological research, and data analysis to develop appropriate reports and publications. The results of serum samples from plant workers with work-related hypersensitivity pneumonitis analyzed for immunological activity with plant environmental samples will be compared to that of a control group. These results may indicate potential etiological agents in the plant that have contributed to the hypersensitivity pneumonitis outbreak. Two papers were submitted this past year to peer-reviewed journals; one paper describes the initial outbreak and the other describes the clinical evaluation of the cohort.
Schools. As the prevalence and seriousness of childhood asthma and teacher/school staff respiratory health complaints have increased, the indoor environment in schools and the health consequences to the occupants have become a larger concern to society. Research over the last year has focused on two major areas: continuation of an epidemiological and engineering approach to understanding school building indoor air quality and occupant health consequences; and a clinical chart review of teachers with health symptoms that may be school building related.
A publication on pilot results from multiple school locations demonstrating a relationship among school building occupancy, moisture and respiratory health is in progress. The researchers, in collaboration with Turner Building Science LLC, developed a field tool for linking environmental and epidemiological data at two study schools. Activities continue to integrate building findings with an epidemiological data set from teachers and students who have health symptoms. This data will be used to explore for any linkages between indoor air quality and health status of the children and teachers in the program. The investigators developed a protocol to retrospectively review the charts of outpatients treated at the Occupational and Environmental Medicine clinic from 1990-present and characterize the illnesses of teachers and school staff seen at the clinic. Ultimately this review will contribute information to indicate intervention strategies and guide future research.
Mortality Study. To further explore lung disease among teachers and metalworkers, we have collected mortality data from 1985 to 1996 using the Multiple Cause of Death File compiled by the National Center for Health Statistics (NCHS). The NCHS data file includes all causes of death listed on the death certificate. We used specific codes from the ninth revision of the International Classification of Diseases (ICD-9) and Standard Industry and Occupation Codes (SIC and SOC) and Census occupation codes to capture deaths by specific diseases and occupations and industries. A proportional mortality study was implemented. Expected counts were adjusted for age, race, sex, and year of death and the reference population for each occupation consisted of other occupations of same socioeconomic status. A one tailed test was performed to identify proportional mortality ratios (PMR) greater than 1.0.
The disease data were examined in three ways, for all diseases combined, for each disease individually and by disease groupings based on disease type (i.e., pulmonary diseases and connective tissue diseases). Analysis of the occupational data is complete and we are currently performing similar analyses using industry codes.
Future Activities:
Our goal in the coming project period will be to complete the data analysis tasks for all parts of this project. This will lead to the preparation of additional manuscripts for publication in peer-reviewed journals.Journal Articles on this Report : 1 Displayed | Download in RIS Format
Other project views: | All 13 publications | 8 publications in selected types | All 6 journal articles |
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Type | Citation | ||
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Hodgson MJ, Bracker A, Yang C, Storey E, Jarvis BJ, Milton D, Lummus Z, Bernstein D, Cole S. Hypersensitivity pneumonitis in a metal-working environment. American Journal of Industrial Medicine 2001;39(6):616-628. |
R825251 (2000) R825251 (Final) |
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Supplemental Keywords:
indoor air, health effects, risk, exposure, children, bacteria, fungus, engineering, epidemiology, measurement methods, occupation, industry, school teachers, metalworkers., Health, Scientific Discipline, Air, Geographic Area, air toxics, State, Epidemiology, Disease & Cumulative Effects, Biochemistry, indoor air, Biology, health effects, risk assessment, interstitial lung disease, exposure and effects, effects assessment, population based study, airway disease, pulmonary disease, mold exposure, lung dysfunction, public health, bioaerosols, ambient particulates, harmful environmental agents, Connecticut (CT), indoor air quality, mycotoxinsProgress and Final Reports:
Original AbstractThe perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Conclusions drawn by the principal investigators have not been reviewed by the Agency.