1
|
Kim JA, Song SY, Jeong W, Jun JK. Non-cancer health risks in firefighters: a systematic review. Epidemiol Health 2022; 44:e2022109. [PMID: 36397239 PMCID: PMC10396521 DOI: 10.4178/epih.e2022109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/16/2022] [Indexed: 08/04/2023] Open
Abstract
osFirefighters are occupationally exposed to hazardous factors that may increase their risk of disease. However, non-cancer disease risk in firefighters has not been systematically examined. This systematic review aimed to identify non-cancer disease risk in firefighters and determine whether the risk differs according to job characteristics. We searched the Cochrane Library, Embase, PubMed, and KoreaMed databases using relevant keywords from their inception to April 30, 2021. The Risk of Bias Assessment Tool for Non-randomized Studies version 2.0 was used to assess the quality of evidence. Due to study heterogeneity, a narrative synthesis was presented. The systematic literature search yielded 2,491 studies, of which 66 met the selection and quality criteria. We confirmed that the healthy worker effect is strong in firefighters as compared to the general population. We also identified a significant increase in the incidence of lumbar disc herniation, lower back pain, angina pectoris, acute myocardial infarction, and post-traumatic stress disorder (PTSD) in firefighters compared to other occupational groups. Contradictory results for the risk of PTSD and anxiety disorders related to rank were reported. Sufficient evidence for increased risk of lumbar disc herniation, lower back pain, angina pectoris, acute myocardial infarction, and PTSD was available. The risk of non-cancer diseases varied depending on job type, years of service, and rank. However, caution should be exercised when interpreting the results because the classification criteria for firefighters' jobs and ranks differ by country.
Collapse
Affiliation(s)
- Jeong Ah Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Soo Yeon Song
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Wonjeong Jeong
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| |
Collapse
|
2
|
Davidson S, Jahnke S, Jung AM, Burgess JL, Jacobs ET, Billheimer D, Farland LV. Anti-Müllerian Hormone Levels among Female Firefighters. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5981. [PMID: 35627519 PMCID: PMC9141260 DOI: 10.3390/ijerph19105981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 02/04/2023]
Abstract
Female firefighters have occupational exposures which may negatively impact their reproductive health. Anti-müllerian hormone (AMH) is a clinical marker of ovarian reserve. We investigated whether AMH levels differed in female firefighters compared to non-firefighters and whether there was a dose-dependent relationship between years of firefighting and AMH levels. Female firefighters from a pre-existing cohort completed a cross-sectional survey regarding their occupational and health history and were asked to recruit a non-firefighter friend or relative. All participants provided a dried blood spot (DBS) for AMH analysis. Linear regression was used to assess the relationship between firefighting status and AMH levels. Among firefighters, the influence of firefighting-related exposures was evaluated. Firefighters (n = 106) and non-firefighters (n = 58) had similar age and BMI. Firefighters had a lower mean AMH compared to non-firefighters (2.93 ng/mL vs. 4.37 ng/mL). In multivariable adjusted models, firefighters had a 33% lower AMH value than non-firefighters (-33.38%∆ (95% CI: -54.97, -1.43)). Years of firefighting was not associated with a decrease in AMH. Firefighters in this study had lower AMH levels than non-firefighters. More research is needed to understand the mechanisms by which firefighting could reduce AMH and affect fertility.
Collapse
Affiliation(s)
- Samantha Davidson
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (S.D.); (A.M.J.); (E.T.J.); (D.B.)
| | - Sara Jahnke
- Center for Fire, Rescue & EMS Health Research, NDRI-USA, Inc., Leawood, KS 66224, USA;
| | - Alesia M. Jung
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (S.D.); (A.M.J.); (E.T.J.); (D.B.)
- Department of Community, Environment & Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA;
| | - Jefferey L. Burgess
- Department of Community, Environment & Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA;
- Cancer Prevention and Control Program, University of Arizona Cancer Center, Tucson, AZ 85719, USA
| | - Elizabeth T. Jacobs
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (S.D.); (A.M.J.); (E.T.J.); (D.B.)
- Cancer Prevention and Control Program, University of Arizona Cancer Center, Tucson, AZ 85719, USA
| | - Dean Billheimer
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (S.D.); (A.M.J.); (E.T.J.); (D.B.)
| | - Leslie V. Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (S.D.); (A.M.J.); (E.T.J.); (D.B.)
- Cancer Prevention and Control Program, University of Arizona Cancer Center, Tucson, AZ 85719, USA
- Department of Obstetrics and Gynecology, College of Medicine-Tucson, University of Arizona, Tucson, AZ 85724, USA
| |
Collapse
|
3
|
Pregnancy, childbirth, and puerperium outcomes in female firefighters in Korea. Ann Occup Environ Med 2020; 32:e8. [PMID: 32082590 PMCID: PMC7008587 DOI: 10.35371/aoem.2020.32.e8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 01/20/2020] [Indexed: 11/20/2022] Open
Abstract
Background Female firefighters are exposed to hazardous environmental (chemical and physical) and working (shift work, psychological, and ergonomic factors) conditions that have reported or are suspected of adverse effects on reproductive health. However, no previous studies have reported on pregnancy, childbirth, and puerperium outcomes (PCPOs) in female firefighters. Methods The present study compared hospital admissions for PCPOs, based on 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes, among Korean female firefighters with those of the general Korean population. Standardized admission ratios (SARs) and their 95% confidence intervals (CIs) were calculated. Results The study population included 1,766 female firefighters. Total follow-up duration was 9,659 person-years. Compared to the general female population, the female firefighters' SARs were higher in all admissions for PCPOs (SAR, 1.92; 95% CI: 1.79–2.05); pregnancy and abortive outcomes (SAR, 1.56; 95% CI: 1.12–2.12); other maternal disorders predominantly related to pregnancy (SAR, 2.65; 95% CI: 1.99–3.46); maternal care related to the fetus, amniotic cavity, and possible delivery problems (SAR, 2.13; 95% CI: 1.74–2.57); labor and delivery complications (SAR, 1.55; 95% CI: 1.15–2.06); delivery (SAR, 1.94; 95% CI: 1.80–2.08); and complications predominantly related to puerperium (SAR, 4.68; 95% CI: 2.02–9.23). Conclusion The results of this study showed high SARs in all and specific subcategories of PCPOs in female firefighters.
Collapse
|
4
|
Watkins ER, Walker A, Mol E, Jahnke S, Richardson AJ. Women Firefighters' Health and Well-Being: An International Survey. Womens Health Issues 2019; 29:424-431. [PMID: 30930075 DOI: 10.1016/j.whi.2019.02.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 02/07/2019] [Accepted: 02/22/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study aimed to identify specific health and well-being issues that women firefighters may experience as part of their daily working practices. Issues identified from this under-represented population can drive future research, education, and strategy to guide safety and health practices. METHODS A total of 840 women firefighters from 14 separate countries (255 United Kingdom and Ireland, 320 North America, 177 Australasia, and 88 mainland Europe) completed the survey over a 4-month period. Questions related to general health and well-being and role-specific health concerns, gender-related issues, and available exercise facilities. RESULTS Women firefighters in North America reported a higher prevalence of lower back (49%) and lower limb (51%) injuries than all other groups. North American respondents reported more heat illnesses (45%) than respondents from other places (36%). Although many participants did not respond, of those who did, 39% thought the menstrual cycle (199/512) or menopause (55/151) affected their work, and 36% were concerned for their ability to meet future job demands. Sixteen percent felt confident they could complete the role after 60 years of age. Women firefighters identified a lack of strength and conditioning support (50%) or lack of gym access (21%). There appears to be poor availability of female-specific personal protective equipment, with availability greatest in the United Kingdom (66%) compared with the sample as a whole (42%). CONCLUSIONS There is a need for female-specific strength and conditioning support and facilities to decrease injury and illness risk and improve longevity. Research and education into gynecological issues, heat exposure, and their effects on women firefighters' fertility and cancer risk is required.
Collapse
Affiliation(s)
- Emily R Watkins
- Extreme Environments Lab, University of Brighton, Welkin Laboratories, Eastbourne, East Sussex, UK
| | - Anthony Walker
- University of Canberra Research Institute for Sports and Exercise, University of Canberra, Canberra, Australia
| | - Eric Mol
- Experts in Firefighting Performance, Dutch Safety Board, Baarn, The Hague, The Netherlands
| | - Sara Jahnke
- Center for Fire, Rescue & EMS Health Research, National Development & Research Institutes, Leawood, Kansas
| | - Alan J Richardson
- Extreme Environments Lab, University of Brighton, Welkin Laboratories, Eastbourne, East Sussex, UK.
| |
Collapse
|
5
|
Petersen KU, Hansen J, Ebbehoej NE, Bonde JP. Infertility in a Cohort of Male Danish Firefighters: A Register-Based Study. Am J Epidemiol 2019; 188:339-346. [PMID: 30452532 DOI: 10.1093/aje/kwy235] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 10/05/2018] [Indexed: 11/14/2022] Open
Abstract
Our aim in this study was to examine infertility among male firefighters in Denmark. Thus, we established a cohort of 4,710 past and present male Danish firefighters through personnel and membership records obtained from employers and trade unions. Information on vital status and infertility from the Danish Civil Registration System, the In Vitro Fertilisation Register, and the National Patient Register for the period 1984-2017 was linked to cohort members using their Danish personal identification numbers. Hazard ratios and corresponding 95% confidence intervals were estimated for male-factor infertility and overall infertility through Cox regression analyses comparing the firefighters with 2 reference groups: a sample of employees and military men. Among the full-time firefighters, the risk of male-factor infertility was increased in comparison with the sample of employees (In Vitro Fertilisation Register model: hazard ratio = 1.46 (95% confidence interval: 1.10, 1.94); National Patient Register model: hazard ratio = 1.53 (95% confidence interval: 1.18, 1.98)). Results were less consistent using the military men as the reference group. Further, the increase in infertility seemed restricted to duration of time employed as a firefighter. No increase in risk of either male-factor infertility or overall infertility was seen among the part-time/volunteer firefighters. Thus, full-time firefighting was associated with a greater risk of being diagnosed with male-factor infertility in our cohort.
Collapse
Affiliation(s)
- Kajsa U Petersen
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Johnni Hansen
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Niels E Ebbehoej
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Jens P Bonde
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| |
Collapse
|
6
|
Jahnke SA, Poston WSC, Jitnarin N, Haddock CK. Maternal and Child Health Among Female Firefighters in the U.S. Matern Child Health J 2018; 22:922-931. [PMID: 29423588 PMCID: PMC5918227 DOI: 10.1007/s10995-018-2468-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objectives Despite increasing attention to the occupational impact of firefighting, little is known specific to the health of women firefighters. In particular, quantitative data is lacking on the impact firefighting has on maternal and child health for women who become pregnant while working as firefighters. Methods A total of 1821 women firefighters responded to requests to complete a self-report survey of questions about pregnancy. Women answered questions about their departments' policies and practices and their own experiences of pregnancy. Those participants who reported a pregnancy while serving as a firefighter were asked detailed questions about their pregnancy and outcomes. Results Female firefighters reported that nearly a quarter of their first pregnancies while in the fire service ended in miscarriage and that increased to a third of pregnancies by the fourth. Rates of pre-term delivery also were high among this population. Conclusions Findings have important implications for policy and practice among women who become pregnant while actively serving in the fire service.
Collapse
Affiliation(s)
- Sara A Jahnke
- Center for Fire, Rescue & EMS Health Research, National Development & Research Institutes, 1920 W. 143d Street, Suite 120, Leawood, KS, 66214, USA.
| | - Walker S C Poston
- Center for Fire, Rescue & EMS Health Research, National Development & Research Institutes, 1920 W. 143d Street, Suite 120, Leawood, KS, 66214, USA
| | - Nattinee Jitnarin
- Center for Fire, Rescue & EMS Health Research, National Development & Research Institutes, 1920 W. 143d Street, Suite 120, Leawood, KS, 66214, USA
| | - Christopher K Haddock
- Center for Fire, Rescue & EMS Health Research, National Development & Research Institutes, 1920 W. 143d Street, Suite 120, Leawood, KS, 66214, USA
| |
Collapse
|
7
|
|
8
|
Reproductive and developmental hazard management guidance: ACOEM Task Force on Reproductive Toxicology. J Occup Environ Med 2011; 53:941-9. [PMID: 21775895 DOI: 10.1097/jom.0b013e318229a549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
9
|
Han AR, Linton JA. Cardiovascular Disease, Cancer and Reproductive Hazards in Firefighters. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2008. [DOI: 10.5124/jkma.2008.51.12.1097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ah Reum Han
- Department of Family Medicine, Yonsei University College of Medicine, Korea. ,
| | - John A. Linton
- Department of Family Medicine, Yonsei University College of Medicine, Korea. ,
| |
Collapse
|
10
|
Abstract
The etiology of male infertilities is largely undetermined, and our knowledge of exogenous factors affecting the male reproductive system is still limited. In particular, the role of specific environmental and occupational factors is incompletely elucidated. Various occupational (physical and chemical) agents have been shown to affect male reproductive functions in animals, but large differences in reproductive function and/or xenobiotic handling between species limit extrapolation to humans. When available, human data are often conflicting and, except in a few instances, usually refer to broad and heterogenous occupational categories or to groups of agents (e.g., solvents). It is often difficult to elucidate the role of a single agent because occupational exposure conditions are often complex and various confounding factors related to lifestyle (smoking, alcohol, and diet) or socioeconomic state may also affect sperm quality, fertility, or pregnancy outcomes. The objective of this work is to summarize the main epidemiological and, where relevant, experimental findings pertaining to agents (physical and chemical) encountered in the occupational environment that might affect the male reproductive system (sperm count, motility and morphology, libido, and fertility) and/or related pregnancy outcomes (spontaneous abortion, stillbirth, low birth weight, and birth defects and childhood malignancy in offspring). Some methodological issues related to research on the reproductive effects of toxicants are also discussed briefly.
Collapse
Affiliation(s)
- S Tas
- Industrial Toxicology and Occupational Medicine Unit, School of Medicine, Catholic University of Louvain, Brussels, Belgium
| | | | | |
Collapse
|
11
|
McDiarmid MA, Lees PS, Agnew J, Midzenski M, Duffy R. Reproductive hazards of fire fighting. II. Chemical hazards. Am J Ind Med 1991; 19:447-72. [PMID: 2035546 DOI: 10.1002/ajim.4700190404] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Studies of the health of fire fighters have historically focused on non-malignant respiratory disease and cancer. More recently, concerns have surfaced about reproductive health effects in many areas of the workforce, including fire fighting. These concerns prompted this review of chemical exposures that may contribute to adverse reproductive health outcomes in male as well as female fire fighters. A review of the industrial hygiene literature was undertaken to identify agents commonly found in fire smoke. These agents were then examined for evidence of reproductive toxicity or mutagenicity/carcinogenicity. This profile of chemical agents and their reproductive toxicities permits a qualitative determination that fire fighters are exposed to potential reproductive toxicants as a part of their normal fire fighting duties. Considerations for mitigating these risks are also discussed.
Collapse
Affiliation(s)
- M A McDiarmid
- Department of Environmental Health Sciences, School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, MD 21205
| | | | | | | | | |
Collapse
|