En tværsnitsundersøgelse af arbejdsbetinget astma i den grønlandske snekrabbe- og dybvandsrejeindustri

Abstract

Introduktion: Produktion og fangst af fisk og skaldyr er en essentiel industri i Grønland, hvori omkring 15% af landets ca. 25.000 erhvervsaktive er beskæftigede. Tidligere studier i Canada har rapporteret en høj prævalens af arbejdsbetinget astma blandt arbejdere, beskæftigede med produktion af snekrabbe (Shionoecetes opilio). Kun et mindre pilot-studie har beskrevet prævalens for arbejdsbetinget astma blandt produktionsarbejdere i den Grønlandske snekrabbe og dybvandsreje (Pandulus borealis) industri. Metode: 311 arbejder blev undersøgt i perioden oktober til november 2016 fordelt på 6 forskellige fabrikker og 3 forskellige fiskeskibe. Vha. Et spørgeskemabaseret interview, positiv prik-test for dels almindelige allergener samt specifikke ekstrakter fra snekrabbe og dybvandsrejer, samt spirometri med reversibilitetstest, blev anvendt for at stille diagnosen ”arbejdsbetinget astma”. Resultater: 27,5% af arbejderne der var, eller tidligere havde været beskæftiget med processering af snekrabbe, var sensibiliseret for dette og signifikant flere end dem, som aldrig havde været beskæftiget med dette (OR=3,18) 10,2% af arbejderne der var, eller tidligere havde været beskæftiget med produktion af dybvandsreje var sensibiliseret for dette, ikke signifikant forskelligt fra personer der aldrig havde været beskæftigede (OR=1,04). Prævalens for sandsynligt arbejdsbetinget astma var signifikant højere blandt snekrabbearbejdere i forhold til dybvandsrejearbejderne (11,9% vs 3,7%, P=0,04) Konklusion: Dette studie observerede en signifikant højere rate af AA, blandt snekrabbearbejderne sammenlignet med dybvandsrejearbejderne. Beskæftigelse med snekrabbe øgede signifikant odds for at være sensibiliseret for dette, med højere odds ved længere ansættelse. Den samme lave rate af AA i den grønlandske industri i forhold til den canadiske, som tidligere studie har beskrevet, bliver genfundet i dette studie. Derudover ses den samme højere rate af sensibilisering for snekrabbe, hvilket kan indikere en vis ”healthy worker effect”. Der er begrænset evidens, der tyder på at den grønlandske population er beskyttet mod at udvikle AA. Den lave rate af AA, der rapporteres til de grønlandske myndigheder, kan sandsynligvis tillægges underrapportering.

Introduction: The production and harvesting of seafood is an essential industry in Greenland employing approximately 15% of the country’s workforce of about 25.000 people. Previous studies in Canada have reported a high prevalence of occupational related asthma (OA) among Snow-crab (Shionoecetes opilio) production workers. An IgE induced mechanism has been proposed supported by studies reporting working with snow-crab releases high molecular allergens to the working environment. A relatively low rate of work related disease and OA, has previously been reported in the workers in the Greenlandic seafood industry. The Greenlandic population has lower incidences of allergic diseases compared to both native Danes and Greenlanders living in Denmark. It has been hypothesised that a traditional Greenlandic lifestyle protects against allergic disease including OA. Only a small pilot-study has described prevalence of sensitisation to snow-crab and shrimp and OA in the Greenlandic production of snow crab and northern prawn (Pandalus borealis). The aim of the study was to describe the prevalence of OA and sensitisation to work-related allergens in the Greenlanders working in the snow-crab and northern prawn industry. Method: A total of 311 workers were recruited in October-November of 2016, spanning six seafood processing plants and three fishing vessels located in western Greenland. Using data from questionnaire-based interviews, positive skin-prick test reactions for specific allergens from snow crab and shrimp extracts, common aeroallergens, and spirometically verified asthma using post bronchodilator test, a diagnostic algorithm was performed to estimate the prevalence of occupational asthma. Furthermore, blood-samples were drawn for later analysis of specific IgE against work-related allergens. Results of these test will not be reported in this preliminary publication. Results: Positive skin-prick test reactions to snow crab extracts were common in snow-crab production workers observed in 27% of workers occupied or previously occupied with the processing of snow-crab with a significant higher rate compared to workers never employed in snow crab production (OR= 3.18). Furthermore, the odds for sensitisation increased with prolonged exposure to work environment where snow-crab production is present. Positive skin-prick test reactions for northern prawn (Pandalus borealis) were observed in 10% of workers occupied or previously occupied with the processing of shrimp, not significantly different compared to workers never occupied in shrimp production (OR 1.04). There were a significantly higher rate of sensitization to snow-crab (28.6%) in the snow-crab production workers, compared to northern prawn sensitization (11,0%) in northern prawn production workers. A significant larger proportion of workers in the snow-crab industry, had symptoms matching this study’s definition of almost certain OA compared to northern prawn productions workers (11,9% vs. 3,7%). Conclusion: This study observed a significant higher rate of OA among snow-crab production workers compared to northern prawn workers. A history of working with snow-crab, significantly raised the odds of being sensitized to snow-crab, with higher odds correlated with longer exposure. The rate of OA was similar to what previously has been reported in the Greenlandic snow-crab industry, and lower than reported in the Canadian snow crab industry. Furthermore, the same high rate of sensitization was seen, suggesting a healthy worker effect. There is little evidence supporting the notion that the Greenlandic population is somehow protected against developing OA. The low rate of OA reported to the Greenlandic authorities, can probably be attributed to failure of reporting.

A master thesis from Aalborg University

En tværsnitsundersøgelse af arbejdsbetinget astma i den grønlandske snekrabbe- og dybvandsrejeindustri

[A cross-sectional study of occupational asthma among Greenlandic snow-crab and northern prawn production workers]