Objectives Exposure to metalworking fluid (MWF) causes respiratory outcomes such as asthma and chronic bronchitis, as well as symptoms including phlegm and wheezing. Chronic obstructive pulmonary disease (COPD) encompasses these outcomes, and so is a potential result of MWF exposure. Recent evidence based on g-estimation suggests that reducing exposure to MWF would substantially decrease years of life lost due to COPD. The objective of this analysis is to examine the exposure-response relationship between direct exposure to MWF and COPD mortality in a large occupational cohort.

Method Hazard ratios were estimated using Cox proportional hazards models for the association between cumulative exposure to the thoracic fraction (PM_9.8) of straight, synthetic, or soluble MWF and COPD mortality. Subjects directly exposed to each fluid type were compared to those who were never directly exposed (assembly workers).

Results Hazard ratios for exposure quartiles increased in a non-monotonic fashion, with a maximum of 1.6 for straight, 1.4 for soluble, and 1.5 for synthetic, reflecting an increased risk of COPD for exposed subjects. However, none of the HRs were significant at the 95% confidence level. Indirect adjustment for cigarette smoking (based on smoking rates in a cross-sectional survey) did not influence the estimates.

Conclusions While the results of this analysis did not reach statistical significance, they provide evidence supporting previous studies showing a risk of COPD associated with MWF exposure. The hazards presented are likely to be underestimates of the true association between COPD and MWF, due to the healthy worker effect.