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Unexpected excessive chronic obstructive pulmonary disease mortality among female silk textile workers in Shanghai, China
  1. Ling Cui1,
  2. Lisa G Gallagher1,
  3. Roberta M Ray2,
  4. Wenjin Li2,3,
  5. Daoli Gao4,
  6. Yingzhe Zhang5,
  7. Sverre Vedal1,
  8. David B Thomas2,3,
  9. Harvey Checkoway1,3
  1. 1Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
  2. 2Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
  3. 3Department of Epidemiology, University of Washington, Seattle, Washington, USA
  4. 4Department of Epidemiology, Zhong Shan Hospital, Fudan University, Shanghai, PR China
  5. 5Research Management Division, China Academy of Safety Science and Technology, Beijing, PR China
  1. Correspondence to Ling Cui, Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Seattle, WA 98105, USA; cuiling{at}


Objective To investigate chronic obstructive pulmonary disease (COPD) mortality among textile workers.

Methods A total of 267 400 Chinese female textile employees were monitored for COPD mortality from 1989 to 2000. Textile factories in the cohort were classified into 10 industrial sectors. Age-adjusted mortality, standardized mortality ratios (SMRs) and 95% CIs were calculated by sector. In addition, RRs (HRs) adjusted for smoking and age were calculated for exposure to cotton and silk textile work compared with the other sectors in the cohort.

Results A majority of textile sectors had lower or similar COPD mortality (age-adjusted SMRs=0.58–1.15) compared with the general female population in the city of Nanjing, China. SMRs for cotton and silk workers were, respectively, 1.02 (95% CI: 0.81 to 1.28) and 2.03 (95% CI: 1.13 to 3.34). Compared with all other textile sectors in the cohort, there was greater COPD mortality among cotton workers (HR=1.40, 95% CI: 1.03 to 1.89) and silk workers (HR=2.54, 95% CI: 1.47 to 4.39).

Conclusion Elevated COPD mortality among cotton workers is consistent with previous reports of adverse respiratory effects of cotton dust. The higher rate of COPD deaths among silk workers was unexpected.

  • Respiratory
  • mortality studies
  • women
  • environment
  • organic dust

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  • Funding This research was supported by National Cancer Institute grant R01CA80180. Other funders: National Institutes of Health.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Human Subjects Division, University of Washington.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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