Work at high altitude and non-fatal cardiovascular disease associated with unfitness to work: Prospective cohort observation

Vinnikov D. Saktapov A. Romanova Z. Ualiyeva A. Krasotski V.
July 2024 Public Library of Science

PLoS ONE
2024 #19 Issue 7 July

Introduction Mining at high altitude exposes workers to hypoxic environment and cold climate in addition to conventional hazards in mining, but very little is known on how to define fitness to work in prospective candidates with pre-existing conditions. The aim of the current study was to define the incidence of cardiovascular diseases leading to unfitness to work as well as their predictors in a prospective observation. Methods A total of 569 prospective employees (median age 34 (interquartile range (IQR) 28;40) years, 95% men 85% mid-altitude residents) for a high-altitude gold mine in Kyrgyzstan operating at 3800–4500 meters above sea level were screened at pre-employment in 2009–2012 and followed by January 2022. Cox regression was used to quantify the association of baseline demographics and physiological variables with newly diagnosed cardiovascular diseases (CVD) leading to unfitness to work, expressed as hazard ratios (HRs) with 95% confidence intervals (CI). Results With 5190 person-years of observation, 155 (27%) workers have left work, of whom 23 had a newly identified CVD leading to unfitness to work (cumulative incidence 4%) with no difference between drivers and other occupations, despite greater blood pressure and body mass index (BMI) in the former at baseline. Age (HR 1.13 (95% CI 1.06;1.22) and BMI (HR 1.18 (95% CI 1.04;1.34)) were associated with a greater chance of having CVD, adjusted for lung function, baseline diagnoses, year of employment and baseline blood pressure. Narrowing the analysis to only men, drivers, smokers and even middle-altitude residents did not change the effect. Conclusion These findings confirmed high efficacy of pre-employment screening limiting access of workers with advanced conditions to work which later yielded low CVD incidence. In addition to conventional contraindications to work at high altitude, age and high BMI should be considered when a decision is made.

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Occupational Health Risks Lab, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russian Federation
Environmental Health Science Lab, al-Farabi Kazakh National University, Almaty, Kazakhstan
Department of Epidemiology, Biostatistics and Evidence-Based Medicine, al-Farabi Kazakh National University, Almaty, Kazakhstan
Medical Department, Kumtor Gold Company, Bishkek, Kyrgyzstan

Occupational Health Risks Lab
Environmental Health Science Lab
Department of Epidemiology
Medical Department

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