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Challenges and opportunities of occupational health and occupational medicine in the context of population aging

Guodong LU ; Hua FU ; Wuzhong LIU ; Zhijun ZHOU ; Yan YIN

Journal of Environmental and Occupational Medicine.2024;41(9):961-966. doi:10.11836/JEOM24108

In the context of facing the dual challenges of aging population and declining birth rates, the absolute number of working-age population in China is decreasing, while the proportion of middle-aged and elderly workers is significantly increasing. However, China possesses a vast labor force, and the advantages of talent dividend are gradually emerging, both of which can offset the negative impact of the shrinking demographic dividend on social productivity. Labor is the most active factor among various production factors and is an important component for developing new quality productive forces. With the development of new quality productive forces, occupational health and occupational medicine are presented with new development opportunities. In the process of aging of the labor force, occupational health and occupational medicine can investigate how to utilize next-generation information technology, artificial intelligence, biotechnology, and other growth engines to safeguard the occupational health of workers, extend their working lives, actively unleash their creativity and initiative, and compensate for the labor shortage caused by an aging population and the potential decrease in labor productivity. This transformation in occupational health and occupational medicine is not only crucial for the health and career development of workers in an aging society, but will also have a positive impact on the creation of an age-friendly society and the sustainable development of productivity.

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Labor participation of Chinese older people and construction of age-friendly occupational health protection system

Shanghui WANG ; Zhan HU

Journal of Environmental and Occupational Medicine.2024;41(9):967-970. doi:10.11836/JEOM24355

Population aging has become a normal state in China, and actively responding to the aging of the population has been elevated to a "national strategy" in China. The communique of the fifth plenary session of the 19th Central Committee of the Communist Party of China emphasized "developing elderly human resources and developing silver economy," which means that capable older people are encouraged to actively participate in economic construction through labor participation; at the same time, promoting the participation of older persons in the process of development and sharing the fruits of development are also crucial for the balanced development and common prosperity of the whole society. Based on the necessity, feasibility, and reality of the elderly's labor participation, this paper proposed the construction of an age-friendly occupational health protection system from two aspects: environmental support and internal capacity support. A sufficient volume of low-aged older people with good quality should be a basic driving force for promoting high-quality economic development, while the current proportion of actively employed elderly people is low, their average education level is far from what we expected, and the channels for employment are limited. In the future construction of an age-friendly occupational health protection system, the institutional environment and occupational environment support for elderly workers should be improved, laws and regulations on the employment of the elderly should be formulated, and an age-friendly work environment should be constructed; at the same time, internal capacity support should be provided for older workers to maintain their working ability in aging process, stimulate their subjective initiative, and pay attention to the career development of the whole life cycle to realize the better participation of the working population in economic development in the process of aging. Through these measures, a more inclusive and sustainable society can be anticipated, making the labor participation of older people an important force to promote social progress.

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Research on aging population of working age in North America: Current situation and policies

Caoyan QI ; Ziyi CHEN ; Qiankui ZHAO ; Yuan SUN ; Qiang HOU ; Guodong LU ; Wuzhong LIU

Journal of Environmental and Occupational Medicine.2024;41(9):971-976. doi:10.11836/JEOM24171

Although there are continuous progresses in economy and society, the accelerated aging process has brought widespread impacts on various aspects of society and economy in China, especially on the supply of the working-age population. Effectively addressing labor force aging has become an urgent challenge for China's economic and social development. North American countries, particularly the United States and Canada, are also facing severe aging population issues, and have entered an aging society earlier than China. These countries have alleviated labor supply shortages through proactive immigration policies, while implementing flexible retirement, reemployment of elderly individuals, and vocational training policies to effectively encourage elderly workers to remain in their jobs. Additionally, the occupational health programs of large enterprises in North America have yielded positive returns on their health investments. Building upon an overview of the current situation and corresponding measures in response to the aging working-age population in North America, this paper presented constructive recommendations to address the aging population issue in China.

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Application and implications of European Union's aging policies in occupational health

Zhenzhen YU ; Jiajun TU ; Guodong LU

Journal of Environmental and Occupational Medicine.2024;41(9):977-981. doi:10.11836/JEOM24129

China has entered a stage of deep aging. The expanding aging population and subsequently an aging labor force pose significant challenges to China’s social and economic development. European Union (EU) countries have entered the aging phase earlier and to a greater extent. To address the labor shortage and the rising dependency ratio, the EU has implemented a series of policies and measures, including raising retirement age, promoting flexible retirement, enhancing work flexibility, improving welfare for elderly workers, creating age-friendly environments, focusing on occupational health, strengthening knowledge and skills training, and leveraging digital technologies in the workplace. These measures aim to prevent premature exit of elderly workers, better balance their work and life needs, improve occupational health and skills, and enhance overall work efficiency of companies. This review discussed the experience and lessons learned from the EU countries in addressing the aging workforce from the perspectives of occupational health and occupational skills development, aiming to provide rational suggestions to assist China in better adapting the challenges of aging workforce after steadily and orderly advancing the gradual reform of the statutory retirement age, thereby improving the efficiency of the overall workforce and the stability of the labor market, driving the talent dividend of highly educated and skilled middle-aged and elderly employees, and ultimately promoting sustained economic and social development.

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Occupational health strategies and insights for elderly workers in Japan and South Korea in the context of declining birth rates and aging populations

Meiling OU ; Jinxiong CEN ; Guodong LU ; Qiang HOU

Journal of Environmental and Occupational Medicine.2024;41(9):982-987. doi:10.11836/JEOM24135

China has a large, advanced, and rapidly aging population, coupled with a trend of decreasing birth rates that is exacerbating the issue of an aging society. It is expected that by 2030, China will become a hyper-aged society. As the demographic dividend gradually diminishes, the working-age population is shrinking in size and becoming increasingly older, making elderly labor force an important resource. Japan and South Korea have accumulated rich experience in promoting the healthy employment and occupational health services for the elderly workforce. It is necessary for China to thoroughly consider the issue and implement corresponding measures. This article compared and analyzed the current employment situation of aging populations in China, Japan, and South Korea, revealing that Japan and South Korea presented certain advantages in healthy employment policies, occupational health measures for the elderly, and digital economy. Taking into account the circumstances in China, we can further strengthen occupational health promotion activities, optimize employment structure, utilize new technologies such as artificial intelligence, promote active aging, ensure the sustainable development of elderly labor force resources, steadily enhance comprehensive national strength, and meet the increasing demand for better quality of life among the people.

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Healthy working life expectancy of adults aged 50 years old in China

Jingjie ZHU ; Suifang LI ; Hua FU ; Na AN ; Junling GAO

Journal of Environmental and Occupational Medicine.2024;41(9):988-994. doi:10.11836/JEOM24150

Background With the increasing aging population in China, there is a significant shortage of labor force. Delaying retirement age has become a potential method to alleviate this labor shortage. Objective To estimate the healthy working life expectancy (HWLE) of individuals aged 50 years old in China. Methods This study was based on data from four waves (2011—2018) of the China Health and Retirement Longitudinal Study (CHARLS). HWLE was estimated for the overall sample of individuals aged 50 years old and above and stratified by sex, educational attainment, marital status, occupation, Hukou type, and region by using continuous-time multistate modelling. Results A total of 50991 person-times aged ≥ 50 years and older were included in the study. The average total life expectancy of the Chinese population aged 50 years old was 29.72 years (95%CI: 29.28, 30.12 years), with a HWLE of 14.05 years (95%CI: 13.76, 14.33 years). The remaining years lived in the states of healthy but not working, not healthy but working, and not healthy and not working were 8.82 years (95%CI: 8.53, 9.15 years), 2.54 years (95%CI: 2.41, 2.68 years),and 4.30 years (95%CI: 4.08, 4.54 years), respectively. The HWLE (95%CI) of individuals in the baseline states of healthy and working, healthy but not working, not healthy but working, and not healthy and not working were 14.97 (14.69, 15.23), 10.86 (10.52, 11.22), 11.73 (11.31, 12.09), and 9.51 (9.09, 9.97) years, respectively. Additionally, women had a higher total life expectancy (95%CI) than men [31.84 (31.10, 32.54) years vs 27.98 (27.35, 28.50) years], but a lower HWLE than men [12.47 (12.12, 12.82) years vs 15.62 (15.23, 15.98) years]. There was no difference in total life expectancy between rural residents and urban residents [29.43 (28.88, 29.97) years vs 30.31 (29.47, 31.02) years], but rural residents had a higher HWLE than urban residents [15.74 (15.39, 16.10) years vs 11.38 (10.97, 11.73) years]. Residents in East China [14.66 (14.22, 15.06) years] and Central China [14.15 (13.86, 14.43) years] had a higher HWLE than residents in West China [13.61 (13.27, 13.98) years] and Northeast China [13.06 (12.51, 13.63) years]. Conclusion The HWLE of Chinese residents supports the policy of raising the retirement age. There are differences in HWLE levels between urban and rural areas, as well as across different regions. Providing more flexible employment opportunities for older adults can help mitigate the labor shortages caused by population aging.

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Associations between disorders in activities of daily living and heavy metal concentrations in elderly people

Tingjun LI ; Jiansheng CAI ; Ruiying LI ; Jie XIAO ; Zeyan YE ; Yuqian CHENG ; Zhe LIU ; Zhiyong ZHANG

Journal of Environmental and Occupational Medicine.2024;41(9):995-1003. doi:10.11836/JEOM24085

Background Heavy metals may play an important role in environmental risk factors associated disorders of activities of daily living (ADL) in older adults. Objective To investigate the associations between plasma levels of six heavy metals (zinc, arsenic, cadmium, lead, manganese, and copper) and ADL disorders in older adults. Methods A cross-sectional survey was conducted from 2018 to 2019 among 1412 rural elderly people in Gongcheng Yao Autonomous County, Guangxi Zhuang Autonomous Region. The plasma metal concentrations were detected by inductively coupled plasma mass spectrometry (ICP-MS), and subsequently classified into three groups (T1-T3) based on tertiles, with the T1 group as the reference. The samples were assessed for ADL disorders using the ADL scale. Logistic regression and restricted cubic spline model (RCS) were used to estimate the odds ratio (OR) and 95% confidence interval (CI) to assess the associations between heavy metals and the prevalence of reporting ADL disorders. Results The mean age of the study population was (68.52 ± 5.92) years, 825 (58.4%) female and 587 (41.6%) male. Of these, 372 (26.34%) subjects reported ADL disorders, and most of them were female (74.30%). The results of logistic regression showed that the participants in the cadmium T2 group (0.15-0.25 µg·L⁻¹) had a higher risk of ADL disorders compared to the T1 group (≤0.15 μg·L⁻¹) (OR=1.552, 95%CI: 1.086, 2.134). After stratification by sex, the relative risk of ADL disorders was lower in the plasma copper T3 group (>1019.58 µg·L⁻¹) compared to the T1 group (≤868.12 μg·L⁻¹) in men (OR=0.481, 95%CI: 0.232, 0.998). The relative risk of ADL disorders was higher in the plasma cadmium T2 group (0.15-0.25 µg·L⁻¹) compared to the T1 group (≤0.15 μg·L⁻¹) in women (OR=1.758, 95%CI: 1.182, 2.616). The RCS results showed that the risk of ADL disorders in men was nonlinearly associated with copper (P_nonlinear=0.011, P_overall<0.05). Conclusion High levels of cadmium are positively associated with the risk of reporting ADL disorders, while high levels of copper are negatively associated with the risk of reporting ADL disorders in men.

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Association between umbilical blood organophosphate esters exposure and meconium microbiome of newborns

Yang LIU ; Liyi ZHANG ; Wenjuan MA ; Yunhui ZHANG

Journal of Environmental and Occupational Medicine.2024;41(9):1004-1011. doi:10.11836/JEOM24163

Background Animal studies have shown that exposure to organophosphate esters (OPEs) disturbs the composition of gut microbiome in rodents and zebrafish. However, current associated evidence in humans is limited. Considering the importance of gut microbiome in neonatal development, we need to investigate the impact of OPEs exposure on the early development stage of neonatal microbiome. Objective To investigate the associations between umbilical OPEs exposure and the diversity and composition of gut microbiome in newborns. Methods Based on the Shanghai Maternal-Child Pairs Cohort (MCPC), 391 mother-infant pairs with comprehensive follow-up information and bio-samples were enrolled in this study. Concentrations of OPEs in neonatal cord blood were quantified using ultra performance liquid chromatography-tandem mass spectrometry. Meconium samples were collected after delivery and measured through 16S rRNA sequencing on the Illumina Miseq platform. Multiple linear regression models were used to assess the effects of OPEs exposure on the alpha diversity of meconium microbiome. Principal coordinate analysis and permutational multivariate analysis of variance based on unweighted UniFrac distance were used to compare the beta diversity differences between high and low exposure groups of OPEs. Linear discriminant analysis effect size (LEfSe) was utilized to analyze the differential gut microbiome taxa between high and low OPEs exposure groups. The functional pathways involved in the meconium microbiome were predicted based on the Kyoto Encyclopedia of Genes and Genomes (KEGG) database, and multivariate analysis by linear models (MaAsLin2) were conducted to explore the effects of OPEs exposure on gut microbiome pathways. Results Seven OPEs were detectable in the neonatal cord blood samples, of which four were detected higher than 50% including tributyl phosphate (TBP), tris (2-butoxyethyl) phosphate (TBEP), 2-ethylhexyl diphenyl phosphate (EHDPP), and tris (2-chloro-1 (chloromethyl) ethyl) phosphate (TDCPP), and the median concentrations of these four congeners were as follows: 0.52 μg·L⁻¹ for TBP, 2.41 μg·L⁻¹ for TBEP, 0.13 μg·L⁻¹ for EHDPP, and 2.23 μg·L⁻¹ for TDCPP. A significant association was observed between umbilical TBEP and TDCPP exposure and alpha diversity indices in neonatal meconium microbiome. Beta diversity significantly differed across varied high and low OPEs exposure groups. The results of LEfSe analysis indicated a significant correlation between umbilical OPEs exposure and 27 genera, including Streptococcus, Corynebacterium, Neisseria, Haemophilus, and Parabacteroides. The MaAsLin2 analysis identified associations between OPEs exposure and upregulation of pathways related to linoleic acid metabolism, steroid biosynthesis, Toll and Imd signaling pathway, retinol metabolism, NOD like receptor signaling pathway, and fatty acid biosynthesis . Conclusion Umbilical OPEs exposure is associated increased alpha diversity indices, increased relative abundances of Neisseria, Streptococcus, Parabacteroides, and Corynebacterium in the gut microbiome, as well as predicted metabolic pathway alterations in linoleic acid metabolism, fatty acid biosynthesis, etc. These findings indicate that umbilical OPEs exposure may disrupt meconium microbiome equilibrium.

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Effect of low-concentration benzene, toluene, and xylene exposure on blood pressure of workers in a petroleum refining enterprise

Bingxian ZHOU ; Qisheng WU ; Shiheng FAN ; Zhuna SU ; Jianye PENG ; Chunyun LU ; Nengde ZHANG ; Lei JIN ; De´e YU ; Jing ZHANG

Journal of Environmental and Occupational Medicine.2024;41(9):1012-1019. doi:10.11836/JEOM24024

Background Workers engaged in benzene-exposed or benzene-containing solvent-exposed operations in China are predominantly subjected to a low concentration of benzene series compounds, and prolonged exposure to low concentrations of benzene, toluene, and xylene (BTX) may have implications for blood pressure. Objective To investigate the influence of low-concentration BTX exposure on the blood pressure of workers, aiming to provide a basis for enterprises to devise associated health management strategies to mitigate the occurrence of hypertension among workers exposed to low concentrations of BTX. Methods Using a cross-sectional design, 884 workers from a petroleum refining enterprise in Hainan who participated in an occupational health examination in 2022 were selected as the study population, and were divided into an exposure group of 649 workers and a control group of 235 workers based on their reporting of BTX exposure or not. Data on workplace BTX concentrations and health examinations of the study subjects were collected and questionnaires were administered. In addition, S-phenylmercapturic acid (S-PMA), hippuric acid (HA), and methyl hippuric acid (MHA, including the three isomers 2-MHA, 3-MHA, and 4-MHA) were measured in the urine of the workers using high-performance liquid chromatography-tandem triple quadrupole mass spectrometry to assess internal BTX burden. The effects of low-concentration BTX exposure on blood pressure were analyzed. Results In 2022, the concentrations of benzene, toluene, and xylene of all monitoring points did not exceeded the national limits by either time-weighted average (TWA) or short-term exposure limit (STEL), indicating low-concentration BTX exposure. Regarding the internal burden of BTX, the concentrations of benzene metabolite S-PMA, toluene metabolite HA, and xylene metabolites 3-MHA and 4-MHA in the urine samples in the exposure group were higher than those in the control group (P < 0.05). The correlation analysis showed a positive correlation between urinary S-PMA concentration and diastolic blood pressure in the workers (r=0.265, P < 0.05). Differences in systolic and diastolic blood pressure distributions were statistically significant among workers grouped by sex, age, work years, educational levels, monthly income, body mass index (BMI), alcohol use, dietary oil, and types of residential address (P < 0.05). Significant differences in systolic blood pressure distribution were observed among workers by smoking status and levels of labor intensity (P < 0.05). Compared with the control group, the workers in the exposure group exhibited a significant increase in diastolic blood pressure (P < 0.05). The results of multiple linear regression showed that age, sex, and BMI had statistically significant effects on systolic blood pressure (P < 0.05), while age, work years, and BMI had statistically significant effects on diastolic blood pressure (P < 0.05). The systolic blood pressure of age > 35 years, male, overweight and obese workers was significantly higher than that of age ≤ 35 years, female, and underweight workers, and the diastolic blood pressure of age > 35 years, work years > 5 years, and obese workers was higher than age ≤35 years, ≤5 years of service, and underweight workers. Low-concentration BTX exposure was one of the main influencing factors for elevated diastolic blood pressure, and the exposed workers showed a 1.337 mmHg increase in diastolic blood pressure compared to the control group (P < 0.05). Conclusion Low-concentration BTX exposure, work years > 5 years, and obesity may elevate blood pressure among petroleum refininig workers. Regular blood pressure monitoring and enhanced health interventions for this occupational group are warranted.

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Adverse drug reactions in patients treated with sodium dimercaptosulphonate injection for mercury poisoning and influencing factors

Ye CHEN ; Huixia JI ; Dandan LIU ; Yang SHEN

Journal of Environmental and Occupational Medicine.2024;41(9):1020-1024. doi:10.11836/JEOM24146

Background Adverse drug reactions (ADRs) to sodium dimercaptosulphonate (DMPS) mercury removal treatment have been reported in occupational mercury poisoning. In recent years, the number of cases of mercury poisoning due to mercury-containing cosmetics has been increasing, and ADRs to the use of DMPS are common in clinical practice. Objective To investigate the occurrence of ADRs and the influencing factors in patients with chronic mercury poisoning and mercury exposure treated with DMPS for mercury removal. Methods Patients treated with DMPS due to mercury poisoning at the Occupational Disease Department of Nanjing Prevention and Treatment Center for Occupational Diseases from June 2017 to December 2023 were included in the study. Information on demographics, baseline characteristics, and treatment regimens was collected at admission. Information on secondhand smoke, place of residence, and blood groups not collected at admission was collected in follow-up. The patients were divided into two groups according to whether ADRs occurred after the use of DMPS and were compared for clinical characteristics, and the influencing factors related to the occurrence of ADRs after DMPS treatment were analyzed by binary logistic regression. Results A total of 72 patients were enrolled in the study, of which 26 reported ADRs during mercury removal. A total of 29 ADRs occurred, mainly rash in 11 cases (37.9%), fever in 5 cases (17.2%), and nausea in 4 cases (13.8%). Most ADRs occurred in the second course (7 cases, 26.9%) and the third course (9 cases, 34.6%). Of the 22 non-menopausal women who experienced ADRs, 13 (59.1%) used DMPS in the week prior to menstruation. The logistic regression analysis showed that smoking (OR=27.911, 95%CI: 2.835, 725.809) and blood type O (OR=6.885, 95%CI: 2.014, 26.896) were associated with elevated occurrence of ADRs after DMPS treatment. Conclusions The probability of ADRs after DMPS treatment is not low, but mild presentations are predominant and resolved with immediate treatment, with a favourable prognosis. The O blood group, smoking individuals, and female patients using DMPS one week before menstruation may be more prone to ADRs.

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