Longitudinal lung function in urban firefighters: A group-based multi-trajectory modelling approach

Abstract

Background and Objective: Urban firefighters are routinely exposed to both physical and chemical hazards that can negatively impact lung health, but it is unclear if firefighters experience accelerated decline in spirometry parameters due to chronic exposure and acute insults. This study aimed to describe sub-groups of firefighters with differing spirometry trajectories and examine the relationship between the identified trajectories and demographic, lifestyle and occupational characteristics. Methods: Data from six waves of the Respiratory Function Measurement and Surveillance for South Australian Metropolitan Fire Service Study (2007–2019) were used to identify spirometry parameter z-score trajectories, using group-based multi-trajectory modelling (GBMTM). Analysis of variance and chi-square statistics were used to assess trajectory group differences in baseline self-reported demographic, lifestyle and occupational characteristics. Results: In the 669 included firefighters, we identified five trajectories for the combination of Forced Expiratory Volume in the first second z-score (FEV1z), Forced Vital Capacity z-score (FVCz) and the ratio of FEV1 and FVC z-score (FEV1/FVCz). There were three stable trajectories of low, average and very high lung function and two declining trajectories of average and high lung function. Analysis of subgroup characteristics revealed no significant differences between expected and actual group proportions for the occupational characteristics of years of service and respiratory protection use. Significant differences were seen in respiratory health and body mass index. Conclusion: GBMTM defined distinct, plausible spirometry trajectory sub-groups. Firefighter longitudinal spirometry trajectory group membership was associated with BMI and respiratory disease or symptoms but not with self-reported smoking history or occupational factors.