Idiopathic Pulmonary Fibrosis Deaths by Industry and Occupation, United States, 2020–2022

A report from CDC's National Institute for Occupational Safety and Health, published in the Morbidity and Mortality Weekly Report*, 2025.*

Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease that scars the lungs and steadily worsens how well they work. Its outlook is poor: median survival is 3–5 years after diagnosis. A recent systematic review estimated that 21% of IPF deaths might be due to exposures at work. CDC looked at which industries and occupations had more IPF deaths than expected.

The disease

• Symptoms: typically unexplained shortness of breath that gets steadily worse, often with a dry cough, and a pattern called usual interstitial pneumonia on high-resolution CT scans.
• Treatment: nothing cures it. Two drugs, pirfenidone and nintedanib, slow its progress, and some patients receive a lung transplant.
• Causes: the exact cause is unknown, but studies link it to cigarette smoking, genetic mutations, viral infections such as Epstein-Barr virus and hepatitis C, and work exposure to pesticides, wood (pine) dust and metal (brass, lead and steel) dust.

What CDC counted

CDC analysed National Vital Statistics System death records for U.S. residents aged 15 and over who died in 2020–2022, the years in which states recorded the industry and occupation where the person spent most of their working life. A death counted as IPF if the certificate listed code J84.1 as the underlying or a contributing cause, leaving out deaths with conditions that point to pulmonary fibrosis with a known cause, such as connective tissue disease, sarcoidosis, pneumoconiosis or hypersensitivity pneumonitis.

Because some jobs are held mostly by men and others mostly by women, and IPF deaths are more common in men, CDC compared industries and occupations using proportionate mortality ratios (PMRs), separately for men and women. A PMR above 1 means IPF accounted for a larger share of deaths in that group than across all workers.

The deaths

During 2020–2022 there were 67,843 IPF deaths: 38,869 with IPF as the underlying cause and 28,974 with it as a contributing cause. That was 0.7% of all deaths among the people studied.

The annual age-adjusted death rate was 7.1 per 100,000 people. Rates were highest among adults aged 75 and over (67.6 per 100,000), males (7.7), non-Hispanic people (7.7) and White people (8.2).

If 21% of IPF deaths are linked to work, then over these three years about 8,340 deaths in men and 5,908 in women might have been caused by exposures on the job — though that estimate comes from studies in other countries and may not fit the U.S. workforce.

By industry

The most IPF deaths occurred among men in manufacturing (7,525; 18.9% of IPF deaths in men) and women in health care and social assistance (4,277; 15.2% of IPF deaths in women). But the highest significantly elevated PMRs were:

In utilities, the occupations with 50 or more IPF deaths were electrical power-line installers and repairers, managers, first-line supervisors of production workers, and electricians. In public administration they included police and sheriff's patrol officers, firefighters, secretaries, office clerks, detectives, social workers, janitors and maintenance workers.

By occupation

The most IPF deaths occurred among men in management (5,715; 14.4%) and women in office and administrative support (4,521; 16.1%). The highest significantly elevated PMRs were among male community and social services workers (1.23) and female farming, fishing and forestry workers (1.24). Health care practitioners and technical workers had elevated PMRs among both men (1.13) and women (1.21).

What might explain it

Workers in some of these industries and jobs are often exposed to secondhand smoke; to vapours, gas, dust and fumes; to biological hazards such as airborne particles indoors; and to chemicals such as pesticides. For some high-risk groups, though, the reason is unclear and may have nothing to do with work.

The overall rate in this study was higher than rates reported for earlier years. That may reflect differences in methods, more precise diagnostic criteria, wider use of diagnostic guidelines, and changes in known risk factors. And as fewer adults smoke, exposures at work and in the environment may play a growing part in IPF.

Limitations

• No ICD-10 code is specific to IPF, and it may be underreported on death certificates.
• Diagnosis depends on access to specialist care and CT scans, which the data do not show; deaths were not checked against medical records.
• Death certificates record neither smoking nor work exposures, and the industry or job recorded may not be the one linked to the disease.
• With many comparisons, some elevated groups may have appeared by chance, and small groups gave wide margins of error.
• Applying the 21% estimate from other populations is speculative.
• The analysis was exploratory: its findings raise hypotheses rather than test them.

What can be done

The elevated groups point to where targeted studies, and steps to find and control harmful workplace exposures, could be considered. Prevention would follow the hierarchy of controls — eliminating or substituting hazards, engineering and administrative controls, and personal protective equipment — alongside smoke-free workplaces and help to quit tobacco. Further research and surveillance, including detailed work histories, are needed to pin down the occupational risk factors for IPF.

Sources

• Jacek M. Mazurek, Girija Syamlal and David N. Weissman, "Idiopathic Pulmonary Fibrosis Mortality by Industry and Occupation — United States, 2020–2022", MMWR, vol. 74, no. 7, 2025. https://www.cdc.gov/mmwr/volumes/74/wr/mm7407a1.htm
• The report gives two different figures for the 2017 IPF death rate that it compares against (5.4 per 100,000 in one place and 5.3 in another), so neither is quoted here.
• Rewritten in hubnx's own words.