Results from a study show that among teachers,the mortality rate from autoimmune diseases is twice that for people in other professional occupations. Autoimmune diseases occur when the body's immune system attacks internal organs. The study suggests that some people may be predisposed to such diseases and that factors in the environment or exposure to infections trigger their onset. Included: Comments from veteran teachers who have multiple sclerosis.
At age 40, high-school guidance counselor Sandra Measer was diagnosed with the autoimmune disease multiple sclerosis. For years she kept that information to herself.
Now Measer is learning that many more teachers across the country also have autoimmune diseases -- more, in fact, than anyone realized.
A 2001 study by a University of Connecticut researcher has revealed that, over an 11-year period, the mortality rate from autoimmune diseases for K-12 teachers was twice the rate for those in other professional occupations. Even more surprising, the death rate from the diseases for high school teachers was 12 percent higher than for elementary school teachers.
The study suggests that infections and environmental factors could play roles in triggering those diseases -- an idea that some teachers support.
Gerald Newberry, director of the National Education Association's Health Information Network urges teachers not to panic or overreact to the studies' findings. He did note, however, that the statistics are significant. "At the minimum, it does push us to look more at school construction and at indoor air quality," Newberry tells Education World. "It's terribly important to do that. We have to look at all factors related to indoor air quality -- chemical storage, ventilation, and carpets. We do know that there are certain causes of health problems that should be addressed while we wait for more information on studies of autoimmune disease deaths."
Teachers could be exposed to the environmental factors that raise their risk of contracting an autoimmune disease early in their careers, according to the UConn study. "This was not released to be alarming," says Dr. Stephen J. Walsh, who prepared the study. "But it is clear that something is going on among schoolteachers; many of them have health problems. A new group of people enter the profession every year -- people who become at-risk when they enter the classroom."
STATISTICS JUMP OUT
Autoimmune diseases occur when the body's immune system attacks certain organs as if those organs were infecting agents. Many of the diseases -- which include multiple sclerosis, systemic lupus, and rheumatoid arthritis -- are diagnosed in people between the ages of 25 and 30; complications from the diseases often begin to cause death ten to 15 years later.
Walsh, assistant professor of community medicine and health care at the University of Connecticut Health Center at the School of Medicine in Farmington, Connecticut, reviewed mortality statistics obtained from the National Institute of Occupational Safety and Health for the period from 1985 to 1995. Only about half of the 50 states list occupations on death certificates, so not every state is included in the study.
At first, Walsh just checked for the number of people who died from 13 autoimmune diseases and the number who were teachers. When he began reviewing statistics for age groups, however, he noticed that the numbers spiked for certain groups; mortality rates for teachers between the ages of 35 and 44 from autoimmune diseases were 50 percent higher than for people in other professional occupations. Among those in the study, 4.1 percent of teachers between 35 and 44 died of autoimmune diseases compared with 1.9 percent of other professionals. In fact, mortality rates from those diseases were elevated for teachers across all age ranges.
In the 35 to 44 age group, high school teachers had a 55 percent higher mortality rate than elementary school teachers and a 143 percent higher rate than those in other professional occupations.
The results, Walsh notes, are not skewed by the fact that a high percentage of teachers are women and that women contract autoimmune diseases at a rate two to five times higher than men. The study took that information into account.
Walsh also stressed that autoimmune diseases still are a relatively rare cause of death for people ages 35 to 44. "The risk still is small that a high school teacher will die from any of these diseases."
Within the study, evidence pointed to infectious agents as possible disease-triggers in both sexes, according to Walsh. Although the causes of autoimmune diseases are not clear, he says, information in the UConn study is consistent with current theories about why autoimmune diseases occur -- a genetic predisposition and an environmental trigger.
Other studies have suggested one possibility for the higher mortality rate among secondary teachers, Walsh says. It appears that some autoimmune illnesses are set off by the Epstein-Barr virus -- the virus that causes mononucleosis, one of the few infectious diseases most common among the teen-age population.
Both elementary and high school teachers also had a 4 percent higher mortality rate from rheumatic fever, another autoimmune disease, than did people in other professions; in the 35 to 44 age group, the number is elevated to 62 percent higher. Scientists know, however, that the trigger for rheumatic fever can be the streptococcus bacteria, which is also the cause of strep throat, a common ailment in children.
The NEA's Newberry tells Education World that he agrees that exposure to infections in poorly ventilated buildings could be a factor in teachers' rate of autoimmune diseases. "Above fifth grade, teachers are exposed to about 140 kids a day," he says. "Over 20 years, that is a lot of people-exposure. ... Fifty percent of our teachers are in schools in need of repair. We have to start asking questions about air quality, paint, lead, and asbestos. There is a lot to know and a lot to find out."
Neither guidance counselor Sandy Measer, nor her colleague Robert Bencker, is surprised by the study's results. Both have multiple sclerosis and both spent more than 20 years working in high schools and middle schools in Hartford, Connecticut.
Measer was diagnosed in 1979. Bencker was diagnosed in 1989, although he began having symptoms in the 1970s and it took doctors several years to confirm the diagnosis. Both teachers now work in an adult education program, in different buildings than they previously worked in.
Bencker suspects that conditions in one of the schools he taught in for a long period of time played a role in his illness -- as did on-the-job stress. "I believe the primary cause is a viral infection that's triggered by some other factor," he says. "Jobs such as teaching are more stressful than others, and stress is a likely trigger."
For her part, Measer says, she would like to see more studies of air quality in schools. A high school she taught in for many years began to sink shortly after it was completed because it was built on a swamp, she continues. The school had no windows, and the ventilation system also had to be redone.
"I think it has to do with what we are breathing," Measer says.
After the study was published in The Journal of Rheumatology and received exposure in the media, Walsh says between 20 and 30 teachers have contacted him by phone and e-mail to talk about their autoimmune diseases. They cite stress, environmental conditions, fungus, mold, or pesticides as factors they believe caused their illnesses.
BEYOND MORTALITY RATES
The next step in researching this topic is documenting teachers who have autoimmune diseases, those who still are teaching, and those who had to retire because of illness, Walsh says. Additional studies also should try to pin down the environmental factors that put teachers at higher risk of contracting an autoimmune disease.
"What's encouraging about our findings," Walsh notes, "is that they identify a well-defined occupational group that experiences more autoimmune diseases than the rest of the population. Teachers are easy to study; there are lots of them, they tend to stay in the profession, and they are easy to track."
Walsh was working on another project studying mortality rates for autoimmune diseases in every other occupational category NIOSH uses. Studying the mortality rates for people in other professions could identify another professional group with a high mortality rate and a similar level of exposure to people. That could lead to the discovery of a common causal factor, he explains.
The NEA's Gerald Newberry said in 2001 that he has not yet asked anyone to undertake a follow-up study. He notes, however, that Walsh's research has raised plenty of questions, saying, "It's enough to ask for an additional study."
Article by Ellen R. Delisio