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Work related asthma. A causal analysis controlling the healthy worker effect.
- Source :
-
Occupational and environmental medicine [Occup Environ Med] 2013 Sep; Vol. 70 (9), pp. 603-10. Date of Electronic Publication: 2013 Jun 12. - Publication Year :
- 2013
-
Abstract
- Objectives: The healthy worker effect usually leads to underestimation of the association between occupational exposure and asthma. The role of irritants in work-related asthma is disputed. We estimated the effect of occupational exposure on asthma expression in a longitudinal study, using marginal structural modelling to control for the healthy worker effect.<br />Methods: Analyses included 1284 participants (17-79 years, 48% men) from the follow-up (2003-2007) of the French Epidemiological study on the Genetics and Environment of Asthma (case-control study). Age at asthma onset, periods with/without attacks over lifetime and occupational history were recorded retrospectively. Exposures to known asthmagens, irritants or low level of chemicals/allergens were evaluated through a job-exposure matrix. The job history was reconstructed into 5-year intervals.<br />Results: Thirty-one per cent of subjects had ever been exposed to occupational asthmagens. Among the 38% of subjects who had asthma (ever), presence of attacks was reported in 52% of all time periods. Using standard analyses, no association was observed between exposure to known asthmagens (OR (95% CI): 0.99 (0.72 to 1.36)) or to irritants/low level of chemicals/allergens (0.82 (0.56 to 1.20)) and asthma attacks. Using a marginal structural model, all associations increased with suggestive evidence for known asthmagens (1.26 (0.90 to 1.76)), and reaching statistical significance for irritants/low level of chemicals/allergens (1.56 (1.02 to 2.40)).<br />Conclusions: The healthy worker effect has an important impact in risk assessment in work-related asthma studies. Marginal structural models are useful to eliminate imbalances in exposure due to disease-driven selection. Results support the role of irritants in work-related asthma.
- Subjects :
- Adolescent
Adult
Age Distribution
Aged
Asthma, Occupational physiopathology
Case-Control Studies
Confidence Intervals
Female
France epidemiology
Healthy Worker Effect
Humans
Incidence
Longitudinal Studies
Male
Middle Aged
Odds Ratio
Reference Values
Severity of Illness Index
Sex Distribution
Young Adult
Asthma, Occupational epidemiology
Asthma, Occupational etiology
Occupational Exposure adverse effects
Occupations
Subjects
Details
- Language :
- English
- ISSN :
- 1470-7926
- Volume :
- 70
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Occupational and environmental medicine
- Publication Type :
- Academic Journal
- Accession number :
- 23759534
- Full Text :
- https://doi.org/10.1136/oemed-2013-101362