Article

Risk and incidence of asthma attributable to occupational exposure among HMO members.

Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA.
American Journal of Industrial Medicine (Impact Factor: 1.59). 02/1998; 33(1):1-10. DOI: 10.1002/(SICI)1097-0274(199801)33:13.0.CO;2-2
Source: PubMed

ABSTRACT Occupational asthma may account for a significant proportion of adult-onset asthma, but incidence estimates from surveillance of physician reports and workers' compensation data (0.9 to 15/100,000) are lower than expected from community-based cross-sectional studies of asthma patients. We conducted a prospective cohort study of 79,204 health maintenance organization members between the ages of 15 and 55 at risk for asthma. Computerized files, medical records, and telephone interviews were used to identify and characterize asthma cases. Evidence for asthma attributable to occupational exposure was determined from work-related symptoms and workplace exposure. The annual incidence of clinically significant, new-onset asthma was 1.3/1,000, and increased to 3.7/1,000 when cases with reactivation of previously quiescent asthma were included. Criteria for onset of clinically significant asthma attributable to occupational exposure were met by 21% (95% CI 12-32%) of cases giving an incidence of 71/100,000 (95% CI 43-111). Physicians documented asking about work-related symptoms in 15% of charts, and recorded suggestive symptoms in three cases, but did not obtain occupational medicine consultation, diagnose occupational asthma, report to the state surveillance program, or bill workers' compensation for any of them. These data suggest that the incidence of asthma attributable to occupational exposures is significantly higher than previously reported, and accounts for a sizable proportion of adult-onset asthma.

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    ABSTRACT: To determine the incidence and epidemiological characteristics of work-related asthma in Korea. During 2004-2009, the Korea Work-Related Asthma Surveillance (KOWAS) program collected data on new cases of work-related asthma from occupational physicians, allergy and chest physicians, regional surveillance systems, and workers' compensation schemes. The incidence was calculated on the basis of industry, occupation, sex, age, and region. In addition, the distribution of causal agents was determined. During the study period, 236 cases of work-related asthma were reported, with 77 cases from more than 1 source. A total of 22.0% (n=52) were reported by occupational physicians, 52.5% (n=124) by allergy and chest physicians, 24.2% (n=57) by regional surveillance systems, and 43.2% (n=102) by workers' compensation schemes. The overall average annual incidence was 3.31 cases/million workers, with a rate of 3.78/million among men and 2.58/million among women. The highest incidence was observed in the 50-59-year age group (7.74/million), in the Gyeonggi/Incheon suburb of Seoul (8.50/million), in the furniture and other instrument manufacturing industries (67.62/million), and among craft and related trades workers (17.75/million). The most common causal agents were isocyanates (46.6%), flour/grain (8.5%), metal (5.9%), reactive dyes (5.1%), and solvents (4.2%). The incidence of work-related asthma in Korea was relatively low, and varied according to industry, occupation, gender, age, and region. Data provided by workers' compensation schemes and physician reports have been useful for determining the incidence and causes of work-related asthma.
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    ABSTRACT: RESUMEN Objetivos: Analizar las principales características y determinantes de las recaídas de enfermedad profesional en un registro poblacional. Material y métodos: Los datos se obtuvieron del Registro de enfermedades profesionales del Instituto Navarro de Salud Laboral en el período 1989-1998. En el análisis se han empleado pruebas estadísticas no paramétricas y regresión logística no condicional para identificar los factores de riesgo de presentación de recaídas. Resultados: En el período de estudio, un 22% de las 4.547 enfermedades profesionales declaradas fueron recaídas de un proceso previo. Asma y enfermedades cutáneas presentaron el mayor porcentaje de recaídas, si bien las enfermedades musculoesqueléticas registraron el mayor número absoluto. La mayor incidencia se ha registrado en la fabricación de vehículos de motor (siete recaídas anuales por cada mil trabajadores) y la principal entidad nosológica ha sido la fatiga de vainas tendinosas. La media de edad en las recaídas ha sido de 40,3 años. En el 75% de casos la recaída se produce en los nueve meses siguientes al proceso inicial, si bien el intervalo de tiempo entre recaídas ha sido menor en el asma profesional, inferior a dos meses en el 75% de casos (p = 0,005). Se asociaron a un mayor riesgo de recaída las edades intermedias, las empresas de más de 25 trabajadores, la fabricación de vehículos de motor, un tiempo de exposición al riesgo superior a dos años y el presentar patología cutánea o respiratoria. Conclusiones: Las recaídas de enfermedades profesionales suponen un problema emergente de salud laboral, que sugieren una insuficiente modificación de las condiciones de trabajo tras constatar el daño. Se producen principalmente en adultos jóvenes en un breve período de tiempo tras el proceso inicial, con patologías que disponen de medidas eficaces de prevención, como el diagnóstico precoz y cese de exposición al agente nocivo. SUMMARY Objectives: To analyze the principal characteristics and determinants of occupational disease relapses in a population register. Material and methods: The study material is the data base of the Register of Occupational Diseases of the Navarre Institute of Occupational Health in the period 1989-1998. Non parametric statistics tests and unconditional logistic regression were performed to model the relationship between socioprofessional factors and risk of occupational disease recurrence. Results: During the study period, 22% of the 4,547 cases of reported occupational diseases were relapses of previous cases. The highest percentage of relapses included asthma and skin diseases, but the musculo-skeletal diseases represented the highest overall figure. The highest incidence occurred in the manufacturing of motor vehicles (7 relapses per 1000 workers yearly) and the principal nosologic entity has been the fatigue of tendinous pods. The average age among relapse cases was 40.3 years. In 75% of cases the relapse is produced within 9 months following the initial process, even though the time interval between relapses was smaller for occupational asthma, under 2 months in 75% of cases (p = 0,005). Middle age, long exposure time, motor vehicle manufacture, greater companies as well as skin and respiratory diseases were found to increase relapse risk in the first year after initial diagnosis, after adjustment for the confounding factors. Conclusion: The professional disease relapses indicate an emerging problem of occupational health, suggesting an insufficient modification of work conditions after the verification of the damage. They are produced largely in young adults in a short period of time after the initial case, with pathologies for which effective risk prevention measures are available, including early diagnosis and early removal from exposure to offending agents.

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