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: 1.74). 02/1998; 33(1):1-10. DOI: 10.1002/(SICI)1097-0274(199801)33:13.0.CO;2-2
Source: PubMed


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.


Available from: Donald K Milton, Feb 04, 2014
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    • "Although fewer studies on new onset asthma have been conducted among adults than children, several cohort studies have found that traffic-related local pollutants can contribute to the onset and manifestation of asthma in adults [55,58,59]. Also, a substantial proportion of adult-onset asthma has been attributed to occupational exposures [60-65]. In a population-based, 10-year prospective study of 6,837 adults (aged 20–44 years at study onset) from 13 countries that participated in the European Community Respiratory Health Surveys (ECRHS and ECRHS II) [66], Kogevinas et al. found large geographic variations in population attributable risk (PAR) for adult-onset asthma due to occupational exposures (PAR range 10-25%); significant excess risk for nurses (relative risk [RR] 2.2, 95% CI 1.3-4.0); "
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    ABSTRACT: Current asthma prevalence among adults in the United States has reached historically high levels. Although national-level estimates indicate that asthma prevalence among adults increased by 33% from 2000 to 2009, state-specific temporal trends of current asthma prevalence and their contributing risk factors have not been explored. We used 2000--2009 Behavioral Risk Factor Surveillance System data from all 50 states and the District of Columbia (D.C.) to estimate state-specific current asthma prevalence by 2-year periods (2000--2001, 2002--2003, 2004--2005, 2006--2007, 2008--2009). We fitted a series of four logistic-regression models for each state to evaluate whether there was a statistically significant linear change in the current asthma prevalence over time, accounting for sociodemographic factors, smoking status, and weight status (using body mass index as the indicator). During 2000--2009, current asthma prevalence increased in all 50 states and D.C., with significant increases in 46/50 (92%) states and D.C. After accounting for weight status in the model series with sociodemographic factors, and smoking status, 10 states (AR, AZ, IA, IL, KS, ME, MT, UT, WV, and WY) that had previously shown a significant increase did not show a significant increase in current asthma prevalence. There was a significant increasing trend in state-specific current asthma prevalence among adults from 2000 to 2009 in most states in the United States. Obesity prevalence appears to contribute to increased current asthma prevalence in some states.
    BMC Public Health 12/2013; 13(1):1156. DOI:10.1186/1471-2458-13-1156 · 2.26 Impact Factor
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    • "The contribution of occupational exposure to the prevalence of asthma is unknown. Estimates of the incidence of occupational asthma from surveillance of occupational physicians' reports and workers' compensation data are lower than expected from community-based cross-sectional studies, and some authors suggest that the incidence of asthma attributable to occupational exposures is significantly higher than previously reported (Milton et al. 1998; Smith and Patton 1999). Previous studies reported that underdiagnosed asthma was frequent in young subjects (Peat et al. 1994; Nish and Schweitz 1992). "
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    ABSTRACT: The prevalence of diagnosed asthma and wheezing in young subjects is increasing; among environmental risk factors, occupational exposure can play a relevant role. The purpose of the study was to evaluate the effects of occupational exposure to a large variety of irritants and/or sensitizers on the incidence of respiratory symptoms and pulmonary function impairment in a group of young apprentices during the first year of work exposure, and to determine the prevalence of asthma-like symptoms and the role of different risk factors (gender, smoking habit, atopy and occupational exposure) in this young population. We studied 448 young apprentices at the first pre-employment evaluation with a standardized questionnaire, spirometry and skin prick tests; in 244 of them clinical and functional evaluation was repeated after 1 year exposure to respiratory irritants or sensitizers. At the first examination, males had higher prevalence of attacks of shortness of breath with wheeze, diagnosis of asthma, smoking habit and atopy than females. At the second examination there was no significant increase in the prevalence of respiratory symptoms. However, incident cases for cough, phlegm, wheezing, shortness of breath with wheeze (SOBWHZ) and asthma were all higher than remittent cases. Incidence of respiratory symptoms was associated with atopy and smoking habit. Respiratory symptoms slightly increase over 1 year occupational exposure to sensitizers or irritants. The loss at the follow-up of subjects with higher smoking habit suggests a small "health worker effect" and could underestimate the effect of occupational exposure in apprentices.
    International Archives of Occupational and Environmental Health 04/2006; 79(3):237-43. DOI:10.1007/s00420-005-0040-0 · 2.20 Impact Factor
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    • "Our occupation-based JEM is consistent with this methodology. There are, however, more sophisticated JEM approaches that use survey responses to modify the risk assignment, either on a probabilistic basis or based on structured or open-ended descriptions of job duties that may be even more targeted for lung disease [Milton et al., 1998,Le Moual et al., 2000,Kennedy et al., 2000,Zock et al., 2004]. In a variant of this approach, the responses from referents within a study can be used to establish the JEM applied to cases, avoiding potential reporting bias linked to disease [Flodin et al., 1996]. "
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    American Journal of Industrial Medicine 08/2005; 48(2):110-7. DOI:10.1002/ajim.20187 · 1.74 Impact Factor
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