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Work related asthma. A causal analysis controlling the healthy worker effect.
MedLine Citation:
PMID:  23759534     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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. 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. 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)). 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.
Authors:
Orianne Dumas; Nicole Le Moual; Valérie Siroux; Dick Heederik; Judith Garcia-Aymerich; Raphaëlle Varraso; Francine Kauffmann; Xavier Basagaña
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-6-12
Journal Detail:
Title:  Occupational and environmental medicine     Volume:  -     ISSN:  1470-7926     ISO Abbreviation:  Occup Environ Med     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-6-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9422759     Medline TA:  Occup Environ Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Inserm, Center for research in Epidemiology and Population Heatlh (CESP), U1018, Respiratory and Environmental Epidemiology team, F-94807, , Villejuif, France.
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