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Chuang YC, Tsai HH, Lin MC, Wu CC, Lin YC, Wang TN. Cluster analysis of phenotypes, job exposure, and inflammatory patterns in elderly and nonelderly asthma patients. Allergol Int 2024; 73:214-223. [PMID: 38290901 DOI: 10.1016/j.alit.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/03/2023] [Accepted: 12/17/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Asthma has been identified as different phenotypes due to various risk factors. Age differences may have potential effects on asthma phenotypes. Our study aimed to identify potential asthma phenotypes among adults divided by age as either younger or older than 65 years. We also compared differences in blood granulocyte patterns, occupational asthmagens, and asthma control-related outcomes among patient phenotype clusters. METHODS We recruited nonelderly (<65 years old) (n = 726) and elderly adults (≥65 years old) (n = 201) with mild-to-severe asthma. We conducted a factor analysis to select 17 variables. A two-step cluster analysis was used to classify subjects with asthma phenotypes, and a discriminant analysis was used to verify the classification of cluster results. RESULTS There were three clusters with different characteristics identified in both the nonelderly and elderly asthmatic adults. In the nonelderly patient group, cluster 2 (obese, neutrophilic phenotypes) had a 1.85-fold significantly increased risk of asthma exacerbations. Cluster 3 (early-onset, atopy, and smoker with an eosinophil-predominant pattern) had a 2.37-fold risk of asthma exacerbations and higher oral corticosteroid (OCS) use than cluster 1 (late-onset and LMW exposure with paucigranulocytic blood pattern). Among elderly patients, cluster 2 had poor lung function and more ex-smokers. Cluster 3 (early-onset, long asthma duration) had the lowest paucigranulocytic blood pattern percentages in the elderly group. CONCLUSIONS The novelty of the clusters was found in age-dependent clusters. We identified three distinct phenotypes with heterogeneous characteristics, asthma exacerbations and medicine use in nonelderly and elderly asthmatic patients, respectively. Classification of age-stratified asthma phenotypes may lead to precise identification of patients, which provides personalized disease management.
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Affiliation(s)
- Yung-Chi Chuang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Hua Tsai
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chao-Chien Wu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yuan-Chung Lin
- Institute of Environmental Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Tsu-Nai Wang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Sit G, Orsi L, Iwatsubo Y, Dananché B, Orsi F, Goldberg M, Leynaert B, Nadif R, Ribet C, Roche N, Roquelaure Y, Varraso R, Zins M, Pilorget C, Le Moual N, Dumas O. Chronic occupational exposures to irritants and asthma in the CONSTANCES cohort. Occup Environ Med 2024; 81:129-135. [PMID: 38418224 DOI: 10.1136/oemed-2023-109100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/12/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVES The impact of chronic occupational exposures to irritants on asthma remains discussed. We studied the associations between occupational exposures and asthma, with specific interest for chronic exposure to irritants, including disinfectants and cleaning products (DCPs) and solvents. METHODS Cross-sectional analyses included 115 540 adults (55% women, mean age 43 years, 10% current asthma) working at inclusion in the French population-based CONSTANCES cohort (2012-2020). Current asthma was defined by ever asthma with symptoms, medication or asthma attacks (past 12 months), and the asthma symptom score by the sum of 5 respiratory symptoms (past 12 months). Both lifetime and current occupational exposures were assessed by the Occupational Asthma-specific Job-Exposure Matrix. Associations were evaluated by gender using logistic and binomial negative regressions adjusted for age, smoking status and body mass index. RESULTS In women, associations were observed between current asthma and lifetime exposure to irritants (OR 1.05, 95% CI 1.00 to 1.11), DCPs (1.06, 95% CI 1.00 to 1.12) and solvents (1.06, 95% CI 0.98 to 1.14). In men, only lifetime exposure to DCPs (1.10, 95% CI 1.01 to 1.20) was associated with current asthma. Lifetime exposure to irritants was associated with higher asthma symptom score both in women (mean score ratio: 1.08, 95% CI 1.05 to 1.11) and men (1.11, 95% CI 1.07 to 1.15), especially for DCPs (women: 1.09, 95% CI 1.06 to 1.13, men: 1.21, 95% CI 1.15 to 1.27) and solvents (women 1.14, 95% CI 1.10 to 1.19, men: 1.10, 95% CI 1.05 to 1.15). For current exposures, no consistent associations were observed with current asthma and asthma symptom score. CONCLUSIONS Lifetime occupational exposures to irritants were associated with current asthma and higher asthma symptom score. These exposures should be carefully considered in asthma management.
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Affiliation(s)
- Guillaume Sit
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Laurent Orsi
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Yuriko Iwatsubo
- Santé Publique France, Direction Santé Environnement Travail, Saint-Maurice, France
| | - Brigitte Dananché
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Florence Orsi
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Marcel Goldberg
- Université Paris Cité, Université Paris-Saclay, UVSQ, Inserm, UMS 11, Cohortes Epidémiologiques en population, Villejuif, France
- Faculty of Medicine, Université de Paris, Paris, France
| | - Benedicte Leynaert
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Rachel Nadif
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Céline Ribet
- Université Paris Cité, Université Paris-Saclay, UVSQ, Inserm, UMS 11, Cohortes Epidémiologiques en population, Villejuif, France
- Faculty of Medicine, Université de Paris, Paris, France
| | - Nicolas Roche
- APHP Centre-Université de Paris, Hôpital et Institut Cochin, Service de Pneumologie, Paris, France
| | - Yves Roquelaure
- Université d'Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) UMR_S1085, Angers, France
| | - Raphäelle Varraso
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Marie Zins
- Université Paris Cité, Université Paris-Saclay, UVSQ, Inserm, UMS 11, Cohortes Epidémiologiques en population, Villejuif, France
- Faculty of Medicine, Université de Paris, Paris, France
| | - Corinne Pilorget
- Santé Publique France, Direction Santé Environnement Travail, Saint-Maurice, France
| | - Nicole Le Moual
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Orianne Dumas
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
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Mwanga HH, Dumas O, Migueres N, Le Moual N, Jeebhay MF. Airway Diseases Related to the Use of Cleaning Agents in Occupational Settings. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00214-9. [PMID: 38432401 DOI: 10.1016/j.jaip.2024.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
Exposure to disinfectants and cleaning products (DCPs) is now a well-established risk factor for work-related asthma (WRA). However, questions remain on the specific causal agents and pathophysiological mechanisms. Few studies have also reported an association between DCPs and rhinitis or chronic obstructive pulmonary disease. This review discusses the recent evidence pertaining to airway diseases attributable to occupational exposure to DCPs. In contrast to other agents, the incidence of WRA due to DCPs has increased over time. The use of DCPs in spray form has clearly been identified as an added risk factor. The mechanisms for WRA associated with DCPs remain poorly studied; however, both allergic and nonallergic responses have been described, with irritant mechanisms thought to play a major role. An early diagnostic workup based on clinical assessment accompanied by evaluation of lung function and immunological and airway inflammatory markers is important to guide optimal care and exposure avoidance to the implicated agent. Future research should focus on the effects of "green" products, pathophysiological mechanisms, and quantitative exposure assessment including the use of barcode-based methods to identify specific agents. There is an urgent need to strengthen preventive measures and interventions to reduce the burden of airway diseases associated with DCPs.
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Affiliation(s)
- Hussein H Mwanga
- Department of Environmental and Occupational Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Division of Occupational Medicine and Centre for Environmental & Occupational Health Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Orianne Dumas
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, Villejuif, France
| | - Nicolas Migueres
- Division of Pulmonology, Department of Chest Diseases, University Hospital of Strasbourg and Fédération de Médecine translationnelle, Strasbourg University, Strasbourg, France; UMR 7357 Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie ICUBE, Strasbourg, France
| | - Nicole Le Moual
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, Villejuif, France.
| | - Mohamed F Jeebhay
- Division of Occupational Medicine and Centre for Environmental & Occupational Health Research, School of Public Health, University of Cape Town, Cape Town, South Africa.
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Holtjer JCS, Bloemsma LD, Beijers RJHCG, Cornelissen MEB, Hilvering B, Houweling L, Vermeulen RCH, Downward GS, Maitland-Van der Zee AH. Identifying risk factors for COPD and adult-onset asthma: an umbrella review. Eur Respir Rev 2023; 32:32/168/230009. [PMID: 37137510 PMCID: PMC10155046 DOI: 10.1183/16000617.0009-2023] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/27/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND COPD and adult-onset asthma (AOA) are the most common noncommunicable respiratory diseases. To improve early identification and prevention, an overview of risk factors is needed. We therefore aimed to systematically summarise the nongenetic (exposome) risk factors for AOA and COPD. Additionally, we aimed to compare the risk factors for COPD and AOA. METHODS In this umbrella review, we searched PubMed for articles from inception until 1 February 2023 and screened the references of relevant articles. We included systematic reviews and meta-analyses of observational epidemiological studies in humans that assessed a minimum of one lifestyle or environmental risk factor for AOA or COPD. RESULTS In total, 75 reviews were included, of which 45 focused on risk factors for COPD, 28 on AOA and two examined both. For asthma, 43 different risk factors were identified while 45 were identified for COPD. For AOA, smoking, a high body mass index (BMI), wood dust exposure and residential chemical exposures, such as formaldehyde exposure or exposure to volatile organic compounds, were amongst the risk factors found. For COPD, smoking, ambient air pollution including nitrogen dioxide, a low BMI, indoor biomass burning, childhood asthma, occupational dust exposure and diet were amongst the risk factors found. CONCLUSIONS Many different factors for COPD and asthma have been found, highlighting the differences and similarities. The results of this systematic review can be used to target and identify people at high risk for COPD or AOA.
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Affiliation(s)
- Judith C S Holtjer
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
| | - Lizan D Bloemsma
- Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
| | - Rosanne J H C G Beijers
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Merel E B Cornelissen
- Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
| | - Bart Hilvering
- Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Laura Houweling
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
- Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Roel C H Vermeulen
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - George S Downward
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anke-Hilse Maitland-Van der Zee
- Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
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5
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Huntley CC, Bhomra P, Walters GI. Job exposure matrices for occupational respiratory disease: a narrative review. Occup Med (Lond) 2023; 73:263-267. [PMID: 37253148 DOI: 10.1093/occmed/kqad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Job exposure matrices (JEMs) are epidemiological tools used to provide estimations of occupational exposures when it is not feasible to complete detailed individual occupational histories. AIMS To identify and summarize the characteristics of published general population JEMs (GPJEM) of inhalable occupational exposures applied in studies of respiratory disease. METHODS MEDLINE and EMBASE databases were searched using pre-defined search terms, with screening performed by two independent reviewers to identify studies reporting the use of a GPJEM. JEM creation papers were subsequently identified and reviewed for each individual GPJEM, noting its characteristics in terms of occupational classification system and exposure estimates. RESULTS From 728 studies identified in initial searches, 33 GPJEMs of inhalable occupational exposures were identified. Versions of the International Standards Classification of Occupations were the most used occupational classification system. Binary, probability and intensity-based exposure estimates were most frequently reported in GPJEMs. CONCLUSIONS Selection of a GPJEM to apply in epidemiological research should be based on the exposure(s) of interest, time period of occupations under review, geographical region for intended use, occupation classification system used and the exposure estimate outcome.
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Affiliation(s)
- C C Huntley
- Occupational and Interstitial Lung Disease Services, University Hospitals Birmingham NHS Foundation Trust, Birmingham B3 3HX, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - P Bhomra
- Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK
| | - G I Walters
- Occupational and Interstitial Lung Disease Services, University Hospitals Birmingham NHS Foundation Trust, Birmingham B3 3HX, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
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Pacheco Da Silva E, Ngutuka M, Dumas O, Orsi L, Ait-Hadad W, Lemire P, Quentin J, Pin I, Varraso R, Siroux V, Le Moual N. Longitudinal associations of household use of cleaning agents and asthma symptoms in women: the EGEA study. Occup Environ Med 2023; 80:218-224. [PMID: 36746618 DOI: 10.1136/oemed-2022-108513] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 01/19/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate the associations between the evolution of household use of cleaning products with the asthma symptom score and its evolution over 8 years. METHODS Our study is based on 509 women participating in the last two surveys of the Epidemiological study on the Genetics and Environment of Asthma (EGEA) study (EGEA2: 2003-2007 (44 years, 19% current smokers) and EGEA3: 2011-2013). We assessed an asthma symptom score and the use of household cleaning products through standardised questionnaires. We studied longitudinal associations of the evolution of weekly use of irritant or spayed cleaning products with (1) the asthma symptom score at EGEA3 and a stable symptom score between EGEA2-EGEA3 (negative binomial models) and (2) the incidence/evolution of asthma symptoms between EGEA2-EGEA3 (logistic/polytomous logistic regressions). Models accounted for familial dependence and were adjusted for age, smoking status, body mass index and occupational exposure to asthmagens. RESULTS Persistent and increased (40% and 16%, respectively) weekly use of irritants or sprays were associated with a higher risk of asthma symptoms at EGEA3 (Mean Score Ratio (MSR)=1.51 (95% CI 1.06 to 2.14) and 1.33 (95% CI 0.85 to 2.08), respectively). A decreased use (19%) was associated with a lower risk of symptoms at EGEA3, compared with a persistent use (MSR=0.59 (95% CI 0.39 to 0.88)). We also observed an association between an increased use of sprays and the incidence of asthma symptoms (OR=2.30 (95% CI 1.08 to 4.91)), compared with no weekly use of irritants/sprays. CONCLUSIONS This longitudinal study, with repeated assessment of exposure and respiratory health, supports the hypothesis that a persistent or increased weekly use of sprayed cleaning products over time may have an adverse effect on the evolution of asthma symptoms.
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Affiliation(s)
- Emilie Pacheco Da Silva
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, 94807 Villejuif, France
| | - Mélanie Ngutuka
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, 94807 Villejuif, France
| | - Orianne Dumas
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, 94807 Villejuif, France
| | - Laurent Orsi
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, 94807 Villejuif, France
| | - Wassila Ait-Hadad
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, 94807 Villejuif, France
| | - Pierre Lemire
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, 94807 Villejuif, France
| | - Joane Quentin
- IAB, Team of Environmental Epidemiology Applied to Development and Respiratory Health, INSERM U1209, University of Grenoble-Alpes, CHU de Grenoble, Grenoble, France
| | - Isabelle Pin
- IAB, Team of Environmental Epidemiology Applied to Development and Respiratory Health, INSERM U1209, University of Grenoble-Alpes, CHU de Grenoble, Grenoble, France
| | - Raphäelle Varraso
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, 94807 Villejuif, France
| | - Valérie Siroux
- IAB, Team of Environmental Epidemiology Applied to Development and Respiratory Health, INSERM U1209, University of Grenoble-Alpes, CHU de Grenoble, Grenoble, France
| | - Nicole Le Moual
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, 94807 Villejuif, France
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Wan W, Ge CB, Friesen MC, Locke SJ, Russ DE, Burstyn I, Baker CJO, Adisesh A, Lan Q, Rothman N, Huss A, van Tongeren M, Vermeulen R, Peters S. Automated Coding of Job Descriptions From a General Population Study: Overview of Existing Tools, Their Application and Comparison. Ann Work Expo Health 2023:7025461. [PMID: 36734402 DOI: 10.1093/annweh/wxad002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/09/2023] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Automatic job coding tools were developed to reduce the laborious task of manually assigning job codes based on free-text job descriptions in census and survey data sources, including large occupational health studies. The objective of this study is to provide a case study of comparative performance of job coding and JEM (Job-Exposure Matrix)-assigned exposures agreement using existing coding tools. METHODS We compared three automatic job coding tools [AUTONOC, CASCOT (Computer-Assisted Structured Coding Tool), and LabourR], which were selected based on availability, coding of English free-text into coding systems closely related to the 1988 version of the International Standard Classification of Occupations (ISCO-88), and capability to perform batch coding. We used manually coded job histories from the AsiaLymph case-control study that were translated into English prior to auto-coding to assess their performance. We applied two general population JEMs to assess agreement at exposure level. Percent agreement and PABAK (Prevalence-Adjusted Bias-Adjusted Kappa) were used to compare the agreement of results from manual coders and automatic coding tools. RESULTS The coding per cent agreement among the three tools ranged from 17.7 to 26.0% for exact matches at the most detailed 4-digit ISCO-88 level. The agreement was better at a more general level of job coding (e.g. 43.8-58.1% in 1-digit ISCO-88), and in exposure assignments (median values of PABAK coefficient ranging 0.69-0.78 across 12 JEM-assigned exposures). Based on our testing data, CASCOT was found to outperform others in terms of better agreement in both job coding (26% 4-digit agreement) and exposure assignment (median kappa 0.61). CONCLUSIONS In this study, we observed that agreement on job coding was generally low for the three tools but noted a higher degree of agreement in assigned exposures. The results indicate the need for study-specific evaluations prior to their automatic use in general population studies, as well as improvements in the evaluated automatic coding tools.
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Affiliation(s)
- Wenxin Wan
- Department Population Health Sciences, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Calvin B Ge
- Department Population Health Sciences, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Melissa C Friesen
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Sarah J Locke
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Daniel E Russ
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Igor Burstyn
- Department of Environmental and Occupational Health, Drexel University, Dornsife School of Public Health, Philadelphia, PA, USA
| | - Christopher J O Baker
- Department of Computer Science, Faculty of Science, Applied Science and Engineering, University of New Brunswick, Saint John, NB, Canada
| | - Anil Adisesh
- Division of Occupational Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - Qing Lan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, MD, USA
| | - Nathaniel Rothman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Anke Huss
- Department Population Health Sciences, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Martie van Tongeren
- Centre for Occupational and Environmental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Roel Vermeulen
- Department Population Health Sciences, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Susan Peters
- Department Population Health Sciences, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
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8
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Sit G, Varraso R, Fezeu LK, Galan P, Orsi F, Pacheco Da Silva E, Touvier M, Hercberg S, Paris C, Le Moual N, Dumas O. Occupational Exposures to Irritants and Sensitizers, Asthma and Asthma Control in the Nutrinet-Santé Cohort. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:3220-3227.e7. [PMID: 36108925 DOI: 10.1016/j.jaip.2022.08.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/11/2022] [Accepted: 08/26/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The role of chronic occupational exposures to irritants in asthma remains not well-defined. Few studies have examined their associations with asthma and its control. OBJECTIVE To study the associations of occupational exposures with asthma and its control, with specific interest for irritants, including disinfectants and cleaning products (DCPs) and solvents. METHODS Analyses included 4,469 adults (3,792 with neither asthma nor respiratory symptoms, 677 with current asthma; 75.9% women, mean age 54 years) of a case-control study (2018) from the French NutriNet-Santé cohort. Current asthma was defined by ever asthma with symptoms, medication or asthma attacks in the past 12 months, adult-onset asthma by age at first asthma attack older than 16 years, and uncontrolled asthma was defined by an Asthma Control Test score less than 20. Ever/current exposures were assessed with the Occupational Asthma-specific Job Exposure Matrix. Associations were evaluated by multinomial logistic regressions adjusted for sex, age, smoking status, and body mass index. RESULTS Ever exposures to sensitizers (high molecular weight [HMW]: OR 1.53, 95% CI 1.18-2.00; and low molecular weight [LMW]: OR 1.42; 95% CI 1.09-1.87), irritants (OR 1.32; 95% CI 1.03-1.68), and DCPs (OR 1.43; 95% CI 1.10-1.85) were associated with current adult-onset asthma. Significant associations between ever exposures and uncontrolled adult-onset asthma were observed for high molecular weight (OR 2.69; 95% CI 1.52-4.78) and low molecular weight (OR 2.27; 95% CI 1.24-4.37) sensitizers, irritants (OR 2.32; 95% CI 1.36-3.95), and DCPs (OR 2.59; 95% CI 1.48-4.54). Results were similar for current exposures, with higher ORs. No association was observed with solvents. CONCLUSIONS Occupational exposures to both sensitizers and irritants were associated with current adult-onset asthma and uncontrolled asthma. Irritant and sensitizing agents should be carefully considered in asthma management.
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Affiliation(s)
- Guillaume Sit
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Raphaëlle Varraso
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Léopold K Fezeu
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), Bobigny, France
| | - Pilar Galan
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), Bobigny, France
| | - Florence Orsi
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Emilie Pacheco Da Silva
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Mathilde Touvier
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), Bobigny, France
| | - Serge Hercberg
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), Bobigny, France
| | - Christophe Paris
- Équipe d'Épidémiologie en santé au travail et ergonomie (ESTER), Université Rennes 1, Institut de recherche en santé, environnement et travail (IRSET), Inserm (U1085), École des Hautes Études en Santé Publique (EHESP), Rennes, France
| | - Nicole Le Moual
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France.
| | - Orianne Dumas
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
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9
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Rai R, Fritschi L, Glass DC, Dorji N, El-Zaemey S. Comparison of agreement in asthmagen exposure assessments between rule-based automatic algorithms and a job exposure matrix in healthcare workers in Australia and Bhutan. BMC Public Health 2022; 22:2089. [DOI: 10.1186/s12889-022-14514-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background:
Assessment of occupational exposures is an integral component of population-based studies investigating the epidemiology of occupational diseases. However, all the available methods for exposure assessment have been developed, tested and used in high-income countries. Except for a few studies examining pesticide exposures, there is limited research on whether these methods are appropriate for assessing exposure in LMICs. The aim of this study is to compare a task-specific algorithm-based method (OccIDEAS) to a job-specific matrix method (OAsJEM) in the assessment of asthmagen exposures among healthcare workers in a high-income country and a low- and middle- income country (LMIC) to determine an appropriate assessment method for use in LMICs for future research.
Methods:
Data were obtained from a national cross-sectional survey of occupational asthmagens exposure in Australia and a cross-sectional survey of occupational chemical exposure among Bhutanese healthcare workers. Exposure was assessed using OccIDEAS and the OAsJEM. Prevalence of exposure to asthmagens and inter-rater agreement were calculated.
Results:
In Australia, the prevalence was higher for a majority of agents when assessed by OccIDEAS than by the OAsJEM (13 versus 3). OccIDEAS identified exposures to a greater number of agents (16 versus 7). The agreement as indicated by κ (Cohen’s Kappa coefficient) for six of the seven agents assessed was poor to fair (0.02 to 0.37). In Bhutan, the prevalence of exposure assessed by OccIDEAS was higher for four of the seven agents and κ was poor for all the four agents assessed (-0.06 to 0.13). The OAsJEM overestimated exposures to high-level disinfectants by assigning exposures to all participants from 10 (Bhutan) and 12 (Australia) ISCO-88 codes; whereas OccIDEAS assigned exposures to varying proportions of participants from these ISCO-codes.
Conclusion:
There was poor to fair agreement in the assessment of asthmagen exposure in healthcare workers between the two methods. The OAsJEM overestimated the prevalence of certain exposures. As compared to the OAsJEM, OccIDEAS appeared to be more appropriate for evaluating cross-country exposures to asthmagens in healthcare workers due to its inherent quality of assessing task-based determinants and its versatility in being adaptable for use in different countries with different exposure circumstances.
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10
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Bemanalizadeh M, Khoshhali M, Goli P, Abdollahpour I, Kelishadi R. Parental Occupational Exposure and Neurodevelopmental Disorders in Offspring: a Systematic Review and Meta-analysis. Curr Environ Health Rep 2022; 9:406-422. [PMID: 35522387 DOI: 10.1007/s40572-022-00356-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Parental occupational exposures might be associated with neurodevelopmental disorders (NDDs) in offspring. We aimed to conduct a systematic review and meta-analysis to summarize and synthesize the current literature and to estimate the pooled magnitude of the underlying association(s) between parental occupational exposures and subsequent risk of NDDs. RECENT FINDINGS In the meta-analysis of 20 included studies, significant associations were found between parental occupational exposure to pesticides or solvents and the risk of attention deficit hyperactivity disorder in offspring. Prenatal occupational exposure to pesticides was significantly associated with motor development or cognition disorders in children. Furthermore, some evidence showed that metals might have a role in the development of autism spectrum disorders. Further studies need to identify the level of parental occupational exposures that can be significantly associated with NDDs. Moreover, utilizing standardized outcome and exposure scales is recommended to incorporate paternal, maternal, and parental as well as both prenatal and postnatal exposure in future studies.
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Affiliation(s)
- Maryam Bemanalizadeh
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehri Khoshhali
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parvin Goli
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ibrahim Abdollahpour
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
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11
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Descatha A, Fadel M, Sembajwe G, Peters S, Evanoff BA. Job-Exposure Matrix: A Useful Tool for Incorporating Workplace Exposure Data Into Population Health Research and Practice. FRONTIERS IN EPIDEMIOLOGY 2022; 2:857316. [PMID: 38455292 PMCID: PMC10910984 DOI: 10.3389/fepid.2022.857316] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/25/2022] [Indexed: 03/09/2024]
Abstract
Workplace exposures to physical, chemical, and psychosocial factors account for a large burden of chronic diseases. Obtaining useful estimates of current and past workplace exposures is challenging, particularly in large general population studies. Job-exposure matrices (JEMs) are a useful tool for exposure assessment, particularly when no individual level exposure data are available. A JEM provides a cross-tabulation of job titles (sometimes combined with industry) and estimated exposures to workers carrying out these jobs during different time periods. The major limitation of JEMs is that they do not account for individual variation in exposures within the same job. This limitation is offset by the advantages of low cost, wide applicability, lack of bias from self-reporting, and the ability to estimate exposures based on job titles when no other exposure data exist. There is growing use of JEMs in research examining the role of workplace exposures in the development of chronic diseases, and interest in their application to public health practice. This paper provides a scoping review of JEM use, some examples of JEMs, and brief guidance for the application of JEMs in epidemiological research. In conclusion, JEMs provide a useful tool for researchers and public health practitioners to estimate occupational exposures in large scale epidemiological studies relevant to many health conditions.
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Affiliation(s)
- Alexis Descatha
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, SFR ICAT, Angers, France
- CHU Angers, Poisoning Control Center-Clinical Data Center,Angers, France
- Department of Occupational Medicine, Epidemiology and Prevention, Northwell Health, Hofstra University, New York, NY, United States
| | - Marc Fadel
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, SFR ICAT, Angers, France
| | - Grace Sembajwe
- Department of Occupational Medicine, Epidemiology and Prevention, Northwell Health, Hofstra University, New York, NY, United States
| | - Susan Peters
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Bradley A. Evanoff
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO, United States
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12
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de Graaf L, Boulanger M, Bureau M, Bouvier G, Meryet-Figuiere M, Tual S, Lebailly P, Baldi I. Occupational pesticide exposure, cancer and chronic neurological disorders: A systematic review of epidemiological studies in greenspace workers. ENVIRONMENTAL RESEARCH 2022; 203:111822. [PMID: 34352232 DOI: 10.1016/j.envres.2021.111822] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 06/13/2023]
Abstract
CONTEXT The greenspace sector includes a broad range of occupations: gardeners, landscapers, municipal workers, maintenance operators of public facilities, golf-course employees and other sports facilities, horticulturists, plant and tree nursery workers etc. The health impact of occupational pesticide exposure has mainly been studied among farmers. Other professionals such as greenspace workers are also extremely exposed, presenting specific exposure features (practices, types of pesticide used). The aim of this review was to summarize epidemiological literature that examine the relationship between pesticide exposure and the risk of cancer and long-term health effects in greenspace workers. METHOD Six main groups of greenspace workers were identified and examined through a systematic literature review based on PubMed and Scopus. The studies were then grouped according to their design, health outcomes and the type of population studied. RESULTS Forty-four articles were selected among the 1679 identified. Fifteen studies were conducted exclusively among greenspace workers, while ten also studied these workers with other pesticide applicators. Six were cohorts from the general population in which greenspace workers were identified. Elevated risks were found in several studies for leukaemia, soft-tissue sarcoma, multiple myeloma, non-Hodgkin lymphoma and Parkinson's disease. DISCUSSION The majority of studies used rough parameters for defining exposure such as job titles which could lead to the misclassification of exposure, with the risk of false or positive negative conclusions. Health outcomes were mainly collected through registries or death certificates, and information regarding potential confounders was often missing. CONCLUSION The review identified only 15 studies conducted exclusively among greenspace workers. Elevated risk was found for several sites of cancer and Parkinson's diseases. Further epidemiological research is needed, conducted specifically on these workers, to better characterize this population, its exposure to pesticides and the related health effects.
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Affiliation(s)
- L de Graaf
- ISPED, Université de Bordeaux, 146 rue Léo Saignat, 33076, Bordeaux, France; INSERM U1219 Epicene, 146 rue Léo Saignat, 33076, Bordeaux, France.
| | - M Boulanger
- INSERM U1086 Anticipe, 3 avenue Général Harris, 14000, Caen, France; Centre de Lutte contre le Cancer François Baclesse, 3 avenue Général Harris, 14000, Caen, France; Université de Caen Normandie, Esplanade de la Paix, 14000, Caen, France
| | - M Bureau
- ISPED, Université de Bordeaux, 146 rue Léo Saignat, 33076, Bordeaux, France; INSERM U1219 Epicene, 146 rue Léo Saignat, 33076, Bordeaux, France
| | - G Bouvier
- ISPED, Université de Bordeaux, 146 rue Léo Saignat, 33076, Bordeaux, France; INSERM U1219 Epicene, 146 rue Léo Saignat, 33076, Bordeaux, France
| | - M Meryet-Figuiere
- INSERM U1086 Anticipe, 3 avenue Général Harris, 14000, Caen, France; Centre de Lutte contre le Cancer François Baclesse, 3 avenue Général Harris, 14000, Caen, France; Université de Caen Normandie, Esplanade de la Paix, 14000, Caen, France
| | - S Tual
- INSERM U1086 Anticipe, 3 avenue Général Harris, 14000, Caen, France; Centre de Lutte contre le Cancer François Baclesse, 3 avenue Général Harris, 14000, Caen, France; Université de Caen Normandie, Esplanade de la Paix, 14000, Caen, France
| | - P Lebailly
- INSERM U1086 Anticipe, 3 avenue Général Harris, 14000, Caen, France; Centre de Lutte contre le Cancer François Baclesse, 3 avenue Général Harris, 14000, Caen, France; Université de Caen Normandie, Esplanade de la Paix, 14000, Caen, France
| | - I Baldi
- ISPED, Université de Bordeaux, 146 rue Léo Saignat, 33076, Bordeaux, France; INSERM U1219 Epicene, 146 rue Léo Saignat, 33076, Bordeaux, France; Service Santé Travail Environnement, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
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13
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Andrianjafimasy MV, Febrissy M, Zerimech F, Dananché B, Kromhout H, Matran R, Nadif M, Oberson-Geneste D, Quinot C, Schlünssen V, Siroux V, Zock JP, Le Moual N, Nadif R, Dumas O. Association between occupational exposure to irritant agents and a distinct asthma endotype in adults. Occup Environ Med 2021; 79:155-161. [PMID: 34413158 DOI: 10.1136/oemed-2020-107065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 07/22/2021] [Indexed: 11/04/2022]
Abstract
AIM The biological mechanisms of work-related asthma induced by irritants remain unclear. We investigated the associations between occupational exposure to irritants and respiratory endotypes previously identified among never asthmatics (NA) and current asthmatics (CA) integrating clinical characteristics and biomarkers related to oxidative stress and inflammation. METHODS We used cross-sectional data from 999 adults (mean 45 years old, 46% men) from the case-control and familial Epidemiological study on the Genetics and Environments of Asthma (EGEA) study. Five respiratory endotypes have been identified using a cluster-based approach: NA1 (n=463) asymptomatic, NA2 (n=169) with respiratory symptoms, CA1 (n=50) with active treated adult-onset asthma, poor lung function, high blood neutrophil counts and high fluorescent oxidation products level, CA2 (n=203) with mild middle-age asthma, rhinitis and low immunoglobulin E level, and CA3 (n=114) with inactive/mild untreated allergic childhood-onset asthma. Occupational exposure to irritants during the current or last held job was assessed by the updated occupational asthma-specific job-exposure matrix (levels of exposure: no/medium/high). Associations between irritants and each respiratory endotype (NA1 asymptomatic as reference) were studied using logistic regressions adjusted for age, sex and smoking status. RESULTS Prevalence of high occupational exposure to irritants was 7% in NA1, 6% in NA2, 16% in CA1, 7% in CA2 and 10% in CA3. High exposure to irritants was associated with CA1 (adjusted OR aOR, (95% CI) 2.7 (1.0 to 7.3)). Exposure to irritants was not significantly associated with other endotypes (aOR range: 0.8 to 1.5). CONCLUSION Occupational exposure to irritants was associated with a distinct respiratory endotype suggesting oxidative stress and neutrophilic inflammation as potential associated biological mechanisms.
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Affiliation(s)
- Miora Valérie Andrianjafimasy
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, 94807, Villejuif, Île-de-France, France
| | - Mickaël Febrissy
- LIPADE, Université Paris 5 Descartes, Paris, Île-de-France, France
| | - Farid Zerimech
- Univ. Lille, ULR 4483 - IMPECS, CHU Lille, F-59000 Lille, Lille, France.,Institut Pasteur de Lille, F-59000, Lille, France
| | | | - Hans Kromhout
- Utrecht University, Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht, Netherlands
| | - Régis Matran
- Univ. Lille, ULR 4483 - IMPECS, CHU Lille, F-59000 Lille, Lille, France.,Institut Pasteur de Lille, F-59000, Lille, France
| | - Mohamed Nadif
- LIPADE, Université Paris 5 Descartes, Paris, Île-de-France, France
| | | | - Catherine Quinot
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, 94807, Villejuif, Île-de-France, France
| | - Vivi Schlünssen
- Aarhus University, Department of Public Health, Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus, Denmark.,National Research Centre for the Working Environment, Kobenhavn, Denmark
| | - Valérie Siroux
- Universite Grenoble Alpes, Inserm, CNRS, Team of environmental epidemiology applied to Reproduction and Respiratory health, IAB, Grenoble, France
| | - Jan-Paul Zock
- Institute for Global Health (ISGlobal) and Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Nicole Le Moual
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, 94807, Villejuif, Île-de-France, France
| | - Rachel Nadif
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, 94807, Villejuif, Île-de-France, France
| | - Orianne Dumas
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, 94807, Villejuif, Île-de-France, France
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14
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Murgia N, Brisman J, Olin A, Dahlman‐Hoglund A, Andersson E, Torén K. Occupational risk factors for airway obstruction in a population-based study in Northern Europe. Am J Ind Med 2021; 64:576-584. [PMID: 33861476 DOI: 10.1002/ajim.23250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/03/2021] [Accepted: 03/23/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Airway obstruction is a key feature of asthma and chronic obstructive pulmonary diseases (COPD). Smoking habits and workplace exposures to vapors, gas, dusts, and fumes (VGDF) could cause or exacerbate airway obstruction. The aim of this study is to evaluate the risk of airway obstruction due to smoking and workplace exposure, and their interaction, in a large population-based study. METHODS In this cross-sectional study, a sample (n = 6153) of the Swedish population aged between 24 and 76 years underwent a questionnaire, clinical examination, blood test, and spirometry to gather information on airway obstruction classified by Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria or American Thoracic Society (ATS)/European Respiratory Society (ERS) criteria, risk factors, and confounders. Occupational exposures to VGDF were rated according to a specific job-exposure matrix. Adjusted logistic regression models were used to evaluate risk factors for airway obstruction in smokers and nonsmokers. RESULTS In total, 9.8% had airway obstruction by GOLD criteria and 10.3% by ATS/ERS. Smokers with a high likelihood of exposure to VGDF had a higher risk of airway obstruction than those not exposed (odds ratio [OR]: 1.74, 95% confidence interval [CI]: 1.15-2.65 by GOLD; OR: 1.58, 95% CI: 1.06-2.37 by ATS/ERS) especially those >50 years of age. In smokers highly exposed to VGDF, risk estimates were higher than in the whole population, and the interaction between high exposure to VGDF and smoking further increased the risk of airway obstruction. CONCLUSIONS This study suggests a possible role for interaction between cigarette smoking and VGDF exposure on the risk of airway obstruction.
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Affiliation(s)
- Nicola Murgia
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital University of Göteborg Göteborg Sweden
- Section of Occupational Medicine, Respiratory Diseases and Toxicology University of Perugia Perugia Italy
| | - Jonas Brisman
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital University of Göteborg Göteborg Sweden
| | - Anna‐Carin Olin
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital University of Göteborg Göteborg Sweden
| | - Anna Dahlman‐Hoglund
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital University of Göteborg Göteborg Sweden
| | - Eva Andersson
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital University of Göteborg Göteborg Sweden
| | - Kjell Torén
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital University of Göteborg Göteborg Sweden
- Section of Occupational Medicine, Respiratory Diseases and Toxicology University of Perugia Perugia Italy
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15
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Audignon-Durand S, Gramond C, Ducamp S, Manangama G, Garrigou A, Delva F, Brochard P, Lacourt A. Development of a Job-Exposure Matrix for Ultrafine Particle Exposure: The MatPUF JEM. Ann Work Expo Health 2021; 65:516-527. [PMID: 33637984 DOI: 10.1093/annweh/wxaa126] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 11/13/2020] [Accepted: 11/19/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Ultrafine particles (UFPs) are generated from common work processes and have thus existed for a long time. Far more prevalent than engineered nanoparticles, they share common toxicological characteristics with them. However, there is no existing retrospective assessment tool specific to UFPs, for example, for epidemiological purposes. Thus, we aimed to develop a job-exposure matrix dedicated to UFPs. METHOD Fifty-seven work processes were identified as well as the chemical composition of UFPs emitted, following a literature review and the input of an expert panel. These work processes were associated with occupational codes as defined by the ISCO 1968 classification. The probability and frequency of UFP exposure were assessed for each combination of occupational code and process. Summarized probabilities and frequencies were then calculated for all ISCO occupational codes associated with several processes. Variations in exposure over time or across industrial sectors were accounted for in the assessment of each occupational code. RESULTS In the ISCO classification, 52.8% of the occupational codes (n = 835) assessed were associated with exposure to UFPs, consisting mainly of carbonaceous, metallic, and mineral families (39.5%, 22 and, 15.8%, respectively). Among them, 42.6% involved very probable exposure, and at a high frequency (regularly or continuously). CONCLUSION These results suggest that occupational exposure to UFPs may be extensive at the workplace and could concern a wide variety of workers. Pending the integration of a third parameter assessing the intensity of UFP exposure, the MatPUF JEM already constitutes a promising and easy-to-use tool to study the possible adverse health effects of UFPs at work. It may also guide prevention policies in the occupational environments concerned, including those involving engineered nanoparticles.
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Affiliation(s)
- Sabyne Audignon-Durand
- University of Bordeaux, Inserm UMR 1219 EPICENE Team, Bordeaux Population Health Research Center, 146 rue Léo Saignat, Bordeaux, France.,Bordeaux University Hospital, Service of Occupational Medicine and Occupational Pathology, 12 rue Dubernat, Talence, France
| | - Céline Gramond
- University of Bordeaux, Inserm UMR 1219 EPICENE Team, Bordeaux Population Health Research Center, 146 rue Léo Saignat, Bordeaux, France
| | - Stéphane Ducamp
- Santé Publique France, Division of Environmental and Occupational health, 12 rue du Val d'Osne, Saint Maurice, France
| | - Guyguy Manangama
- University of Bordeaux, Inserm UMR 1219 EPICENE Team, Bordeaux Population Health Research Center, 146 rue Léo Saignat, Bordeaux, France.,Bordeaux University Hospital, Service of Occupational Medicine and Occupational Pathology, 12 rue Dubernat, Talence, France
| | - Alain Garrigou
- University of Bordeaux, Inserm UMR 1219 EPICENE Team, Bordeaux Population Health Research Center, 146 rue Léo Saignat, Bordeaux, France
| | - Fleur Delva
- University of Bordeaux, Inserm UMR 1219 EPICENE Team, Bordeaux Population Health Research Center, 146 rue Léo Saignat, Bordeaux, France.,Bordeaux University Hospital, Service of Occupational Medicine and Occupational Pathology, 12 rue Dubernat, Talence, France
| | - Patrick Brochard
- University of Bordeaux, Inserm UMR 1219 EPICENE Team, Bordeaux Population Health Research Center, 146 rue Léo Saignat, Bordeaux, France.,Bordeaux University Hospital, Service of Occupational Medicine and Occupational Pathology, 12 rue Dubernat, Talence, France
| | - Aude Lacourt
- University of Bordeaux, Inserm UMR 1219 EPICENE Team, Bordeaux Population Health Research Center, 146 rue Léo Saignat, Bordeaux, France
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16
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Forster F, Kreißl S, Wengenroth L, Vogelberg C, von Mutius E, Schaub B, Nowak D, Weinmann T, Radon K, Gerlich J. Third Follow-Up of the Study on Occupational Allergy Risks (SOLAR III) in Germany: Design, Methods, and Initial Data Analysis. Front Public Health 2021; 9:591717. [PMID: 33748056 PMCID: PMC7969718 DOI: 10.3389/fpubh.2021.591717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 02/05/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Asthma and allergies are complex diseases affected by genetic and environmental factors, such as occupational and psychosocial factors, as well as interactions between them. Although childhood is a critical phase in the development of asthma and allergies, few cohort studies on occupational outcomes followed up participants from childhood onwards. We present design, methods, and initial data analysis for the third follow-up of SOLAR (Study on Occupational Allergy Risks), a prospective and population-based German asthma and allergy cohort. Methods: The SOLAR cohort was initially recruited in 1995-1996 for Phase II of the German branch of the International Study of Asthma and Allergies in Childhood (ISAAC II) and followed up three times since, in 2002-2003, 2007-2009, and 2017-2018. During the third follow-up (SOLAR III), participants were between 29 and 34 years old. Since SOLAR focuses on occupational exposures, follow-ups were conducted at important points in time of the development of participants' career. To evaluate the potential of selection bias, responders and non-responders were compared based on variables from earlier study phases. In responders, frequency and pattern of missing values were examined and compared within the subsets of paper and online versions of the used questionnaires. Results: In total, 1,359 participants completed the questionnaire of the third follow-up (47.3% of eligible participants). Initially, the cohort started with 6,399 participants from the ISAAC II questionnaire study. A selection process led to a study population that is more female, higher educated, smokes less and has a higher proportion of certain asthma and allergy symptoms (also in their parents) than the initial cohort. Pattern and frequency of missing values were different for paper and online questionnaires. Discussion: The third follow-up of the SOLAR cohort offers the opportunity to analyze the course of asthma and allergies and their associations to environmental, occupational and psychosocial risk factors over more than 20 years from childhood to adulthood. Selection processes within the cohort might lead to bias that needs to be considered in future analyses.
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Affiliation(s)
- Felix Forster
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.,Comprehensive Pneumology Centre Munich, German Centre for Lung Research, Munich, Germany
| | - Sylvia Kreißl
- Paediatric Department, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Dresden, Germany
| | - Laura Wengenroth
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.,Comprehensive Pneumology Centre Munich, German Centre for Lung Research, Munich, Germany
| | - Christian Vogelberg
- Paediatric Department, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Dresden, Germany
| | - Erika von Mutius
- Comprehensive Pneumology Centre Munich, German Centre for Lung Research, Munich, Germany.,Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Bianca Schaub
- Comprehensive Pneumology Centre Munich, German Centre for Lung Research, Munich, Germany.,Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.,Comprehensive Pneumology Centre Munich, German Centre for Lung Research, Munich, Germany
| | - Tobias Weinmann
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.,Comprehensive Pneumology Centre Munich, German Centre for Lung Research, Munich, Germany
| | - Katja Radon
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.,Comprehensive Pneumology Centre Munich, German Centre for Lung Research, Munich, Germany
| | - Jessica Gerlich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.,Comprehensive Pneumology Centre Munich, German Centre for Lung Research, Munich, Germany
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Identification and Remediation of Environmental Exposures in Patients With Interstitial Lung Disease: Evidence Review and Practical Considerations. Chest 2021; 160:219-230. [PMID: 33609518 DOI: 10.1016/j.chest.2021.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/07/2020] [Accepted: 02/13/2021] [Indexed: 11/21/2022] Open
Abstract
A relationship between inhalational exposure to materials in the environment and development of interstitial lung disease (ILD) is long recognized. Hypersensitivity pneumonitis is an environmentally -induced diffuse parenchymal lung disease. In addition to hypersensitivity pneumonitis, domestic and occupational exposures have been shown to influence onset and progression of other ILDs, including idiopathic interstitial pneumonias such as idiopathic pulmonary fibrosis. A key component of the clinical evaluation of patients presenting with ILD includes elucidation of a complete exposure history, which may influence diagnostic classification of the ILD as well as its management. Currently, there is no standardized approach to environmental evaluation or remediation of potentially harmful exposures in home or workplace environments for patients with ILD. This review discusses evidence for environmental contributions to ILD pathogenesis and draws on asthma and occupational medicine literature to frame the potential utility of a professional evaluation for environmental factors contributing to the development and progression of ILD. Although several reports suggest benefits of environmental assessment for those with asthma or certain occupational exposures, lack of information about benefits in broader populations may limit application. Determining the feasibility, long-term outcomes, and cost-effectiveness of environmental evaluation and remediation in acute and chronic ILDs should be a focus of future research.
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18
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Cocco P, Satta G, Meloni F, Pilia I, Ahmed F, Becker N, Casabonne D, de Sanjosé S, Foretova L, Maynadié M, Nieters A, Staines A, 't Mannetje A, Zucca M, Ennas MG, Campagna M, De Matteis S, Benavente Y. Occupational exposure to organic dust and risk of lymphoma subtypes in the EPILYMPH case-control study. Scand J Work Environ Health 2021; 47:42-51. [PMID: 33103203 PMCID: PMC7801142 DOI: 10.5271/sjweh.3925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Indexed: 11/23/2022] Open
Abstract
Objectives This study aimed to estimate the risk of lymphoma and its major subtypes in relation to occupational exposure to specific organic dusts. Methods We explored the association in 1853 cases and 1997 controls who participated in the EpiLymph case-control study, conducted in six European countries in 1998-2004. Based on expert assessment of lifetime occupational exposures, we calculated the risk of the major lymphoma subtypes associated with exposure to six specific organic dusts, namely, flour, hardwood, softwood, natural textile, synthetic textile, and leather, and two generic (any types) groups: wood and textile dusts. Risk was predicted with unconditional regression modeling, adjusted by age, gender, study center, and education. Results We observed a 2.1-fold increase in risk of follicular lymphoma associated with ever exposure to leather dust [95% confidence interval (CI) 1.01-4.20]. After excluding subjects who ever worked in a farm or had ever been exposed to solvents, risk of B-cell lymphoma was elevated in relation to ever exposure to leather dust [odd ratio (OR) 2.2, 95% CI 1.00-4.78], but it was not supported by increasing trends with the exposure metrics. Risk of Hodgkin lymphoma was elevated (OR 2.0, 95% CI 0.95-4.30) for exposure to textile dust, with consistent upward trends by cumulative exposure and three independent exposure metrics combined (P=0.023, and P=0.0068, respectively). Conclusions Future, larger studies might provide further insights into the nature of the association we observed between exposure to textile dust and risk of Hodgkin lymphoma.
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Affiliation(s)
- Pierluigi Cocco
- Department of Medical Sciences and Public Health, Occupational Medicine unit, University of Cagliari, Monserrato (Cagliari) Italy.
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19
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Adult Asthma among Workers in Ontario. Results from the Occupational Disease Surveillance System. Ann Am Thorac Soc 2020; 16:563-571. [PMID: 30682323 DOI: 10.1513/annalsats.201810-701oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: Given that approximately 15% of new-onset adult asthma cases originate because of exposures in the workplace, there is a need for systematic and ongoing monitoring of risk among workers. Objectives: To characterize the risk of new-onset adult asthma among workers in Ontario. Methods: We used 575,379 provincial accepted time-loss workers' compensation claimants data linked to physician billing data. Workers aged 15 to 65 years with a nonasthma compensation claim between January 1, 2002, and December 31, 2013, were eligible for inclusion. Cohort entry corresponded to the date of the claim. The case definition required two or more records for asthma within a 12-month period, within a 3-year time window after cohort entry. A 3-year washout period preceding cohort entry was used to exclude prevalent cases. Workers at risk of new-onset adult asthma were followed from cohort entry date to date of diagnosis, emigration, age 65 years, death, or end of study period. Cox regression models were used to generate birth year- and sex-adjusted hazard ratios (HRs) by occupation, industry, and exposures identified using a job exposure matrix. Sex-stratified risk estimates were also generated. Results: Increased risks were detected among well-recognized groups, including bakers (HR, 1.60; 95% confidence interval [CI], 1.22-2.09) and painters and decorators (HR, 1.67; 95% CI, 1.23-2.28). In the job exposure matrix analysis, flour and isocyanates were associated with increased risk of asthma. Concrete finishers (HR, 1.93; 95% CI, 1.12-3.32) and shipping and receiving clerks (HR, 1.21; 95% CI, 1.03-1.43) also showed elevated risk, whereas results varied across woodworker groups. Decreased risks were detected for nursing and farming groups. Conclusions: This practical data linkage approach was successful for examining associations across hundreds of jobs. Unexpected and previously unrecognized findings deserve further investigation and emphasize the importance of an ongoing system to guide research as well as prevention.
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20
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Henneberger PK, Kurth LM, Doney B, Liang X, Andersson E. Development of an Asthma-Specific Job Exposure Matrix for Use in the United States. Ann Work Expo Health 2020; 64:82-95. [PMID: 31746973 PMCID: PMC9990745 DOI: 10.1093/annweh/wxz089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/25/2019] [Accepted: 11/04/2019] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Existing asthma-specific job-exposure matrices (JEMs) do not necessarily reflect current working conditions in the USA and do not directly function with occupational coding systems commonly used in the USA. We initiated a project to modify an existing JEM to address these limitations, and to apply the new JEM to the entire US employed population to estimate quantitatively the extent of probable work-related asthma exposures nationwide. METHODS We started with an asthma-specific JEM that was developed for northern Europe (the N-JEM) and modified it to function with the 2010 US Standard Occupational Classification (SOC-2010) codes and to reflect working conditions in the USA during the post-2000 period. This involved cross walking from the 1988 International Standard Classification of Occupations (ISCO-88) codes used in the N-JEM to the SOC-2010 codes, transferring the N-JEM exposure assignments to the SOC-2010 codes, and modifying those assignments to reflect working conditions in the USA. The new US asthma JEM (USA-JEM) assigns exposures to 19 agents organized into five categories. The USA-JEM and N-JEM were applied to the same sample of working adults with asthma to compare how they performed, and the USA-JEM was also applied to the entire 2015 US working population to estimate the extent of occupational asthma exposures nationally. RESULTS The USA-JEM assigns at least one asthma-related probable exposure to 47.5% and at least one possible exposure to 14.9% of the 840 SOC-2010 detailed occupations, and 9.0% of the occupations have both probable exposure to at least one agent and possible exposure to at least one other agent. The USA-JEM has greater sensitivity for cleaning products, highly reactive disinfectants and sterilants, and irritant peak exposures than the N-JEM. When applied to the entire 2015 US working population, the USA-JEM determined that 42.6% of workers had probable exposure to at least one type of occupational asthma agent. DISCUSSION A new asthma-specific JEM for application in the USA was developed. Additional work is needed to compare its performance to similar JEMs and, if possible, to exposure assessments generated on a case-by-case basis.
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Affiliation(s)
- Paul K Henneberger
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Laura M Kurth
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Brent Doney
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Xiaoming Liang
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Eva Andersson
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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22
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Walters GI, Burge PS, Moore VC, Robertson AS. Cleaning agent occupational asthma in the West Midlands, UK: 2000-16. Occup Med (Lond) 2019; 68:530-536. [PMID: 30184236 DOI: 10.1093/occmed/kqy113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Cleaning agents are now a common cause of occupational asthma (OA) worldwide. Irritant airway and sensitization mechanisms are implicated for a variety of old and new agents. Aims To describe the exposures responsible for cleaning agent OA diagnosed within a UK specialist occupational lung disease service between 2000 and 2016. Methods The Birmingham NHS Occupational Lung Disease Service clinical database was searched for cases of OA caused by cleaning agents, and data were gathered on age, gender, atopic status, smoking history, symptom onset, diagnostic investigations (including Occupational Asthma SYStem analysis of workplace serial peak expiratory flow measurements and specific inhalational challenge), proposed mechanism, industry, occupation and causative agent. Results Eighty patients with cleaning agent OA (77% female, 76% arising de novo) were identified. The median annual number of cases was 4 (interquartile range = 2-7). The commonest cleaning agents causing OA were chloramines (31%), glutaraldehyde (26%) and quaternary ammonium compounds (11%) and frequently implicated industries were healthcare (55%), education (18%) and leisure (8%). Conclusions Certain cleaning agents in common usage, such as chlorine-releasing agents, quaternary ammonium compounds and aldehydes, are associated with sensitization and asthma. Their use alters over time, and this is particularly evident in UK healthcare where cleaning and decontamination practice and policy have changed. Vigilance for OA in workplaces such as hospitals, nursing homes, leisure centres and swimming pools, where these cleaning agents are regularly used, is therefore essential.
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Affiliation(s)
- G I Walters
- Birmingham Regional NHS Occupational Lung Disease Service, Birmingham Chest Clinic, Queensway, Birmingham, UK.,Occupational and Environmental Medicine, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - P S Burge
- Birmingham Regional NHS Occupational Lung Disease Service, Birmingham Chest Clinic, Queensway, Birmingham, UK.,Occupational and Environmental Medicine, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - V C Moore
- Birmingham Regional NHS Occupational Lung Disease Service, Birmingham Chest Clinic, Queensway, Birmingham, UK
| | - A S Robertson
- Birmingham Regional NHS Occupational Lung Disease Service, Birmingham Chest Clinic, Queensway, Birmingham, UK
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Stoleski S, Minov J, Karadzinska-Bislimovska J, Mijakoski D, Atanasovska A, Bislimovska D. Asthma and Chronic Obstructive Pulmonary Disease Associated With Occupational Exposure in Dairy Farmers - Importance of Job Exposure Matrices. Open Access Maced J Med Sci 2019; 7:2350-2359. [PMID: 31592062 PMCID: PMC6765081 DOI: 10.3889/oamjms.2019.630] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 11/21/2022] Open
Abstract
AIM To evaluate the prevalence of chronic respiratory symptoms, lung function impairment, and chronic obstructive respiratory diseases in dairy farmers. Our objective is to then examine their relation to exposure duration and to explore the usefulness of job exposure matrices as tools for exposure assessment, and predictors for respiratory health impairment. METHODS A cross-sectional study was performed, including 83 dairy farmers (mean age: 52.6 ± 8.7 years; mean exposure duration: 23.7 ± 7.6 years) and 80 office workers as a control group (mean age: 52.7 ± 8.2 years) matched for age, smoking habits, and socioeconomic status. Methods of evaluating examined subjects included a questionnaire on respiratory symptoms in the last 12 months, spirometry and histamine challenge, as well as the use of job exposure matrices (JEM). RESULTS Dairy farmers had a significantly higher prevalence of cough (38.5), phlegm (27.7%), and wheezing (21.7%), than controls (p < 0.05). All mean baseline spirometric parameters were lower in dairy farmers compared to the controls, but statistical significance was confirmed only for MEF25, MEF50, and MEF75% (p = 0.010, p = 0.001, and p = 0.004, respectively). The prevalence of bronchial hyperresponsiveness, asthma, and chronic obstructive pulmonary disease was higher in dairy farmers but without statistical significance. JEM were useful tools for exposure assessment and predictors of factors for asthma and COPD development. CONCLUSION The results suggest that occupational exposure among crop farmers is associated with a higher prevalence of respiratory symptoms, lung function impairment, and a higher prevalence of chronic respiratory diseases. JEM showed good potential for farming exposure evaluation and promoted their applicability within the diagnostic algorithm focused on respiratory health assessment.
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Affiliation(s)
- Saso Stoleski
- Institute for Occupational Health of Republic of Macedonia, WHO Collaborating Center, Galen Collaborating Center, Skopje, Republic of Macedonia
| | - Jordan Minov
- Institute for Occupational Health of Republic of Macedonia, WHO Collaborating Center, Galen Collaborating Center, Skopje, Republic of Macedonia
| | - Jovanka Karadzinska-Bislimovska
- Institute for Occupational Health of Republic of Macedonia, WHO Collaborating Center, Galen Collaborating Center, Skopje, Republic of Macedonia
| | - Dragan Mijakoski
- Institute for Occupational Health of Republic of Macedonia, WHO Collaborating Center, Galen Collaborating Center, Skopje, Republic of Macedonia
| | - Aneta Atanasovska
- Institute for Occupational Health of Republic of Macedonia, WHO Collaborating Center, Galen Collaborating Center, Skopje, Republic of Macedonia
| | - Dragana Bislimovska
- Institute for Occupational Health of Republic of Macedonia, WHO Collaborating Center, Galen Collaborating Center, Skopje, Republic of Macedonia
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Shakik S, Arrandale V, Holness DL, MacLeod JS, McLeod CB, Peter A, Demers PA. Dermatitis among workers in Ontario: results from the Occupational Disease Surveillance System. Occup Environ Med 2019; 76:625-631. [PMID: 31320492 PMCID: PMC6824611 DOI: 10.1136/oemed-2018-105667] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/24/2019] [Accepted: 06/19/2019] [Indexed: 11/21/2022]
Abstract
Objectives Dermatitis is the most common occupational skin disease, and further evidence is needed regarding preventable risk factors. The Occupational Disease Surveillance System (ODSS) derived from administrative data was used to investigate dermatitis risk among industry and occupation groups in Ontario. Methods ODSS cohort members were identified from Workplace Safety and Insurance Board (WSIB) accepted lost time claims. A case was defined as having ≥2 dermatitis physician billing claims during a 12-month period within 3 years of cohort entry. A 3-year look-back period prior to cohort entry was used to exclude prevalent cases without a WSIB claim. Workers were followed for 3 years or until dermatitis diagnosis, age 65 years, emigration, death or end of follow-up (31 December 2016), whichever occurred first. Age-adjusted and sex-adjusted Cox proportional hazard models estimated HRs and 95% CIs. The risk of dermatitis was explored using a job exposure matrix that identifies exposure to asthmagens, many of which also cause contact dermatitis. Results Among 597 401 workers, 23 843 cases of new-onset dermatitis were identified. Expected elevated risks were observed among several groups including furniture and fixture industries, food and beverage preparation and chemicals, petroleum, rubber, plastic and related materials processing occupations and workers exposed to metal working fluids and organic solvents. Decreased risk was observed among farmers, nurses and construction industries, and occupations exposed to latex and indoor cleaning products. Conclusions ODSS can contribute to occupational dermatitis surveillance in Ontario by identifying occupational groups at risk of dermatitis that can then be prioritised for prevention activities.
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Affiliation(s)
- Sharara Shakik
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Victoria Arrandale
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Dorothy Linn Holness
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Occupational Health, St Michael's Hospital, Toronto, Ontario, Canada
| | - Jill S MacLeod
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Christopher B McLeod
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alice Peter
- Population Health and Prevention, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Ontario, Canada
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Influence of Childhood Asthma and Allergies on Occupational Exposure in Early Adulthood: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16122163. [PMID: 31248069 PMCID: PMC6617119 DOI: 10.3390/ijerph16122163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/11/2019] [Accepted: 06/17/2019] [Indexed: 11/17/2022]
Abstract
We aimed to determine whether history of asthma/allergies in childhood was associated with avoidance of jobs with exposure to asthmagens in early adulthood. The Melbourne Atopic Cohort Study recruited 620 children at high risk of allergic diseases at birth (1990–1994). Asthma, hay fever and eczema were evaluated by questionnaires during childhood. A follow-up in early adulthood (mean age: 18 years) collected information on the current job. Occupational exposure to asthmagens/irritants was evaluated using a job-exposure matrix. The association between history of asthma/allergies in childhood and working in a job with exposure to asthmagens/irritants was evaluated by logistic regression, adjusted for age, sex and parental education. Among 363 participants followed-up until early adulthood, 17% worked in a job with exposure to asthmagens/irritants. History of asthma (35%) was not associated with working in an exposed job (adjusted OR: 1.16, 95% CI: 0.65–2.09). Subjects with history of hay fever (37%) and eczema (40%) were more likely to enter exposed jobs (significant for hay fever: 1.78, 1.00–3.17; but not eczema: 1.62, 0.91–2.87). In conclusion, young adults with history of allergies were more likely to enter exposed jobs, suggesting no avoidance of potentially hazardous exposures. Improved counselling against high risk jobs may be needed for young adults with these conditions.
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Bayesian Correction for Exposure Misclassification and Evolution of Evidence in Two Studies of the Association Between Maternal Occupational Exposure to Asthmagens and Risk of Autism Spectrum Disorder. Curr Environ Health Rep 2019; 5:338-350. [PMID: 30030714 DOI: 10.1007/s40572-018-0205-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW Inference in epidemiologic studies is plagued by exposure misclassification. Several methods exist to correct for misclassification error. One approach is to use point estimates for the sensitivity (Sn) and specificity (Sp) of the tool used for exposure assessment. Unfortunately, we typically do not know the Sn and Sp with certainty. Bayesian methods for exposure misclassification correction allow us to model this uncertainty via distributions for Sn and Sp. These methods have been applied in epidemiologic literature, but are not considered a mainstream approach, especially in occupational epidemiology. RECENT FINDINGS Here, we illustrate an occupational epidemiology application of a Bayesian approach to correct for the differential misclassification error generated by estimating occupational exposures from job codes using a job exposure matrix (JEM). We argue that analyses accounting for exposure misclassification should become more commonplace in the literature.
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Elshaer NS, Foda NM, Kassem HS, Ayaad MW, Meleis DS. Bronchial asthma among workers in Alexandria and its association with occupation, eosinophil count, total serum immunoglobulin E antibodies, and glutathione S-transferase genes polymorphism. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2011.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Noha S. Elshaer
- Community Medicine Department, Faculty of Medicine, Alexandria University, Egypt
| | - Nermine M.T. Foda
- Community Medicine Department, Faculty of Medicine, Alexandria University, Egypt
| | - Heba S. Kassem
- Pathology Department, Clinical Genomics Center, Faculty of Medicine, Alexandria University, Egypt
| | - Mona W. Ayaad
- Clinical Pathology Department, Faculty of Medicine, Alexandria University, Egypt
| | - Dorreya S. Meleis
- Community Medicine Department, Faculty of Medicine, Alexandria University, Egypt
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Forster F, Weinmann T, Gerlich J, Schlotz W, Weinmayr G, Genuneit J, Windstetter D, Vogelberg C, von Mutius E, Nowak D, Radon K. Work-related stress and incident asthma and rhinitis: results from the SOLAR study. Int Arch Occup Environ Health 2019; 92:673-681. [PMID: 30656403 DOI: 10.1007/s00420-019-01402-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 01/13/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study analyzes the association of work-related stress with incident asthma and rhinitis in young adults with a special focus on gender-specific differences. METHODS Incident asthma, wheezing and rhinitis were measured in a cohort of 2051 young German adults (aged 16-18 years at baseline) recruited by the prospective population-based SOLAR study (Study of Occupational Allergy Risks). Work-related stress was measured by the Trier Inventory for the Assessment of Chronic Stress (TICS). Two TICS scales, work overload and work discontent, were analysed. Logistic regression was conducted to calculate odds ratios (OR) and 95% confidence intervals (CI). RESULTS In females, the odds for incident asthma were found to be 17% higher for each increase of the work discontent score by one point (OR 1.17, 95% CI 1.04-1.31). In males, no association was statistically significant. Incident rhinitis showed no association with any exposure variable. CONCLUSION This study shows a link between work-related stress and incident asthma which seems to be confined to women. This study adds evidence about the association of work-related stress and asthma in young adults and can contribute to prevention for that particular age group.
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Affiliation(s)
- Felix Forster
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr.1, 80336, Munich, Germany. .,Institute for Medical Informatics, Biometry, and Epidemiology, LMU Munich, Munich, Germany. .,Comprehensive Pneumology Centre Munich, Member of German Centre for Lung Research, Munich, Germany.
| | - Tobias Weinmann
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr.1, 80336, Munich, Germany.,Comprehensive Pneumology Centre Munich, Member of German Centre for Lung Research, Munich, Germany.,Munich Center of Health Sciences (MC-Health), Munich, Germany
| | - Jessica Gerlich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr.1, 80336, Munich, Germany.,Comprehensive Pneumology Centre Munich, Member of German Centre for Lung Research, Munich, Germany.,Munich Center of Health Sciences (MC-Health), Munich, Germany
| | - Wolff Schlotz
- Max Planck Institute of Empirical Aesthetics, Frankfurt am Main, Germany
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Jon Genuneit
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Doris Windstetter
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr.1, 80336, Munich, Germany.,Comprehensive Pneumology Centre Munich, Member of German Centre for Lung Research, Munich, Germany
| | - Christian Vogelberg
- Paediatric Department, University Hospital Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Erika von Mutius
- Dr. v. Haunersches Kinderspital, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Pneumology Centre Munich, Member of German Centre for Lung Research, Munich, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr.1, 80336, Munich, Germany.,Comprehensive Pneumology Centre Munich, Member of German Centre for Lung Research, Munich, Germany
| | - Katja Radon
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr.1, 80336, Munich, Germany.,Comprehensive Pneumology Centre Munich, Member of German Centre for Lung Research, Munich, Germany.,Munich Center of Health Sciences (MC-Health), Munich, Germany
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Schyllert C, Andersson M, Hedman L, Ekström M, Backman H, Lindberg A, Rönmark E. Job titles classified into socioeconomic and occupational groups identify subjects with increased risk for respiratory symptoms independent of occupational exposure to vapour, gas, dust, or fumes. Eur Clin Respir J 2018; 5:1468715. [PMID: 29785256 PMCID: PMC5954483 DOI: 10.1080/20018525.2018.1468715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/13/2018] [Indexed: 11/03/2022] Open
Abstract
Objectives: To evaluate the ability of three different job title classification systems to identify subjects at risk for respiratory symptoms and asthma by also taking the effect of exposure to vapours, gas, dust, and fumes (VGDF) into account. Background: Respiratory symptoms and asthma may be caused by occupational factors. There are different ways to classify occupational exposure. In this study, self-reported occupational exposure to vapours, gas, dust and fumes was used as well as job titles classifed into occupational and socioeconomic Groups according to three different systems. Design: This was a large population-based study of adults aged 30-69 years in Northern Sweden (n = 9,992, 50% women). Information on job titles, VGDF-exposure, smoking habits, asthma and respiratory symptoms was collected by a postal survey. Job titles were used for classification into socioeconomic and occupational groups based on three classification systems; Socioeconomic classification (SEI), the Nordic Occupations Classification 1983 (NYK), and the Swedish Standard Classification of Occupations 2012 (SSYK). Associations were analysed by multivariable logistic regression. Results: Occupational exposure to VGDF was a risk factor for all respiratory symptoms and asthma (odds ratios (ORs) 1.3-2.4). Productive cough was associated with the socioeconomic groups of manual workers (ORs 1.5-2.1) and non-manual employees (ORs 1.6-1.9). These groups include occupations such as construction and transportation workers, service workers, nurses, teachers and administration clerks which by the SSYK classification were associated with productive cough (ORs 2.4-3.7). Recurrent wheeze was significantly associated with the SEI group manual workers (ORs 1.5-1.7). After adjustment for also VGDF, productive cough remained significantly associated with the SEI groups manual workers in service and non-manual employees, and the SSYK-occupational groups administration, service, and elementary occupations. Conclusions: In this cross-sectional study, two of the three different classification systems, SSYK and SEI gave similar results and identified groups with increased risk for respiratory symptoms while NYK did not give conclusive results. Furthermore, several associations were independent of exposure to VGDF indicating that also other job-related factors than VGDF are of importance.
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Affiliation(s)
- Christian Schyllert
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN unit, Umeå University, Umeå, Sweden
| | - Martin Andersson
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN unit, Umeå University, Umeå, Sweden
| | - Linnea Hedman
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN unit, Umeå University, Umeå, Sweden.,Department of Health Sciences, Division of Nursing, Luleå University of Technology, Luleå, Sweden
| | - Magnus Ekström
- Department of Respiratory Medicine and Allergology, Institution for Clinical Sciences, Lund University, Lund, Sweden
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN unit, Umeå University, Umeå, Sweden
| | - Anne Lindberg
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN unit, Umeå University, Umeå, Sweden
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Le Moual N, Zock JP, Dumas O, Lytras T, Andersson E, Lillienberg L, Schlünssen V, Benke G, Kromhout H. Update of an occupational asthma-specific job exposure matrix to assess exposure to 30 specific agents. Occup Environ Med 2018; 75:507-514. [PMID: 29650699 DOI: 10.1136/oemed-2017-104866] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/09/2018] [Accepted: 03/15/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVES We aimed to update an asthmagen job exposure matrix (JEM) developed in the late 1990s. Main reasons were: the number of suspected and recognised asthmagens has since tripled; understanding of the aetiological role of irritants in asthma and methodological insights in application of JEMs have emerged in the period. METHODS For each agent of the new occupational asthma-specific JEM (OAsJEM), a working group of three experts out of eight evaluated exposure for each International Standard Classification of Occupations, 1988 (ISCO-88) job code into three categories: 'high' (high probability of exposure and moderate-to-high intensity), 'medium' (low-to-moderate probability or low intensity) and 'unexposed'. Within a working group, experts evaluated exposures independently from each other. If expert assessments were inconsistent the final decision was taken by consensus. Specificity was favoured over sensitivity, that is, jobs were classified with high exposure only if the probability of exposure was high and the intensity moderate-to-high. In the final review, all experts checked assigned exposures and proposed/improved recommendations for expert re-evaluation after default application of the JEM. RESULTS The OAsJEM covers exposures to 30 sensitisers/irritants, including 12 newly recognised, classified into seven broad groups. Initial agreement between the three experts was mostly fair to moderate (κ values 0.2-0.5). Out of 506 ISCO-88 codes, the majority was classified as unexposed (from 82.6% (organic solvents) to 99.8% (persulfates)) and a minority as 'high-exposed' (0.2% (persulfates) to 2.6% (organic solvents)). CONCLUSIONS The OAsJEM developed to improve occupational exposure assessment may improve evaluations of associations with asthma in epidemiological studies and contribute to assessment of the burden of work-related asthma.
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Affiliation(s)
- Nicole Le Moual
- Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
- Inserm, U1168, VIMA: Aging and chronic diseases. Epidemiological and public health approaches, Inserm, F-94807, Villejuif, France
| | - Jan-Paul Zock
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain
- University Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Orianne Dumas
- Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
- Inserm, U1168, VIMA: Aging and chronic diseases. Epidemiological and public health approaches, Inserm, F-94807, Villejuif, France
| | - Theodore Lytras
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain
- University Pompeu Fabra (UPF), Barcelona, Spain
| | - Eva Andersson
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Linnéa Lillienberg
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Vivi Schlünssen
- Department of Public Health, Danish Ramazzini Centre, Aarhus University and National Research Center for the Working Environment, Copenhagen, Denmark
| | - Geza Benke
- Monash Centre for Occupation and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Hans Kromhout
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
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Doney BC, Henneberger PK, Humann MJ, Liang X, Kelly KM, Cox-Ganser JM. Occupational Exposure to Vapor-Gas, Dust, and Fumes in a Cohort of Rural Adults in Iowa Compared with a Cohort of Urban Adults. MMWR. SURVEILLANCE SUMMARIES : MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES 2017; 66:1-5. [PMID: 29095802 PMCID: PMC5829718 DOI: 10.15585/mmwr.ss6621a1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Problem/Condition Many rural residents work in the field of agriculture; however, employment in nonagricultural jobs also is common. Because previous studies in rural communities often have focused on agricultural workers, much less is known about the occupational exposures in other types of jobs in rural settings. Characterizing airborne occupational exposures that can contribute to respiratory diseases is important so that differences between rural and urban working populations can be assessed. Reporting Period 1994–2011. Description of System This investigation used data from the baseline questionnaire completed by adult rural residents participating in the Keokuk County Rural Health Study (KCRHS). The distribution of jobs and occupational exposures to vapor-gas, dust, and fumes (VGDF) among all participants was analyzed and stratified by farming status (current, former, and never) then compared with a cohort of urban workers from the Multi-Ethnic Study of Atherosclerosis (MESA). Occupational exposure in the last job was assessed with a job-exposure matrix (JEM) developed for chronic obstructive pulmonary disease (COPD). The COPD JEM assesses VGDF exposure at levels of none or low, medium, and high. Results The 1,699 KCRHS (rural) participants were more likely to have medium or high occupational VGDF exposure (43.2%) at their last job than their urban MESA counterparts (15.0% of 3,667 participants). One fifth (20.8%) of the rural participants currently farmed, 43.1% were former farmers, and approximately one third (36.1%) had never farmed. These three farming groups differed in VGDF exposure at the last job, with the prevalence of medium or high exposure at 80.2% for current farmers, 38.7% for former farmers, and 27.4% for never farmers, and all three percentages were higher than the 15.0% medium or high level of VGDF exposure for urban workers. Interpretation Rural workers, including those who had never farmed, were more likely to experience occupational VGDF exposure than urban workers. Public Health Action The occupational exposures of rural adults assessed using the COPD JEM will be used to investigate their potential association with obstructive respiratory health problems (e.g., airflow limitation and chronic bronchitis). This assessment might highlight occupations in need of preventive interventions.
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Affiliation(s)
- Brent C Doney
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, Morgantown, West Virginia
| | - Paul K Henneberger
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, Morgantown, West Virginia
| | - Michael J Humann
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, Morgantown, West Virginia
| | - Xiaoming Liang
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, Morgantown, West Virginia
| | - Kevin M Kelly
- The University of Iowa, Department of Occupational and Environmental Health, Iowa City, Iowa
| | - Jean M Cox-Ganser
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, Morgantown, West Virginia
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32
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Singer AB, Windham GC, Croen LA, Daniels JL, Lee BK, Qian Y, Schendel DE, Fallin MD, Burstyn I. Maternal Exposure to Occupational Asthmagens During Pregnancy and Autism Spectrum Disorder in the Study to Explore Early Development. J Autism Dev Disord 2017; 46:3458-3468. [PMID: 27511194 PMCID: PMC5073112 DOI: 10.1007/s10803-016-2882-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Maternal immune activity has been linked to children with autism spectrum disorder (ASD). We examined maternal occupational exposure to asthma-causing agents during pregnancy in relation to ASD risk. Our sample included 463 ASD cases and 710 general population controls from the Study to Explore Early Development whose mothers reported at least one job during pregnancy. Asthmagen exposure was estimated from a published job-exposure matrix. The adjusted odds ratio for ASD comparing asthmagen-exposed to unexposed was 1.39 (95 % CI 0.96-2.02). Maternal workplace asthmagen exposure was not associated with ASD risk in this study, but this result does not exclude some involvement of maternal exposure to asthma-causing agents in ASD.
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Affiliation(s)
- Alison B Singer
- Department of Epidemiology and Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA.
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
| | - Gayle C Windham
- Division of Environmental and Occupational Disease, California Department of Public Health, Richmond, CA, USA
| | - Lisa A Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Julie L Daniels
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Brian K Lee
- Department of Epidemiology and Biostatistics and the A.J. Drexel Autism Institute, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Yinge Qian
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Diana E Schendel
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
- Department of Economics and Business, National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - M Daniele Fallin
- Department of Epidemiology and Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
- Department of Mental Health and the Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Igor Burstyn
- Department of Epidemiology and Biostatistics and the A.J. Drexel Autism Institute, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
- Department of Environmental and Occupational Health and the A.J. Drexel Autism Institute, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
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Weinmann T, Gerlich J, Heinrich S, Nowak D, Mutius EV, Vogelberg C, Genuneit J, Lanzinger S, Al-Khadra S, Lohse T, Motoc I, Walter V, Radon K. Association of household cleaning agents and disinfectants with asthma in young German adults. Occup Environ Med 2017; 74:684-690. [PMID: 28483971 DOI: 10.1136/oemed-2016-104086] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 03/28/2017] [Accepted: 04/13/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We scrutinised the association of private use of household sprays and disinfectants with asthma incidence in young adults in the transition from school to working life. METHODS Between 2007 and 2009,2051 young adults aged 19-24 years living in two major German cities took part in the Study on Occupational Allergy Risks II. Self-reported exposure to household sprays and disinfectants was characterised according to a composite score for frequency of use as no use (score=0), low use (score between 1 and the median), medium use (score between the median and the 90th percentile) and high use (score above the 90th percentile). Two outcome variables (current asthma and current wheezing) with four mutually exclusive categories (never, incident, persistent and remittent) were used for the risk analyses. Multinomial logistic regression models examined the association between the frequency of using household sprays and disinfectants with asthma and wheezing adjusting for potential confounders. RESULTS Compared with no use, high use of disinfectants was associated with a more than twofold increased odds of incident asthma (OR 2.79, 95% CI 1.14 to 6.83). In addition, low/medium use of disinfectants was associated with remittent asthma (OR 2.39, 95% CI 1.29 to 4.47). The evidence for an association between high usage of household sprays and asthma incidence was weak (OR 2.79, 95% CI 0.84 to 9.20). CONCLUSION Our results support the hypothesis of an association between the use of cleaning products and elevated risks for asthma and wheezing in young adults at the start of working life.
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Affiliation(s)
- Tobias Weinmann
- Occupational and Environmental Epidemiology & NetTeaching Unit, Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Munich (LMU), Munich, Germany
| | - Jessica Gerlich
- Occupational and Environmental Epidemiology & NetTeaching Unit, Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Munich (LMU), Munich, Germany
| | - Sabine Heinrich
- Occupational and Environmental Epidemiology & NetTeaching Unit, Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Munich (LMU), Munich, Germany
| | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Munich (LMU), Munich, Germany
| | - Erika von Mutius
- Dr. v. Haunersches Kinderspital, University Hospital of Munich (LMU), Munich, Germany
| | - Christian Vogelberg
- Paediatric Department, University Hospital Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Jon Genuneit
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Stefanie Lanzinger
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Tina Lohse
- Epidemiology, Biostatistics and Prevention Institute, Chronic Disease Epidemiology, University of Zurich, Zurich, Switzerland
| | - Irina Motoc
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Viola Walter
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Katja Radon
- Occupational and Environmental Epidemiology & NetTeaching Unit, Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Munich (LMU), Munich, Germany
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Singer AB, Burstyn I, Thygesen M, Mortensen PB, Fallin MD, Schendel DE. Parental exposures to occupational asthmagens and risk of autism spectrum disorder in a Danish population-based case-control study. Environ Health 2017; 16:31. [PMID: 28359263 PMCID: PMC5374665 DOI: 10.1186/s12940-017-0230-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/28/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Environmental exposures and immune conditions during pregnancy could influence development of autism spectrum disorder (ASD) in offspring. However, few studies have examined immune-triggering exposures in relation to ASD. We evaluated the association between parental workplace exposures to risk factors for asthma ("asthmagens") and ASD. METHODS We conducted a population-based case-control study in the Danish population using register linkage. Our study population consisted of 11,869 ASD cases and 48,046 controls born from 1993 through 2007. Cases were identified by ICD-10 codes in the Danish Psychiatric Central Register. ASD cases and controls were linked to parental Danish International Standard Classification of Occupations (DISCO-88) job codes. Parental occupational asthmagen exposure was estimated by linking DISCO-88 codes to an asthma-specific job-exposure matrix. RESULTS Our maternal analyses included 6706 case mothers and 29,359 control mothers employed during the pregnancy period. We found a weak inverse association between ASD and any maternal occupational asthmagen exposure, adjusting for sociodemographic covariates (adjusted OR: 0.92, 95% CI: 0.86-0.99). In adjusted analyses, including 7647 cases and 31,947 controls with employed fathers, paternal occupational asthmagen exposure was not associated with ASD (adjusted OR: 0.98, 95% CI: 0.92-1.05). CONCLUSIONS We found a weak inverse association between maternal occupational asthmagen exposure and ASD, and a null association between paternal occupational exposure and ASD. We suggest that unmeasured confounding negatively biased the estimate, but that this unmeasured confounding is likely not strong enough to bring the effect above the null. Overall, our results were consistent with no positive association between parental asthmagen exposure and ASD in the children.
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Affiliation(s)
- Alison B Singer
- Department of Epidemiology and Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.
- Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark.
- Department of Epidemiology, University of North Carolina at Chapel Hill, CB #7435, Chapel Hill, NC, 27599, USA.
| | - Igor Burstyn
- Department of Environmental and Occupational Health, Department of Epidemiology and Biostatistics, the A.J. Drexel Autism Institute, Drexel University Dornsife School of Public Health, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Malene Thygesen
- Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
- Department of Economics and Business, National Centre for Register-based Research, Aarhus University, Fuglesangs Allé 4, Building 2631, DK-8210, Aarhus V, Denmark
| | - Preben Bo Mortensen
- Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
- Department of Economics and Business, National Centre for Register-based Research, Aarhus University, Fuglesangs Allé 4, Building 2631, DK-8210, Aarhus V, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - M Daniele Fallin
- Department of Epidemiology and Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Diana E Schendel
- Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
- Department of Economics and Business, National Centre for Register-based Research, Aarhus University, Fuglesangs Allé 4, Building 2631, DK-8210, Aarhus V, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Department of Public Health, Section for Epidemiology, Aarhus University, Bartholins Allé 2, Building 1260, DK-8000, Aarhus C, Denmark
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Rava M, Ahmed I, Kogevinas M, Le Moual N, Bouzigon E, Curjuric I, Dizier MH, Dumas O, Gonzalez JR, Imboden M, Mehta AJ, Tubert-Bitter P, Zock JP, Jarvis D, Probst-Hensch NM, Demenais F, Nadif R. Genes Interacting with Occupational Exposures to Low Molecular Weight Agents and Irritants on Adult-Onset Asthma in Three European Studies. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:207-214. [PMID: 27504716 PMCID: PMC5289825 DOI: 10.1289/ehp376] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/18/2016] [Accepted: 06/13/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND The biological mechanisms by which cleaning products and disinfectants-an emerging risk factor-affect respiratory health remain incompletely evaluated. Studying genes by environment interactions (G × E) may help identify new genes related to adult-onset asthma. OBJECTIVES We identified interactions between genetic polymorphisms of a large set of genes involved in the response to oxidative stress and occupational exposures to low molecular weight (LMW) agents or irritants on adult-onset asthma. METHODS Our data came from three large European cohorts: Epidemiological Family-based Study of the Genetics and Environment of Asthma (EGEA), Swiss Cohort Study on Air Pollution and Lung and Heart Disease in Adults (SAPALDIA), and European Community Respiratory Health Survey in Adults (ECRHS). A candidate pathway-based strategy identified 163 genes involved in the response to oxidative stress and potentially related to exposures to LMW agents/irritants. Occupational exposures were evaluated using an asthma job-exposure matrix and job-specific questionnaires for cleaners and healthcare workers. Logistic regression models were used to detect G × E interactions, adjusted for age, sex, and population ancestry, in 2,599 adults (mean age, 47 years; 60% women, 36% exposed, 18% asthmatics). p-Values were corrected for multiple comparisons. RESULTS Ever exposure to LMW agents/irritants was associated with current adult-onset asthma [OR = 1.28 (95% CI: 1.04, 1.58)]. Eight single nucleotide polymorphism (SNP) by exposure interactions at five loci were found at p < 0.005: PLA2G4A (rs932476, chromosome 1), near PLA2R1 (rs2667026, chromosome 2), near RELA (rs931127, rs7949980, chromosome 11), PRKD1 (rs1958980, rs11847351, rs1958987, chromosome 14), and PRKCA (rs6504453, chromosome 17). Results were consistent across the three studies and after accounting for smoking. CONCLUSIONS Using a pathway-based selection process, we identified novel genes potentially involved in adult asthma by interaction with occupational exposure. These genes play a role in the NF-κB pathway, which is involved in inflammation. Citation: Rava M, Ahmed I, Kogevinas M, Le Moual N, Bouzigon E, Curjuric I, Dizier MH, Dumas O, Gonzalez JR, Imboden M, Mehta AJ, Tubert-Bitter P, Zock JP, Jarvis D, Probst-Hensch NM, Demenais F, Nadif R. 2017. Genes interacting with occupational exposures to low molecular weight agents and irritants on adult-onset asthma in three European studies. Environ Health Perspect 125:207-214; http://dx.doi.org/10.1289/EHP376.
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Affiliation(s)
- Marta Rava
- Inserm, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Villejuif, France
- Spanish National Cancer Research Centre (CNIO), Genetic and Molecular Epidemiology Group, Human Cancer Genetics Program, Madrid, Spain
| | - Ismail Ahmed
- Inserm UMR 1181 [Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI)], Villejuif, France
- Institut Pasteur, UMR 1181, B2PHI, Paris, France
- Univ Versailles St.-Quentin-en-Yvelines, UMR 1181, B2PHI, Montigny le Bretonneux, France
| | - Manolis Kogevinas
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Nicole Le Moual
- Inserm, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Villejuif, France
- Univ Versailles St.-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France
| | - Emmanuelle Bouzigon
- Inserm, UMR-946, Genetic Variation and Human Diseases Unit, Paris, France
- Univ Paris Diderot, Sorbonne Paris Cité, Institut Universitaire d’Hématologie, Paris, France
| | - Ivan Curjuric
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Switzerland
| | - Marie-Hélène Dizier
- Inserm, UMR-946, Genetic Variation and Human Diseases Unit, Paris, France
- Univ Paris Diderot, Sorbonne Paris Cité, Institut Universitaire d’Hématologie, Paris, France
| | - Orianne Dumas
- Inserm, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Villejuif, France
- Univ Versailles St.-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France
| | - Juan R. Gonzalez
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Medea Imboden
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Switzerland
| | - Amar J. Mehta
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Switzerland
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Pascale Tubert-Bitter
- Inserm UMR 1181 [Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI)], Villejuif, France
- Institut Pasteur, UMR 1181, B2PHI, Paris, France
- Univ Versailles St.-Quentin-en-Yvelines, UMR 1181, B2PHI, Montigny le Bretonneux, France
| | - Jan-Paul Zock
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Deborah Jarvis
- Respiratory Epidemiology and Public Health, Imperial College, London, United Kingdom
- MRC-HPA (Medical Research Council and Health Protection Agency) Centre for Environment and Health, London, United Kingdom
| | - Nicole M. Probst-Hensch
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Switzerland
| | - Florence Demenais
- Inserm, UMR-946, Genetic Variation and Human Diseases Unit, Paris, France
- Univ Paris Diderot, Sorbonne Paris Cité, Institut Universitaire d’Hématologie, Paris, France
| | - Rachel Nadif
- Inserm, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Villejuif, France
- Univ Versailles St.-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France
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Abstract
PURPOSE OF REVIEW The present review summarizes the recent literature on the relation between chronic workplace irritant exposures and asthma, focusing on exposures of low to moderate levels. We discuss results from epidemiological surveys, potential biological mechanisms, and needs for further research. These aspects are largely illustrated by studies on exposure to cleaning products. RECENT FINDINGS Recent results from nine population-based and workplace-based epidemiological studies, mostly cross-sectional, found an increased risk of both new-onset and work-exacerbated asthma among participants exposed to moderate level of irritants and/or cleaning products. SUMMARY Evidence of a causal effect of chronic workplace irritant exposure in new-onset asthma remains limited, mainly because of a lack of longitudinal studies and the difficulty to evaluate irritant exposures. However, recent epidemiological studies strengthen the evidence of an effect of chronic exposure to irritants in work-related asthma. The underlying mechanism remains unknown but may be related to oxidative stress, neurogenic inflammation and dual irritant and adjuvant effects. However, disentangling chronic irritant effects from either acute irritant-induced asthma or immunological low molecular weight agent-induced asthma is difficult for some agents. Further research is needed to improve assessment of irritant exposures and identify biomarkers.
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Tagiyeva N, Teo E, Fielding S, Devereux G, Semple S, Douglas G. Occupational exposure to asthmagens and adult onset wheeze and lung function in people who did not have childhood wheeze: A 50-year cohort study. ENVIRONMENT INTERNATIONAL 2016; 94:60-68. [PMID: 27209001 DOI: 10.1016/j.envint.2016.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/04/2016] [Accepted: 05/04/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND There are few prospective studies that relate the development of adult respiratory disease with exposure to occupational asthmagens. OBJECTIVE To evaluate the risk of adult onset wheeze (AOW) and obstructive lung function associated with occupational exposures over 50years. METHODS A population-based randomly selected cohort of children who had not had asthma or wheezing illness, recruited in 1964 at age 10-15years, was followed-up in 1989, 1995, 2001 and 2014 by spirometry and respiratory questionnaire. Occupational histories were obtained in 2014 and occupational exposures determined with an asthma-specific job exposure matrix. The risk of AOW and lung function impairment was analysed in subjects without childhood wheeze using logistic regression and linear mixed effects models. RESULTS All 237 subjects (mean age: 61years, 47% male, 52% ever smoked) who took part in the 2014 follow-up had completed spirometry. Among those who did not have childhood wheeze, spirometry was measured in 93 subjects in 1989, in 312 in 1995 and in 270 subjects in 2001 follow-up. For longitudinal analysis of changes in FEV1 between 1989 and 2014 spirometry records were available on 191 subjects at three time points and on 45 subjects at two time points, with a total number of 663 records. AOW and FEV1<LLN were associated with occupational exposure to food-related asthmagens (adjusted odds ratios (adjORs) 95% CI: 2.7 [1.4, 5.1] and 2.9 [1.1, 7.7]) and biocides/fungicides (adjOR 95% CI: 1.8 [1.1, 3.1] and 3.4 [1.1, 10.8]), with evident dose-response effect (p-trends<0.05). Exposure to food-related asthmagens was also associated with reduced FEV1, FVC and FEF25-75% (adjusted regression coefficients 95% CI: -7.2 [-12.0, -2.4], -6.2 [-10.9, -1.4], and -13.3[-23.4, -3.3]). Exposure to wood dust was independently associated with AOW, obstructive lung function and reduced FEF25-75%. Excess FEV1 decline of 6-8ml/year was observed with occupational exposure to any asthmagen, biocides/fungicides and food-related asthmagens (p<0.05). CONCLUSIONS This longitudinal study confirmed previous findings of increased risks of adult onset wheezing illness with occupational exposure to specific asthmagens. A novel finding was the identification of food-related asthmagens and biocides/fungicides as potential new occupational risk factors for lung function impairment in adults without childhood wheeze.
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Affiliation(s)
- Nara Tagiyeva
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
| | - Edmund Teo
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Shona Fielding
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Graham Devereux
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Sean Semple
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Graham Douglas
- Respiratory Unit, Aberdeen Royal Infirmary, Aberdeen, UK
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Quinot C, Dumas O, Henneberger PK, Varraso R, Wiley AS, Speizer FE, Goldberg M, Zock JP, Camargo CA, Le Moual N. Development of a job-task-exposure matrix to assess occupational exposure to disinfectants among US nurses. Occup Environ Med 2016; 74:130-137. [PMID: 27566782 DOI: 10.1136/oemed-2016-103606] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 06/29/2016] [Accepted: 08/02/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Occupational exposure to disinfectants is associated with work-related asthma, especially in healthcare workers. However, little is known about the specific products involved. To evaluate disinfectant exposures, we designed job-exposure (JEM) and job-task-exposure (JTEM) matrices, which are thought to be less prone to differential misclassification bias than self-reported exposure. We then compared the three assessment methods: self-reported exposure, JEM and JTEM. METHODS Disinfectant use was assessed by an occupational questionnaire in 9073 US female registered nurses without asthma, aged 49-68 years, drawn from the Nurses' Health Study II. A JEM was created based on self-reported frequency of use (1-3, 4-7 days/week) of 7 disinfectants and sprays in 8 nursing jobs. We then created a JTEM combining jobs and disinfection tasks to further reduce misclassification. Exposure was evaluated in 3 classes (low, medium, high) using product-specific cut-offs (eg, <30%, 30-49.9%, ≥50%, respectively, for alcohol); the cut-offs were defined from the distribution of self-reported exposure per job/task. RESULTS The most frequently reported disinfectants were alcohol (weekly use: 39%), bleach (22%) and sprays (20%). More nurses were classified as highly exposed by JTEM (alcohol 41%, sprays 41%, bleach 34%) than by JEM (21%, 30%, 26%, respectively). Agreement between JEM and JTEM was fair-to-moderate (κ 0.3-0.5) for most disinfectants. JEM and JTEM exposure estimates were heterogeneous in most nursing jobs, except in emergency room and education/administration. CONCLUSIONS The JTEM may provide more accurate estimates than the JEM, especially for nursing jobs with heterogeneous tasks. Use of the JTEM is likely to reduce exposure misclassification.
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Affiliation(s)
- C Quinot
- INSERM, U1168, VIMA: Aging and Chronic Diseases. Epidemiological and Public Health Approaches, F-94807, Villejuif, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
| | - O Dumas
- INSERM, U1168, VIMA: Aging and Chronic Diseases. Epidemiological and Public Health Approaches, F-94807, Villejuif, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France.,Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - P K Henneberger
- Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - R Varraso
- INSERM, U1168, VIMA: Aging and Chronic Diseases. Epidemiological and Public Health Approaches, F-94807, Villejuif, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
| | - A S Wiley
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - F E Speizer
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - M Goldberg
- INSERM, U1168, VIMA: Aging and Chronic Diseases. Epidemiological and Public Health Approaches, F-94807, Villejuif, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France.,INSERM-UVSQ, UMS 011, Villejuif, France
| | - J P Zock
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.,ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - C A Camargo
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - N Le Moual
- INSERM, U1168, VIMA: Aging and Chronic Diseases. Epidemiological and Public Health Approaches, F-94807, Villejuif, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
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Radon K, Llanqui U, Arce A, Herrera R, Herbig B, Nowak D, Parra M. Job strain, bullying and violence at work and asthma in Peruvian cleaners-a cross-sectional analysis. J Asthma 2016; 53:1018-25. [PMID: 27437609 DOI: 10.1080/02770903.2016.1180698] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES An increased asthma prevalence was found in cleaners. Many of them work in precarious employment conditions, potentially leading to stress, a known risk factor for asthma. We aimed to analyze whether asthma in cleaners might partly be explained by psychosocial working conditions. METHODS The study population of this cross-sectional study included 199 cleaners employed at regional public health services in Puno Province (Peru). They were compared to 79 unexposed workers from Lima, Peru (response 83%). Both groups answered the short version of the European Working Condition Survey and a modified version of the European Community Respiratory Health screening questionnaire. After multiple imputation, the association between psychosocial working conditions and asthma (wheeze without cold or use of asthma medication) was assessed. RESULTS The 12-months prevalence of asthma was 22% among cleaners versus 5% among unexposed workers (pChi(2) = .001). Cleaners were more likely than unexposed workers to work with temporary or sub-contracts, have a high employment insecurity, high strain working conditions and low social support (all pChi(2) < .05). Twenty-six percent vs. 10% reported a high bullying score; 39% vs. 8% had experienced violence at work (both pChi(2) < .001). High bullying score (adjusted Odds Ratio 5.6; 95% Confidence Interval 1.5-21.4) and violence (2.4; 1.1-5.4) were the main predictors of asthma. Taking these factors into account, being a cleaner was not statistically significantly associated with the outcome (3.5; 0.9-13.8). CONCLUSIONS Poor psychosocial working conditions of cleaners may partly explain the high prevalence of asthma. The underlying mechanism might be a stress-induced inflammatory immune response.
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Affiliation(s)
- Katja Radon
- a Center for International Health at the Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich (LMU), Member of DZL, German Centre for Lung Research , Munich , Germany
| | - Uriel Llanqui
- b Social Health Insurance , Care Net Puno, Center for Prevention of Work-related Risks , Puno , Perú
| | - Andrés Arce
- c Cardioclinic , Occupational and Preventive Health Center , San Borja, Lima , Perú
| | - Ronald Herrera
- a Center for International Health at the Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich (LMU), Member of DZL, German Centre for Lung Research , Munich , Germany
| | - Britta Herbig
- d Research Unit Applied Medicine and Psychology at Work , Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich (LMU) , Munich , Germany
| | - Dennis Nowak
- a Center for International Health at the Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich (LMU), Member of DZL, German Centre for Lung Research , Munich , Germany
| | - Manuel Parra
- a Center for International Health at the Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich (LMU), Member of DZL, German Centre for Lung Research , Munich , Germany.,e Consultant in Occupational Health and Health Promotion , Providencia, Santiago , Chile
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Fell AK, Abrahamsen R, Henneberger PK, Svendsen MV, Andersson E, Torén K, Kongerud J. Breath-taking jobs: a case-control study of respiratory work disability by occupation in Norway. Occup Environ Med 2016; 73:600-6. [PMID: 27365181 PMCID: PMC5013093 DOI: 10.1136/oemed-2015-103488] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 05/31/2016] [Indexed: 11/04/2022]
Abstract
Background The current knowledge on respiratory work disability is based on studies that used crude categories of exposure. This may lead to a loss of power, and does not provide sufficient information to allow targeted workplace interventions and follow-up of patients with respiratory symptoms. Objectives The aim of this study was to identify occupations and specific exposures associated with respiratory work disability. Methods In 2013, a self-administered questionnaire was mailed to a random sample of the general population, aged 16–50, in Telemark County, Norway. We defined respiratory work disability as a positive response to the survey question: ‘Have you ever had to change or leave your job because it affected your breathing?’ Occupational exposures were assessed using an asthma-specific job-exposure matrix, and comparison of risks was made for cases and a median of 50 controls per case. Results 247 workers had changed their work because of respiratory symptoms, accounting for 1.7% of the respondents ever employed. The ‘breath-taking jobs’ were cooks/chefs: adjusted OR 3.6 (95% CI 1.6 to 8.0); welders: 5.2 (2.0 to 14); gardeners: 4.5 (1.3 to 15); sheet metal workers: 5.4 (2.0 to 14); cleaners: 5.0 (2.2 to 11); hairdressers: 6.4 (2.5 to 17); and agricultural labourers: 7.4 (2.5 to 22). Job changes were also associated with a variety of occupational exposures, with some differences between men and women. Conclusions Self-report and job-exposure matrix data showed similar findings. For the occupations and exposures associated with job change, preventive measures should be implemented.
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Affiliation(s)
- A K Fell
- Department of Occupational and Environmental Medicine, Telemark Hospital, Skien, Norway
| | - R Abrahamsen
- Department of Occupational and Environmental Medicine, Telemark Hospital, Skien, Norway Faculty Division Rikshospitalet, University of Oslo, Norway
| | - P K Henneberger
- National Institute for Occupational Safety and Health (NIOSH), Morgantown, West Virginia, USA
| | - M V Svendsen
- Department of Occupational and Environmental Medicine, Telemark Hospital, Skien, Norway
| | - E Andersson
- Department of Occupational and Environmental Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - K Torén
- Department of Occupational and Environmental Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J Kongerud
- Faculty Division Rikshospitalet, University of Oslo, Norway Department of Respiratory Medicine, Oslo University Hospital, Oslo, Norway
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An official American Thoracic Society Workshop Report: presentations and discussion of the fifth Jack Pepys Workshop on Asthma in the Workplace. Comparisons between asthma in the workplace and non-work-related asthma. Ann Am Thorac Soc 2016. [PMID: 26203621 DOI: 10.1513/annalsats.201505-281st] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The fifth Jack Pepys Workshop on Asthma in the Workplace focused on the similarities and differences of work-related asthma (WRA) and non-work-related asthma (non-WRA). WRA includes occupational asthma (OA) and work-exacerbated asthma (WEA). There are few biological differences in the mechanisms of sensitization to environmental and occupational allergens. Non-WRA and OA, when due to high-molecular-weight agents, are both IgE mediated; it is uncertain whether OA due to low-molecular-weight agents is also IgE mediated. Risk factors for OA include female sex, a history of upper airway symptoms, and a history of bronchial hyperresponsiveness. Atopy is a risk factor for OA due to high-molecular-weight agents, and exposure to cleaning agents is a risk factor for both OA and non-WRA. WEA is important among workers with preexisting asthma and may overlap with irritant-induced asthma, a type of OA. Induced sputum cytology can confirm airway inflammation, but specific inhalation challenge is the reference standard diagnostic test. Inhalation challenges are relatively safe, with the most severe reactions occurring with low-molecular-weight agents. Indirect health care costs account for about 50% of total asthma costs. Workers with poor asthma control (WRA or non-WRA) are less likely to be employed. Income loss is a major contributor to the indirect costs of WRA. Overall, asthma outcomes probably are worse for adult-onset than for childhood-onset asthma but better for OA than adult-onset non-WRA. Important aspects of management of OA are rapid and proper confirmation of the diagnosis and reduction of exposure to sensitizers or irritants at work and home.
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Sadhra SS, Kurmi OP, Chambers H, Lam KBH, Fishwick D. Development of an occupational airborne chemical exposure matrix. Occup Med (Lond) 2016; 66:358-64. [PMID: 27067914 DOI: 10.1093/occmed/kqw027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Population-based studies of the occupational contribution to chronic obstructive pulmonary disease generally rely on self-reported exposures to vapours, gases, dusts and fumes (VGDF), which are susceptible to misclassification. AIMS To develop an airborne chemical job exposure matrix (ACE JEM) for use with the UK Standard Occupational Classification (SOC 2000) system. METHODS We developed the ACE JEM in stages: (i) agreement of definitions, (ii) a binary assignation of exposed/not exposed to VGDF, fibres or mists (VGDFFiM), for each of the individual 353 SOC codes and (iii) assignation of levels of exposure (L; low, medium and high) and (iv) the proportion of workers (P) likely to be exposed in each code. We then expanded the estimated exposures to include biological dusts, mineral dusts, metals, diesel fumes and asthmagens. RESULTS We assigned 186 (53%) of all SOC codes as exposed to at least one category of VGDFFiM, with 23% assigned as having medium or high exposure. We assigned over 68% of all codes as not being exposed to fibres, gases or mists. The most common exposure was to dusts (22% of codes with >50% exposed); 12% of codes were assigned exposure to fibres. We assigned higher percentages of the codes as exposed to diesel fumes (14%) compared with metals (8%). CONCLUSIONS We developed an expert-derived JEM, using a strict set of a priori defined rules. The ACE JEM could also be applied to studies to assess risks of diseases where the main route of occupational exposure is via inhalation.
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Affiliation(s)
- S S Sadhra
- Institute of Occupational and Environmental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK,
| | - O P Kurmi
- CTSU, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - H Chambers
- Centre for Workplace Health, Health and Safety Laboratory, Harpur Hill, Buxton SK17 9JN, UK
| | - K B H Lam
- Institute of Occupational and Environmental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - D Fishwick
- Centre for Workplace Health, Health and Safety Laboratory, Harpur Hill, Buxton SK17 9JN, UK
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Fritschi L, Crewe J, Darcey E, Reid A, Glass DC, Benke GP, Driscoll T, Peters S, Si S, Abramson MJ, Carey RN. The estimated prevalence of exposure to asthmagens in the Australian workforce, 2014. BMC Pulm Med 2016; 16:48. [PMID: 27061283 PMCID: PMC4826519 DOI: 10.1186/s12890-016-0212-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/31/2016] [Indexed: 11/25/2022] Open
Abstract
Background There is very little information available on a national level as to the number of people exposed to specific asthmagens in workplaces. Methods We conducted a national telephone survey in Australia to investigate the prevalence of current occupational exposure to 277 asthmagens, assembled into 27 groups. Demographic and current job information were obtained. A web-based tool, OccIDEAS, was used to collect job task information and assign exposure to each asthmagen group. Results In the Australian Workplace Exposure Study – Asthma (AWES- Asthma) we interviewed 4878 participants (2441 male and 2437 female). Exposure to at least one asthmagen was more common among men (47 %) than women (40 %). Extrapolated to the Australian population, approximately 2.8 million men and 1.7 million women were estimated to be exposed. Among men, the most common exposures were bioaerosols (29 %) and metals (27 %), whilst the most common exposures among women were latex (25 %) and industrial cleaning and sterilising agents (20 %). Conclusions This study provides information about the prevalence of exposure to asthmagens in Australian workplaces which will be useful in setting priorities for control and prevention of occupational asthma. Electronic supplementary material The online version of this article (doi:10.1186/s12890-016-0212-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lin Fritschi
- School of Public Health, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia.
| | - Julie Crewe
- School of Public Health, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia
| | - Ellie Darcey
- School of Public Health, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia
| | - Alison Reid
- School of Public Health, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia
| | - Deborah C Glass
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Geza P Benke
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tim Driscoll
- Sydney School of Public Health, University of Sydney, New South Wales, Australia
| | - Susan Peters
- School of Population Health, University of Western Australia, Perth, Western Australia, Australia
| | - Si Si
- School of Public Health, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia
| | - Michael J Abramson
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Renee N Carey
- School of Public Health, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia
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Christensen BH, Thulstrup AM, Hougaard KS, Skadhauge LR, Hansen KS, Schlünssen V. Occupational exposure during pregnancy and the risk of hay fever in 7-year-old children. CLINICAL RESPIRATORY JOURNAL 2016; 7:183-8. [PMID: 22650447 DOI: 10.1111/j.1752-699x.2012.00300.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The prevalence of allergic diseases including hay fever has increased in the last decades, especially in Westernised countries. The aim of this study was to analyse whether occupational exposure during pregnancy is associated with development of hay fever in 7-year-old Danish children. METHODS A total of 42,696 women and their children from the Danish National Birth Cohort were categorised according to maternal occupational exposure. Exposure information was obtained by combining job title in pregnancy with a commonly used asthma Job Exposure Matrix. Information on hay fever in the child was obtained by an internet questionnaire at follow-up at 7 years of age. RESULTS Adjusted logistic regression analyses showed no significant association between maternal occupational exposure during pregnancy and hay fever among the 7-year-old children. Stratifying for atopic status in the children did not change the results. The prevalence of hay fever was 10.0% in the atopic children compared with 3.6% in the non-atopic children. Maternal atopic disposition increased the risk of hay fever in the offspring, odds ratio (OR) 2.49 [95% confidence interval (CI) 2.26; 2.74]. Rural residence during pregnancy decreased the risk for hay fever [OR 0.74 (95% CI 0.59; 0.92)] as did parity, OR 0.72 (95% CI 0.66; 0.80) and 0.70 (95% CI 0.48; 1.00) for 2nd and 3rd child, respectively, compared with the firstborn child. CONCLUSION The results suggest that occupational exposure among pregnant women in Denmark is not a risk factor for hay fever among young children.
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Affiliation(s)
- Berit Hvass Christensen
- Section of Environmental and Occupational Medicine, Department of Public Health, Aarhus University, Aarhus,
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Establishing a birth cohort to investigate the course and aetiology of asthma and allergies across three generations - rationale, design, and methods of the ACROSSOLAR study. BMC Public Health 2015; 15:1210. [PMID: 26637409 PMCID: PMC4670515 DOI: 10.1186/s12889-015-2555-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 12/01/2015] [Indexed: 01/12/2023] Open
Abstract
Background Atopic diseases are a major burden of disease on a global scale. Regarding their aetiology, the early years of life are assumed to play a crucial role. In addition, there is growing evidence that elucidating the impact of cross-generational effects and epigenetic mechanisms such as DNA methylation can substantially widen the scientific knowledge of the occurrence and progression of these diseases. We are thus aiming at following the course of asthma, allergies, and potential risk factors for their occurrence across three generations by establishing a birth cohort in the offspring of an existing population-based cohort. Methods/Design 2051 young adults who have been recruited in 1995 for Phase II of the International Study of Asthma and Allergies in Childhood (ISAAC) and who have subsequently been followed-up by the Study on Occupational Allergy Risks (SOLAR) are asked bi-annually since 2009 if they conceived a child in the meantime. If parenthood is reported, parents are invited to enrol along with their children in the ACROSSOLAR cohort. Participation involves completing a questionnaire assessing general and health-related information about the course of the pregnancy and the first year of life of their children. Subsequently, the children are followed up until primary school age when asthma and allergies can be diagnosed reliably. In addition, DNA for epigenetic analysis will be collected and analysed. Longitudinal data analysis techniques will then be used to assess potential associations between early-life exposures and onset of childhood asthma and allergies taking into account epigenetics. Discussion Birth cohorts are especially suited to elucidate the impact of genetic predisposition, epigenetics, exposures during the first years of life, and gene-environment interactions on the occurrence and progression of asthma and allergies. By building upon an existing cohort, ACROSSOLAR offers a unique and cost-effective opportunity to investigate the aetiology of atopic disease in a prospective and cross-generational way.
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Crewe J, Carey R, Glass D, Peters S, Abramson MJ, Benke G, Reid A, Driscoll T, Fritschi L. A comprehensive list of asthmagens to inform health interventions in the Australian workplace. Aust N Z J Public Health 2015; 40:170-3. [PMID: 26558880 DOI: 10.1111/1753-6405.12479] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 07/01/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To develop a comprehensive list of asthmagens which may occur in occupational settings in Australia. METHODS Potential asthmagens considered for this list were identified through work health and safety classification databases in Australia and through lists developed by professional associations in other countries. Inclusion criteria were: there is evidence that the agent is asthmagenic; it is used in occupational settings; and it is available in Australia. RESULTS The final list contained 277 asthmagens in 27 groups that may be found in occupational circumstances in Australia. Three other agents that have been documented as asthmagens in Australia were included: almond dust, fluoride (in aluminium pot room fumes); and sawdust from the Australian Blackwood. CONCLUSIONS This is the first comprehensive and inclusive list of Australian occupationally relevant asthmagens to have been compiled. IMPLICATIONS This list is specific for Australian workplace exposure to asthmagens. It will help focus policy and preventative practices and reduce the burden of occupational asthma. It will also be useful in future studies to identify those who are exposed to the asthmagens and provide information to assist regulators to identify industries, occupations, specific activities and existing exposure standards that can be targeted to improve worker health and welfare.
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Affiliation(s)
- Julie Crewe
- School of Public Health, Curtin University, Western Australia
| | - Renee Carey
- School of Public Health, Curtin University, Western Australia
| | - Deborah Glass
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Monash University, Victoria
| | - Susan Peters
- School of Population Health, University of Western Australia
| | - Michael J Abramson
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Monash University, Victoria
| | - Geza Benke
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Monash University, Victoria
| | - Alison Reid
- School of Public Health, Curtin University, Western Australia
| | - Tim Driscoll
- Sydney School of Public Health, University of Sydney, New South Wales
| | - Lin Fritschi
- School of Public Health, Curtin University, Western Australia
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Henneberger PK, Liang X, Lillienberg L, Dahlman-Höglund A, Torén K, Andersson E. Occupational exposures associated with severe exacerbation of asthma. Int J Tuberc Lung Dis 2015; 19:244-50. [PMID: 25574926 DOI: 10.5588/ijtld.14.0132] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The exacerbation of asthma by workplace conditions is common, but little is known about which agents pose a risk. OBJECTIVE We used data from an existing survey of adults with asthma to identify occupational exposures associated with severe exacerbation of asthma. DESIGN Questionnaires were completed by 557 working adults with asthma. Severe exacerbation of asthma in the past 12 months was defined as asthma-related hospitalization, or reports of both unplanned asthma care and treatment with a short course of oral corticosteroids. Occupational exposures for the same time period were assessed using an asthma-specific job exposure matrix. We modeled severe exacerbation to yield prevalence ratios (PRs) for exposures while controlling for potential confounders. RESULTS A total of 164 participants (29%) were positive for severe exacerbation, and 227 (40.8%) were assessed as being exposed to asthma agents at work. Elevated PRs were observed for several specific agents, notably the irritant subcategories of environmental tobacco smoke (PR 1.84, 95%CI 1.34-2.51) among all participants, inorganic dusts (PR 2.53, 95%CI 1.37-4.67) among men, and the low molecular weight subcategory of other highly reactive agents (PR 1.97, 95%CI 1.08-3.60) among women. CONCLUSION Among working adults with asthma, severe exacerbation was associated with several occupational agents.
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Affiliation(s)
- P K Henneberger
- Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - X Liang
- Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - L Lillienberg
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - A Dahlman-Höglund
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - K Torén
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - E Andersson
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
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Quinn MM, Henneberger PK, Braun B, Delclos GL, Fagan K, Huang V, Knaack JL, Kusek L, Lee SJ, Le Moual N, Maher KA, McCrone SH, Mitchell AH, Pechter E, Rosenman K, Sehulster L, Stephens AC, Wilburn S, Zock JP. Cleaning and disinfecting environmental surfaces in health care: Toward an integrated framework for infection and occupational illness prevention. Am J Infect Control 2015; 43:424-34. [PMID: 25792102 DOI: 10.1016/j.ajic.2015.01.029] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/25/2015] [Accepted: 01/27/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Cleaning and Disinfecting in Healthcare Working Group of the National Institute for Occupational Safety and Health, National Occupational Research Agenda, is a collaboration of infection prevention and occupational health researchers and practitioners with the objective of providing a more integrated approach to effective environmental surface cleaning and disinfection (C&D) while protecting the respiratory health of health care personnel. METHODS The Working Group, comprised of >40 members from 4 countries, reviewed current knowledge and identified knowledge gaps and future needs for research and practice. RESULTS An integrated framework was developed to guide more comprehensive efforts to minimize harmful C&D exposures without reducing the effectiveness of infection prevention. Gaps in basic knowledge and practice that are barriers to an integrated approach were grouped in 2 broad areas related to the need for improved understanding of the (1) effectiveness of environmental surface C&D to reduce the incidence of infectious diseases and colonization in health care workers and patients and (2) adverse health impacts of C&D on health care workers and patients. Specific needs identified within each area relate to basic knowledge, improved selection and use of products and practices, effective hazard communication and training, and safer alternatives. CONCLUSION A more integrated approach can support multidisciplinary teams with the capacity to maximize effective and safe C&D in health care.
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Dumas O, Matran R, Zerimech F, Decoster B, Huyvaert H, Ahmed I, Le Moual N, Nadif R. Occupational exposures and fluorescent oxidation products in 723 adults of the EGEA study. Eur Respir J 2015; 46:258-61. [PMID: 25837036 DOI: 10.1183/09031936.00177614] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 02/04/2015] [Indexed: 01/03/2023]
Affiliation(s)
- Orianne Dumas
- INSERM U1168, VIMA: Aging and chronic diseases, Epidemiological and public health approaches, Villejuif, France Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France Channing Division of Network Medicine, Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA Dept of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Farid Zerimech
- Laboratoire de Biochimie, Centre de Biologie Pathologie, CHRU de Lille, Lille, France
| | | | - Helene Huyvaert
- Univ Lille Nord de France, Lille, France Laboratoire de Biochimie, Centre de Biologie Pathologie, CHRU de Lille, Lille, France
| | - Ismail Ahmed
- INSERM UMR 1181 «Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases» (B2PHI), Villejuif, France Univ Versailles St-Quentin-en-Yvelines, UMR 1181, B2PHI, Montigny le Bretonneux, France
| | - Nicole Le Moual
- INSERM U1168, VIMA: Aging and chronic diseases, Epidemiological and public health approaches, Villejuif, France Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France
| | - Rachel Nadif
- INSERM U1168, VIMA: Aging and chronic diseases, Epidemiological and public health approaches, Villejuif, France Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France
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50
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Simpson JL, Guest M, Boggess MM, Gibson PG. Occupational exposures, smoking and airway inflammation in refractory asthma. BMC Pulm Med 2014; 14:207. [PMID: 25526871 PMCID: PMC4391679 DOI: 10.1186/1471-2466-14-207] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 12/16/2014] [Indexed: 11/26/2022] Open
Abstract
Background The influence of occupation and ex/passive smoking on inflammatory phenotype is not well understood. The aim of this study was to examine the relationship between occupation, past smoking and current passive smoking and airway inflammation in a population of adults with refractory asthma. Methods Sixty-six participants with refractory asthma were characterised. Occupational exposure to asthma causing or worsening agents were identified with an asthma-specific job exposure matrix. Exposure to passive cigarette smoke was determined by questionnaire and exhaled carbon monoxide assessment. The carbon content of macrophages was assessed in a sub-group of participants. Results Nineteen participants had smoked previously with low smoking pack years (median 1.7 years). Ex-smokers more commonly lived with a current smoker (26% vs. 9%, p = 0.11) and were more likely to allow smoking inside their home (26% vs. 4%, p = 0.02) compared to never smokers. Twenty participants had occupations with an identified exposure risk to an asthmagen; thirteen had exposures to irritants such as motor vehicle exhaust and environmental tobacco smoke. Sputum neutrophils were elevated in participants with asthma who had occupational exposures, particularly those who were diagnosed with asthma at a more than 30 years of age. Conclusions Sputum neutrophils are elevated in refractory asthma with exposure to occupational asthmagens. In addition to older age, exposure to both environmental and occupational particulate matter may contribute to the presence of neutrophilic asthma. This may help explain asthma heterogeneity and geographical variations in airway inflammatory phenotypes in asthma.
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Affiliation(s)
- Jodie L Simpson
- Centre for Asthma and Respiratory Disease, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia. .,Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Maya Guest
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.
| | - May M Boggess
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia. .,School of Mathematical and Statistical Sciences, Arizona State University, Tempe, AZ, USA.
| | - Peter G Gibson
- Centre for Asthma and Respiratory Disease, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia. .,Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
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