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Work related asthma. A causal analysis controlling the healthy worker effect
Orianne Dumas1, Nicole Le Moual, Valérie Siroux
1Inserm, Center for research in Epidemiology and Population Heatlh (CESP), U1018, Respiratory and Environmental Epidemiology team, F-94807, Villejuif, France. orianne.dumas@inserm.fr
Occupational and Environmental Medicine
|June 14, 2013
Summary
Occupational exposure to irritants significantly increases asthma attack risk, challenging previous findings. Marginal structural models help correct for the healthy worker effect in occupational asthma research.
Area of Science:
- Occupational health
- Epidemiology
- Respiratory medicine
Background:
- The healthy worker effect often underestimates occupational exposure risks for asthma.
- The role of irritants in occupational asthma remains debated.
Purpose of the Study:
- To estimate the effect of occupational exposure on asthma using marginal structural modeling.
- To control for the healthy worker effect in work-related asthma studies.
Main Methods:
- Longitudinal analysis of 1284 participants (age 17-79) from the French Epidemiological study on the Genetics and Environment of Asthma.
- Retrospective data collection on asthma onset, attack history, and occupational history (reconstructed in 5-year intervals).
- Exposure assessment using a job-exposure matrix for asthmagens, irritants, chemicals, and allergens.
Main Results:
- Standard analyses showed no significant association between occupational exposures and asthma attacks.
- Marginal structural modeling revealed increased associations, with statistical significance for irritants/low-level chemicals/allergens (OR 1.56, 95% CI 1.02-2.40).
- Suggestive evidence for an association was found for known asthmagens (OR 1.26, 95% CI 0.90-1.76).
Conclusions:
- The healthy worker effect significantly impacts risk assessment in occupational asthma.
- Marginal structural models effectively address exposure imbalances caused by disease-driven selection.
- Findings support a significant role for irritants in work-related asthma.
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