Le Moual Nicole, Kennedy Susan M, Kauffmann Francine
Epidemiology and Biostatistics, INSERM U472, Villejuif, France.
Am J Epidemiol. 2004 Dec 1;160(11):1108-16. doi: 10.1093/aje/kwh316.
The association of asthma with occupational exposures was studied in 14,151 adults, aged 25-59 years, from the general population of the 1975 French Pollution Atmospherique et Affections Respiratoires Chroniques (PAARC) Survey. Associations of asthma with specific jobs, such as personal care workers, waiters, and stock clerks, were observed, with age-, sex-, and smoking-adjusted odds ratios between 1.5 and 1.7. Exposures to 18 asthmagenic agents (low and high molecular weight and mixed environment) were estimated by an asthma-specific job exposure matrix. Risks associated with asthma increased when subjects with imprecise estimates of exposure were excluded. Risks increased further with increasing specificity of the definition of asthma when considering jobs or specific agents, such as industrial cleaning agents, latex, flour, highly reactive chemicals, and textiles. For example, for industrial cleaning agents, odds ratios increased from 1.55 (95% confidence interval (CI): 1.08, 2.23) for "ever asthma," to 2.17 (95% CI: 1.41, 3.34) for asthma onset after age 14 years, to 2.35 (95% CI: 1.38, 4.00) for asthma onset after beginning current job, and to 2.51 (95% CI: 1.33, 4.75) for asthma with airflow limitation. Results underlined the importance of the specificity of exposure and asthma definitions and indicated a deleterious role of occupational exposure on asthma, especially for cleaning agents.
在1975年法国大气污染与慢性呼吸道疾病(PAARC)调查的普通人群中,对14151名年龄在25至59岁之间的成年人进行了哮喘与职业暴露之间关联的研究。观察到哮喘与特定工作(如个人护理工作者、服务员和仓库管理员)之间的关联,年龄、性别和吸烟调整后的优势比在1.5至1.7之间。通过特定于哮喘的工作暴露矩阵估算了18种致喘物(低分子量、高分子量和混合环境)的暴露情况。当排除暴露估计不准确的受试者时,与哮喘相关的风险增加。在考虑工作或特定物质(如工业清洁剂、乳胶、面粉、高反应性化学品和纺织品)时,随着哮喘定义特异性的增加,风险进一步增加。例如,对于工业清洁剂,“曾患哮喘”的优势比从1.55(95%置信区间(CI):1.08,2.23)增加到14岁后发病的哮喘为2.17(95%CI:1.41,3.34),当前工作开始后发病的哮喘为2.35(95%CI:1.38,4.00),气流受限的哮喘为2.51(95%CI:1.33,4.75)。结果强调了暴露和哮喘定义特异性的重要性,并表明职业暴露对哮喘有有害作用,尤其是对于清洁剂。