Lillienberg Linnéa, Dahlman-Höglund Anna, Schiöler Linus, Torén Kjell, Andersson Eva
1. Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, SE-40530 Göteborg, Sweden.
Ann Occup Hyg. 2014 May;58(4):469-81. doi: 10.1093/annhyg/meu002. Epub 2014 Feb 6.
We have recently published a study on new-onset asthma in a large population in northern Europe using a modified job exposure matrix (N-JEM) to better reflect exposure assignment in these countries. The aim of this paper was to investigate how the N-JEM differs in exposure assignment and asthma risks from an already established JEM.
The study comprised 6253 men and 7031 women from northern Europe, born 1945-1973, who had answered both a screening (1989-1992) and a follow-up questionnaire (1999-2001). During the study period (1980-2000), there were 136 men and 293 women with new-onset asthma. Hazard ratios of new-onset asthma were calculated for both JEMs using Cox regression models. The analyses were made separately for men and women and were also stratified for atopy. Cohen's kappa (κ) was used to show agreements in exposure assignment (yes/no) between the JEMs. Population attributable risks (PARs) were calculated as well.
The agreement in exposure assignment between the JEMs was substantial for the group 'any exposure' to asthma agents (κ = 0.78). The agreement between comparable exposure groups in the JEMs varied from κ = 1.00 (pharmaceutical product antigens, textile dust, cleaning agents) to κ = 0.27 (low molecular weight agents). Significant increased asthma risks were seen for men exposed to isocyanates and accidental peak exposure with both JEMs. With the N-JEM, increased asthma risks were seen for men exposed to plant-associated antigens (all and non-atopic), epoxy compounds (all and non-atopic), and acrylates (non-atopic). With the other JEM, increased asthma risks were seen in men and women exposed to 'possible exposure to irritant gases or fumes' (all and non-atopic), a group classified as having low asthma risk. Men and women exposed to cleaning agents also showed significant asthma risks with both JEMs. PAR with the N-JEM was 14.3% for men and 6.6% for women, compared with 12.9% and 8.3% with the other JEM.
Acrylates, epoxy compounds, and isocyanates are three exposure groups in the modified asthma JEM that might better reflect exposure situations in northern Europe than the already established JEM. Exposure to 'possible exposure to irritant gases or fumes', a low asthma risk group in the established JEM, seems to be a group with high asthma risk in northern Europe. It is important to continuously update JEMs, which are based only on occupational titles, in order to find new risk groups and to better reflect changes in work exposures when old risks disappear and new emerge.
我们最近发表了一项关于北欧大量人群新发哮喘的研究，使用了改良的工作暴露矩阵（N-JEM）以更好地反映这些国家的暴露分配情况。本文的目的是研究N-JEM在暴露分配和哮喘风险方面与已建立的工作暴露矩阵（JEM）有何不同。
该研究包括来自北欧的6253名男性和7031名女性，出生于1945年至1973年，他们既回答了筛查问卷（1989 - 1992年），也回答了随访问卷（1999 - 2001年）。在研究期间（1980 - 2000年），有136名男性和293名女性患有新发哮喘。使用Cox回归模型计算两种工作暴露矩阵下新发哮喘的风险比。分析分别针对男性和女性进行，并且也按特应性进行了分层。Cohen's kappa（κ）用于显示两种工作暴露矩阵在暴露分配（是/否）方面的一致性。还计算了人群归因风险（PARs）。
对于“任何暴露”于哮喘致病因子的组，两种工作暴露矩阵在暴露分配方面的一致性很高（κ = 0.78）。两种工作暴露矩阵中可比暴露组之间的一致性从κ = 1.00（药品抗原、纺织粉尘、清洁剂）到κ = 0.27（低分子量因子）不等。在两种工作暴露矩阵中，暴露于异氰酸酯和意外峰值暴露的男性哮喘风险显著增加。使用N-JEM时，暴露于植物相关抗原（所有和非特应性）、环氧化合物（所有和非特应性）以及丙烯酸酯（非特应性）的男性哮喘风险增加。使用另一种工作暴露矩阵时，暴露于“可能暴露于刺激性气体或烟雾”（所有和非特应性）的男性和女性哮喘风险增加，该组被归类为哮喘风险较低。暴露于清洁剂的男性和女性在两种工作暴露矩阵中也显示出显著的哮喘风险。N-JEM的男性人群归因风险为14.3%，女性为6.6%，而另一种工作暴露矩阵的分别为12.9%和8.3%。
丙烯酸酯、环氧化合物和异氰酸酯是改良哮喘工作暴露矩阵中的三个暴露组，与已建立的工作暴露矩阵相比，可能能更好地反映北欧的暴露情况。在已建立的工作暴露矩阵中哮喘风险较低的“可能暴露于刺激性气体或烟雾”组，在北欧似乎是哮喘风险较高的组。持续更新仅基于职业名称的工作暴露矩阵很重要，以便找到新的风险组，并在旧风险消失和新风险出现时更好地反映工作暴露的变化。
