Dumas Orianne, Varraso Raphaëlle, Zock Jan Paul, Henneberger Paul K, Speizer Frank E, Wiley Aleta S, Le Moual Nicole, Camargo Carlos A
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.
INSERM, VIMA: Aging and chronic diseases. Epidemiological and public health approaches, U1168, F-94807, Villejuif, France UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Saint-Quentin-en-Yvelines, France.
Occup Environ Med. 2015 Jul;72(7):482-8. doi: 10.1136/oemed-2014-102547. Epub 2015 Feb 24.
Nurses are at increased risk of occupational asthma, an observation that may be related to disinfectants exposure. Whether asthma history influences job type or job changes among nurses is unknown. We investigated this issue in a large cohort of nurses.
The Nurses' Health Study II is a prospective study of US female nurses enrolled in 1989 (ages 24-44 years). Job status and asthma were assessed in biennial (1989-2011) and asthma-specific questionnaires (1998, 2003). Associations between asthma history at baseline (diagnosis before 1989, n=5311) and job type at baseline were evaluated by multinomial logistic regression. The relations of asthma history and severity during follow-up to subsequent job changes were evaluated by Cox models.
The analytic cohort included 98 048 nurses. Compared with nurses in education/administration (likely low disinfectant exposure jobs), women with asthma history at baseline were less often employed in jobs with likely high disinfectant exposure, such as operating rooms (odds ratio 0.73 (95% CI 0.63 to 0.86)) and emergency room/inpatient units (0.89 (0.82 to 0.97)). During a 22-year follow-up, nurses with a baseline history of asthma were more likely to move to jobs with lower exposure to disinfectants (HR 1.13 (1.07 to 1.18)), especially among those with more severe asthma (HR for mild persistent: 1.13; moderate persistent 1.26; severe persistent: 1.50, compared with intermittent asthma, p trend: 0.004).
Asthma history was associated with baseline job type and subsequent job changes among nurses. This may partly reflect avoidance of tasks involving disinfectant use, and may introduce bias in cross-sectional studies on disinfectant exposure and asthma in nurses.
护士患职业性哮喘的风险增加，这一现象可能与接触消毒剂有关。哮喘病史是否会影响护士的工作类型或工作变动尚不清楚。我们在一大群护士中调查了这个问题。
护士健康研究II是一项对1989年（年龄24 - 44岁）登记入组的美国女性护士进行的前瞻性研究。在1989年至2011年每两年一次的调查以及1998年、2003年的特定哮喘问卷中评估工作状况和哮喘情况。通过多项逻辑回归评估基线时（1989年之前诊断，n = 5311）的哮喘病史与基线工作类型之间的关联。通过Cox模型评估随访期间哮喘病史和严重程度与后续工作变动的关系。
分析队列包括98048名护士。与教育/行政岗位的护士（可能是低消毒剂接触工作）相比，基线时有哮喘病史的女性较少从事可能高消毒剂接触的工作，如手术室（优势比0.73（95%CI 0.63至0.86））和急诊室/住院病房（0.89（0.82至0.97））。在22年的随访期间，基线时有哮喘病史的护士更有可能转向消毒剂接触较低的工作（风险比1.13（1.07至1.18）），尤其是在哮喘较严重的护士中（轻度持续性哮喘的风险比：1.13；中度持续性哮喘1.26；重度持续性哮喘：1.50，与间歇性哮喘相比，p趋势：0.004）。
哮喘病史与护士的基线工作类型和后续工作变动有关。这可能部分反映了对涉及使用消毒剂任务的回避，并且可能在护士消毒剂接触与哮喘的横断面研究中引入偏差。
