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How much adult asthma can be attributed to occupational factors?

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Abstract

PURPOSE: Many occupational factors can cause asthma or reactivate preexisting disease. We carried out a critical review and synthesis of the available literature to estimate the proportion of adult asthma that is attributable to workplace factors.

METHODS: We reviewed published citations from 1966 through May 1999 as well as recent abstracts of studies providing risk estimates for asthma among various occupations. We extracted published attributable risk estimates, derived others from published data, and extrapolated estimates from the incidence rates of occupational asthma. We used a semiquantitative score to rank studies based on their characteristics.

RESULTS: We obtained 43 attributable risk estimates from 19 different countries: 23 were published estimates, 8 were derived from published data, and 12 were extrapolated from incidence data. The median value for the attributable risk of occupationally associated asthma was 9% (25th to 75th interquartile range: 5% to 19%). The derived estimates (median attributable risk = 25%) were significantly greater than published values (median = 9%, P = 0.002), whereas the extrapolated estimates were significantly lower (median = 5%, P = 0.04). The 12 highest scored studies based on their characteristics yielded a median risk estimate of 15%.

CONCLUSION: Occupational factors are associated with about 1 in 10 cases of adult asthma, including new onset disease and reactivation of preexisting asthma.

Section snippets

Study selection

We identified published citations by searching the computerized database Medline from January 1966 through May 1999 using the key words “asthma and risk and occupation(al)(ally).” We identified 396 entries for potential inclusion, 295 of which were published after 1989. After review of the relevant English language articles, we also selected appropriate reference citations and, in turn, retrieved their relevant citations. To identify recent studies, we reviewed the published abstracts of the

Published population attributable risk estimate sources

There were 23 studies that estimated the attributable risk of asthma due to occupational exposures (Table 1)10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, including data from 17 countries. The estimates varied widely, from 2% to 33%. The median value for the attributable risks from all 23 studies was 9% (25th to 75th percentile: 6% to 18%); the mean (± SD) value was 12% ± 8%.

Three estimates were based on extrapolation (21), theoretical modeling (27),

Discussion

We identified many studies that measured the contribution of occupational factors to adult asthma. Although the studies involved more than 20 countries and varied in their characteristics, half of the attributable risk estimates were between 5% and 19%, with a median of 9%. The published estimates of the attributable risk were lower than those we derived from available data. This suggests that if publication bias exists, it may be toward lower estimates. In contrast, estimates of the

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    Supported by a Research Career Development Award KO4 HL03225 (PDB) and by the Swedish Council for Worklife Research (KT).

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