Mortality, morbidity and occupational exposure to airway irritating agents among men with a respiratory diagnosis in adolescence

Pernilla Wiebert ^1*, Magnus Svartengren ¹, Magnus Lindberg ², Tomas Hemmingsson ³, Ingvar Lundberg ³ and Gun Nise ¹

¹ Department of Public Health Sciences, Karolinska Institutet, Sweden
² Department of Medicine, Karolinska Institutet, Sweden
³ National Institute for Working Life, Karolinska Institutet, Sweden

^* To whom correspondence should be addressed. E-mail: pernilla.wiebert{at}ki.se.

Accepted 18 July 2007

Abstract

Objectives: To elucidate the influence of an airway diagnosis in adolescence on future health and occupation in Swedish men. Methods: Data was collected from the linkage of four Swedish national registers: The Military Service Conscription Register, the Population and Housing Censuses, the Inpatient Care Register and the National Cause of Death Register. A job-exposure matrix for airway irritating substances was developed for application on the conscription cohort. The cohort includes 39,321 Swedish men born 1949-51. Three groups; i) healthy, ii) asthmatics (mild and severe asthma) and iii) subjects with allergic rhinitis without concurrent asthma were identified at conscription and analysed for mortality, inpatient care and strategies for choice of occupation with emphasis on airway irritating job-exposure. Analyses were adjusted for smoking and childhood socio-economic position. Results: The prevalence of total asthma was 1.8%, severe asthma 0.45% and allergic rhinitis 2.7%. Mortality for all causes was significantly higher in total asthma, hazard ratio (HR) 1.49 (95% CI 1.00-2.23), and lower in allergic rhinitis, HR 0.52 (95% CI 0.30-0.91). Asthma was a risk factor for inpatient care while allergic rhinitis was associated with less inpatient care (odds ratio (OR) for total asthma 1.16 (95% CI 1.00-1.34), severe asthma 1.38 (95% CI 1.04-1.85), allergic rhinitis 0.92 (95% CI 0.82-1.03). Asthmatics tended to avoid jobs with a high probability for airway irritating exposure (OR 0.88, 95% CI 0.71-1.09), but not to the same extent as subjects with allergic rhinitis (OR 0.58, 95% CI 0.47-0.70). (OR:s from 1990.) Conclusion: Subjects with asthma did not change their exposure situation to the same extent as subjects with allergic rhinitis. Further, asthmatics had an increased risk for morbidity and mortality compared to healthy subjects and subjects with allergic rhinitis.

Keywords: allergy, asthma, cohort, job-exposure matrix, occupation

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