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Asthma history, job type and job changes among US nurses
  1. Orianne Dumas1,2,
  2. Raphaëlle Varraso3,4,
  3. Jan Paul Zock5,
  4. Paul K Henneberger6,
  5. Frank E Speizer1,
  6. Aleta S Wiley1,
  7. Nicole Le Moual3,4,
  8. Carlos A Camargo Jr1,2
  1. 1Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
  2. 2Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
  3. 3INSERM, VIMA: Aging and chronic diseases. Epidemiological and public health approaches, U1168, F-94807, Villejuif, France
  4. 4UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Saint-Quentin-en-Yvelines, France
  5. 5Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
  6. 6Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Morgantown, USA
  1. Correspondence to Dr Orianne Dumas, Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital, 181 Longwood Avenue, Boston, MA 02115, USA; orianne.dumas{at}channing.harvard.edu

Abstract

Objectives 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.

Methods 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.

Results 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).

Conclusions 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.

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