The burden of occupational asthma is underestimated partly due to the lack of knowledge regarding asthmagen exposures. To study work-related asthma in population-based cohorts, improvement of exposure assessment is crucial. An asthma-specific Job-Exposure Matrix (JEM) was developed at the end of the 1990s (Kennedy SM et al, 2000;http://asthmajem.vjf.inserm.fr/;ISCO-88 system). An update of the JEM is necessary since the number of suspected asthmagens has tripled since 2000.
For this update, evaluation of exposure to 8 broad groups and 33 specific asthmagens, including 11 newly recognised, were classified into three categories: high (high probability of exposure and moderate-to-high intensity), medium (low-to-moderate probability or low intensity), no (unlikely to be exposed). A working group of three experts was assigned for each asthmagen. Important methodological aspects were kept in mind during the process: (1) within a working group, experts evaluated exposures independently from each other. Cohen’s Kappa’s were calculated to estimate initial agreement. If expert assessments were inconsistent the final decision was taken by consensus. (2) specificity was favoured over sensitivity, i.e. jobs were classified with high exposure only if the probability of exposure was high and the intensity moderate-to-high.
Initial agreement between the three experts was mostly fair-to-moderate (0.2–0.5). Out of 506 jobs, 82.4% (organic solvents) to 99.8% (persulfates) were classified as non-exposed and 0% (enzymes) to 2.5% (organic solvents) as highly-exposed. The final steps in progress include review of assigned exposures by all experts and improvement of a two-step expert re-evaluation after application of the JEM (checking ISCO code and exposure assessment for selected jobs). The JEM will soon be available for ISCO-88 and is foreseen for other classifications (ISCO-68;ISCO-08;PCS-2003).
This new Asthma-specific JEM will enable improved evaluations of associations between occupational exposures and asthma phenotypes in epidemiological studies and determination of the burden of disease due to occupational asthmagens.
Grant: PHC Van-Gogh
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