Objectives Occupational use of disinfectants among healthcare workers has been associated with asthma. However, most studies are cross-sectional, and longitudinal studies are not entirely consistent. To limit the healthy worker effect, it is important to conduct studies among early- to mid-career workers. We investigated the prospective association between use of disinfectants and asthma incidence in a large cohort of early- to mid-career female nurses.
Methods The Nurses’ Health Study 3 is an ongoing, prospective, internet-based cohort of female nurses in the USA and Canada (2010–present). Analyses included 17 280 participants without a history of asthma at study entry (mean age: 34 years) and who had completed ≥1 follow-up questionnaire (sent every 6 months). Occupational use of high-level disinfectants (HLDs) was evaluated by questionnaire. We examined the association between HLD use and asthma development, adjusted for age, race, ethnicity, smoking status and body mass index.
Results During 67 392 person-years of follow-up, 391 nurses reported incident clinician-diagnosed asthma. Compared with nurses who reported ≤5 years of HLD use (89%), those with >5 years of HLD use (11%) had increased risk of incident asthma (adjusted HR (95% CI), 1.39 (1.04 to 1.86)). The risk of incident asthma was elevated but not statistically significant in those reporting >5 years of HLD use and current use of ≥2 products (1.72 (0.88 to 3.34)); asthma risk was significantly elevated in women with >5 years of HLD use but no current use (1.46 (1.00 to 2.12)).
Conclusions Occupational use of HLDs was prospectively associated with increased asthma incidence in early- to mid-career nurses.
- occupational asthma
- longitudinal studies
- health care workers
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Contributors OD contributed to the study conception, analysis and interpretation of the data, and primary manuscript preparation. AJG, SH and JEC contributed to the acquisition and interpretation of the data and critical revision of the manuscript. KMB, NLM and RV were involved in the data interpretation and critical revision of the manuscript. CAC participated in the study conception, data interpretation and critical revision of the manuscript. All authors approved the final version of the manuscript and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding This work was supported by the National Institute for Occupational Safety and Health (R01 OH-10359) and National Institutes of Health (R24-ES028521-01 and U01-HL145386-01).
Disclaimer The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention.
Competing interests CAC reports grants from NIOSH/CDC and NIH during the conduct of the study. JEC reports grants from National Institute of Occupational Safety and Health, grants from National Institute of Environmental Health Sciences and grants from National Heart, Lung and Blood Institute during the conduct of the study.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Along with a general description of the cohort, the policies and guidelines for access to data from the Nurses’ Health Studies are published on the Nurses’ Health Study website (https://www.nurseshealthstudy.org/researchers).
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