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Work-related asthma in the USA: nationally representative estimates with extended follow-up
  1. James N Laditka,
  2. Sarah B Laditka,
  3. Ahmed A Arif,
  4. Jessica N Hoyle
  1. Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
  1. Correspondence to Dr Sarah B Laditka, Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC 28223, USA; sladitka{at}


Objective We studied the associations of working in occupations with high asthma trigger exposures with the prevalence and incidence of asthma, and with ever reporting an asthma diagnosis throughout working life.

Methods We used the nationally representative Panel Study of Income Dynamics (1968–2015; n=13 957; 205 498 person-years), with annual reports of occupation and asthma diagnoses across 48 years. We compared asthma outcomes in occupations likely to have asthma trigger exposures with those in occupations with limited trigger exposures. We estimated the prevalence ratios and the incidence risk ratios using log-binomial regression adjusted for age, sex, race/ethnicity, education, and current and past atopy and smoking, and accounting for the survey design and sampling weights. We calculated the attributable risk fractions and population attributable risks, and used multinomial logistic Markov models and microsimulation to estimate the percentage of people ever diagnosed with asthma during working life.

Results The adjusted prevalence ratio comparing high-risk occupations with low-risk was 4.1 (95% CI 3.5 to 4.8); the adjusted risk ratio was 2.6 (CI 1.8 to 3.9). The attributable risk was 16.7% (CI 8.5 to 23.6); the population attributable risk was 11.3% (CI 5.0 to 17.2). In microsimulations, 14.9% (CI 13.4 to 16.3) with low trigger exposure risk reported asthma at least once, ages 18–65, compared with 23.9% (CI 22.3 to 26.0) with high exposure risk.

Conclusion Adults were more than twice as likely to report a new asthma diagnosis if their occupation involved asthma triggers. Work exposures to asthma triggers may cause or aggravate about 11% of all adult asthma and increase the risk of work-life asthma by 60%.

  • asthma
  • epidemiology
  • longitudinal studies
  • occupational asthma

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  • Contributors JNL, SBL and AAA contributed to the conception and design of this study. All authors reviewed the research literature. JNL acquired the data. JNL and SBL analysed the data and drafted the first version of the manuscript. All authors contributed to the writing of the manuscript. All authors critically revised the manuscript and approved the final manuscript for publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The institutional review board (IRB) at our university determined that this research did not require IRB review.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. The data used for this study are available from the Panel Study of Income Dynamics ( The collection of data used in this study was partly supported by the National Institutes of Health under grant number R01 HD069609, and the National Science Foundation under award number 1157698.