Chest
Volume 92, Issue 4, October 1987, Pages 613-617
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Clinical Investigations
Occupational Asthma in a National Disability Survey

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The contribution of workplace exposures to the prevalence of asthma in adults has been minimized in the epidemiology of this illness. Analysis of the 1978 Social Security Disability Survey provides a population-based assessment as a novel approach utilizing self-attributed, occupationally related asthma as a measure of disease. Of 6,063 respondents, 468 (7.7 percent) identified asthma as a personal medical condition; 72 (1.2 percent [15.4 percent of all those with asthma]) attributed it to workplace exposures. These subjects were older and included more men and cigarette smokers than groups of both asthmatic and nonasthmatic subjects. The relative risk for occupationally attributed asthma was elevated among industrial and agricultural workers as compared with white collar and service occupations. Analysis of disability benefit status did not indicate that this introduced major reporting bias in this survey. This study suggests that occupational factors may have a greater role in adult asthma than previously thought.

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Survey Design

The SDA was completed in 1978 by the Social Security Administration. Questionnaires were administered in household interviews to a national sample of noninstitutionalized adults aged 18 to 64 years. Respondents were derived from two sampling frames. One frame comprised 6,900 subjects selected from 1976 Health Interview Survey (HIS) respondents, representing the community at large but drawing disproportionately among those with activity limitations. The second frame comprised 4,500 subjects

RESULTS

Of 6,063 respondents, 468 (7.7 percent) stated that they had asthma. All but 12 listed this as a physician’s diagnosis. Seventy-two respondents attributed asthma to “bad working conditions.” These occupationally related asthma cases represented 15.4 percent of all asthma and 1.2 percent of all respondents. Table 1 presents demographic data for those with occupationally related asthma, those with all other types of asthma, and nonasthmatic subjects. Occupational cases were older and had a

DISCUSSION

These data indicate that the problem of occupationally related asthma may be larger indeed than previously estimated. These results, which suggest reconsideration of the minor role generally allotted workplace exposures in the etiology of asthma overall, must be interpreted with the caution warranted by the study design.

In the ideal world (if the workplace was not then risk-free), one could study all employees, identifying prospectively, by strict medical criteria, all those with asthma,

CONCLUSION

In summary then, potential effects of selection through sampling error; of assessment in illness and exposure; and of misattribution of cause do not appear to have been major sources of bias in this analysis. Rejecting these as likely explanations for the findings reported here, one must return to the conclusion that the high prevalence of occupationally attributed asthma detected in this study is a valid observation, implying that revision is necessary in our assessment of this public health

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This research and the preparation of this study were assisted by a grant from the Robert Wood Johnson Foundation, Princeton, NJ. The opinions, conclusions, and proposals in the text are those of the author and do not necessarily represent the views of the Robert Wood Johnson Foundation.

Manuscript received December 22; revision accepted March 2.

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