Am. J. Respir. Crit. Care Med., Volume 160, Number 6, December 1999, 2028-2033

Asthma-related Work Disability in Sweden
The Impact of Workplace Exposures

PAUL D. BLANC, SUSAN ELLBJÄR, CHRISTER JANSON, DAN NORBÄCK, EVA NORRMAN, PETER PLASCHKE, and KJELL TORÉN

Division of Occupational and Environmental Medicine, Department of Medicine and the Cardiovascular Research Institute, University of California San Francisco, San Francisco, California; Departments of Respiratory Medicine and Allergology, and Occupational and Environmental Medicine, Sahlgrenska University Hospital, Göteborg, Sweden; Departments of Lung Medicine, and Medical Science/ Occupational and Environmental Medicine, Akademiska Sjukhuset, Uppsala, Sweden; and Department of Respiratory Medicine and Allergology, University Hospital, Umeå, Sweden

Work disability due to respiratory disease, especially asthma, is common and costly among working age adults. The goal of this analysis was to characterize the risk factors for such disability. We analyzed data from the Swedish part of the European Community Respiratory Health Survey (ECRHS), a random population-based sample of adults age 20 to 44, enriched with symptomatic subjects at increased likelihood of having asthma. We analyzed structured interview data available for 2,065 subjects and further analyzed methacholine challenge and skin prick test data for 1,562 of these. We defined respiratory work disability as reported job change or work loss due to breathing affected by a job. We used binary generalized linear modeling with a log link to estimate disability risk. Eighty-four subjects (4%) reported such work disability. This increased to 13% among those with asthma (45 of 350 subjects). Adjusting for covariates, occupations at high risk for asthma were associated with disability (prevalence ratio [PR] 1.8; 95% confidence interval [CI] 1.1 to 3.0), as was self-reported regular exposure to environmental tobacco smoke (ETS) at work (PR 1.8; 95% CI 1.1 to 3.1) and self- reported job exposure to vapors, gases, dust, or fumes (VGDF) (PR 4.3; 95% CI 2.2 to 8.6). Workplace ETS exposure was also associated with methacholine challenge-positive asthma reported to be symptomatic at work among male subjects (PR 4.2; 95% CI 1.8 to 9.8), whereas high asthma-risk occupations were associated with this outcome among female subjects (PR 2.7; 95% CI 1.05 to 7.1). Respiratory work disability, defined as breathing-related job change due to work loss, was associated with workplace exposures themselves, even after taking into account other covariates. Better control of workplace exposures, including workplace ETS, may reduce work disability caused by respiratory conditions, especially adult asthma. Blanc PD, Ellbjär S, Janson C, Norbäck D, Norrman E, Plaschke P, Torén K. Asthma-related work disability in Sweden: the impact of workplace exposures.

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