Published ahead of print on September 13, 2007, doi:10.1164/rccm.200703-415PP
© 2008 American Thoracic Society doi: 10.1164/rccm.200703-415PP
The Healthy Worker Effect in AsthmaWork May Cause Asthma, but Asthma May Also Influence Work1 INSERM U780, Villejuif, France; 2 Faculty of Medicine, Université Paris-Sud, IFR69, Villejuif, France; 3 Harvard School of Public Health, Boston, Massachusetts; 4 School of Public Health, University of California, Berkeley, California; and 5 School of Occupational and Environmental Hygiene, University of British Columbia, Vancouver, British Columbia, Canada Correspondence and requests for reprints should be addressed to Nicole Le Moual, Ph.D., INSERM U780, Recherche en Epidémiologie et Biostatistique, 16 avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France. E-mail: lemoual{at}vjf.inserm.fr ABSTRACT Despite the increasing attention to the relationship between asthma and work exposures, occupational asthma remains underrecognized and its population burden underestimated. This may be due, in part, to the fact that traditional approaches to studying asthma in populations cannot adequately take into account the healthy worker effect (HWE). The HWE is the potential bias caused by the phenomenon that sicker individuals may choose work environments in which exposures are low; they may be excluded from being hired; or once hired, they may seek transfer to less exposed jobs or leave work. This article demonstrates that population- and workplace-based asthma studies are particularly subject to HWE bias, which leads to underestimates of relative risks. Our objective is to describe the HWE as it relates to asthma research, and to discuss the significance of taking HWE bias into account in designing and interpreting asthma studies. We also discuss the importance of understanding HWE bias for public health practitioners and for clinicians. Finally, we emphasize the timeliness of this review in light of the many longitudinal "child to young adult" asthma cohort studies currently underway. These prospective studies will soon provide an ideal opportunity to examine the impact of early workplace environments on asthma in young adults. We urge occupational and childhood asthma epidemiologists collaborate to ensure that this opportunity is not lost.
Key Words: epidemiology • asthma • occupational exposure • healthy worker effect This article has been cited by other articles:
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