Occupational exposure to disinfectants and asthma incidence in US nurses: A prospective cohort study
Occupational exposure to disinfectants and asthma incidence in US nurses: A prospective cohort study
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DOI：
10.1002/ajim.23067
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发表时间：
2019-11-06
影响因子：
3.5
通讯作者：
Camargo, Carlos A.
中科院分区：
文献类型：
--
作者：
Dumas, Orianne;Boggs, Krislyn M.;Camargo, Carlos A.
背景医护人员接触消毒剂与呼吸系统健康影响有关，特别是哮喘。然而，大多数研究都是横断面的，消毒剂暴露在哮喘发展中的作用需要纵向研究。我们在一大群美国女护士中调查了职业接触消毒剂与哮喘事件之间的关联。方法护士健康研究 II 是一个由 1989 年注册的 116429 名女护士组成的前瞻性队列。分析包括 2009 年仍在从事护理工作且没有哮喘病史的 61539 名参与者（基线；平均年龄：55 岁）。在 277744 人年的随访期间（2009 年至 2015 年），370 名护士报告了医生诊断的哮喘事件。通过问卷和工作-任务-暴露矩阵（JTEM）评估职业暴露。我们检查了消毒剂暴露与随后哮喘发展之间的关联，并根据年龄、种族、民族、吸烟状况和体重指数进行了调整。结果每周使用消毒剂仅清洁表面（23% 暴露）或清洁医疗器械（19% 暴露）与哮喘事件无关（调整后的表面风险比 [95% 置信区间]，1.12 [0.87-1.43]；器械，1.13） [0.87-1.48]）。通过 JTEM 评估，未观察到高浓度接触特定消毒剂/清洁产品（甲醛、戊二醛、漂白剂、过氧化氢、酒精季铵盐或酶清洁剂）与哮喘发病率之间存在关联。结论在晚期职业护士人群中，我们观察到接触消毒剂与哮喘发病率之间没有显着关联。消毒剂暴露在哮喘发展中的潜在作用值得在职业生涯早期阶段的医护人员中进行进一步研究，以限制健康工作者的影响。
BackgroundExposure to disinfectants among healthcare workers has been associated with respiratory health effects, in particular, asthma. However, most studies are cross-sectional and the role of disinfectant exposures in asthma development requires longitudinal studies. We investigated the association between occupational exposure to disinfectants and incident asthma in a large cohort of U.S. female nurses.MethodsThe Nurses' Health Study II is a prospective cohort of 116429 female nurses enrolled in 1989. Analyses included 61539 participants who were still in a nursing job and with no history of asthma in 2009 (baseline; mean age: 55 years). During 277744 person-years of follow-up (2009-2015), 370 nurses reported incident physician-diagnosed asthma. Occupational exposure was evaluated by questionnaire and a Job-Task-Exposure Matrix (JTEM). We examined the association between disinfectant exposure and subsequent asthma development, adjusted for age, race, ethnicity, smoking status, and body mass index.ResultsWeekly use of disinfectants to clean surfaces only (23% exposed) or to clean medical instruments (19% exposed) was not associated with incident asthma (adjusted hazard ratio [95% confidence interval] for surfaces, 1.12 [0.87-1.43]; for instruments, 1.13 [0.87-1.48]). No association was observed between high-level exposure to specific disinfectants/cleaning products evaluated by the JTEM (formaldehyde, glutaraldehyde, bleach, hydrogen peroxide, alcohol quats, or enzymatic cleaners) and asthma incidence.ConclusionsIn a population of late career nurses, we observed no significant association between exposure to disinfectants and asthma incidence. A potential role of disinfectant exposures in asthma development warrants further study among healthcare workers at earlier career stage to limit the healthy worker effect.