哮喘联盟

   摘要
   目的:健康工人效应常常导致职业暴露与哮喘相关性的低估。刺激物对工作相关哮喘的影响备受争议。在此纵向研究中，我们通过边缘结构模型控制健康工人效应，评估职业暴露对哮喘表现的影响。
   方法：纳入的1284例参与者(17～79岁, 48% 为男性)来自于2003～2007年法国哮喘基因和环境流行病学研究（病例对照研究）随访人群。研究回顾性地记录了哮喘初发年龄、一生中发作/不发作的周期、职业史。通过职业-暴露矩阵，评估对以下物质的暴露情况：已知哮喘原、刺激物或低水平化学物/过敏原。以5年为周期进行职业史重组。
   结果：31%参与者曾经有过职业哮喘原暴露。在38%曾患过哮喘的受试者中，52%在所有时间段有过哮喘发作。标准分析发现已知哮喘原暴露(OR (95% CI): 0.99 (0.72 to 1.36))或刺激物/低水平化学物/哮喘原暴露(0.82 (0.56 to 1.20))与哮喘发作无明显相关性。利用边缘结构模型分析发现，所有的相关性均增加了。其中，已知哮喘原暴露(1.26 (0.90 to 1.76))出现提示性证据，而刺激物/低水平化学物/哮喘原暴露(1.56 (1.02 to 2.40))出现统计学显著性证据。
   结论：健康工人效应对职业相关哮喘的风险评估具有重要影响。边缘结构模型可有效用于消除因疾病导向选择导致的暴露不平衡。结果支持刺激物在职业相关哮喘中的作用。
 

（苏楠 审校）
Occup Environ Med. 2013 Jun 12. [Epub ahead of print]

 

Work related asthma. A causal analysis controlling the healthy worker effect.
 

Dumas O, Le Moual N, Siroux V, Heederik D, Garcia-Aymerich J, Varraso R, Kauffmann F, Basagaña X.
 

Abstract
OBJECTIVES: The healthy worker effect usually leads to underestimation of the association between occupational exposure and asthma. The role of irritants in work-related asthma is disputed. We estimated the effect of occupational exposure on asthma expression in a longitudinal study, using marginal structural modelling to control for the healthy worker effect.
METHODS: Analyses included 1284 participants (17-79 years, 48% men) from the follow-up (2003-2007) of the French Epidemiological study on the Genetics and Environment of Asthma (case-control study). Age at asthma onset, periods with/without attacks over lifetime and occupational history were recorded retrospectively. Exposures to known asthmagens, irritants or low level of chemicals/allergens were evaluated through a job-exposure matrix. The job history was reconstructed into 5-year intervals.
RESULTS: Thirty-one per cent of subjects had ever been exposed to occupational asthmagens. Among the 38% of subjects who had asthma (ever), presence of attacks was reported in 52% of all time periods. Using standard analyses, no association was observed between exposure to known asthmagens (OR (95% CI): 0.99 (0.72 to 1.36)) or to irritants/low level of chemicals/allergens (0.82 (0.56 to 1.20)) and asthma attacks. Using a marginal structural model, all associations increased with suggestive evidence for known asthmagens (1.26 (0.90 to 1.76)), and reaching statistical significance for irritants/low level of chemicals/allergens (1.56 (1.02 to 2.40)).
CONCLUSIONS: The healthy worker effect has an important impact in risk assessment in work-related asthma studies. Marginal structural models are useful to eliminate imbalances in exposure due to disease-driven selection. Results support the role of irritants in work-related asthma.
 

Occup Environ Med. 2013 Jun 12. [Epub ahead of print]