Asthma Clinical Trial
Official title:
Occupation and Asthma in an Urban Low Income Population
To study work-related asthma in a low-income, urban population.
BACKGROUND:
Work-related asthma is asthma that is attributable to, or is made worse by, environmental
exposures in the workplace. Published estimates of the proportion of adult asthma
attributable to occupational factors have varied widely, depending on population,
methodology, and definitions, from 2 percent to 33 percent. Occupational asthma is of great
public health importance because it is potentially preventable, can cause substantial
disability, and in some cases is completely curable. Among adults in the United States,
asthma has become a major public health problem, with rates most elevated among low income,
urban, African American and Latino sectors of the population, and with substantial evidence
suggesting potential occupational contributions to the excess rates. These important sectors
of the U.S. population have, however, been inadequately represented in the occupational
asthma research literature.
DESIGN NARRATIVE:
This was a case control study of physician-diagnosed asthma, occupation, industry, and
workplace environmental exposures designed to evaluate the hypothesis that a substantial
component of the asthma burden in a low income, urban, largely minority population was due
to occupational factors. The study design addressed a variety of methodologic challenges
including healthy worker effects, difficulty contacting and recruiting this potentially high
risk population, large numbers of potential etiologic agents, mixed exposures, small
workplaces, and low absolute incidence of occupational asthma.
The study population was the catchment population of Bellevue Hospital, a general hospital
in lower Manhattan, New York City, with busy ambulatory care services that serve low income
working communities. Cases and controls were recruited from among outpatients and inpatients
at Bellevue Hospital and interviewed face-to-face or by telephone. Occupation, industry, and
occupational exposures were determined by questionnaire supplemented by a Job Exposure
Matrix. Odds ratios (ORs) of association between asthma and specific industrial,
occupational, and exposure categories, controlled for major confounders, were estimated. The
ORs were used to calculate occupation- and industry-specific Attributable Fractions, and an
overall Population Attributable Fraction of asthma attributable to occupational factors. New
onset occupational asthma and work-aggravated asthma were investigated separately.
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Observational Model: Case Control, Time Perspective: Retrospective
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