AJM Theme Issue: Pulmonology/Allergy
Clinical research study
Risk Factors for Work Disability in Severe Adult Asthma

https://doi.org/10.1016/j.amjmed.2006.01.016Get rights and content

Abstract

Purpose

We aimed to elucidate the prevalence of and risk factors for work disability in severe adult asthma and to evaluate the impact of work disability on downstream health outcomes.

Methods

We used data from a prospective cohort study of 465 adults with severe asthma. Structured telephone interviews ascertained asthma status and employment history. A job exposure matrix (JEM) was used to characterize the likelihood of workplace exposure to “asthmagens.”

Results

The prevalence of asthma-related complete work disability was 14% among working-age adults with severe asthma (95% confidence interval, 11%-18%). Among those who were currently employed, the prevalence of partial work disability was 38% (95% confidence interval, 31%-45%). Sociodemographic (P = .027) and medical factors (P = .020) were related to the risk of complete work disability. Both sociodemographic characteristics (P = .06) and work exposures based on the JEM (P = .012) were related to partial work disability. In additional models, poorer asthma severity, physical health status, and mental health status were all associated with a higher risk of complete and partial work disability.

Conclusions

Work disability is common among adults with severe asthma. There are three sets of risk factors for work disability that are potentially modifiable: smoking, workplace exposures, and asthma severity.

Section snippets

Subject Recruitment

We used data from a prospective cohort study of adult members of Northern California Kaiser Permanente (KP). Recruitment methods have been reported in detail.16, 17, 18 To establish a cohort with more severe asthma, we recruited adults after recent hospitalization for asthma.19, 20, 21, 22, 23 Eligible subjects were adult KP members (≥18 years) who were hospitalized with a principal International Classification of Diseases, 9th revision (ICD-9) discharge diagnosis code for asthma (codes 493.xx)

Risk of Work Disability

Subject characteristics are summarized in Table 1. The prevalence of asthma-related complete work disability was 14% among working-age adults with severe asthma (95% confidence interval [CI] 11%-18%) (Figure 1). Among those who were not currently employed, more than 1 in 4 cases of complete work disability could be attributed to asthma (26%; 95% CI, 21%-32%). In the subgroup who was currently employed, the prevalence of partial work disability was 38% (95% CI, 31%-45%).

As shown in Table 2,

Discussion

In this cohort of insured adults with severe asthma, the prevalence of complete and partial work disability was substantial. Compared with the general population of California adults, adults with asthma were 31% less likely to be currently employed. Sociodemographic factors and medical factors were both associated with the risk of complete work disability caused by asthma, whereas sociodemographic factors and workplace exposures contributed to partial work disability. In addition, poorer asthma

Conclusion

Work disability is common among adults with severe asthma and is associated with adverse downstream health outcomes. On the basis of our results, we identified three sets of risk factors for work disability that are potentially modifiable: smoking, workplace exposures, and asthma severity. A combined clinical approach that includes smoking cessation, a careful occupational history, and optimization of asthma therapy has the potential to prevent work loss, financial deterioration, and negative

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    Dr. Eisner was supported by K23 HL04201, National Heart, Lung, and Blood Institute, National Institutes of Health, with co-funding by the Social Security Administration.

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