Chest
Volume 109, Issue 3, March 1996, Pages 688-696
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Clinical Investigations: Asthma
Asthma, Employment Status, and Disability Among Adults Treated by Pulmonary and Allergy Specialists

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Objective

Identify risk factors for work disability among adults with asthma treated by pulmonary and allergy specialists.

Design

Cross-sectional survey, including retrospective work history data.

Participants

Sixty-eight pulmonary and 16 allergy internal medicine subspecialists maintaining a registry of patient visits for asthma; 698 registered patients aged 18 to 50 years, of whom 601 (86%) were studied

Measures

Computer-assisted, telephone-administered structured interview assessing asthma severity, perceived general health status, asthma quality of life, demographics, and work history. Complete work disability defined as total work cessation attributed to asthma; partial work disability defined as change in job, duties, or reduction in work hours attributed to asthma.

Results

Complete cessation of work due to asthma was reported by 40 (7%; 95% confidence interval [CI], 5 to 9%) and partial work disability by 53 (10%; 95% CI, 7 to 12%) of 550 subjects with a history of labor force participation. Severity of asthma score predicted both complete disability (odds ratio [OR], 7.9; 95% CI, 4.2 to 15 per 10-point increment) and partial disability (OR 2.6; 95% CI, 1.6 to 4.2). Taking illness severity into account, job conditions, occupation, and work exertion carried a combined disability OR of 3.9 (95% CI, 1.7 to 8.6).

Conclusions

Work disability is common among adults with asthma receiving specialist care. Severity of disease is a powerful predictor, but not the sole predictor of disability in this group. Working conditions, including job-related exposures, are associated with added disability risk even after taking illness severity into account.

Section snippets

Overview

This study analyzed the impact of disease severity, demographic characteristics, psychosocial factors, and occupational variables on the prevalence of work disability among adults with asthma. The persons with asthma whom we studied were derived from a random sample of northern California, board-certified pulmonary or allergy subspecialty internists. These physicians maintained a registry of all persons meeting standard clinical criteria for asthma who were seen for treatment in the outpatient

Demographics

We interviewed 601 subjects. Their demographic characteristics and smoking histories are presented in Table 1. The gender mix was predominantly female (69%); Hispanics and nonwhites comprised 33% of study subjects. Two thirds, 401 (67%), had attended at least some college. Although 226 (38%) had smoked cigarettes at some point (defined as a lifetime consumption of more than 100 cigarettes), only 42 (7%) were current smokers at the time of interview.

Asthma Severity and Health Status

Table 2 includes the measures in the severity

Discussion

We found that work disability is common among the adults with asthma followed up by pulmonary or allergy specialists. Severity of disease, quantified by an asthma-specific measure, was a strong predictor of disability, but not its only predictor. In particular, working conditions, including physical demands and chemical exposures, appeared to contribute as potent an incremental disability risk, even after taking into account other subject characteristics, including illness severity.

Our findings

ACKNOWLEDGMENTS

The authors thank Jonathan Henke for his programming help, Dr. Patricia Katz for her questionnaire input, ana Dr. Charles Gherman of the Kaiser Permanente Health Plan for his assistance.

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  • Cited by (0)

    Supported by a First Award R29 HL48959 and Research Career Development Award K04 HL03225 (Dr. Blanc), National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md

    revision accepted October 12.

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