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Risk and incidence of asthma attributable to occupational exposure among HMO members.

Milton-DK; Solomon-GM; Rosiello-RA; Herrick-RF
Am J Ind Med 1998 Jan; 33(1):1-10
Occupational asthma among health maintenance organization (HMO) members was investigated. Previous 6 month health records of 79,204 persons, 15 to 55 years old, enrolled in the Fallonan, Community Health Plan, a Massachusetts based HMO, who had been identified as at risk for asthma were studied. Definition of at risk was based on previous reports of symptoms and treatments for asthma. The records were searched to identify cases of clinically significant asthma (potential cases) that occurred over a 3mo period, July through September 1995, by a computerized procedure using SENSOR criteria. The SENSOR criteria consisted of an emergency room visit for asthma, hospitalization for asthma, a diagnosis of occupational asthma, or an outpatient diagnosis of asthma accompanied by treatment with beta- agonist inhalers. A total of 108 potential asthma cases were identified. A chart review of these was performed to confirm those that were physician diagnosed and which received significant treatment. Seventy four cases were identified. These were then interviewed by telephone questionnaire to confirm asthma diagnosis, to assess the effect of work on symptoms, and to obtain a detailed work history. Sixty six subjects completed the questionnaire. New onset cases accounted for 35% of interviewed subjects. When interviewed cases with complete charts were included this yielded a total of 26 cases, representing an annual incidence rate of 1.3 cases per 1,000 person months (case/1,000). The incidence rate increased to 3.7case/1,000 when reactivated asthma cases were included in the analysis. Fourteen cases could be definitely attributed to occupational exposure based on their work history, representing an annual incidence rate of 71 cases per 100,000 person months. Physicians documented asking about work related symptoms in 15% of the reviewed charts and recorded symptoms suggestive of asthma for three cases; however, they did not seek an occupational medicine consultation, diagnose occupational asthma, or report to the state surveillance program or workers' compensation board for any of the cases. The authors conclude that the incidence of occupational asthma is significantly higher than previously reported and that occupational asthma accounts for much adult onset asthma.
NIOSH-Publication; NIOSH-Grant; Training; Bronchial-asthma; Occupational-diseases; Health-programs; Health-protection; Information-systems; Surveillance-programs; Epidemiology; Author Keywords: incidence; occupational asthma; reactive airways dysfunction syndrome; cohort study; health maintenance organization
Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115
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American Journal of Industrial Medicine
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Harvard School of Public Health, Boston, Massachusetts