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Prevalence of Asthma, Asthma Attacks, and Emergency Department Visits for Asthma Among Working Adults — National Health Interview Survey, 2011–2016


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Jacek M. Mazurek, MD, PhD1; Girija Syamlal, MBBS1 (View author affiliations)

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Summary

What is already known about this topic?

In 2010, an estimated 8.2% of U.S. adults had current asthma; among them, 49.1% reported at least one asthma attack in the past year. Up to 51% of adult asthma might be related to work and could therefore potentially be prevented.

What is added by this report?

During 2011–2016, among an estimated 160.7 million working adults, 6.8% had current asthma. Among those with asthma, 44.7% experienced an asthma attack, and 9.9% had an asthma-related emergency department visit in the previous year. The current asthma prevalence was highest among workers employed in the health care and social assistance industry (8.8%) and in health care support occupations (8.8%).

What are the implications for public health practice?

This information might assist physicians to identify workers who should be evaluated for possible work-related asthma and could help public health officials identify workplaces where detailed investigations for prevention and control might be appropriate. Guidelines promoting effective management of work-related asthma are available.

In 2010, an estimated 8.2% of U.S. adults had current asthma, and among these persons, 49.1% had had an asthma attack during the past year (1). Workplace exposures can cause asthma in a previously healthy worker or can trigger asthma exacerbations in workers with current asthma* (2). To assess the industry- and occupation-specific prevalence of current asthma, asthma attacks, and asthma-related emergency department (ED) visits among working adults, CDC analyzed 2011–2016 National Health Interview Survey (NHIS) data for participants aged ≥18 years who, at the time of the survey, were employed at some time during the 12 months preceding the interview. During 2011–2016, 6.8% of adults (11 million) employed at any time in the past 12 months had current asthma; among those, 44.7% experienced an asthma attack, and 9.9% had an asthma-related ED visit in the previous year. Current asthma prevalence was highest among workers in the health care and social assistance industry (8.8%) and in health care support occupations (8.8%). The increased prevalence of current asthma, asthma attacks, and asthma-related ED visits in certain industries and occupations might indicate increased risks for these health outcomes associated with workplace exposures. These findings might assist health care and public health professionals in identifying workers in industries and occupations with a high prevalence of current asthma, asthma attacks, and asthma-related ED visits who should be evaluated for possible work-related asthma. Guidelines intended to promote effective management of work-related asthma are available (2,3).

The NHIS is an annual survey that collects health information from a nationally representative sample of the noninstitutionalized U.S. civilian population through personal interviews. Survey participants were considered to be working in the last 12 months if they reported having a job or business at any time during the past 12 months.§ For analyses, information on respondents’ current industry (21 major groups/79 detailed industries) and occupation (23 major groups/94 detailed occupations) were used. Participants who had ever been told by a doctor or other health professional that they had asthma and reported that they still have asthma were considered to have current asthma. Persons with at least one asthma attack in the past year, or at least one asthma-related ED visit in the past year were identified by affirmative responses to questions “During the past 12 months, have you had an episode of asthma or an asthma attack?” and “During the past 12 months, have you had to visit an emergency room or urgent care center because of asthma?,” respectively.

Data were weighted to produce nationally representative estimates using sample weights, and variance estimates were calculated to account for the clustered survey design. Estimates with a relative standard error (standard error of the estimate divided by the estimate) ≥30% were not reported. The Rao-Scott chi-square test was used to determine statistically significant differences (p<0.05) between groups. Data were analyzed using statistical software.

During 2011–2016, an estimated (annual average) 160.7 million adults were working at any time during the past 12 months (Table 1), 6.8% (11.0 million) of whom had current asthma. Current asthma prevalence was highest among workers aged 18–24 years (8.5%), females (8.9%), non-Hispanic blacks (8.2%), those with higher than a high school education (7.2%), those categorized as “poor”** (8.7%), those having health insurance (7.1%), and those living in the Northeast (7.6%).

Among workers with current asthma, 44.7% (4.9 million) had at least one asthma attack, and 9.9% (1.1 million) had at least one asthma-related ED visit in the past 12 months (Table 1). The proportion of workers with current asthma who had at least one asthma attack was highest among workers aged 45–64 years (47.4%), females (48.4%), non-Hispanic whites (45.4%), those with higher than a high school education (45.2%), those categorized as poor (49.2%), those with no health insurance (47.5%), and those living in the South (46.1%). The proportion of workers with current asthma who had at least one asthma-related ED visit was highest among workers aged 18–24 years (10.5%), females (11.7%), non-Hispanic blacks (17.6%), those with less than high school education (13.3%), those categorized as poor (17.0%), those with no health insurance (14.5%), and those living in the South (11.3%).

By major industry, current asthma prevalence was highest among workers in the major industry groups of health care and social assistance (8.8%) followed by educational services (8.2%) (Table 2); these groups also had the first and second highest numbers of workers with asthma attacks (860,000 and 602,000, respectively) and asthma-related ED visits (212,000 and 102,000, respectively). The highest prevalence of asthma attacks was among workers with asthma in the transportation and warehousing (51.7%) industries, and the highest prevalence of asthma-related ED visits was among workers in retail trade (12.4%).

By detailed industry sector, current asthma prevalence was highest among workers in electronics and appliance stores (11.9%) (Table 2). Among persons with current asthma, the highest asthma attack prevalence was among workers in wood products manufacturing (57.3%), followed by the plastics and rubber products manufacturing (56.7%), and the highest prevalence of asthma-related ED visits was among workers in private households (22.9%). The highest numbers of asthma attacks (307,000) and asthma-related ED visits (75,000) were among persons working in ambulatory health care services.

By major occupation group, current asthma prevalence was highest among workers in health care support (8.8%), followed by personal care and service (8.6%) occupations (Table 3). Among those with current asthma, the highest prevalence of asthma attacks was among workers in the education, training, and library (51.5%) major occupations; the highest prevalence of asthma-related ED visits was among workers in personal care and service (17.4%) occupations. The highest numbers of workers with asthma attacks (711,000) and asthma-related ED visits (137,000) were in the office and administrative support major occupation.

By detailed occupation subgroup, the highest prevalence of current asthma (10.7%) and asthma attack in the past 12 months (64.0%) was among workers in other education, training, and library occupations†† (Table 3). Prevalence of asthma-related ED visits was highest among personal appearance workers§§ (25.0%). The highest number of workers with asthma attacks was among those working in other management occupations¶¶ (302,000), and the highest number of workers with asthma-related ED visits was among retail sales workers (99,000).

Discussion

This report provides industry- and occupation-specific prevalence estimates of current asthma, and among those with current asthma, the prevalence of at least one asthma attack and at least one asthma-related ED visit in the past year. The numbers of workers reporting asthma attacks and asthma-related ED visits in specific industries and occupations correlate with the numbers of workers and current asthma prevalence in each group. The increased prevalence of current asthma, asthma attacks, and asthma-related ED visits in certain industries and occupations might indicate increased risks for these health outcomes associated with workplace exposures. The highest prevalence of current asthma was among workers in the health care and social assistance industry and in health care support occupations. New-onset work-related asthma in these workers has been associated with exposure to cleaning and disinfecting products, powdered latex gloves, and aerosolized medications (4). Nearly two thirds of the workers with asthma in the wood products and in the plastics and rubber products manufacturing industries had at least one asthma attack in the past year. Workers in these industries are at increased risk for work-related asthma (5,6), and the high proportion of workers with a history of an asthma attack in this report suggests a high risk for work-related exacerbation of asthma. Education, training, and library workers are also at risk for work-related asthma and adverse health outcomes (7).

NHIS did not collect data on severity of asthma exacerbations and asthma work-relatedness. The subset of patients who experience severe asthma exacerbations have an accelerated decline in lung function, greater health care utilization, and a lower quality of life (3,8). Based on the estimate that approximately 51% of adult asthma might be caused or made worse by work (9), as many as 5.6 million workers might have asthma or asthma outcomes related to work that could be prevented. Physicians should consider work-related asthma in all workers with new-onset or worsening asthma (2,3).

Workplace conditions and exposures associated with asthma include irritant chemicals, dusts, secondhand tobacco smoke, allergens and sensitizers, emotional stress, worksite temperature, and physical exertion (3). A list of asthmagens causing work-related asthma by sensitization or acute irritant-induced asthma is available (http://www.aoecdata.org/ExpCodeLookup.aspx). Identification of potential asthma-related agents in the workplace can be facilitated by obtaining safety data sheets.*** Guidelines intended to promote effective management of work-related asthma are available (2,3). The preferred primary strategy to prevent work-related asthma and reduce signs, symptoms, and progression of disease is exposure control (i.e., elimination or substitution of hazardous products, engineering controls, and respiratory protection). However, if these approaches are unsuccessful, removal of the worker from exposure might sometimes be necessary for management of work-related asthma (2,3,10).

The findings in this report are subject to at least four limitations. First, information on asthma, asthma attacks, and asthma-related ED visits was self-reported and not validated by medical records. It is likely that some respondents had misdiagnosed or undiagnosed asthma. Second, no temporal information on asthma onset and exacerbations was available; thus, it was not possible to determine asthma association with work. Third, only workers employed at some time in the past 12 months were included in this study. Those with severe asthma might have left employment in industries and occupations with workplace exposures that exacerbate their asthma; thus, industry and occupation in this report might not accurately identify workers’ industry and occupation where exposures occur. Finally, small sample sizes for some groups resulted in unreliable estimates.

These findings might assist physicians to identify workers who should be evaluated for possible work-related asthma in industries and occupations with a high prevalence of asthma, asthma attacks, and asthma-related ED visits and could help public health officials identify workplaces where detailed investigations for prevention and control might be appropriate. Continued surveillance is important to assess asthma prevalence and trends by respondents’ industry and occupation.

Acknowledgments

David N. Weissman, Respiratory Health Division, National Institute for Occupational Safety and Health, CDC.

Conflict of Interest

No conflicts of interest were reported.


Corresponding author: Jacek Mazurek, JMazurek1@cdc.gov, 304-285-5983.

1Respiratory Health Division, National Institute for Occupational Safety and Health, CDC.


* Work-related asthma is defined as either occupational asthma (i.e., new-onset asthma caused by factors related to work) or work-exacerbated asthma (i.e., preexisting or concurrent asthma worsened by factors related to work).

https://www.cdc.gov/nchs/nhis/quest_data_related_1997_forward.htm.

§ ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2014/samadult_layout.pdf.

Industry and occupation information that employed sample adults had during the week before the interview. Additional information on the industry and occupation coding schemes can be found at ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2014/srvydesc.pdf.

** Poverty index is based on family income and family size using the U.S. Census Bureau’s poverty thresholds for the previous calendar year. Persons categorized as “poor” have family incomes <100% of the poverty threshold, “near poor” have family incomes ≥100% to <200% of the poverty threshold, “not poor” have family incomes ≥200% of the poverty threshold. ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2016/srvydesc.pdf, https://www.census.gov/data/tables/time-series/demo/income-poverty/historical-poverty-thresholds.html.

†† Audio-visual and multimedia collections specialists; farm and home management advisors; instructional coordinators; teacher assistants; miscellaneous education, training, and library workers (25-9000 Other Education, Training, and Library Occupations). https://www.bls.gov/soc/2010/2010_major_groups.htm#25-0000.

§§ Barbers; hairdressers, hairstylists and cosmetologists; makeup artists, theatrical and performance; manicurists and pedicurists; shampooers; skin care specialists (39-5000 Personal Appearance Workers). https://www.bls.gov/soc/2010/2010_major_groups.htm#39-0000.

¶¶ Farmers, ranchers, and other agricultural managers; construction managers; education administrators; architectural and engineering managers; food service managers; funeral service managers; gaming managers; lodging managers; medical and health services managers; natural sciences managers; postmasters and mail superintendents; property, real estate, and community association managers; social and community service managers; emergency management directors (11-9000 Other Management Occupations). https://www.bls.gov/soc/2010/2010_major_groups.htm#11-0000.

*** https://www.osha.gov/Publications/HazComm_QuickCard_SafetyData.html.

References

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TABLE 1. Current asthma* prevalence and proportion of adults working at any time in the past 12 months with current asthma who had at least one asthma attack§ or emergency department (ED) visit for asthma in the past 12 months (annual average), by selected characteristics — National Health Interview Survey, 2011–2016Return to your place in the text
Characteristic Workers (x 1,000)** Current asthma Proportion of persons with current asthma who had ≥1 asthma attack in past 12 months Proportion of persons with current asthma who had ≥1 asthma ED visit in past 12 months
No. (x 1,000)** % (95% CI) p-value % (95% CI) p-value % (95% CI) p-value
Age group (yrs)
18–24 22,005 1,858 8.5 (7.8–9.1) <0.001 36.8 (33.3–40.3) <0.001 10.5 (8.0–13.0) 0.30
25–44 68,651 4,529 6.6 (6.3–6.9) 46.2 (44.1–48.4) 10.4 (9.2–11.7)
45–64 60,927 4,072 6.7 (6.4–7.0) 47.4 (45.2–49.5) 9.3 (8.1–10.5)
≥65 9,126 513 5.6 (5.0–6.2) 40.6 (34.4–45.8) 8.0 (5.5–10.5)
Sex
Men 84,415 4,181 5.0 (4.7–5.2) <0.001 39.0 (36.6–41.4) <0.001 7.0 (5.9–8.2) <0.001
Women 76,294 6,791 8.9 (8.6–9.2) 48.4 (46.7–50.1) 11.7 (10.6–12.8)
Race/Ethnicity
Hispanic 25,359 1,272 5.0 (4.7–5.4) <0.001 44.9 (41.1–48.7) 0.51 15.7 (12.7–18.7) <0.001
White, non-Hispanic 106,291 7,667 7.2 (7.0–7.5) 45.4 (43.7–47.1) 7.6 (6.7–8.5)
Black, non-Hispanic 18,770 1,542 8.2 (7.7–8.8) 42.5 (38.9–46.0) 17.6 (14.9–20.3)
Other 10,289 490 4.8 (4.2–5.4) 42.9 (37.0–48.9) 7.1 (3.9–10.3)
Education level
≤High school 52,305 3,255 6.2 (5.9–6.5) <0.001 43.8 (41.3–46.3) 0.62 13.3 (11.6–15.0) <0.001
>High school 107,813 7,697 7.2 (6.9–7.4) 45.2 (43.6–46.9) 8.5 (7.6–9.4)
Unknown 591 ††
Poverty index§§
Poor 14,335 1,251 8.7 (8.1–9.3) <0.001 49.2 (45.5–52.9) <0.001 17.0 (14.3–19.5) <0.001
Near poor 23,012 1,617 7.0 (6.6–7.5) 44.3 (40.7–47.9) 12.8 (10.5–15.1)
Not poor 114,200 7,544 6.6 (6.4–6.8) 44.2 (42.5–45.9) 7.9 (6.9–8.8)
Unknown 9,163 560 6.2 (5.4–6.9) 44.5 (38.1–50.9) 13.5 (9.5–17.6)
Health insurance status
Not insured 24,577 1,344 5.5 (5.1–5.9) <0.001 47.5 (43.3–51.6) 0.34 14.5 (12.0–17.1) <0.001
Insured 135,328 9,576 7.1 (6.9–7.3) 44.5 (43.1–45.9) 9.3 (8.4–10.2)
Unknown 804 52 6.4 (3.4–9.0)
Region
Northeast 28,621 2,182 7.6 (7.2–8.1) <0.001 43.0 (40.5–45.4) 0.22 8.2 (6.5–9.9) 0.38
Midwest 37,804 2,679 7.1 (6.7–7.5) 43.7 (40.7–46.7) 8.9 (7.1–10.6)
South 57,064 3,483 6.1 (5.8–6.4) 46.1 (43.5–48.8) 11.3 (9.7–12.9)
West 37,220 2,628 7.1 (6.7–7.4) 45.7 (42.8–48.6) 10.6 (8.9–12.4)
Total 160,709 10,972 6.8 (6.7–7.0) 44.7 (43.3–46.1) 9.9 (9.1–10.7)

Abbreviation: CI = confidence interval.
* Defined as a “yes” response to the questions “Have you ever been told by a doctor or other health professional that you had asthma?” and “Do you still have asthma?”
Survey respondents who answered “yes” to the question “Did you have a job or business at any time in the past 12 months?”
§ Defined as a “yes” response to the question “During the past 12 months, have you had an episode of asthma or an asthma attack?”
Defined as a “yes” response to the question “During the past 12 months, have you had to visit an emergency room or urgent care center because of asthma?”
** Weighted to provide national estimates.
†† Estimates suppressed because relative standard error for the estimate was ≥30%.
§§ Poverty index is based on family income and family size using the U.S. Census Bureau’s poverty thresholds for the previous calendar year. Persons who are categorized as “poor” have family incomes <100% of the poverty threshold, “near poor” have family incomes ≥100% to <200% of the poverty threshold, and “not poor” have family incomes ≥200% of the poverty threshold. ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2016/srvydesc.pdf, https://www.census.gov/data/tables/time-series/demo/income-poverty/historical-poverty-thresholds.html.

TABLE 2. Current asthma* prevalence and proportion of adults working at any time in the past 12 months with current asthma who had at least one asthma attack§ or emergency department (ED) visit for asthma in the past 12 months (annual average), by industry** — National Health Interview Survey, 2011–2016Return to your place in the text
Industry Workers (x 1,000)†† Current asthma Proportion of persons with current asthma who had ≥1 asthma attack in past 12 months Proportion of persons with current asthma who had ≥1 asthma ED visit in past 12 months
No. (x 1,000)†† % (95% CI) % (95%CI) % (95% CI)
Health care and social assistance 21,270 1,878 8.8 (8.3–9.4) 45.8 (42.8–49.1) 11.3 (9.3–13.2)
Ambulatory health care services 8,135 710 8.7 (7.9–9.6) 43.2 (38.2–48.1) 10.5 (7.4–13.6)
Hospitals 6,693 551 8.2 (7.3–9.2) 51.7 (46.0–57.4) 10.1 (6.6–13.7)
Nursing and residential care facilities 2,978 262 8.8 (7.4–10.2) 45.2 (36.0–54.3) 13.8 (8.0–19.6)
Social assistance 3,463 355 10.3 (8.8–11.8) 42.9 (35.4–50.5) 12.3 (8.1–16.5)
Education services 15,237 1,243 8.2 (7.5–8.8) 48.4 (44.5–52.3) 8.2 (6.0–10.4)
Arts, entertainment, and recreation 3,569 287 8.1 (6.7–9.4) 50.0 (40.3–59.7) §§
Performing arts, spectator sports, and related 1,030 96 9.3 (6.5–12.1) 47.5 (31.0–64.0)
Museums, historical sites, and similar institutions 415 30 7.2 (3.6–10.7)
Amusement, gambling, and recreation 2,124 162 7.6 (5.9–9.4) 54.2 (41.7–66.6)
Accommodation and food services 11,233 864 7.7 (6.9–8.5) 40.1 (34.8–45.3) 11.0 (7.9–14.2)
Accommodation 1,737 151 8.7 (6.6–10.9) 51.3 (38.0–64.6)
Food services and drinking places 9,496 712 7.5 (6.7–8.4) 37.7 (32.2–43.1) 11.0 (7.5–14.5)
Finance and insurance 7,186 539 7.5 (6.6–8.5) 38.3 (32.4–44.2) 6.0 (3.1–9.0)
Monetary authorities –– central bank 2,122 140 6.6 (5.1–8.1) 31.9 (20.1–43.7)
Credit intermediation and related activities 1,197 83 6.9 (5.0–8.9) 46.0 (31.5–60.4)
Securities, commodity contracts, and other financial investments and related activities 1,163 80 6.9 (4.6–9.2) 34.8 (18.9–50.6)
Insurance carriers and related activities 2,704 237 8.8 (7.1–10.5) 40.6 (31.3–49.9)
Retail trade 16,714 1,247 7.5 (6.9–8.1) 46.4 (42.3–50.0) 12.4 (9.6–15.2)
Motor vehicle and parts dealers 1,807 114 6.3 (4.7–7.9) 44.4 (30.3–58.6)
Furniture and home furnishings stores 471 29 6.2 (3.1–9.4)
Electronics and appliance stores 549 65 11.9 (7.9–16.0) 37.8 (19.9–55.8)
Building material and garden equipment and supplies dealers 1,277 77 6.0 (4.1–8.0) 46.6 (30.1–63.1)
Food and beverage stores 3,241 215 6.7 (5.4–7.9) 45.8 (36.1–55.4) 14.1 (7.2–21.0)
Health and personal care stores 1,241 87 7.0 (4.9–9.1) 47.0 (31.7–62.4)
Gasoline stations 608 71 11.8 (7.8–15.7) 47.5 (30.0–65.0)
Clothing and clothing accessories stores 1,446 103 7.3 (5.3–9.2) 41.7 (29.0–54.5)
Sporting goods, camera, hobby, book and music stores 763 83 10.9 (7.8–13.9) 44.8 (28.8–60.7)
General merchandise stores 3,115 237 7.6 (6.1–9.2) 52.8 43.4–62.2) 13.1 (6.0–20.1)
Miscellaneous store retailers 1,140 102 9.0 (6.5–11.5) 50.4 (35.9–64.9)
Nonstore retailers and non-specified retail trade 1,057 64 6.0 (4.0–8.0) 45.1 (28.2–61.9)
Public administration 7,737 569 7.4 (6.5–8.2) 45.6 (39.1–52.1) 11.6 (6.4–16.7)
Information 3,438 228 6.6 (5.5–7.8) 48.8 (39.6–57.9) 13.1 (6.0–20.1)
Publishing industries (except internet) 702 48 6.9 (4.0–9.7) 51.2 (35.3–67.1)
Motion picture and sound recording industries 470 28 6.0 (3.5–8.5) 38.5 (17.1–60.0)
Broadcasting and telecommunications 1,742 106 6.1 (4.5–7.6) 49.1 (36.1–62.0)
Information services and data processing 524 45 8.7 (5.3–12.0) 51.8 (28.4–75.3)
Professional, scientific, and technical services 11,399 738 6.5 (5.8–7.2) 49.2 (44.2–54.1) 8.0 (5.2–10.7)
Administrative & support and waste management & remediation services 7,323 471 6.4 (5.6–7.2) 46.5 (40.4–52.6) 11.6 (8.0–15.3)
Mining 960 59 6.1 (3.9–8.3) 40.2 (21.6–58.8)
Oil and gas extraction 102
Mining (except oil and gas) 211
Support activities for mining 648 40 6.2 (3.4–9.0)
Other services (except public administration) 8,024 491 6.1 (5.4–6.9) 41.7 (35.3–48.2) 11.1 (7.4–14.9)
Repair and maintenance 2,287 121 5.3 (3.8–6.8) 33.6 (20.5–46.8)
Personal services (barber shops, beauty salons, nail salons, laundry, funeral homes and cemeteries) 2,219 117 5.3 (4.1–6.5) 37.4 (26.4–48.3) 16.5 (8.4–24.6)
Religious, grantmaking, civic, labor, professional, and similar organizations 2,486 162 6.5 (5.3–7.8) 44.1 (33.8–55.0)
Private households 1,032 91 8.9 (6.3–11.4) 53.2 (37.6–68.7) 22.9 (9.6–36.3)
Utilities 1,390 82 5.9 (4.3–7.6) 34.9 (20.3–49.4)
Transportation and warehousing 6,569 383 5.8 (5.0–6.7) 51.7 (43.4–60.0) 11.7 (7.7–15.6)
Transportation (including support activities for transportation) 4,544 245 5.4 (4.6–6.2) 55.1 (46.3–64.0) 14.9 (9.7–20.2)
Postal service, couriers, and messengers 1,460 108 7.4 (4.5–10.4) 44.4 (23.5–65.3)
Warehousing and storage 565 30 5.3 (2.8–7.8) 49.8 (25.1–74.5)
Manufacturing 16,067 860 5.4 (4.9–5.9) 40.0 (35.2–44.8) 6.7 (4.6–8.9)
Food manufacturing 1,954 104 5.3 (4.1–6.6) 33.1 (21.2–45.0)
Beverage and tobacco product manufacturing 301
Textile mills 98
Textile product mills 138
Apparel manufacturing 299 24 8.0 (3.2–12.7)
Leather and allied product manufacturing 28
Wood product manufacturing 447 34 7.7 (3.2–12.2) 57.3 (29.5–85.1)
Paper manufacturing 434 22 5.1 (2.2–7.9)
Printing and related support activities 613 36 5.9 (3.4–8.4) 46.2 (24.41–67.9)
Petroleum and coal products manufacturing 138
Chemical manufacturing 1,365 59 4.3 (3.1–5.6) 54.6 (31.5–77.6)
Plastics and rubber products manufacturing 549 20 3.6 (1.6–5.6) 56.7 (30.0–83.3)
Nonmetallic mineral product manufacturing 446 22 4.8 (2.1–7.6)
Primary metal manufacturing 572 43 7.5 (3.5–11.4)
Fabricated metal product manufacturing 1,228 55 4.5 (2.9–6.0) 34.0 (17.9–50.2)
Machinery manufacturing 1,437 80 5.6 (3.8–7.3) 47.2 (32.8–61.6)
Computer and electronic product manufacturing 1,316 70 5.3 (3.9–6.8) 44.1 (30.7–57.5)
Electrical equipment, appliance, and component manufacturing 496 32 6.5 (3.4–9.6)
Transportation equipment manufacturing 2,323 131 5.6 (4.4–6.9) 33.7 (23.1–44.3)
Furniture and related product manufacturing 483 26 5.5 (2.7–8.2)
Miscellaneous manufacturing 1,403 67 4.8 (3.3–6.3) 39.5 (23.9–55.1)
Real estate and rental and leasing 3,054 168 5.5 (4.3–6.7) 45.9 (34.9–56.9) 12.5 (4.4–20.5)
Real estate 2,643 142 5.4 (4.2–6.6) 48.7 (37.1–60.3) 14.0 (5.8–22.1)
Rental and leasing services 295 24 8.0 (3.0–11.6)
Lessors of nonfinancial intangible assets (except copyrighted works) 115
Agriculture, forestry, fishing, and hunting 2,358 123 5.2 (4.0–6.5) 38.8 (27.8–49.9)
Crop production 1,210 58 4.8 (3.2–6.3) 41.4 (26.8–56.1)
Animal production 680 44 6.5 (3.6–9.5)
Forestry and logging 171
Fishing, hunting, and trapping 68
Support activities for agriculture and forestry 228
Wholesale trade 3,898 192 4.9 (4.0–5.9) 36.7 (27.2–46.2)
Merchant wholesalers, durable goods 1,898 87 4.6 (3.1–5.9) 36.6 (21.3–51.9)
Merchant wholesalers, nondurable goods 1,963 104 5.3 (3.9–6.8) 37.3 (25.9–49.7)
Nonspecified wholesale trade 38
Construction 10,234 451 4.4 (3.8–5.0) 41.0 (33.8–48.1) 11.3 (6.8–15.9)
Management of companies and enterprises 111
Armed forces 360
Unknown 2,578 83 3.2 (2.4–4.1) 46.0 (32.3–59.8)
Total 160,709 10,972 6.8 (6.7–7.0) 44.7 (43.3–46.1) 9.9 (9.1–10.7)

Abbreviation: CI = confidence interval.
* Defined as a “yes” response to the questions “Have you ever been told by a doctor or other health professional that you had asthma?” and “Do you still have asthma?”
Survey respondents who answered “yes” to the question “Did you have a job or business at any time in the past 12 months?”
§ Defined as a “yes” response to the question “During the past 12 months, have you had an episode of asthma or an asthma attack?”
Defined as a “yes” response to the question “During the past 12 months, have you had to visit an emergency room or urgent care center because of asthma?”
** Industry that employed sample adults were working in during the week prior to their interview. ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2014/srvydesc.pdf.
†† Weighted to provide national estimates.
§§ Estimates suppressed because relative standard error for the estimate was ≥30%.

TABLE 3. Current asthma* prevalence and proportion of adults working at any time in the past 12 months with current asthma who had at least one asthma attack§ or emergency department (ED) visit for asthma in the past 12 months (annual average), by occupation** — National Health Interview Survey, 2011–2016Return to your place in the text
Occupation Workers (x 1,000)†† Current asthma Proportion with current asthma and ≥1 asthma attack in past 12 months Proportion with current asthma and ≥1 asthma ED visit in past 12 months
No. (x 1,000)†† % (95% CI) % (95% CI) % (95% CI)
Health care support 3,754 331 8.8 (7.6–10.0) 45.5 (38.4–52.6) 13.5 (9.1–18.0)
Nursing, psychiatric, and home health aides 2,211 192 8.7 (7.1–10.2) 45.0 (35.9–54.2) 16.0 (9.7–22.3)
Occupational and physical therapist assistants and aides 107 §§
Other health care support occupations 1,436 135 9.4 (7.3–11.5) 46.1 (35.2–57.1)
Personal care and service 5,666 488 8.6 (7.5–9.7) 44.6 (38.8–50.5) 17.4 (12.9–21.8)
Supervisors, personal care and service workers 167 14 8.1 (3.3–12.9)
Animal care and service workers 285 26 9.0 (4.0–14.1)
Entertainment attendants and related workers 310           —
Funeral service workers 43
Personal appearance workers 1,168 48 4.1 (2.6–5.6) 46.0 (28.1–63.8) 25.0 (10.3–39.7)
Transportation, tourism, and lodging attendants 155
Other personal care and service workers 3,539 364 10.3 (8.8–11.7) 44.8 (38.2–51.4) 16.2 (11.1–21.3)
Health care practitioners and technical 8,752 754 8.6 (7.8–9.5) 49.7 (44.7–54.8) 8.9 (6.1–11.7)
Health diagnosing and treating practitioners 5,991 534 8.9 (7.9–10.0) 49.4 (43.5–55.4) 8.6 (5.3–11.8)
Health technologists and technicians 2,651 209 7.9 (6.4–9.3) 48.8 (39.1–58.5) 8.6 (3.8–13.4)
Other health care practitioners and technical 110
Education, training, and library 10,233 867 8.5 (7.7–9.3) 51.5 (46.9–56.2) 8.8 (6.0–11.6)
Postsecondary teachers 1,623 113 6.9 (5.4–8.5) 38.1 (27.7–48.5)
Primary, secondary, and special education school teachers 6,046 525 8.7 (7.6–9.8) 51.7 (45.7–57.7) 8.5 (4.9–12.2)
Other teachers and instructors 1,078 82 7.7 (5.3–10.1) 48.3 (32.6–64.0)
Librarians, curators, and archivists 324
Other education, training, and library occupations 1,162 124 10.7 (8.0–13.3) 64.0 (51.7–76.4)
Arts, design, entertainment, sports, and media 3,408 273 8.0 (6.7–9.3) 51.0 (41.7–60.3)
Art and design workers 1,242 108 8.7 (6.3–11.1) 52.0 (36.9–67.0)
Entertainers and performers, sports and related workers 794 64 8.0 (5.0–11.0)
Media and communication workers 966 77 8.0 (5.7–10.3) 57.2 (42.5–71.9)
Media and communication equipment workers 406 25 6.1 (2.9–9.3) 62.8 (35.7–89.8)
Office and administrative support 19,777 1,588 8.0 (7.5–8.6) 44.8 (41.2–48.5) 8.6 (6.8–10.5)
Supervisors, office and administrative support workers 1,256 112 8.9 (6.7–11.2) 38.3 (25.9–50.8)
Communications equipment operators 88
Financial clerks 2,926 199 6.8 (5.6–8.0) 41.1 (30.7–51.5) 6.1 (2.6–9.5)
Information and record clerks 5,427 479 8.8 (7.7–10.0) 41.6 (35.3–47.9) 8.6 (5.3–11.9)
Material recording, scheduling, dispatching, and distributing workers 3,993 282 7.1 (5.8–8.4) 44.6 (33.9–55.2) 6.8 (3.2–10.3)
Secretaries and administrative assistants 2,907 209 7.2 (5.9–8.5) 46.9 (37.7–56.1) 11.9 (4.9–18.9)
Other office and administrative support workers 3,181 281 8.9 (7.6–10.2) 54.8 (47.6–62.1) 11.4 (6.5–16.3)
Food preparation and serving related 8,771 668 7.7 (6.7–8.6) 40.2 (34.2–46.1) 10.7 (7.2–14.3)
Supervisors, food preparation, and serving workers 951 78 8.3 (5.3–11.2) 52.8 (35.0–70.7)
Cooks and food preparation workers 3,317 232 7.0 (5.7–8.3) 41.2 (32.1–50.4) 12.7 (6.3–19.2)
Food and beverage serving working 3,617 292 8.2 (6.7–9.6) 38.1 (29.3–46.9) 10.4 (5.3–15.6)
Other food preparation and serving related workers 887 65 7.4 (5.1–9.7) 30.4 (15.1–45.7)
Community and social services 2,862 217 7.6 (6.5–8.8) 46.0 (37.5–54.4) 6.3 (2.8–9.7)
Counselors, social workers, and other community and social service specialists 2,199 173 7.9 (6.6–9.2) 43.0 (34.4–51.6) 7.4 (3.1–11.7)
Religious workers 663 44 6.7 (4.2–9.1) 57.5 (38.0–77.1)
Business and financial operations 7,710 588 7.6 (6.7–8.5) 41.0 (34.9–47.1) 9.5 (5.9–13.0)
Business operations specialists 4,162 319 7.7 (6.5–8.8) 37.9 (30.1–45.7) 8.8 (4.2–13.3)
Financial specialists 3,548 269 7.6 (6.2–8.9) 44.8 (35.8–53.7) 10.3 (4.9–15.7)
Legal 1,791 136 7.6 (5.8–9.4) 38.6 (27.1–50.1)
Lawyers, judges, and related workers 1,109 97 8.7 (6.2–11.3) 34.6 (20.7–48.5)
Legal support workers 682 40 5.8 (3.6–8.1) 48.3 (29.1–67.5)
Sales and related 16,266 1,152 7.1 (6.5–7.7) 42.9 (38.6–47.2) 12.4 (9.6–15.3)
Supervisors, sales workers 3,985 234 5.9 (4.9–6.9) 43.7 (34.6–52.8)
Retail sales workers 7,364 644 8.8 (7.8–9.7) 44.1 (38.4–49.9) 15.4 (11.2–19.6)
Sales representatives, services 1,911 121 6.3 (4.6–8.1) 34.2 (21.6–46.7)
Sales representatives, wholesale and manufacturing 1,392 61 4.4 (2.9–5.8) 41.0 (25.3–56.6)
Other sales and related workers 1,614 92 5.7 (4.1–7.3) 45.3 (31.4–59.3)
Protective service 3,272 232 7.1 (5.7–8.5) 40.4 (30.3–50.4)
First–line supervisors/managers, protective service workers 211
Firefighting and prevention workers 347 18 5.1 (2.2–8.0)
Law enforcement workers 1,306 105 8.1 (5.3–10.9) 39.1 (22.2–55.9)
Other protective service workers 1,408 95 6.8 (5.0–8.6) 40.1 (26.8–53.4)
Life, physical, and social science 1,668 110 6.6 (4.7–8.5) 41.5 (28.0–54.9)
Life scientists 348 24 6.9 (3.0–10.8) 35.7 (16.5–54.8)
Physical scientists 541 28 5.2 (2.8–7.7) 47.6 (25.1–70.1)
Social scientists and related workers 414
Life, physical, and social science technicians 365 20 5.4 (2.8–8.1)
Management 15,259 956 6.3 (5.7–6.8) 46.9 (42.0–51.7) 6.9 (4.4–9.4)
Chief executives; general and operations managers; legislators 2,172 138 6.3 (5.0–7.7) 36.3 (24.6–48.1)
Advertising, marketing, promotions, public relations, and sales managers 1,068 61 5.7 (3.8–7.5) 49.8(33.8–65.8)
Operations specialties managers 2,911 171 5.9 (4.7–7.1) 38.8 (28.1–49.4)
Other management occupations 9,108 588 6.5 (5.7–7.2) 51.4 (45.4–57.3) 7.3 (3.8–10.7)
Architecture and engineering 3,301 175 5.3 (4.2–6.4) 38.4 (27.9–49.0)
Architects, surveyors, and cartographers 291
Engineers 2,272 111 4.9 (3.7–6.1) 39.9 (27.1–52.7)
Drafters, engineering, and mapping technicians 738 44 5.9 (3.6–8.2) 33.6 (13.3–53.9)
Computer and mathematical 5,021 290 5.8 (4.8–6.8) 46.3 (38.1–54.5)
Computer specialists 4,774 276 5.8 (4.8–6.8) 45.9 (37.4–54.3)
Mathematical science occupations 247
Building and grounds cleaning and maintenance 6,518 364 5.6 (4.8–6.4) 51.0 (43.9–58.1) 15.1 (10.1–20.1)
Supervisors, building and grounds cleaning and maintenance workers 510 30 5.8 (2.6–9.0) 55.5 (30.8–80.1)
Building cleaning and pest control workers 4,552 307 6.8 (5.8–7.8) 51.7 (43.9–59.5) 16.7 (10.9–22.5)
Grounds maintenance workers 1,456 28 1.9 (1.1–2.7) 38.9 (16.1–61.8)
Installation, maintenance, and repair 5,513 312 5.7 (4.7–6.7) 39.1 (30.2–48.0)
Supervisors of installation, maintenance, and repair workers 315 36 11.5 (5.9–17.1)
Electrical and electronic equipment mechanics, installers, and repairers 681 33 4.8 (2.8–6.9)
Vehicle and mobile equipment mechanics, installers, and repairers 2,076 100 4.8 (3.3–6.4) 28.7 (15.4–42.0)
Other installation, maintenance, and repair occupations 2,441 143 5.9 (4.3–7.4) 46.7 (33.8–59.7)
Farming, fishing, and forestry 1,278 68 5.4 (3.6–7.1) 43.8 (26.4–61.2)
Supervisors, farming, fishing, and forestry workers 59
Agricultural workers 1,084 67 6.2 (4.2–8.2) 43.5 (25.8–61.1)
Fishing and hunting workers 45
Forest, conservation, and logging workers 90
Transportation and material moving 9,240 494 5.4 (4.7–6.1) 49.3 (42.8–55.8) 11.6 (8.3–14.9)
Supervisors, transportation and material moving workers 171
Air transportation workers 236 17 7.0 (3.2–10.8) 56.7 (29.7–83.7)
Motor vehicle operators 4,390 211 4.8 (4.0–5.7) 45.1 (36.8–53.5) 15.5 (9.5–21.5)
Rail transportation workers 100
Water transportation workers 60
Other transportation workers 327
Material moving workers 3,957 226 5.7 (4.6–6.9) 48.9 (38.4–59.3) 9.4 (5.1–13.6)
Production 9,490 484 5.1 (4.5–5.8) 36.3 (30.6–42.0) 10.2 (6.9–13.5)
Supervisors, production workers 821 55 6.7 (3.9–9.4) 39.5 (19.0–60.1)
Assemblers and fabricators 1,409 71 5.0 (3.4–6.7) 37.9 (20.4–55.5)
Food processing workers 776 43 5.6 (3.4–7.7) 32.7 (15.0–50.3)
Metal workers and plastic workers 1,938 115 5.9 (4.2–7.7) 30.2 (17.5–42.9)
Printing workers 288
Textile, apparel, and furnishings workers 682 26 3.9 (1.8–5.9) 37.7 (15.7–59.6)
Woodworkers 155
Plant and system operators 274
Other production occupations 3,148 132 4.2 (3.3–5.1) 40.8 (30.0–51.6)
Construction and extraction 8,139 324 4.0 (3.4–4.6) 37.5 (30.3–44.8) 8.2 (4.6–11.7)
Supervisors, construction and extraction workers 649 26 4.0 (1.9–6.1)
Construction trades workers 6,789 264 3.9 (3.2–4.6) 35.4 (27.7–43.0) 8.8 (4.7–12.9)
Helpers, construction trades 59
Other construction and related workers 402
Extraction workers 240
Military 367
Refused, not ascertained, don’t know 2,653 92 3.5 (2.5–4.5) 50.1 (36.2–64.1)
Total 160,672 10,957 6.8 (6.7–7.0) 44.7 (43.3–46.1) 9.9 (9.1–10.7)

Abbreviation: CI = confidence interval.
* Defined as a “yes” response to the questions “Have you ever been told by a doctor or other health professional that you had asthma?” and “Do you still have asthma?”
Survey respondents who answered “yes” to the question “Did you have a job or business at any time in the past 12 months?”
§ Defined as a “yes” response to the question “During the past 12 months, have you had an episode of asthma or an asthma attack?”
Defined as a “yes” response to the question “During the past 12 months, have you had to visit an emergency room or urgent care center because of asthma?”
** Occupation that employed sample adults had during the week prior to their interview. ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2014/srvydesc.pdf.
†† Weighted to provide national estimates.
§§ Estimates suppressed because relative standard error for the estimate was ≥30%.

Suggested citation for this article: Mazurek JM, Syamlal G. Prevalence of Asthma, Asthma Attacks, and Emergency Department Visits for Asthma Among Working Adults — National Health Interview Survey, 2011–2016. MMWR Morb Mortal Wkly Rep 2018;67:377–386. DOI: http://dx.doi.org/10.15585/mmwr.mm6713a1.

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