TY - JOUR

T1 - Job strain and the risk of severe asthma exacerbations

T2 - a meta-analysis of individual-participant data from 100 000 European men and women

AU - Heikkilä, K

AU - Madsen, I E H

AU - Nyberg, S T

AU - Fransson, E I

AU - Westerlund, H

AU - Westerholm, P J M

AU - Virtanen, M

AU - Vahtera, J

AU - Väänänen, A

AU - Theorell, T

AU - Suominen, S B

AU - Shipley, M J

AU - Salo, P

AU - Rugulies, R

AU - Pentti, J

AU - Pejtersen, J H

AU - Oksanen, T

AU - Nordin, M

AU - Nielsen, M L

AU - Kouvonen, A

AU - Koskinen, A

AU - Koskenvuo, M

AU - Knutsson, A

AU - Ferrie, J E

AU - Dragano, N

AU - Burr, H

AU - Borritz, M

AU - Bjorner, J B

AU - Alfredsson, L

AU - Batty, G D

AU - Singh-Manoux, A

AU - Kivimäki, M

AU - IPD-Work Consortium

N1 - © 2014 The Authors. Allergy Published by John Wiley & Sons Ltd.

PY - 2014/6

Y1 - 2014/6

N2 - BACKGROUND: Many patients and healthcare professionals believe that work-related psychosocial stress, such as job strain, can make asthma worse, but this is not corroborated by empirical evidence. We investigated the associations between job strain and the incidence of severe asthma exacerbations in working-age European men and women.METHODS: We analysed individual-level data, collected between 1985 and 2010, from 102 175 working-age men and women in 11 prospective European studies. Job strain (a combination of high demands and low control at work) was self-reported at baseline. Incident severe asthma exacerbations were ascertained from national hospitalization and death registries. Associations between job strain and asthma exacerbations were modelled using Cox regression and the study-specific findings combined using random-effects meta-analyses.RESULTS: During a median follow-up of 10 years, 1 109 individuals experienced a severe asthma exacerbation (430 with asthma as the primary diagnostic code). In the age- and sex-adjusted analyses, job strain was associated with an increased risk of severe asthma exacerbations defined using the primary diagnostic code (hazard ratio, HR: 1.27, 95% confidence interval, CI: 1.00, 1.61). This association attenuated towards the null after adjustment for potential confounders (HR: 1.22, 95% CI: 0.96, 1.55). No association was observed in the analyses with asthma defined using any diagnostic code (HR: 1.01, 95% CI: 0.86, 1.19).CONCLUSIONS: Our findings suggest that job strain is probably not an important risk factor for severe asthma exacerbations leading to hospitalization or death.

AB - BACKGROUND: Many patients and healthcare professionals believe that work-related psychosocial stress, such as job strain, can make asthma worse, but this is not corroborated by empirical evidence. We investigated the associations between job strain and the incidence of severe asthma exacerbations in working-age European men and women.METHODS: We analysed individual-level data, collected between 1985 and 2010, from 102 175 working-age men and women in 11 prospective European studies. Job strain (a combination of high demands and low control at work) was self-reported at baseline. Incident severe asthma exacerbations were ascertained from national hospitalization and death registries. Associations between job strain and asthma exacerbations were modelled using Cox regression and the study-specific findings combined using random-effects meta-analyses.RESULTS: During a median follow-up of 10 years, 1 109 individuals experienced a severe asthma exacerbation (430 with asthma as the primary diagnostic code). In the age- and sex-adjusted analyses, job strain was associated with an increased risk of severe asthma exacerbations defined using the primary diagnostic code (hazard ratio, HR: 1.27, 95% confidence interval, CI: 1.00, 1.61). This association attenuated towards the null after adjustment for potential confounders (HR: 1.22, 95% CI: 0.96, 1.55). No association was observed in the analyses with asthma defined using any diagnostic code (HR: 1.01, 95% CI: 0.86, 1.19).CONCLUSIONS: Our findings suggest that job strain is probably not an important risk factor for severe asthma exacerbations leading to hospitalization or death.

KW - Asthma, Occupational

KW - Disease Progression

KW - Europe

KW - European Continental Ancestry Group

KW - Female

KW - Humans

KW - Male

KW - Proportional Hazards Models

KW - Risk

KW - Severity of Illness Index

KW - Stress, Psychological

U2 - 10.1111/all.12381

DO - 10.1111/all.12381

M3 - Journal article

C2 - 24725175

VL - 69

SP - 775

EP - 783

JO - Allergy: European Journal of Allergy and Clinical Immunology

JF - Allergy: European Journal of Allergy and Clinical Immunology

SN - 0105-4538

IS - 6

ER -