American Journal of Epidemiology Advance Access published online on January 6, 2009
American Journal of Epidemiology, doi:10.1093/aje/kwn387
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ORIGINAL CONTRIBUTION |
Occupational Exposures and Asthma in Health-Care Workers: Comparison of Self-Reports With a Workplace-Specific Job Exposure Matrix
Correspondence to Dr. George L. Delclos, Division of Environmental and Occupational Health Sciences, University of Texas School of Public Health, P.O. Box 20186, Houston, TX 77225-0186 (e-mail: george.delclos{at}uth.tmc.edu).
Received for publication August 1, 2008. Accepted for publication November 11, 2008.
The authors compared self-reported occupational exposures with a workplace-specific job exposure matrix (JEM) in a 2004 survey of Texas health-care professionals (n = 3,650), by asthma status. Sensitivity, specificity, chance-corrected (
) and chance-independent (
) agreement, and associations of self-reported exposures with asthma were compared with those for the JEM. Among asthmatics, the median sensitivity of self-reported exposures was 74% (range, 53–90); specificity was 64% (range, 27–74). For nonasthmatics, median sensitivity was 67% (range, 40–88) and specificity was 70% (range, 33–82). Sensitivity was higher among asthmatics for exposures involving perceptible odors. Specificity was higher among nonasthmatics for instrument cleaning and exposure to adhesives/solvents. Asthmatics showed better agreement with the JEM for patient-care-related cleaning ( = 0.51 vs. 0.40); there was little difference for other exposures. In all cases, confidence intervals overlapped. Prevalence ratios were higher with self-reported exposures than with the JEM; differences were greatest for cleaning products, adhesives/solvents, and gases/vapors. However, confidence intervals overlapped with those obtained using the JEM. In asthma studies, differential reporting bias by health status should be taken into consideration. Findings favor using externally developed methods of exposure classification, although information gleaned from examining distributions of exposure self-reports, particularly among nondiseased persons, can provide useful information for improving the reliability of exposure ascertainment.
asthma; bias (epidemiology); epidemiologic methods; occupational exposure
Abbreviations: CI, confidence interval; JEM, job exposure matrix