Association of Occupational Exposure to Disinfectants with Incidence of Chronic Obstructive Pulmonary Disease Among US Female Nurses

Details

• Personal Author:
  Boggs KM ; Camargo CA Jr. ; Dumas O ; Henneberger, Paul K. ; Le Moual N ; Quinot C ; Speizer FE ; Varraso R ; Zock J-P
• Description:
  IMPORTANCE: Exposure to disinfectants in health careworkers has been associated with respiratory health outcomes, including asthma. Despite the biological plausibility of an association between disinfectants (irritant chemicals) and risk of chronic obstructive pulmonary disease (COPD), available data are sparse. OBJECTIVE: To investigate the association between exposure to disinfectants and COPD incidence in a large cohort of US female nurses. DESIGN, SETTING, AND PARTICIPANTS: The Nurses' Health Study II is a US prospective cohort study of 116,429 female registered nurses from 14 US states who were enrolled in 1989 and followed up through questionnaires every 2 years since. The present study included women who were still in a nursing job and had no history of COPD in 2009, and used data from the 2009 through 2015 questionnaires. Clean and complete data used for this analysis were available in July 2018, and analyses were conducted from September 2018 through August 2019. EXPOSURES: Occupational exposure to disinfectants, evaluated by questionnaire and a job-task-exposure matrix (JTEM). MAIN OUTCOMES AND MEASURES: Incident physician-diagnosed COPD evaluated by questionnaire. RESULTS: Among the 73,262 women included in the analyses, mean (SD) age at baseline was 54.7 (4.6) years and 70,311 (96.0%) were white, 1,235 (1.7%) black, and 1,716 (2.3%) other; and 1,345 (1.8%) Hispanic, and 71,917 (98.2%) non-Hispanic. Based on 368,145 person-years of follow-up, 582 nurses reported incident physician-diagnosed COPD. Weekly use of disinfectants to clean surfaces only (16,786 [22.9%] of participants exposed) and to clean medical instruments (13,899 [19.0%] exposed) was associated with COPD incidence, with adjusted hazard ratios of 1.38 (95%CI, 1.13-1.68) for cleaning surfaces only and 1.31 (95%CI, 1.07-1.61) for cleaning medical instruments after adjustment for age, smoking (pack-years), race, ethnicity, and body mass index. High-level exposure, evaluated by the JTEM, to several specific disinfectants (ie, glutaraldehyde, bleach, hydrogen peroxide, alcohol, and quaternary ammonium compounds) was significantly associated with COPD incidence, with adjusted hazard ratios ranging from 1.25 (95%CI, 1.04-1.51) to 1.36 (95%CI, 1.13-1.64). Associations were not modified by smoking or asthma status (P for interaction > .15). CONCLUSIONS AND RELEVANCE: These longitudinal results suggest that regular use of chemical disinfectants among nurses may be a risk factor for developing COPD. If future studies confirm these results, exposure-reduction strategies that are compatible with infection control in health care settings should be developed. [Description provided by NIOSH]
• Subjects:
  Alcoholic Beverages Asthma Asthma, Occupational Cohort Studies Diagnosis Disinfectants Health Personnel Lung Occupational Exposure Occupational Health Race Factors Respiratory System Risk Assessment Risk Factors Safety Smokers Surveys And Questionnaires Tobacco Products Women

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• Keywords:
  Alcohol Ammonium Compounds Chronic Obstructive Pulmonary Disease Cigarette Smoking Cleaning Compounds Clinical Diagnosis Cohort Studies COPD Exposure Assessment Glutaraldehyde Health Care Workers Health Surveys Household Bleach Hydrogen Peroxide JEM Job Exposure Matrix Lung Irritants Nurses Occupational Exposure Pulmonary Disorders Questionnaires Racial Factors Risk Factors Smoking

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• ISSN:
  2574-3805
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Massachusetts ; OSHA Region 1 ; OSHA Region 3 ; West Virginia
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  RHD - Respiratory Health Division
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  2
• Issue:
  10
• NIOSHTIC Number:
  nn:20057604
• Citation:
  JAMA Netw Open 2019 Oct; 2(10):e1913563
• Contact Point Address:
  Orianne Dumas, PhD, INSERM U1168, VIMA-Aging and Chronic Diseases, Epidemiological and Public Health Approaches, 16 Ave Paul Vaillant Couturier, 94807 Villejuif CEDEX, France
• Email:
  orianne.dumas@inserm.fr
• Federal Fiscal Year:
  2020
• Performing Organization:
  Brigham and Women's Hospital, Boston, Massachusetts
• Peer Reviewed:
  True
• Start Date:
  20130901
• Source Full Name:
  JAMA Network Open
• End Date:
  20170831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:ee3797f0da8a8643bc2f92bf0eda4ccbb22fd71d0462bdd6d1348a88164265ee313fc7abe8d7b6a76e864c338db4902d25b3e957c2ae777f50d653ea57e6ee38
• Download URL:
  https://stacks.cdc.gov/view/cdc/214882/cdc_214882_DS1.pdf
• File Type:
  [PDF - 933.03 KB ]