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A strategy to reduce healthy worker effect in a cross-sectional study of asthma and metalworking fluids.

Abstract：

:This report describes the reanalysis of a cross-sectional study of asthma in a large cohort of autoworkers with exposure to metalworking fluids (MWF). There is strong evidence from case reports, clinical studies, and medical surveillance data that exposure to MWF can cause asthma, yet no association was found in the original analysis. The central hypothesis of the reanalysis was that the absence of an association between asthma and MWF exposure was the result of bias caused by the self-selection of asthmatics out of exposed jobs. We addressed the potential job transfer bias by redefining exposure and disease status at the time of asthma onset, rather than at the time of the health survey. This permitted us to treat the cross-sectional study as if it were a historical cohort study, despite the fact that the population was a biased sample of the full cohort. This approach resulted in a significantly elevated incidence rate ratio of 3.2 (95% CI: 1.2-8.3) for synthetic MWF estimated in a Cox proportional hazards model. Although the cross-sectional design makes it impossible to document or control for differential selection out of the workforce, the approach described here provides a strategy for reducing the healthy-worker effect due to job transfer bias in cross-sectional studies.

journal_name

Am J Ind Med

journal_title

American journal of industrial medicine

authors

Eisen EA,Holcroft CA,Greaves IA,Wegman DH,Woskie SR,Monson RR

doi

10.1002/(sici)1097-0274(199706)31:6<671::aid-ajim1

subject

Has Abstract

pub_date

1997-06-01 00:00:00

pages

671-7

issue

6

eissn

0271-3586

issn

1097-0274

pii

10.1002/(SICI)1097-0274(199706)31:6<671::AID-AJIM1

journal_volume

31

pub_type

杂志文章

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