Occupational exposures and asthma in health-care workers: comparison of self-reports with a workplace-specific job exposure matrix

Am J Epidemiol. 2009 Mar 1;169(5):581-7. doi: 10.1093/aje/kwn387. Epub 2009 Jan 6.


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 (kappa) and chance-independent (phi) 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 (phi = 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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.
  • Validation Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Asthma / epidemiology*
  • Asthma / etiology*
  • Bias
  • Cross-Sectional Studies
  • Environmental Monitoring / methods*
  • Epidemiologic Methods
  • Epidemiological Monitoring
  • Female
  • Health Personnel
  • Humans
  • Male
  • Middle Aged
  • Occupational Exposure / adverse effects
  • Occupational Exposure / analysis*
  • Poisson Distribution
  • Risk Assessment / methods
  • Self Disclosure*
  • Sensitivity and Specificity
  • Texas / epidemiology
  • Workplace
  • Young Adult