title: Healthy worker effect in cohort studies on chronic bronchitis.
abstract: OBJECTIVE
  Despite the recognition of selection biases arising from the healthy worker effect in occupational mortality studies, the possibility of similar effects in occupational cohort studies on respiratory symptoms is not well known. Two mechanisms are responsible for the healthy worker effect in respiratory cohort studies. One is health-based selection of workers into employment (healthy him effect), and the other is health-based differential losses to follow-up (healthy worker survivor effect). The aim of the present paper was to estimate the magnitude of the healthy worker survivor effect in cohort studies of symptoms of chronic bronchitis.
  
  
  METHODS
  A meta-analysis of occupational cohort studies of symptoms of chronic bronchitis was performed that included published articles identified in searches of the Medline bibliographic databases between 1980 and March 2001 and the reference lists of the located articles.
  
  
  RESULTS
  Eight cohort studies were identified using an a priori selection criterion. The pooled odds ratio of the prevalence of chronic bronchitis for subjects leaving the cohorts was 1.23 when these subjects were compared with those who remained under study (95% confidence interval 1.04-1A4).
  
  
  CONCLUSIONS
  The prevalence of respiratory symptoms among exposed workers may he underestimated if the healthy worker survivor effect is not taken into account
authors.affiliation: Department of Medicine, Joint Departments of Epidemiology and Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. Katja.Radon@arbeits.med.uni-muenchen.de
authors.forename: Katja
authors.initials: K
authors.lastname: Radon
authors.forename: Mark
authors.initials: M
authors.lastname: Goldberg
authors.forename: Margaret
authors.initials: M
authors.lastname: Becklake
mesh_terms: D029481:Bronchitis, Chronic / Q000453:epidemiology*; D015331:Cohort Studies; D015989:Healthy Worker Effect; D006801:Humans; D009784:Occupational Diseases / Q000453:epidemiology*; D015983:Selection Bias