Healthy worker effect in cohort studies on chronic bronchitis.
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
Radon
Katja
K
Department of Medicine, Joint Departments of Epidemiology and Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. Katja.Radon@arbeits.med.uni-muenchen.de
Goldberg
Mark
M
Becklake
Margaret
M
D029481:Bronchitis, Chronic / Q000453:epidemiology*; D015331:Cohort Studies; D015989:Healthy Worker Effect; D006801:Humans; D009784:Occupational Diseases / Q000453:epidemiology*; D015983:Selection Bias