Mortality, morbidity and occupational exposure to airway-irritating agents among men with a respiratory diagnosis in adolescence.
OBJECTIVE
To examine the influence of an airway diagnosis in adolescence on future health and occupation in Swedish men.


METHODS
Data were collected from the linkage of four Swedish national registers: the Military Service Conscription Register, the Population and Housing Censuses, the Inpatient Care Register and the National Cause of Death Register. A job-exposure matrix for airway-irritating substances was developed for application on the conscription cohort. The cohort included 49 321 Swedish men born 1949-51. Three groups-(1) healthy, (2) asthmatics (mild and severe asthma) and (3) subjects with allergic rhinitis without concurrent asthma-were identified at conscription and analysed for mortality, in-patient care and strategies for choice of occupation with emphasis on airway-irritating job exposure. Analyses were adjusted for smoking and childhood socioeconomic position.


RESULTS
The prevalence of total asthma was 1.8%, severe asthma 0.45% and allergic rhinitis 2.7%. Mortality for all causes was significantly higher in total asthma, hazard ratio (HR) 1.49 (95% CI 1.00 to 2.23), and lower in allergic rhinitis, HR 0.52 (95% CI 0.30 to 0.91). Asthma was a risk factor for inpatient care while allergic rhinitis was associated with less in-patient care (odds ratio (OR) for total asthma 1.16 (95% CI 1.00 to 1.34), severe asthma 1.38 (95% CI 1.04 to 1.85), allergic rhinitis 0.92 (95% CI 0.82 to 1.03)). Those with asthma tended to avoid jobs with a high probability for airway-irritating exposure (OR 0.88, 95% CI 0.71 to 1.09), but not to the same extent as subjects with allergic rhinitis (OR 0.58, 95% CI 0.47 to 0.70) (ORs from 1990).


CONCLUSIONS
Subjects with asthma did not change their exposure situation to the same extent as subjects with allergic rhinitis. Further, asthmatics had an increased risk for morbidity and mortality compared to healthy subjects and subjects with allergic rhinitis.
Dr P Wiebert, Department of Occupational and Environmental Health, Norrbacka, Karolinska Hospital, SE-171 76 Stockholm, Sweden; pernilla.wiebert@sll.se.
P
P
Wiebert
M
M
Svartengren
M
M
Lindberg
T
T
Hemmingsson
I
I
Lundberg
G
G
Nise
D000293:Adolescent; D001249:Asthma / Q000175:diagnosis* / Q000401:mortality / Q000523:psychology; D002321:Career Choice; D015986:Confounding Factors, Epidemiologic; D004651:Employment; D005500:Follow-Up Studies; D006801:Humans; D007509:Irritants / Q000633:toxicity*; D008297:Male; D008887:Military Medicine; D009017:Morbidity; D015995:Prevalence; D016016:Proportional Hazards Models; D012221:Rhinitis, Allergic, Perennial / Q000175:diagnosis / Q000401:mortality / Q000523:psychology; D012306:Risk; D012907:Smoking / Q000009:adverse effects; D012959:Socioeconomic Factors; D013548:Sweden
D007509:Irritants