title: The self-reported health of U.S. flight attendants compared to the general population.
abstract: BACKGROUND
  Few studies have examined the broad health effects of occupational exposures in flight attendants apart from disease-specific morbidity and mortality studies. We describe the health status of flight attendants and compare it to the U.S. population. In addition, we explore whether the prevalence of major health conditions in flight attendants is associated with length of exposure to the aircraft environment using job tenure as a proxy.
  
  
  METHODS
  We surveyed flight attendants from two domestic U.S. airlines in 2007 and compared the prevalence of their health conditions to contemporaneous cohorts in the National Health and Nutrition Survey (NHANES), 2005-2006 and 2007-2008. We weighted the prevalence of flight attendant conditions to match the age distribution in the NHANES and compared the two populations stratified by gender using the Standardized Prevalence Ratio (SPR). For leading health conditions in flight attendants, we analyzed the association between job tenure and health outcomes in logistic regression models.
  
  
  RESULTS
  Compared to the NHANES population (n =5,713), flight attendants (n = 4,011) had about a 3-fold increase in the age-adjusted prevalence of chronic bronchitis despite considerably lower levels of smoking. In addition, the prevalence of cardiac disease in female flight attendants was 3.5 times greater than the general population while their prevalence of hypertension and being overweight was significantly lower. Flight attendants reported 2 to 5.7 times more sleep disorders, depression, and fatigue, than the general population. Female flight attendants reported 34% more reproductive cancers. Health conditions that increased with longer job tenure as a flight attendant were chronic bronchitis, heart disease in females, skin cancer, hearing loss, depression and anxiety, even after adjusting for age, gender, body mass index (BMI), education, and smoking.
  
  
  CONCLUSIONS
  This study found higher rates of specific diseases in flight attendants than the general population. Longer tenure appears to explain some of the higher disease prevalence. Conclusions are limited by the cross-sectional design and recall bias. Further study is needed to determine the source of risk and to elucidate specific exposure-disease relationships over time.
authors.affiliation: Department of Environmental Health, Harvard School of Public Health, Building 1, Room 1401, 655 Huntington Avenue, Boston, MA, USA. emcneely@hsph.harvard.edu.
authors.forename: Eileen
authors.initials: E
authors.lastname: McNeely
authors.forename: Sara
authors.initials: S
authors.lastname: Gale
authors.forename: Ira
authors.initials: I
authors.lastname: Tager
authors.forename: Laurel
authors.initials: L
authors.lastname: Kincl
authors.forename: Julie
authors.initials: J
authors.lastname: Bradley
authors.forename: Brent
authors.initials: B
authors.lastname: Coull
authors.forename: Steve
authors.initials: S
authors.lastname: Hecker
mesh_terms: D000293:Adolescent; D000328:Adult; D000337:Aerospace Medicine; D001007:Anxiety / Q000453:epidemiology; D001991:Bronchitis / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006306:Health Surveys; D034381:Hearing Loss / Q000453:epidemiology; D006331:Heart Diseases / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D009784:Occupational Diseases / Q000453:epidemiology*; D015995:Prevalence; D057566:Self Report; D012878:Skin Neoplasms / Q000453:epidemiology; D012893:Sleep Wake Disorders / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D055815:Young Adult