Job strain and the risk of severe asthma exacerbations: a meta-analysis of individual-participant data from 100 000 European men and women.
BACKGROUND
Many patients and healthcare professionals believe that work-related psychosocial stress, such as job strain, can make asthma worse, but this is not corroborated by empirical evidence. We investigated the associations between job strain and the incidence of severe asthma exacerbations in working-age European men and women.


METHODS
We analysed individual-level data, collected between 1985 and 2010, from 102 175 working-age men and women in 11 prospective European studies. Job strain (a combination of high demands and low control at work) was self-reported at baseline. Incident severe asthma exacerbations were ascertained from national hospitalization and death registries. Associations between job strain and asthma exacerbations were modelled using Cox regression and the study-specific findings combined using random-effects meta-analyses.


RESULTS
During a median follow-up of 10 years, 1 109 individuals experienced a severe asthma exacerbation (430 with asthma as the primary diagnostic code). In the age- and sex-adjusted analyses, job strain was associated with an increased risk of severe asthma exacerbations defined using the primary diagnostic code (hazard ratio, HR: 1.27, 95% confidence interval, CI: 1.00, 1.61). This association attenuated towards the null after adjustment for potential confounders (HR: 1.22, 95% CI: 0.96, 1.55). No association was observed in the analyses with asthma defined using any diagnostic code (HR: 1.01, 95% CI: 0.86, 1.19).


CONCLUSIONS
Our findings suggest that job strain is probably not an important risk factor for severe asthma exacerbations leading to hospitalization or death.
Finnish Institute of Occupational Health, Helsinki, Finland.
K
K
Heikkilä
I E H
IE
Madsen
S T
ST
Nyberg
E I
EI
Fransson
H
H
Westerlund
P J M
PJ
Westerholm
M
M
Virtanen
J
J
Vahtera
A
A
Väänänen
T
T
Theorell
S B
SB
Suominen
M J
MJ
Shipley
P
P
Salo
R
R
Rugulies
J
J
Pentti
J H
JH
Pejtersen
T
T
Oksanen
M
M
Nordin
M L
ML
Nielsen
A
A
Kouvonen
A
A
Koskinen
M
M
Koskenvuo
A
A
Knutsson
J E
JE
Ferrie
N
N
Dragano
H
H
Burr
M
M
Borritz
J B
JB
Bjorner
L
L
Alfredsson
G D
GD
Batty
A
A
Singh-Manoux
M
M
Kivimäki
D059366:Asthma, Occupational / Q000453:epidemiology* / Q000209:etiology*; D018450:Disease Progression; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D012306:Risk; D012720:Severity of Illness Index; D013315:Stress, Psychological; D044465:White People
asthma; exacerbation; job strain; psychosocial; work stress