Association of Occupational Exposure to Disinfectants With Incidence of Chronic Obstructive Pulmonary Disease Among US Female Nurses

Orianne Dumas,Raphaëlle Varraso,Catherine Quinot,Frank E Speizer,Carlos A Camargo,Nicole Le Moual,Paul K Henneberger,Jan-Paul Zock,Krislyn M Boggs

doi:10.1001/jamanetworkopen.2019.13563

Abstract

Exposure to disinfectants in health care workers has been associated with respiratory health outcomes, including asthma. Despite the biological plausibility of an association between disinfectants (irritant chemicals) and risk of chronic obstructive pulmonary disease (COPD), available data are sparse. To investigate the association between exposure to disinfectants and COPD incidence in a large cohort of US female nurses. The Nurses' Health Study II is a US prospective cohort study of 116 429 female registered nurses from 14 US states who were enrolled in 1989 and followed up through questionnaires every 2 years since. The present study included women who were still in a nursing job and had no history of COPD in 2009, and used data from the 2009 through 2015 questionnaires. Clean and complete data used for this analysis were available in July 2018, and analyses were conducted from September 2018 through August 2019. Occupational exposure to disinfectants, evaluated by questionnaire and a job-task-exposure matrix (JTEM). Incident physician-diagnosed COPD evaluated by questionnaire. Among the 73 262 women included in the analyses, mean (SD) age at baseline was 54.7 (4.6) years and 70 311 (96.0%) were white, 1235 (1.7%) black, and 1716 (2.3%) other; and 1345 (1.8%) Hispanic, and 71 917 (98.2%) non-Hispanic. Based on 368 145 person-years of follow-up, 582 nurses reported incident physician-diagnosed COPD. Weekly use of disinfectants to clean surfaces only (16 786 [22.9%] of participants exposed) and to clean medical instruments (13 899 [19.0%] exposed) was associated with COPD incidence, with adjusted hazard ratios of 1.38 (95% CI, 1.13-1.68) for cleaning surfaces only and 1.31 (95% CI, 1.07-1.61) for cleaning medical instruments after adjustment for age, smoking (pack-years), race, ethnicity, and body mass index. High-level exposure, evaluated by the JTEM, to several specific disinfectants (ie, glutaraldehyde, bleach, hydrogen peroxide, alcohol, and quaternary ammonium compounds) was significantly associated with COPD incidence, with adjusted hazard ratios ranging from 1.25 (95% CI, 1.04-1.51) to 1.36 (95% CI, 1.13-1.64). Associations were not modified by smoking or asthma status (P for interaction > .15). These longitudinal results suggest that regular use of chemical disinfectants among nurses may be a risk factor for developing COPD. If future studies confirm these results, exposure-reduction strategies that are compatible with infection control in health care settings should be developed.

Highlights

Chronic obstructive pulmonary disease (COPD) is the third leading cause of mortality worldwide and among the diseases contributing the most to disability-adjusted life-years.[1]
Use of any disinfectants was positively associated with COPD incidence, with an adjusted hazard ratio (AHR) of 1.35
Associations were observed for use of disinfectants both to clean surfaces only (AHR, 1.38; 95% CI, 1.13-1.68) and to clean medical instruments (AHR, 1.31; 95% CI, 1.07-1.61)

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is the third leading cause of mortality worldwide and among the diseases contributing the most to disability-adjusted life-years.[1] tobacco smoke remains the major risk factor for COPD development in the United States and other industrialized countries, occupational exposures contribute substantially to the burden of disease.[2] A growing body of data suggests that 15% to 20% of cases of COPD are attributable to occupational exposures.[3,4] despite the general recognition of an association between occupational exposures and COPD,[2,5] few individual causal agents have been identified.[5,6] Most studies on occupation and COPD have investigated broad exposure categories (eg, “vapor, gases, dust, or fumes”), which include many agents.[7] Industry-specific studies, which generally provide more insight regarding specific causal agents than population-based studies, have focused on a limited number of occupational settings, which are often occupations with predominantly male workers.[3] chemical exposures are an important component of vapor, gases, dust, or fumes 7 and may account for a large part of COPD risk,[4,8] their association with COPD remains unclear.[3]

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Conclusion