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Job strain and the risk of severe asthma exacerbations: a meta-analysis of individual-participant data from 100 000 European men and women.

Katriina Heikkilä 1, * Ida E.H. Madsen 2 Solja T. Nyberg 1 Eleonor I. Fransson 3, 4 Hugo Westerlund 5 Peter J.M. Westerholm 6 Marianna Virtanen 1, 5 Jussi Vahtera 7 Ari Väänänen 1 Töres Theorell 8 Sakari B Suominen 9, 10 Martin J Shipley 5 Paula Salo 1, 11 Reiner Rugulies 12, 2 Jaana Pentti 1 Jan H. Pejtersen 13 Tuula Oksanen 1 Maria Nordin 14 Martin L. Nielsen 15 Anne Kouvonen 16, 17 Aki Koskinen 1 Markku Koskenvuo 18 Anders Knutsson 19 Jane E. Ferrie 5 Nico Dragano 20 Hermann Burr 21 Marianne Borritz 22 Jakob B. Bjorner 2 Lars Alfredsson 23 David G Batty 24 Archana Singh-Manoux 5, 25 Mika Kivimäki 5 
Abstract : 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. 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. 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). Our findings suggest that job strain is probably not an important risk factor for severe asthma exacerbations leading to hospitalization or death.
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Katriina Heikkilä, Ida E.H. Madsen, Solja T. Nyberg, Eleonor I. Fransson, Hugo Westerlund, et al.. Job strain and the risk of severe asthma exacerbations: a meta-analysis of individual-participant data from 100 000 European men and women.. Allergy, Wiley, 2014, 69 (6), pp.775-83. ⟨10.1111/all.12381⟩. ⟨inserm-01151643⟩



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