Asthma Among Employed Adults, by Industry and Occupation — 21 States, 2013

Workers in various industries and occupations are at risk for work-related asthma* (1). Data from the 2006–2007 adult Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-back Survey (ACBS), an in-depth asthma survey conducted with respondents who report an asthma diagnosis, from 33 states indicated that up to 48% of adult current asthma might be related to work and could therefore potentially be prevented (2). Identification of the industries and occupations with increased prevalence of asthma might inform work-related asthma intervention and prevention efforts. To assess the industry-specific and occupation-specific proportions of adults with current asthma by state, CDC analyzed data from the 2013 BRFSS industry and occupation module, collected from 21 states for participants aged ≥18 years who, at the time of the survey interview, were employed or had been out of work for <12 months. Among these respondents, 7.7% had current asthma; based on the Asthma Call-back Survey results, this finding means as many as 2.7 million U.S. workers might have asthma caused by or exacerbated by workplace conditions. State-specific variations in the prevalence of current asthma by industry and occupation were observed. By state, current asthma prevalence was highest among workers in the information industry (18.0%) in Massachusetts and in health care support occupations (21.5%) in Michigan. Analysis of BRFSS industry and occupation and optional asthma modules can be used to identify industries and occupations to assess for asthma among workers, identify workplace exposures, and guide the design and evaluation of effective work-related asthma prevention and education programs (1).

BRFSS is a state-based, random-digit–dialed telephone survey of the noninstitutionalized U.S. population aged ≥18 years that collects information on health risk factors, preventive health practices, and disease status. The survey includes core questions, optional modules, and state-specific questions.^† During 2013, the industry and occupation module^§ was administered for the first time in 19 states. The module collected information on the industry and occupation of respondents employed in the 12 months preceding the interview for their current or most recent job. Two additional states (Washington^¶ and Wyoming**) collected industry and occupation information using state-added questions. The median American Association of Public Opinion Research response rate among the 21 states collecting information on industry and occupation was 44.0% (range = 31.1%–59.2%).^††

BRFSS participants who responded “yes” to both questions: “Has a doctor, nurse, or other health professional ever told you that you had asthma?” and “Do you still have asthma?” were considered to have current asthma. Participants who, at the time of the interview, indicated that they were employed for wages, out of work for <1 year, or self-employed were considered employed in the 12 months before the interview. Information on respondent’s industry of employment and occupation was coded by CDC coders based on the 2002 North American Industry Classification System and the 2000 Standard Occupational Classification System, respectively.^§§ The current analysis used 21 industry categories and 23 occupation categories.

Landline and cellular telephone household data were weighted to produce estimates representative of the state populations using the survey sample weight for each BRFSS participant. Estimated proportions with corresponding 95% confidence intervals (CIs) were calculated. Statistically significant differences in distribution were determined using the Rao-Scott chi-square test with statistical significance at p≤0.05.

A sample of 208,788 adults in the 21 states, representing an estimated 125 million persons, participated in BRFSS and completed the industry and occupation module. Among these participants, 107,327 adults, representing an estimated 74 million persons (59.8% of the estimated survey population) were employed in the 12 months before the interview during 2013. Among adults employed at any time in the 12 months preceding the interview, 7.7% had current asthma.

The proportion of workers with current asthma differed significantly by age, sex, race/ethnicity, household income, and state (Table 1). Overall, prevalence of current asthma among workers ranged from 5.0% in Mississippi to 10.0% in Michigan, and was highest in the health care and social assistance industry (10.7%) and in health care support occupations (12.4%) (Table 2). Industry-specific, and occupation-specific prevalence of current asthma was highest among workers in the information industry (18.0%) in Massachusetts and in health care support occupations (21.5%) in Michigan (Table 3). Among the five industries with the highest current asthma prevalence, health care and social assistance was identified in 20 of the 21 states, retail trade in 16 states, and education in 14 states. Among the five occupations with the highest current asthma prevalence, office and administrative support was identified in 16 of the 21 states, health care practitioners and technical in 15 states, and sales and related in 13 states.

Acknowledgments

BRFSS state coordinators; Naomi Anderson, MPH, Washington Department of Labor and Industries; Jennifer Marcum, DrPH, Washington Department of Labor and Industries; Karla Armenti, ScD, University of New Hampshire.

Corresponding author: Katelynn Dodd, [email protected], 304-285-6305.

¹Respiratory Health Division, National Institute for Occupational Safety and Health, CDC; ²Association of Schools and Programs of Public Health/CDC Public Health Fellowship Program.

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TABLE 1. Prevalence of current asthma* among adults employed during the 12 months preceding the interview,^† by selected characteristics and state of residence — Behavioral Risk Factor Surveillance System (BRFSS), 21 states, 2013

Abbreviation: CI = confidence interval.
* “Yes” response to both questions: “Have you ever been told by a doctor or other health professional that you have asthma?” and “Do you still have asthma?”
^† Participants who, at the time of the interview, indicated they were employed for wages, out of work for <1 year, or self-employed.
^§ Unweighted sample size.
^¶ Weighted to the state population using the survey sample weights for each BRFSS participant.
** For differences in current asthma prevalence: Rao-Scott chi-square test; p-value <0.05.

TABLE 2. Prevalence of current asthma* among adults employed in the 12 months preceding the interview,^† ranked by industry and occupation categories — Behavioral Risk Factor Surveillance System (BRFSS), 21 states, 2013

Abbreviation: CI = confidence interval.
* “Yes” response to both questions: “Have you ever been told by a doctor or other health professional that you have asthma?” and “Do you still have asthma?”
^† Participants who, at the time of the interview, indicated they were employed for wages, out of work for <1 year, or self-employed.
^§ Weighted to the state population using the survey sample weights for each BRFSS participant.
^¶ Unreliable estimates with a relative standard error ≥30 are not reported.

TABLE 3. The five industries and occupations with the highest prevalence of current asthma* among adults employed in the 12 months preceding the interview,^† by state — Behavioral Risk Factor Surveillance System (BRFSS), 21 states, 2013

Abbreviation: CI = confidence interval.
* “Yes” response to both questions: “Have you ever been told by a doctor or other health professional that you have asthma?” and “Do you still have asthma?”
^† Participants who, at the time of the interview, indicated they were employed for wages, out of work for <1 year, or self-employed.
^§ Weighted to the state population using the survey sample weights for each BRFSS participant.
^¶ Unreliable estimates with a relative standard error ≥30 are not reported.