Original articles
The work impact of asthma and rhinitis: Findings from a population-based survey

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Abstract

Asthma and rhinitis are common chronic conditions that affect adults of working age. Little is known about their relative impacts on work loss and decreased productivity. Using random digit telephone dialing, we carried out a population-survey of adults in Northern California aged 18–50 years. We interviewed 125 persons with asthma (with or without concomitant rhinitis) and 175 persons with rhinitis alone. Study eligibility was based on subject report of a physician's diagnosis of asthma and/or a rhinitis-related condition. Any adult labor force participation since condition onset was lower among those with asthma (88%) than among those with rhinitis alone (97%) (P = 0.002). In contrast, among those still employed, decreased job effectiveness was more frequently reported in the rhinitis group (43 of 121; 36%) compared to those with asthma (14 of 72; 19%) (P = 0.02). Condition-attributed lost work was common in both groups, with more than 20% reporting one or more complete or partial work days lost in the 4 weeks previous to interview. Taking into account age, gender, race, and smoking status, those with asthma were more likely to have no labor force participation after diagnosis (OR = 3.0; 95% CI 1.1–7.7) and less likely to report decreased job effectiveness among those remaining employed (OR = 0.4; 95% CI 0.2–0.9). Excluding subjects from the rhinitis group most likely to have unreported asthma based on past medication use had little impact on these associations. Both asthma and rhinitis negatively affect work productivity. Those with asthma are less likely to be employed at all, while among those remaining on the job, rhinitis is a more potent cause of decreased work effectiveness. The economic impact of asthma and rhinitis and related conditions may be under-appreciated.

Introduction

Asthma and rhinitis are both common and costly conditions among persons of working age. The negative impacts of these health conditions on work and employment can be defined in a number of different ways, including lower labor force participation rates, changes in employment or job responsibilities as an adjustment to the condition, lost work time due to illness, or decreased work effectiveness of productivity while still on the job. Related negative impacts include general limitation of activities or impairment of quality of life.

For asthma these negative impacts have been studied more than they have been for rhinitis. Among adults in the U.S., asthma is one of the leading non-musculoskeletal causes of work limitations affecting the employment of millions of Americans [1]. When quantified in terms of indirect health costs, decreased work productivity due to asthma, based on two separate estimates, accounted for hundreds of millions of dollars annually in the U.S. 2, 3. International data suggest a similar global burden of disease [4].

Estimates of the occupational impact of rhinitis are limited. The most widely cited U.S. cost estimate for work and productivity loss is based on the National Medical Expenditure Survey and is limited to allergic rhinitis [5]. In that study, the estimated costs of lost work productivity due to rhinitis were only 15% as much as those derived using similar methods for asthma 2, 5. These productivity assumptions, however, may have been too conservative. For example, a recent clinical drug trial in seasonal allergic rhinitis using a more direct assessment found that those with rhinitis and employed reported a 1.8% loss of work time and a 38.7% work impairment while on the job [6]. We evaluated the work impacts of asthma and rhinitis compared to one another using a population-based survey. We hypothesized that both conditions would have important occupational effects, but that the impact of asthma would be greater.

Section snippets

Overview

We studied the prevalence of work and other activity limitations among adults with asthma or rhinitis by analyzing survey responses to telephone interviews carried out in a random population-based sample. Subjects were identified through random digit dialing. Screening questions identified potentially eligible subjects based on age and reported physician diagnosis of the conditions of study interest. Structured telephone interviews assessed demographic characteristics, health status, health

Results

Table 1 shows the demographic data for the 125 subjects with asthma (with or without concomitant rhinitis) compared to the 175 subject with rhinitis alone. A significantly greater proportion of those with asthma reported household incomes below $20,000 (25% vs. 10%, P < 0.001). A significantly greater proportion of those in the rhinitis group were married or living with a partner (65% vs. 49% for asthma, P = 0.01). Although there were not other statistically significant differences in the other

Discussion

Our findings indicate that both asthma and rhinitis, independently, have major quality-of-life and economic impacts through occupational disability. Occupational disability can take many forms, including decreased labor force participation rates, change of job or job responsibilities due to health reasons, lost work days, or decreased effectiveness on the job because of illness. For asthma, reduced labor force participation appears to be a more prominent disability effect. For rhinitis,

Acknowledgements

This project was supported by Research Career Development Award K04 HL03225; R01 HL56438 and K23 HL04201, National Heart Lung and Blood Institute, National Institutes of Health; R01 OH03480 National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention.

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