Asthma, chronic obstructive pulmonary disease, and asthma-COPD overlap among US working adults

Abstract

Background

Asthma-COPD overlap (ACO) is a respiratory condition with more severe respiratory symptoms, poorer quality of life, and increased hospital admissions compared with asthma or COPD alone.

Objectives

Estimate asthma, chronic obstructive pulmonary disease (COPD), and ACO prevalence among workers by industry and occupation and assess physical and mental health status, healthcare utilization, among workers with ACO.

Methods

The 2014–2018 National Health Interview Survey (NHIS) data for working adults aged ≥18 years employed (sample n = 99,424) in the 12 months prior to the survey were analyzed. Age-adjusted ACO, COPD and asthma prevalence and prevalence ratios adjusted for age, sex, race and smoking status were estimated.

Results

During 2014–2018, of the estimated 166 million (annual average) US workers, age-adjusted asthma, COPD, and ACO prevalence was 6.9%, 4.0%, and 1.1%, respectively. ACO prevalence was highest among workers aged ≥65 years (2.0%), females (1.6%), current smokers (1.9%), those living below the federal poverty level (2.3%), and workers in the accommodation and food services (1.6%) industry and personal care and service (2.3%) occupations. Workers with ACO had more frequent (p < 0.05) physician office visits, emergency department visits; and were more likely to be in poorer mental health, obese, have more lost workdays, more bed days, and comorbidities compared to workers with asthma alone and workers with COPD alone.

Conclusion: Higher ACO prevalence among worker groups and increased healthcare utilization underscores the need for early identification of asthma and COPD, assessment of potential workplace exposures, and implementation of tailored interventions to reduce ACO among working adults.

Keywords:

• Asthma-COPD overlap
• prevalence industry
• occupation
• workers
• exposures
• workplace

Acknowledgements

The authors would like to thank Drs. Janet B. Croft and Laura Kurth for technical review and providing useful suggestions

Authors’ contributions

Girija Syamlal contributed to conceptualization, methodology, data analyses, interpretation and writing – original draft preparation. Katelynn Dodd contributed to conceptualization, writing – reviewing and editing of the manuscript. Jacek Mazurek contributed to supervision, writing – reviewing and editing of the manuscript.

Disclosure statement

The authors report there are no competing interests to declare.

Disclaimer

The findings and conclusions of this report are those of the authors and do not necessarily represent the view of the National Institute for Occupational Safety and Health. This manuscript was prepared and written by NIOSH employees as part of their employment. Mention of a specific product or company does not constitute an endorsement by the Centers for Disease Control and Prevention.

Institution and ethics approval and informed consent

The National Health Interview Survey (NHIS) data was approved by the Research Ethics Review Board of the National Center for Health Statistics. For this study, a secondary data analysis, publicly available NHIS data were used, and National Institute for Occupational Safety and Health Internal Review Board approval was not required.

Funding

The author(s) reported there is no funding associated with the work featured in this article.