Parental occupation is a risk factor for childhood wheeze and asthma
Nara Tagiyeva, Graham Devereux, Sean Semple, Andrea Sherriff,
John Henderson, Peter Elias, Jon G Ayres
Online Data Supplement
Tables
Table E1. Association between maternal ante-natal and post-natal exposure to latex and biocides/fungicides and childhood atopy (IgE and allergen skin
prick testing) at 91 months and ventilatory function and airway responsiveness (expressed as dose-response slope) at 102 months adjusted for child’s:
sex, birth weight, gestational age, maternal age at delivery, home ownership status, education, parity, smoking during pregnancy and maternal asthma
Childhood outcome
Exposure
IgE*
Maternal to:
B
p
SPT**
95% CI
OR
p
FEV1*
95% CI
B
p
BHR*
95% CI
B
p
95% CI
Latex antenatal
-0.003 0.655 -0.015 0.009
0.999 0.978 0.926 1.078
0.019 0.158 -0.007 0.046
Latex postnatal
-0.004 0.631 -0.020 0.012
1.050 0.331 0.952 1.158
0.020 0.263 -0.015 0.055 -0.008 0.245 -0.022 0.006
Biocides/fungicides antenatal
-0.001 0.907 -0.019 0.017
0.913 0.132 0.811 1.028
0.027 0.194 -0.014 0.067 -0.003 0.674 -0.019 0.012
Biocides/fungicides postnatal
-0.013 0.285 -0.037 0.011
1.003 0.968 0.862 1.168
0.033 0.220 -0.020 0.086 -0.005 0.612 -0.026 0.015
-0.030 0.223 -0.079 0.019
1.101 0.517 0.823 1.472
Paternal postnatal exposure to flour
* Linear Regression
** Logistic Regression
-0.011 0.852 -0.122 0.101
0.000 0.951 -0.011 0.010
0.031 0.176 -0.014 0.075
Table E2. Jobs associated with high and moderate levels of workplace and ‘take-home’ exposures
to biocides/fungicides and latex
Job code
Job title
Biocides/fungicides at work place
9111
Farm workers
6292
Pest control officers
5119
Agricultural and fishing trades
8223
Agricultural machinery drivers
6139
Animal care occupations
8118
Electroplaters
5111
Farmers
5492
Furniture makers, other craft woodworkers
5113
Gardeners and groundsmen/groundswomen
5112
Horticultural trades
9132
Industrial cleaning process occupations
1219
Managers in animal husbandry, forestry and fishing
3218
Medical and dental technicians
3214
Medical radiographers
8117
Metal making and treating process operatives
8125
Metal working machine operatives
3212
Midwives
3211
Nurses
6111
Nursing auxiliaries and assistants
8121
Paper and wood machine operatives
3213
Paramedics
3217
Pharmaceutical dispensers
8129
Plant and machine operatives
6291
Undertakers and mortuary assistants
2216
Veterinarians
8126
Water and sewerage plant operatives
Biocides/fungicides ‘take-home’
9111
Farm workers
8223
Agricultural machinery drivers
5111
Farmers
5492
Furniture makers, other craft woodworkers
5113
Gardeners and groundsmen/groundswomen
5112
Horticultural trades
9132
Industrial cleaning process occupations
6292
Pest control officers
Latex at work place
6112
Ambulance staff (excluding paramedics)
2112
Biological scientists and biochemists
2111
Chemists
6113
Dental nurses
2215
Dental practitioners
3218
Medical and dental technicians
2211
Medical practitioners
3214
Medical radiographers
3212
Midwives
3211
Nurses
6111
Nursing auxiliaries and assistants
3213
Paramedics
3217
Pharmaceutical dispensers
2213
Pharmacists/pharmacologists
Exposure level
High
High
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
High
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
High
High
High
High
High
High
High
High
High
High
High
High
High
High
2216
6131
8139
3112
5433
3111
8138
3119
2321
Veterinarians
Veterinary nurses and assistants
Assemblers and routine operatives
Electrical/electronics technicians
Fishmongers, poultry dressers
Laboratory technicians
Routine laboratory testers
Science and engineering technicians
Scientific researchers
High
High
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
Table E 3. Frequencies of biocides/fungicides and latex by a level of exposure at workplace and
‘take-home’ exposure in maternal and paternal job exposure matrices
Exposure at work place
Mothers
ante-natal n (%) post-natal n (%)
Biocides & fungicides*
low
moderate
high
Latex*
low
moderate
high
2686 (24.0)
1570 (14.0)
1102 (9.8)
14 (0.1)
1964 (17.5)
659 (5.9)
108 (1.0)
1197 (10.7)
1246 (26.9)
653 (14.1)
586 (12.7)
7 (0.2)
869 (18.8)
188 (4.1)
26 (0.6)
655 (14.1)
Potential ‘take-home' exposure to the workplace sensitisers
Mothers
ante-natal n (%) post-natal n (%)
Biocides & fungicides*
low
moderate
high
Latex*
low
moderate
high
* Any
Fathers
ante-natal n (%) post-natal n (%)
2256 (23.8)
1811 (19.1)
428 (4.5)
17 (0.2)
1166 (12.3)
733 (7.7)
158 (1.7)
275 (2.9)
1073 (20.2)
827 (15.5)
237 (4.5)
9 (0.2)
615 (11.6)
368 (6.9)
79 (1.5)
168 (3.2)
Fathers
ante-natal n (%) post-natal n (%)
1562 (14.0)
1528 (13.7)
21 (0.2)
13 (0.1)
642 (13.9)
630 (13.6)
5 (0.1)
7 (0.2)
1473 (15.5)
1315 (13.9)
146 (1.5)
12 (0.1)
648 (12.2)
561 (10.5)
79 (1.5)
8 (0.2)
325 (2.9)
325 (2.9)
-
108 (2.3)
108 (2.3)
-
74 (0.8)
74 (0.8)
-
27 (0.5)
27 (0.5)
-
Table E 4. Maternal jobs at 18-week gestation with high exposure to biocides/fungicides and latex
High exposure to biocides/fungicides
Farm workers
Pest control officers
Total
Frequency Percent
13
92.9
1
7.1
14
100.0
High exposure to latex
Ambulance staff (excluding paramedics)
Biological scientists and biochemists
Chemists
Dental nurses
Dental practitioners
Medical and dental technicians
Medical practitioners
Medical radiographers
Midwives
Nurses
Nursing auxiliaries and assistants
Paramedics
Pharmaceutical dispensers
Pharmacists/pharmacologists
Veterinarians
Veterinary nurses and assistants
Total
Frequency Percent
3
.3
34
2.8
4
.3
28
2.3
7
.6
13
1.1
77
6.4
22
1.8
77
6.4
690
57.6
210
17.5
1
.1
10
.8
8
.7
7
.6
6
.5
1197
100.0
Table E 5. Maternal jobs at 18-week gestation with medium exposure to biocides/fungicides and
latex
Frequency
Percent
Agricultural and fishing trades nec.
2
.2
Agricultural machinery drivers
1
.1
Animal care occupations nec.
13
1.2
Farmers
3
.3
Furniture makers, other craft woodworkers
6
.5
Gardeners and groundsmen/groundswomen
5
.5
Horticultural trades
4
.4
Industrial cleaning process occupations
Managers in animal husbandry, forestry
and fishing nec.
Medical and dental technicians
1
.1
5
.5
13
1.2
Medical radiographers
Metal making and treating process
operatives
Metal working machine operatives
22
2.0
3
.3
21
1.9
Midwives
77
7.0
Medium exposure to biocides/fungicides
Nurses
690
62.6
Nursing auxiliaries and assistants
210
19.1
Paper and wood machine operatives
4
.4
Paramedics
1
.1
10
.9
Plant and machine operatives nec.
4
.4
Veterinarians
7
.6
1102
100.0
Frequency
49
Percent
45.4
2
1.9
Laboratory technicians
10
9.3
Routine laboratory testers
15
13.9
Rubber process operatives
1
.9
Science and engineering technicians nec.
18
16.7
Scientific researchers
13
12.0
108
100.0
Pharmaceutical dispensers
Total
Medium exposure to latex
Assemblers and routine operatives nec.
Electrical/electronics technicians
Total
Figures
Figure E1. Association between childhood wheeze and asthma and maternal exposure to latex ante-natally (a) and post-natally (b). Adjusted for
child’s: gender, birth weight, gestational age at delivery; maternal: asthma, age at delivery, parity, highest education qualification, smoking at
pregnancy, and home ownership status (0- no exposure, L- low, M- medium, H- high intensity exposure, DDA- doctor diagnosed asthma, grey circlesthe highest identified exposure, p-values for trend at timepoint).
a)
b)
10.0
10.0
p 0.082
p 0.037
p 0.005
p 0.001
p 0.002
p 0.043
p 0.307
p 0.210
p 0.046
p 0.006
p 0.050
p 0.156
Adjusted 1.0
OR
Adjusted 1.0
OR
Child's
age (mths)
p 0.025
p 0.009
p 0.022
Exposure
level
p 0.003
0.1
0 LMH
0 LMH
0 LMH
0 LMH
0 LMH
0 LMH
0 LMH
0 LMH
Exposure
level
0-6
mth
6-18
18 -30
30 -42
42 -54
54-69
69-81
91
Child's
age (mths)
Childhood wheeze between 0-81 months
DDA
0.1
0 LMH
0-6
mth
0 LMH
0 LMH
0 LMH
0 LMH
0 LMH
0 LMH
0 LMH
6-18
18 -30
30 -42
42 -54
54-69
69-81
91
Childhood wheeze between 0-81 months
DDA
Figure E2. Association between childhood wheeze and asthma and maternal exposure to biocides/fungicides ante-natally (a) and post-natally (b).
Adjusted for child’s: gender, birth weight, gestational age at delivery; maternal: asthma, age at delivery, parity, highest education qualification,
smoking at pregnancy, and home ownership status (0- no exposure, L- low, M- medium, grey circles- the highest identified exposure, p-values for
trend at timepoint).
a)
b)
3.0
3.0
0.003
0.050
0.011
0.012
0.034
0.059
0.319
0.193
0.902
0.206
Adjusted
1.0
OR
0.045
0.204
0.008
0.277
0.520
0.199
0 L M
0 L M
0 L M
0 L M
0 L M
0 L M
No L M
No L M
6-18
18 -30
30 -42
42 -54
54-69
69-81
91
Adjusted 1.0
OR
0.3
Exposure
level
Child's
age (mths)
0.3
0 LM
0 LM
0 LM
0 LM
0 LM
0 LM
0 LM
0 LM
Exposure
level
0-6
mth
6-18
18 -30
30 -42
42 -54
54-69
69-81
91
Child's
age (mths)
Childhood wheeze between 0-81 months
DDA
0-6
mth
Childhood wheeze between 0-81 months
DDA
Figure E3. Association between childhood wheeze and asthma and maternal combined ante- and/or post-natal high intensity exposure to latex (a) and
moderate intensity exposure to biocides/fungicides (b). Adjusted for child’s: gender, birth weight, gestational age at delivery; maternal: asthma, age at
delivery, parity, highest education qualification, smoking at pregnancy, and home ownership status (0- neither ante-natal nor post-natal exposure, Aonly ante-natal, P- only post-natal, represented by grey circles, B- both ante-natal and post-natal exposures, DDA- doctor diagnosed asthma, p-values
for post-natal exposure)
a)
b)
10.0
10.0
0.002
0.011
0.001
0.002
0.001
0.007
0.002
0.041
0.177
0.211
0.083
0.194
0.084
0.124
0.200
0.975
0.020
0.040
Adjusted
OR
Exposure 0.1
period
Child's
age (mths)
Adjusted
OR
1.0
0 APB
0-6
mth
0 APB
6-18
0 APB
18 -30
0 APB
30 -42
0 APB
0 APB
42 -54
Childhood wheeze between 0-81 months
54-69
0 APB
69-81
0 APB
91
DDA
1.0
Exposure 0.1
period
Child's
age (mths)
0 APB
0-6
mth
0 A PB
0 APB
6-18
18 -30
0 A PB
0 AP B
0 AP B
0 AP B
0 AP B
30 -42
42 -54
54-69
69-81
91
Childhood wheeze between 0-81 months
DDA
Figure E4 Association between childhood wheeze and asthma and paternal exposure to flour dust ante-natally (a) and post-natally (b). Adjusted for
child’s: gender, birth weight, gestational age at delivery, maternal: asthma, age at delivery, parity, highest education qualification, smoking at
pregnancy, and home ownership status (0- no exposure, L- low, M- medium, H- high intensity exposure, represented by grey circles, DDA- doctor
diagnosed asthma, p-values for significant trend at timepoint).
a)
b)
Adjusted
OR
Child's
age (mths)
p trend
0.018
p trend
0.018
Adjusted
OR
1.0
Exposure 0.1
level
p trend
0.039
10.0
10.0
0 LMH
0 LMH
0 LMH
0 LMH
0 LMH
0 LMH
0 LMH
0 LMH
0 LMH
0-6
mth
6-18
18 -30
30 -42
42 -54
54-69
69-81
91
91
DDA
SPT+
Childhood wheeze between 0-81 months
1.0
Exposure 0.1
level
Child's
age (mths)
0 LMH
0 LMH
0 LMH
0 LMH
0 LMH
0 LMH
0 LMH
0 LMH
0 LMH
0-6
mth
6-18
18 -30
30 -42
42 -54
54-69
69-81
91
91
DDA
SPT+
Childhood wheeze between 0-81 months
Figure E5. Association between reporting childhood wheeze and non-respiratory conditions by mothers in non-medical and medical occupations (Acc
– accidents, Hospit – hospitalisation)
Mothers in non-medical occupation
Mothers in medical occupation
70
60
50
40
% with
condition
30
20
10
0
Occupation
NM
NM
Child's
age (mths)
0-6
mth
6-18 18 -30 30 -42 42 -54 54-69 69-81
NM
NM
NM
NM
Wheeze with whistling
NM
NM
NM
NM
NM
NM
81
81
81
81
81
Ear Ear Stom Acc Hospit
ache disch ache