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Latex Exposure and subsequent Health Care Utilization in Health care Workers: Results from the Duke Health and Safety Surveillance System

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  • Medicine


Background Occupational latex exposure in health care workers (HCWs) has been linked to an array of atopic conditions, including asthma, urticaria, and conjunctivitis. Although studies have explored sensitization rates at varying exposure levels, there has been little longitudinal research on the reported outcomes after latex exposure. We investigated the relationship between between latex exposure, as determined by years worked as a HCW, and subsequent atopic disease outcomes as determined from medical claims data. The aims of this retrospective cohort study are to match previously identified healthcare employees with potential latex exposure from the Duke Health and Safety Surveillance System (DHSSS) to subsequent health outcomes potentially related to latex allergies and symptoms; identify the risk factors associated with these outcomes, and describe the extent and type of these problems. Based on the results, suggestions for future research and possible surveillance strategies will be proposed. Methods Using a comprehensive integrated surveillance system for health care workers in a tertiary health care system, a cohort of2,119 HCWs were evaluated through a questionnaire for potential for latex exposure, a history of latex use and latex allergy, or symptoms likely to be latex allergy. Data was linked to medical claims for a two- year period (2002 and 2003) and de-identified individuals with less then 24 months of insurance for the two- year period were excluded from analysis. Using the International Classification of Diseases, Ninth Revision (ICD- 9, seven categories of atopic health outcomes (asthma, lungs, conjunctivitis, dermatitis, rhinitis, skin, and urticaria) were derived by grouping diseases potentially related to latex exposure according to the literature. Atopic outcome prevalence rates were calculated for strata defined by age, race, gender, years as a health care worker, years of latex glove use, and occupation. Logistic regression was used to relate these risk factors to the atopic outcomes. Results In all seven outcomes categories, the prevalence among female employees was significantly higher than males. Blacks had a higher prevalence than Whites and Other (summary variable containing Asian/Pacific Islander/American Indian) for Asthma, Lung, and Urticaria medical claims; however the employees in the Other race/ethnicity category had a higher prevalence of conjunctivitis, dermatitis, rhinitis, and skin. Asthma was the only atopic outcome with a statistically significant relationship to the exposure variable (years as a HCW). Logistic regression results extended those from the stratified analysis. Seven sets of multivariate models were created, each using one of the latex related medical claim categories as the dependent variable. Females were found to have 3.12 (1.45-6.70) greater adjusted odds than males of having had asthma across all models. No significant associations were found in the fully adjusted model for age, race, years worked as a HCW, and occupational group. Having worked less than 23 years as a health care worker was found to be significantly associated with lung disease. No significant associations were observed between the rhinitis, conjunctivitis, skin, or urticaria when adjusting for age, gender, race/ethnicity, duration as HCW, and occupational group. Discussion Overall, the studies results show little evidence that risk factors for latex allergy result in significantly increased prevalence of atopic outcomes as determined for medical claims. These results emphasize the need for future investigations examining the relationship between actual reactivity rates and latex exposure.

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