Adverse occupational outcome among workers with occupational asthma: A systematic review and meta-analysis of influencing factors
系统综述和荟萃分析显示，超过三分之一的职业性哮喘患者出现失业、长期病假、残疾或提前退休等不良职业结局，且与数据来源、研究规模、肺功能和暴露时长等因素相关。
OBJECTIVES: Occupational asthma (OA) often interferes with workers’ ability to maintain employment. We synthesized the prevalence of adverse occupational outcome (AOO)—unemployment, chronic sick leave, disability, and early retirement—caused by OA. METHODS: Following PRISMA methodological recommendations and PROSPERO registration (CRD42024528750), we searched PubMed, Scopus, and Web of Science for studies published between January 1980 and September 2024 that reported quantitative employment outcomes in adults with OA. Risk of bias was assessed using the Joanna Briggs Institute Checklist for Prevalence Studies. Pooled prevalences were calculated using random-effects generalized linear mixed models on the logit scale with Hartung–Knapp 95% confidence and prediction intervals (CI and PI). RESULTS: A total of 25 studies comprising 3393 participants were included. The pooled prevalence of AOO was 35.9% (95% CI 28.6–43.9; I 2 =86.0%; 95% PI 10.2–73.4). Prevalence of AOO varied by: (i) data sources (registry/compensation: 50.1% versus clinic: 32.0%; P=0.015); (ii) study size (>80 participants: 43.4% versus ≤80: 27.9%; P=0.033); (iii) baseline forced expiratory volume in 1 second (FEV 1 ) (≤85% predicted: 38.2% versus >85% predicted: 13.8%; P=0.008); and (iv) exposure duration before symptom onset (>7.1 years: 35.7% versus ≤7.1 years: 15.7%; P=0.015). Heterogeneity across studies was substantial and several subgroups included fewer than five studies. CONCLUSIONS: More than one-third of workers with OA experience an AOO. The findings highlight the need for harmonized outcome definitions and for interventions integrating early referral, exposure control, and structured return-to-work programs to avoid AOO.