Use of marginal structural models to allow for the healthy worker effect

Marginal structural models can be used to allow for the health worker effect. The current paper follows 1284 participants in the French epidemiological study on the genetics and environment in asthma (AGEA) from 1991-5 to 2003-7 and plots the incidence of asthma and asthma attacks related to exposure to occupational allergens and respiratory irritants assesed with a job-exposure matrix. An unadjusted model showed no increase in incidence of asthma attacks related to occupational exposures. A marginal structural model adjusting for the healthy worker effect showed a statistically significant increase in asthma attacks related to respiratory irritant exposures (OR 1.56 (0.09-4.4) and a marginal effect for known asthmagens (OR 1.26 (0.9-1.76)

References

	Dumas O, Moual NL, Siroux V, Heederik D, Garcia-Aymerich J, Kauffmann F, Basagaña X, Work related asthma. A causal analysis controlling the healthy worker effect, Occup Environ Med, 2013;70:603-610,

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