BACKGROUND: In the US, demand for workers who provide home care is increasing. In Massachusetts, an estimated 48,000 workers are employed as home care aides (home health aides and personal care aides). Home care aides may encounter respiratory hazards on-the-job, including cleaning products. In fact, a recent study in Massachusetts found that 80% of home care visits involved cleaning; bleach, a known asthma-casing agent, was commonly used. The burden of asthma among home care aides in Massachusetts has not been previously reported. We used population-based surveillance data to estimate asthma prevalence among this group compared to that among all other workers.
METHODS: Annually, questions on asthma are included in the Behavioral Risk Factor Surveillance System (BRFSS). In the 2011-2014 Massachusetts BRFSS, open-ended questions on occupation and industry were asked of respondents employed in the past year. Responses were assigned Census codes (COC, CIC) by the National Institute for Occupational Safety and Health using computer-assisted methods. The analysis included workers with both occupation and industry codes (n=32,875; 94% of eligible). Home care aides (n=368) were those with industry coded to Home Health Care Services (CIC 8170) or Individual and Family Services (CIC 8370) or Private Households (CIC 9290), and occupation coded to Nursing, Psychiatric, and Home Health Aides (COC 3600) or Personal Care Aides (COC 4610). Current asthma prevalence and corresponding 95% confidence intervals were calculated. Stratified analyses were used to examine factors more common among home care aides and also associated with asthma.
RESULTS: Compared to all other workers, home care aides were significantly more likely to be female (92.5 vs. 48.3%), age ≥ 45 years (57.0 vs. 49.0%), Hispanic (15.1 vs. 8.2%), have an education ≤ high school (51.5 vs. 30.4%) and be current smokers (26.4 vs. 15.9%). Current asthma prevalence was significantly higher among home care aides (20.0%) than among all other workers (10.0%). Despite this, home care aides were no more likely to report having received influenza vaccination in the past year (41.6% vs. 41.7%).
CONCLUSIONS: Home care aides have higher asthma prevalence compared to other workers in Massachusetts, even after considering additional factors known to be associated with asthma. While more research is needed to identify specific factors that cause or exacerbate asthma among home care aides, steps can be taken now to reduce exposures to known respiratory hazards in clients’ homes that could protect workers and clients alike. Increased outreach around influenza vaccination is also warranted.