Risiko Gangguan Pernapasan Akibat Pajanan Isosianat di Tempat Kerja yang Dinilai Menggunakan Kuesioner, Estimasi Pajanan oleh Ahli Higiene, serta Matriks Pajanan Penyebab Asma di Tempat Kerja

Abstract

Abstrak
Penelitian kohort pada 202 orang telah dilakukan selama 4-9 tahun, untuk menilai hubungan antara pajanan isosianat (asmagen) dan gangguan saluran napas bagian atas dan bawah di tempat kerja pada mantan pelajar (magang) sekolah kejuruan pengecatan-mobil. Koefsien Kappa dihitung untuk menilai kesepakatan antara kuisioner  self-report, penilaian ahli higiene industri, dan kategori pajanan berdasarkan matriks pajanan di tempat kerja (job exposure matrix, JEM). Hal di atas digunakan untuk menilai keberlangsungan pajanan hingga pasca pendidikan. Analisis regresi Cox dipakai untuk menilai hubungan antara insidens luaran dan kontinuitas pajanan isosianat pasca pendidikan. Nilai kappa antara ketiga metode tersebut berkisar antara 0,78 dan 0,82. Berdasarkan kategori pajanan berbasis-JEM, risiko gangguan saluran pernapasan atas akibat pajanan isosianat pasca pendidikan sebesar 2,3 (95% CI 0,9-6,2) setelah disesuaikan dengan ada tidaknya mengi dan PC20  yang rendah di akhir masa pendidikan. Risiko
gangguan saluran pernapasan bawah akibat kerja pasca-magang, setelah disesuaikan dengan ada tidaknya PC20  yang rendah di akhir masa magang adalah 1,9 (95% CI 0,7-5,0). Hasil yang sama didapat  pada penggunaan kuesioner self-report dan penilaian oleh ahli higiene industri. Disimpulkan bahwa kuesioner self-report, penilaian pajanan oleh ahli higiene industri, serta kategori pajanan berbasis-JEM dapat digunakan untuk menilai pajanan isosianat. Pajanan isosianat jangka-panjang juga tampak berkaitan dengan peningkatan risiko gangguan pernapasan akibat kerja.
Kata Kunci: asmagen, pajanan ditempat kerja, pelaporan sendiri

Abstract
Evaluation of risks for the development of work-related  rhinoconjunctival and chest symptoms associated with continued post-apprenticeship exposure to isocyanates using different exposure estimates was done in an inception cohort of 202 apprentices in car-painting, with a 4- to 9-year follow-up after the end of the apprenticeship in 2002. The risk of developing work-related rhinoconjunctival and chest symptoms in association with different estimates of continued exposure to isocyanates post-apprenticeship (i.e. assessed through self-reporting, investigator scoring and the use of asthma-specifc job exposure matrix (JEM) categories) was evaluated using Cox regression analysis. The agreement between different exposure estimates was evaluated using the Cohen’s  kappa coeffcient. The kappa statistics ranged between 0.78 and 0.82. We found continued exposure to isocyanates post-apprenticeship, as estimated by the JEM, for at least one year, was associated with an increased risk for incident work-related
rhinoconjunctival symptoms (hazard ratio 2.3; 95% CI 0.9 to 6.2) after adjusting for wheezing symptoms and PC20  at the end of the apprenticeship. The risk of work-related chest symptoms was 1.9 (95% CI 0.7 to 5.0) after adjusting for PC20  £ 32 mg/ml at the end of the apprenticeship. Similar fndings were found when using different methods of exposure assessment (self-reports and investigator scores). We concluded that self-reports, investigator scores and asthma-specifc JEM categories showed good agreement on the assessment of continued exposure to isocyanates post-apprenticeship. In addition, these three methods showed consistent associations between the risks of work-related respiratory symptoms and continued exposure to isocyanates. Key words: asthmagenic, job exposure matrix, self report method