Occupational Exposure to Disinfectants and Risk of Incident Cardiovascular Disease among US Nurses: The Nurses' Health Study II.

BACKGROUND

Exposure to certain chemicals in disinfectants has been associated with vascular dysfunction in toxicological studies, but the association between disinfectant exposure and clinical cardiovascular disease (CVD) remains unclear.

OBJECTIVE

The aim of this study was to evaluate the association between occupational exposure to disinfectants and subsequent risk of CVD among US nurses.

METHODS

We included 75,675 participants from The Nurses' Health Study II who maintained a nursing job and reported data on occupational disinfectant exposure. We estimated hazard ratios (HR) and 95% confidence intervals (CIs) of incident CVD, including coronary heart disease (CHD) and stroke, using Cox proportional hazard models comparing job types and general disinfection tasks between participants. We also used a job-task-exposure matrix to evaluate the risk of CVD by frequency of cleaning/disinfection tasks and exposure levels of seven specific disinfectants (formaldehyde, glutaraldehyde, hypochlorite bleach, hydrogen peroxide, alcohol, quaternary ammonium compounds, and enzymatic cleaners).

RESULTS

During 10 y of follow-up (2009-2019), we documented 726 incident cases of CVD. In fully adjusted models, the hazard ratio of CVD among nurses who worked in operating rooms was 1.72 [95% confidence interval (CI): 1.25, 2.36], in comparison with those working as educators or administrators. A similar pattern of associations was found when we separately assessed the risk for CHD and stroke [HR=1.69 (95% CI: 1.11, 2.58) and HR=1.69 (95% CI: 1.05, 2.74), respectively] among operating room nurses, in comparison with those working as educators or administrators. Those who used disinfectants weekly had modest elevations in CVD risk (HR=1.21; 95% CI: 1.04, 1.40), in comparison with women who never used disinfectants. The highest CVD risk was observed among nurses using disinfectants or spray or aerosol products 4-7 d/wk and those exposed to the highest levels of the seven specific disinfectants listed above.

CONCLUSION

Exposure to disinfectants in real-world health care settings was associated with a higher risk of CVD, including CHD and stroke, among US nurses. https://doi.org/10.1289/EHP14945.