Occupational exposure to disinfectants and risk of incident cardiovascular disease among US nurses: the Nurses' Health Study II.

Abstract

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: To evaluate the association between occupational exposure to disinfectants and subsequent risk of CVD among United States (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 7 specific disinfectants (formaldehyde, glutaraldehyde, hypochlorite bleach, hydrogen peroxide, alcohol, quaternary ammonium compounds, and enzymatic cleaners).

Results: During 10 years 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% CI: 1.25 to 2.36), compared 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 to 2.58] and 1.69 [95% CI: 1.05 to 2.74 ], respectively) among operating room nurses, compared 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 to 1.40]), compared with women who never used disinfectants. The highest CVD risk was observed among nurses using disinfectants or spray or aerosol products 4-7 days/week and those exposed to the highest levels of the 7 specific disinfectants listed above.

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