Third Follow-Up of the Study on Occupational Allergy Risks (SOLAR III) in Germany: Design, Methods, and Initial Data Analysis

Abstract

Introduction: Asthma and allergies are complex diseases affected by genetic and environmental factors, such as occupational and psychosocial factors, as well as interactions between them. Although childhood is a critical phase in the development of asthma and allergies, few cohort studies on occupational outcomes followed up participants from childhood onwards. We present design, methods, and initial data analysis for the third follow-up of SOLAR (Study on Occupational Allergy Risks), a prospective and population-based German asthma and allergy cohort. Methods: The SOLAR cohort was initially recruited in 1995-1996 for Phase II of the German branch of the International Study of Asthma and Allergies in Childhood (ISAAC II) and followed up three times since, in 2002-2003, 2007-2009, and 2017-2018. During the third follow-up (SOLAR III), participants were between 29 and 34 years old. Since SOLAR focuses on occupational exposures, follow-ups were conducted at important points in time of the development of participants' career. To evaluate the potential of selection bias, responders and non-responders were compared based on variables from earlier study phases. In responders, frequency and pattern of missing values were examined and compared within the subsets of paper and online versions of the used questionnaires. Results: In total, 1,359 participants completed the questionnaire of the third follow-up (47.3% of eligible participants). Initially, the cohort started with 6,399 participants from the ISAAC II questionnaire study. A selection process led to a study population that is more female, higher educated, smokes less and has a higher proportion of certain asthma and allergy symptoms (also in their parents) than the initial cohort. Pattern and frequency of missing values were different for paper and online questionnaires. Discussion: The third follow-up of the SOLAR cohort offers the opportunity to analyze the course of asthma and allergies and their associations to environmental, occupational and psychosocial risk factors over more than 20 years from childhood to adulthood. Selection processes within the cohort might lead to bias that needs to be considered in future analyses.

Keywords: asthma; atopic dermatitis; cohort study; epidemiological methods; occupational asthma; rhinitis.

Figure 1

Flowchart of the SOLAR study phases. From top to bottom: study phase, time period of data collection, age of participants, number of participants, response based on number of invited participants, and proportion of ISAAC II cohort remaining.

Figure 2

Percentage of missing values for paper and online questionnaires from first to last questionnaire item. Question numbers: 16: doctor diagnosis of respiratory outcomes; 45: indoor mold; 48: skin-straining activities at home; 68: ETS; 78–79: symptoms of rhinoconjunctivitis due to an occupation; 80: wheezing due to an occupation; 82: quitting jobs because of symptoms of asthma or allergies; 84: use of gloves; 85: duration of glove use; 86: declaration of occupational disease; 87: reason of declaration of occupational disease.