Table 6: Key features and results of research on dampness and health in workplaces other than schools

Author

Study Type

Buildings

Subjects

Dampness or Mold Related Risk Factors Confounders Controlled Key Findings

Chao et al. 2003 [66]

Cross sectional

98 adults in 21 offices in 4 buildings Mold spore count in air, floor and chair dust. Principal component analysis factors based on mold. Personal and job factors, temperature, humidity, carbon dioxide, dust load on floor and chairs With higher chair mold levels there were statistically significant increases in upper respiratory symptoms [OR=1.35, CI=1.07 - 1.70], and non-specific symptoms [OR=1.87, CI=1.11 - 3.15], but not with eye symptoms. Airborne mold levels were not significantly associated with symptoms in the final models that controlled for confounding by other factors.

Cox-Ganser et al. 2005 [54]

Main study was cross sectional.

Supplemental study compares outcome prevalence in study with reference populations.

Main study: 888 adults from 1 damp building

 

Supplemental study: 248 adults in high respiratory symptom, vs. low respiratory symptom, vs. no respiratory symptom groups

Damp building

Smoking

Main Study: In study population of 888 adults relative to subjects of NHANES survey, there were statistically significant elevations in ever asthma [OR=2.2, CI=1.9 - 2.6], current asthma [OR=2.4, CI=2.0 - 3.0], adult onset asthma [OR=3.3, CI=2.7 - 4.0], wheeze [OR=2.5, CI=2.2 - 2.8], nasal symptoms [OR=1.5, CI=1.4 - 1.6], eye symptoms [OR=1.6, CI=1.4 - 1.7].

In study population relative to population in 100 representative office buildings, there were statistically significant elevations in wheeze [OR=2.9, CI=2.2 - 3.7], cough [OR=2.7, CI=2.3 - 3.2], tight chest [OR=4.7, CI=3.8 - 5.7], shortness of breath [OR=4.6, CI=3.7 - 5.7], 7-fold more adult onset asthma after starting work in building.

Supplementary study: Objective tests confirmed more abnormal lung function and breathing medication use in subjects with more self-reported symptoms.

Jaakkola et al. 2002 [55]

Case control

512 adults with new asthma and 912 control adults without asthma

Water damage, visible dampness, visible mold, mold odor

Sex, age, parental atopy or asthma, education level as indicator of socio economic status, smoking, environmental tobacco smoke, dampness at home, pets, occupational exposures to sensitizers, dusts, or fumes

An increased risk of new asthma (development of the disease of asthma) was associated with visible mold or mold odor at work [OR=1.54, CI=1.01 - 2.32]. There were no statistically significant associations of new asthma with water damage or damp stains without visible mold or mold odor.

Jarvis and Morey 2001 [69]

Before versus after evacuation from an office building with planned mold remediation

488 occupants of mold remediated building and 122 people who had moved from this buildings to another building, reference population was 261 occupants in non-remediated office building

Before versus after evacuation from an office building with planned mold remediation

Not specified

There were statistically significant 32% to 50% decreases in throat, nose, eye, and headache symptoms after evacuation from the damp office building, but no statistically significant changes in chest tightness, shortness of breath, cough, or wheeze.

Karvala et al. 2010 [56]

Cross sectional (analysis of case histories)

694 adult patients with respiratory symptoms who had been exposed to molds at work

Date of first exposure to moisture damaged workplace, level of mold exposure based on extent of mold damage and levels of airborne molds

Patients with residential moisture damage were excluded

There was a statistically significant association of high level of mold exposure at work with development of probable work-related asthma although the odds ratio and confidence limits were not reported.

Karvala et al. 2011 [57]

Longitudinal

483 patients initially with asthma-like symptoms related to damp work places but without asthma, 62 of which developed asthma 3-12 years later

Continued exposure to damp or mold workplace environment, dampness remediation at work

Age, gender, atopic history, smoking habits

Continued exposure to damp or mold in workplace environment was associated with increased risk of developing asthma [OR=4.6, CI=1.8 - 11.6] The risk of developing asthma was lower and not statistically significant if there had been a dampness/mold remediation at work [OR=2.0, CI=0.7 - 5.40] suggesting that mold remediation at work reduced the risk of developing asthma.

Kim et al. 2016 [58]

Cross sectional

1356 working adults who reported that they have or ever had asthma

Self-reported dampness or mold at work (visible water damage, visible mold, mold odor)

Gender, age, smoking status, second hand smoke, history of allergy

Exposure to workplace dampness or mold was associated with increased asthma exacerbation [OR=1.79, CI=1.19 - 2.67].

Mendell et al. 2003 [64]

Cross sectional

2345 adults in 80 complaint office buildings in U.S.

Water in outdoor air intake, moist internal duct insulation, poor drain pan drainage, water damage in workspace

Age, sex, smoking status, asthma status

Poor cooling coil drain pan drainage was associated with at least 3 of the following symptoms: Wheeze, shortness of breath, tight chest, cough [OR=2.6, CI=1.3 - 5.2]

Poor cooling coil drain pan drainage was associated with having all three of wheeze, shortness of breath, cough [OR=2.8, CI=1.1 - 5.2]

Menzies et al 1998 [70]

Cross sectional

214 adults in 6 office buildings

Mold spore levels in air, floor dust & HVAC supply air, Indoor minus outdoor humidity

Age, sex, atopic status, smoking; temperature, humidity, carbon dioxide, total volatile organic compounds, total suspended particulates

For workers with respiratory symptoms versus those without symptoms, the probability of detectable Alternaria (a mold) in office air was significantly elevated [OR=4.2, CI=1.1 - 16.2]

For workers with symptoms, there was a significantly higher indoor air minus outdoor air humidity level (p < 0.010)

Menzies et al 2003 [65]

Blinded crossover intervention study

771 adults in 3 office buildings

Ultraviolet germicidal irradiation of cooling coils as an intervention

The within-person analysis controls personal factors, temperature, humidity, carbon dioxide, nitrogen dioxide, ozone.

Operation of ultraviolet germicidal system was associated with statistically significant reductions in symptoms as follows: Any symptom [OR=0.8, CI=0.7 - 0.99]; Mucosal symptom [OR=0.7, CI=0.6 - 0.9]; Respiratory symptom [OR=0.6, CI=0.4 - 0.9]

Operation of ultraviolet germicidal system was associated with a non-significant reduction in musculoskeletal symptoms [OR=0.8, CI=0.6 - 1.1]

Norback et al. 2000 [59]

Nordstrom et al. 1999 [60]

Wieslander et al. 1999 [61]

Cross sectional

87 or 88 staff (depending on analysis) from four geriatric hospitals

Dampness in concrete floor and associated elevated airborne concentrations of 2-ethyl-1-hexanol from degradation of a plasticizer in the PVC floor covering of the concrete

Age, sex, atopy, dampness at home

Age, sex, tobacco smoking, atopy, psychosocial work environment, building age

Age, sex, smoking habits, atopy, psychosocial index

In the two buildings with floor dampness, and elevated airborne concentrations of 2-ethyl-1-hexanol, asthma symptoms were increased [OR=8.6, CI=1.3 - 56.7]

Eye symptoms increased, not statistically significantly [OR=1.72, CI=0.89 - 3.32]

Nasal symptoms increased [OR=1.13, CI=1.04 - 1.24]

Throat symptoms increased [OR=1.15, CI=1.05 - 1.26]

General symptoms increased [OR=1.16, CI=1.07 - 1.25]*

There was no association with facial skin symptoms

Weekly eye symptoms in past 3 months increased [OR=1.29, CI=1.15 - 1.45]

Weekly nose symptoms in past 3 months increased [OR=1.10, CI=1.02 - 1.18]

There was a statistically significant decrease in tear film break up time and increase in nasal lysosome (a marker of inflammation) but no statistically significant change in nasal openness

Park et al. 2006 [67]

Cross sectional

888 adults in one 20-story water damaged building

Fungi and endotoxin concentration in floor and chair dust ranked as low, medium, and high for each

Age, gender, race, smoking, duration of occupancy

In groups with highest versus lowest fungal concentrations in floor dust, there were statistically significant increases in lower respiratory symptoms [OR=1.7, CI=1.02 - 2.77 to OR=2.4, CI=1.29 - 4.59]; throat irritation [OR=1.7, CI=1.06 - 2.82]; rash/itchy skin [OR=3.0, CI=1.47 - 6.19].

Endotoxin increased associations of fungi on respiratory symptom, .i.e., presence of both endotoxin and fungi was associated with greater increase than their added individual effects.

Sahakian et al 2009 [68]

Cross sectional

1396 office workers

Self-reported workplace dampness defined as visible mold, moldy/musty odor, or water damage; workplace air conditioning

Age, gender, smoking status, race, education, household income, geographic region, seasonal allergies, flu shot in prior year, obesity

With workplace dampness:

Respiratory infections of various types increased or decreased but the changes were not statistically significant

Work related nasal symptoms, lower respiratory symptoms, work related lower respiratory symptoms, constitutional symptoms, and asthma increased but the increases were not statistically significant

Nasal symptoms decreased but the decrease was not statistically significant

Workdays lost to respiratory symptoms increased [PR=1.30, CI=1.02 - 1.65]

There were no statistically significant changes in visits to doctors

Wan et al. 1999 [62]

Cross sectional

1113 adults in 9 air conditioned office buildings

Visible mold or mildew, signs of water damage, flooding

Age, sex, atopy, job satisfaction, perceived ventilation

Skin symptoms increased in buildings with mold [OR=2.97, CI=1.52 - 5.82], increased with water damage [OR=3.36, CI=1.70 - 6.63], and increased with flooding [OR=2.6, CI=1.19 - 2.56]. Headache increased with mold [OR=1.61, CI=1.01 - 2.56].

There were non-statistically significant increases in many other symptoms including shortness of breath with mold, water damage, or flooding.

Wan et al 1999b [63]

Cross sectional

109 adults in 8 office and 8 daycare buildings

Visible mold, water damage, flooding. Mold and  bacteria colony forming units, & endotoxin in air. ß-1,3-glucan (a marker of mold) in air .

Sex, ventilation rate, type of building

Shortness of breath, but none of nine other symptoms, was statistically significantly increased in buildings with mold [OR=20.75, CI=2.23 - 193.5] There were no statistically significant associations of water damage or flooding with symptoms of any type.

Zhang et al. 2012 [71]

Longitudinal

429 adults in workplace buildings

Floor dampness, dampness or molds, moldy odor, at baseline and 10 years later

Age, sex, atopy, smoking, education level

There were no statistically significant associations of dampness and mold at baseline with subsequent new sick building syndrome symptoms. Floor dampness in the final year was associated with onset of mucosal symptoms [OR=4.46, CI=1.39 - 14.35]. Floor dampness at any workplace during the 10 year period was associated with onset of mucosal symptoms [OR=2.43, CI=1.05 - 5.64] There were non-statistically significant increases in onset of general and mucosal symptoms with other indicators of dampness and mold. There were decreased remissions of symptoms present at baseline in buildings with dampness and mold indicators, but only one decrease in remission was statistically significant with decreased remission of general symptoms in buildings repaired because of dampness [OR=0.21, CI=0.07 - 0.70]. There was evidence, sometimes statistically significant, that dampness and mold was associated with increased biomarkers of inflammation and increased bronchial responsiveness

Key to table: CI = 95% confidence interval; OR = odds ratio; PR = prevalence ratio *In this study, general symptoms were not defined but the term usually refers to headache, fatigue, dizziness, difficulty concentrating.