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

Yixian Wang,O. Dumas,R. Varraso,Yang Sun,Janet W Rich-Edwards,Joann E Manson,K. Mukamal,Yu Zhang,Carlos A. Camargo,C. Messerlian

Published 2025 in Environmental Health Perspectives

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: 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

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