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Robinson CF, Schnorr TM, CassinelliII RT, Calvert GM, Steenland K, Gersic C. Tenth Revision Mortality Rates and Niosh Life Table Analysis. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s211-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ruder AM, Waters MA, Carreón T, Butler MA, Davis-King KE, Calvert GM, Schulte PA, Ward EM, Connally LB, Lu J, Wall D, Zivkovich Z, Heineman EF, Mandel JS, Morton RF, Reding DJ, Rosenman KD. The Upper Midwest Health Study: A Case-Control Study of Primary Intracranial Gliomas in Farm and Rural Residents. J Agric Saf Health 2006; 12:255-74. [PMID: 17131948 DOI: 10.13031/2013.22013] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Since several studies indicated that farmers and agricultural workers had an excess risk of brain cancer, the National Institute for Occupational Safety and Health initiated the Upper Midwest Health Study to examine risk of intracranial glioma in the non-metropolitan population. This population-based, case-control study evaluated associations between gliomas and rural and farm exposures among adults (ages 18 to 80) in four upper midwestern states (Iowa, Michigan, Minnesota, Wisconsin). At diagnosis/selection, participants lived in non-metropolitan counties where the largest population center had fewer than 250,000 residents. Cases were diagnosed 1 January 1995 through 31 January 1997. Over 90% of 873 eligible ascertained cases and over 70% of 1670 eligible controls consented to participate. Participants and nonparticipants, evaluated for "critical questions" on main and refusant questionnaires, differed significantly in farming and occupational experience, ethnicity, education, and lifestyle. The 1,175 controls were more likely than the 798 cases to have reported ever drinking alcohol (77% vs. 73%, adjusted odds ratio (OR) 0. 73, 95% confidence interval (CI) 0.59-0.92) and having had panoramic dental x-rays (34% vs. 29%, OR 0. 75, CI 0.61-0.92). Controls spent a greater percentage of their lives in non-metropolitan counties (78% vs. 75%, OR 0.81, CI 0.67-1.09). Among ever-farmers, controls were more likely to have had exposure to farm insecticides (57% vs. 50%, OR 0.75, CI 0.59-0.95) and farm animals (96% vs. 91%, OR 0.48, CI 0.25-0.90). Moving to a farm as an adolescent (ages 11 to 20) vs. as an adult was associated with a greater risk of glioma. In our study sample, farm or rural residence and summary farm exposures were associated with decreased glioma risk. However, nonparticipation by never-farming eligible controls could have affected results. Comparisons of farm chemical exposures may clarify associations between farming and glioma that others have reported.
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Affiliation(s)
- A M Ruder
- National Institute for Occupational Safety and Health, Mailstop R-16, 4676 Columbia Parkway, Cincinnati, OH 45226, USA.
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Calvert GM, Rice FL, Boiano JM, Sheehy JW, Sanderson WT. Occupational silica exposure and risk of various diseases: an analysis using death certificates from 27 states of the United States. Occup Environ Med 2003; 60:122-9. [PMID: 12554840 PMCID: PMC1740467 DOI: 10.1136/oem.60.2.122] [Citation(s) in RCA: 182] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although crystalline silica exposure is associated with silicosis, lung cancer, pulmonary tuberculosis, and chronic obstructive pulmonary disease (COPD), there is less support for an association with autoimmune disease, and renal disease. METHODS Using data from the US National Occupational Mortality Surveillance (NOMS) system, a matched case-control design was employed to examine each of several diseases (including silicosis, lung cancer, stomach cancer, oesophageal cancer, COPD, pulmonary tuberculosis, sarcoidosis, systemic lupus erythematosus, systemic sclerosis, rheumatoid arthritis, and various types of renal disease). Cases were subjects whose death certificate mentioned the disease of interest. A separate control group for each of the diseases of interest was selected from among subjects whose death certificate did not mention the disease of interest or any of several diseases reported to be associated with crystalline silica exposure. Subjects were assigned into a qualitative crystalline silica exposure category based on the industry/occupation pairing found on their death certificate. We also investigated whether silicotics had a higher risk of disease compared to those without silicosis. RESULTS Those postulated to have had detectable crystalline silica exposure had a significantly increased risk for silicosis, COPD, pulmonary tuberculosis, and rheumatoid arthritis. In addition, a significant trend of increasing risk with increasing silica exposure was observed for these same conditions and for lung cancer. Those postulated to have had the greatest crystalline silica exposure had a significantly increased risk for silicosis, lung cancer, COPD, and pulmonary tuberculosis only. Finally, those with silicosis had a significantly increased risk for COPD, pulmonary tuberculosis, and rheumatoid arthritis. CONCLUSIONS This study corroborates the association between crystalline silica exposure and silicosis, lung cancer, COPD, and pulmonary tuberculosis. In addition, support is provided for an association between crystalline silica exposure and rheumatoid arthritis.
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Affiliation(s)
- G M Calvert
- Division of Surveillance, Hazard Evaluations and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio 45226, USA.
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Ballard TJ, Calvert GM. Surveillance of acute occupational pesticide-related illness and injury: the US experience. Ann Ist Super Sanita 2002; 37:175-9. [PMID: 11758274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
In the United States there are numerous state-based and national surveillance systems that collect data on acute pesticide-related illnesses and injuries. On the state level, Arizona, California, Florida, Louisiana, New York, Oregon, Texas, and Washington routinely collect illness data due to pesticide exposure and conduct comprehensive case investigations. On the national level, the American Association of Poison Control Centers coordinates the Toxic Exposure Surveillance System, and the Bureau of Labor Statistics provides annual estimates of the number of occupational pesticide-related illnesses and injuries that result in days away from work. The various systems are described and compared, and examples are provided of prevention measures that have been implemented as a result of surveillance activities.
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Affiliation(s)
- T J Ballard
- Laboratorio di Igiene Ambientale, Istituto Superiore di Sanità, Rome, Italy
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Abstract
Silica exposure has been associated with kidney disease and rheumatoid arthritis; an autoimmune mechanism has been proposed. Approximately 2 million people are occupationally exposed to silica in the United States, 100,000 at more than twice the National Institute for Occupational Safety and Health recommended exposure limit of 0.05 mg/m(3). We examined renal disease morbidity and mortality, as well as arthritis mortality, in a cohort of 4,626 silica-exposed workers in the industrial sand industry (an industry previously unstudied). We compared the cohort with the U.S. population and also conducted internal exposure-response analyses using a job-exposure matrix based on more than 4,000 industrial hygiene samples. We found excess mortality from acute renal disease [standardized mortality ratio (SMR) = 2.61, 95% confidence intervals (95% CIs) = 1.49--4.24; 16 deaths], chronic renal disease (SMR = 1.61, 95% CI = 1.13--2.22; 36 deaths), and arthritis (SMR = 4.36, 95% CI = 2.76--6.54; 23 deaths) on the basis of multiple-cause mortality data, which considered any mention of disease on a death certificate. Linking the cohort with the U.S. registry of end-stage renal disease for the years 1977-1996, we found an excess of end-stage renal disease incidence (standardized incidence ratio = 1.97, 95% CI = 1.25--2.96; 23 cases), which was highest for glomerulonephritis (standardized incidence ratio = 3.85, 95% CI = 1.55--7.93; 7 cases). We found increasing end-stage renal disease incidence with increasing cumulative exposure; standardized rate ratios by quartile of cumulative exposure were 1.00, 3.09, 5.22, and 7.79. A positive exposure-response trend was also observed for rheumatoid arthritis on the basis of death certificate data. These data represent the largest number of kidney disease cases analyzed to date in a cohort with well-defined silica exposure and suggest a causal link between silica and kidney disease. Excess risk of end-stage renal disease due to a lifetime of occupational exposure at currently recommended limits is estimated to be 14%, above a background end-stage renal disease risk of 2%.
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Affiliation(s)
- K Steenland
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH 45226, USA
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Sweeney MH, Calvert GM, Egeland GA, Fingerhut MA, Halperin WE, Piacitelli LA. Review and update of the results of the NIOSH medical study of workers exposed to chemicals contaminated with 2,3,7,8-tetrachlorodibenzodioxin. Teratog Carcinog Mutagen 2000; 17:241-7. [PMID: 9508733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In 1987, the National Institute for Occupational Safety and Health conducted a cross-sectional medical study to examine the long-term health effects of occupational exposure to chemicals and materials contaminated with 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). This study compared living workers employed more than 15 years earlier in the production of sodium trichlorophenol (NaTCP), and 2,4,5-trichlorophenoxyacetic ester (2,4,5-T ester) with an unexposed comparison group. Health status of the worker and comparison populations was collected through a comprehensive set of standardized interviews and medical examinations. Lipid adjusted serum TCDD levels were also measured. Workers had a statistically significantly elevated mean serum lipid-adjusted TCDD level (workers = 220 pg per g of lipid [range = not detected-3,400 pg per g of lipid], and referents 7 pg per g of lipid [range not detected-20 pg per g of lipid], P < 0.001). Compared to a community-based referent population, the prevalence of chronic bronchitis, chronic obstructive pulmonary disease, peripheral neuropathy, depression, cardiovascular outcomes (myocardial infarction, angina, cardiac arrhythmias, hypertension, and abnormal peripheral arterial flow), abnormal porphyrin levels, and abnormal ventilatory function parameters FEV1.0, FVC, or FEV1.0/FVC% in workers, was not statistically significantly different. In contrast, relationships were observed between serum 2,3,7,8-TCDD levels and the enzyme gamma-glutamyltransferase (GGT), the reproductive hormones serum testosterone, luteinizing, and follicle-stimulating hormones, and abnormal high-density lipoprotein concentration, counts of CD3/Ta1 cells (helper lymphocytes), and fasting serum glucose levels. Current diagnosis of chloracne was associated with the highest levels of serum 2,3,7,8-TCDD. Analysis of other endpoints continues.
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Affiliation(s)
- M H Sweeney
- National Institute for Occupational Safety and Health, Cincinnati, Ohio 45226, USA
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Abstract
Cardiovascular disease is the leading cause of death, and the role of occupation continues to generate interest. Using the National Occupational Mortality Surveillance system, proportionate mortality ratio (PMR) analyses were used to examine the association between occupation and ischemic heart disease among 16- to 60-year-old males. We used data from 1982-1992 from 27 states. Separate analyses were conducted for blue-collar and white-collar occupations. Among the blue-collar occupations with the highest PMRs for ischemic heart disease mortality were sheriffs, correctional institution officers, policemen, firefighters, and machine operators. Physicians (blacks only) and clergy (both races) were among the white-collar occupations with the highest PMRs for ischemic heart disease. Although more study is needed, consideration should be made for targeting high-PMR occupations, with improvement in work organization to reduce occupational stress and promotion of healthy lifestyles through cardiovascular disease prevention programs.
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Affiliation(s)
- G M Calvert
- Surveillance Branch, National Institute for Occupational Safety & Health, Centers for Disease Control and Prevention, Cincinnati, Ohio 45226, USA
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Connally LB, Schulte PA, Alderfer RJ, Goldenhar LM, Calvert GM, Davis-King KE, Sanderson WT. Developing the National Institute for Occupational Safety and Health's cancer control demonstration projects for farm populations. J Rural Health 1999; 12:258-64. [PMID: 10162856 DOI: 10.1111/j.1748-0361.1996.tb00814.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Calvert GM, Sweeney MH, Deddens J, Wall DK. Evaluation of diabetes mellitus, serum glucose, and thyroid function among United States workers exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin. Occup Environ Med 1999; 56:270-6. [PMID: 10450245 PMCID: PMC1757731 DOI: 10.1136/oem.56.4.270] [Citation(s) in RCA: 98] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Some studies suggest that exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) may affect glucose metabolism and thyroid function. To further assess the relation between exposure to TCDD and endocrine function, data from the largest morbidity study of industrial workers exposed to TCDD were examined. METHODS A cross sectional study of workers employed > 15 years earlier in the manufacture of 2,4,5-trichlorophenol or one of its derivatives at two United States chemical plants was conducted. The referent group consisted of people with no occupational exposure to phenoxy herbicides and were recruited from the neighbourhoods where the workers lived. RESULTS A total of 281 workers and 260 unexposed referents participated. The mean current serum lipid adjusted TCDD concentration among workers was 220 pg/g lipid, and among referents was 7 pg/g lipid (p < 0.05). The half life extrapolated TCDD concentrations (the estimated TCDD concentration when occupational exposure to TCDD stopped) among workers averaged 1900 pg/g lipid (range: not detected--30,000 pg/g lipid). Overall, the prevalence of diabetes mellitus was not significantly different between the workers and referents. Also, there was not a significant positive trend between prevalence of diabetes and increasing serum TCDD concentration. However, diabetes was found in six of 10 (60%) workers with current serum TCDD concentrations > 1500 pg/g lipid. After excluding subjects being treated for diabetes, workers in the group with the highest half life extrapolated TCDD concentrations had a significantly increased adjusted mean serum glucose concentration compared with referents (p = 0.03). Workers were also found to have a significantly higher adjusted mean free thyroxine index compared with referents (p = 0.02), especially among workers in the group with the highest half life extrapolated TCDD concentrations. However, no evidence was found that workers exposed to TCDD were at increased risk of thyroid disease. CONCLUSIONS These findings provide modest evidence that exposure to TCDD may affect thyroid function and glucose metabolism.
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Affiliation(s)
- G M Calvert
- Division of Surveillance, Hazard Evaluations and Field Studies, Centers for Disease Control and Prevention, Cincinnati, Ohio 45226, USA.
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Calvert GM, Mueller CA, Fajen JM, Chrislip DW, Russo J, Briggle T, Fleming LE, Suruda AJ, Steenland K. Health effects associated with sulfuryl fluoride and methyl bromide exposure among structural fumigation workers. Am J Public Health 1998; 88:1774-80. [PMID: 9842373 PMCID: PMC1509053 DOI: 10.2105/ajph.88.12.1774] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study assessed the health effects associated with occupational exposure to methyl bromide and sulfuryl fluoride among structural fumigation workers. METHODS A cross-sectional study of 123 structural fumigation workers and 120 referents in south Florida was conducted. Nerve conduction, vibration, neurobehavioral, visual, olfactory, and renal function testing was included. RESULTS The median lifetime duration of methyl bromide and sulfuryl fluoride exposure among workers was 1.20 years and 2.85 years, respectively. Sulfuryl fluoride exposure over the year preceding examination was associated with significantly reduced performance on the Pattern Memory Test and on olfactory testing. In addition, fumigation workers had significantly reduced performance on the Santa Ana Dexterity Test of the dominant hand and a nonsignificantly higher prevalence of carpal tunnel syndrome than did the referents. CONCLUSIONS Occupational sulfuryl fluoride exposures may be associated with subclinical effects on the central nervous system, including effects on olfactory and some cognitive functions. However, no widespread pattern of cognitive deficits was observed. The peripheral nerve effects were likely caused by ergonomic stresses experienced by the fumigation workers.
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Affiliation(s)
- G M Calvert
- Division of Surveillance, Hazard Evaluations and Field Studies, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA.
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Abstract
To address the genotoxicity of in vivo methyl bromide (CAS 74-83-9) exposure in humans, we collected blood and oropharyngeal cells as part of a cross-sectional morbidity study of methyl bromide-exposed fumigation workers and their referents. Micronuclei were measured in lymphocytes and oropharyngeal cells, and hypoxanthine-guanine phosphoribosyl transferase gene (hprt) mutations were measured in lymphocytes. A total of 32 workers and 28 referents provided specimens. Among current non-smokers, mean hprt variant frequencies (Vfs) were found to be elevated among workers compared to referents (geometric mean: workers=4.49x10(-6), referents=2.96x10-(6); two-sided p=0.22); this difference was more pronounced among workers with 4 h or more of recent methyl bromide exposure compared to referents (geometric mean: workers=6.56x10(-6), referents=2.96x10(-6); two-sided p=0.06). Mean oropharyngeal cell micronuclei were higher among workers compared to referents (mean: workers=2.00, referents=1.31; two-sided p=0.08); the results were similar when workers with 4 h or more of recent methyl bromide exposure were compared to referents (mean: workers=2.07, referents=1.31; two-sided p=0.13). No consistent differences between workers and referents were observed for frequencies of kinetochore-negative lymphocyte micronuclei, or kinetochore-positive lymphocyte micronuclei. The study was limited by a sample size sufficient only for detecting relatively large differences, absence of a reliable method to measure the intensity of workplace methyl bromide exposures, and relatively infrequent methyl bromide exposure (e.g., the median length of exposure to methyl bromide during the 2 weeks preceding the survey was 4 h). In conclusion, our findings provide some evidence that methyl bromide exposure may be associated with genotoxic effects in lymphocytes and oropharyngeal cells. Further study on the genotoxicity of methyl bromide exposure in humans is warranted.
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Affiliation(s)
- G M Calvert
- Division of Surveillance, Hazard, Evaluations and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 4676 Columbia Parkway, R-21, Cincinnati, OH 45226, USA.
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Calvert GM, Wall DK, Sweeney MH, Fingerhut MA. Evaluation of cardiovascular outcomes among U.S. workers exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin. Environ Health Perspect 1998; 106 Suppl 2:635-43. [PMID: 9599711 PMCID: PMC1533414 DOI: 10.1289/ehp.98106635] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Some animal studies and some human studies suggest that exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) may be associated with adverse effects on the cardiovascular system. As part of a cross-sectional medical study comparing workers employed 15 years earlier in the manufacture of 2,4,5-trichlorophenol or one of its derivatives at two U.S. chemical plants with an unexposed comparison group, we examined the association between TCDD exposure and various cardiovascular outcomes. A total of 281 workers and 260 unexposed referents participated. The workers had substantial exposure to TCDD, as demonstrated by significantly elevated mean serum TCDD concentration of 220 pg/g of lipid, compared with 7 pg/g of lipid among the referents. No significant association was found between TCDD exposure and any of the cardiovascular outcomes including myocardial infarction, angina, cardiac arrhythmias, hypertension, and abnormal peripheral arterial flow. Although our study had sufficient statistical power to detect an elevated risk for cardiac arrhythmias, hypertension, and abnormal peripheral arterial flow, it had low power (approximately 50%) to detect an elevated risk for myocardial infarction and angina. Our review of the literature suggests that our negative findings are consistent with those from other cross-sectional medical studies. Although several mortality studies of TCDD-exposed cohorts found significantly increased risks for cardiovascular disease mortality, similar increased risks were not observed in other mortality studies. The data available do not provide definitive conclusions but indicate that further examination of the association between TCDD exposure and cardiovascular disease should be pursued.
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Affiliation(s)
- G M Calvert
- Division of Surveillance, Hazard Evaluations and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio 45226, USA.
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Abstract
Metalworking fluids (MWFs) are commonly used in a variety of industrial machining and grinding operations. The National Institute for Occupational Safety and Health (NIOSH) estimates that more that one million workers are exposed to MWFs. NIOSH conducted a comprehensive and systematic review of the epidemiologic studies that examined the association between MWF exposure and cancer. Substantial evidence was found for an increased risk of cancer at several sites (larynx, rectum, pancreas, skin, scrotum, and bladder) associated with at least some MWFs used prior to the mid-1970s. This paper provides the evidence pertaining to cancer at these sites. Cancer at those sites found to have more limited or less consistent evidence for an association with MWF (stomach, esophagus, lung, prostate, brain, colon, and hematopoietic system) will not be discussed in this paper but are discussed in the recent NIOSH Criteria for a Recommended Standard-Occupational Exposure to MWFs. Because the changes in MWF composition that have occurred over the last several decades may not be sufficient to eliminate the cancer risks associated with MWF exposure, reductions in airborne MWF exposures are recommended.
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Affiliation(s)
- G M Calvert
- Division of Surveillance, Hazard Evaluations and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio 45226, USA.
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Calvert GM, Mueller CA, O'Neill VL, Fajen JM, Briggle T, Fleming LE. Agreement between company-recorded and self-reported estimates of duration and frequency of occupational fumigant exposure. Am J Ind Med 1997; 32:364-8. [PMID: 9258390 DOI: 10.1002/(sici)1097-0274(199710)32:4<364::aid-ajim7>3.0.co;2-u] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Investigators must often rely on self-reported work history information collected with questionnaires. However, little is known about the agreement between self-reported estimates of exposure and records kept by companies. As part of a cross-sectional medical study of structural fumigation workers, self-reported work history information was collected on both duration and frequency of exposure using an interviewer-administered questionnaire. All company records available on these workers were also collected. Only 15 of 81 structural fumigation companies identified by study participants as current or past structural fumigation employers had records suitable for comparison. These 15 companies employed 32 of the workers who participated in the cross-sectional medical study. The exposure information provided by the 32 workers was compared to information obtained from company records. By examining the agreement between these two data sources, potential limitations were identified in both the self-reported and company-recorded exposure data. By recognizing these limitations in the exposure data, we identified the most appropriate exposure measures to be used in subsequent data analyses. This exercise also demonstrated the difficulties in undertaking these exposure comparisons in an industry consisting of many small, independent companies. Similar difficulties with assessing exposures may be experienced by investigators studying other service industries consisting of many small, independent companies (e.g., dry cleaning, auto repair).
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Affiliation(s)
- G M Calvert
- Division of Surveillance, Hazard Evaluations and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH 45226, USA.
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Calvert GM, Steenland K, Palu S. End-stage renal disease among silica-exposed gold miners. A new method for assessing incidence among epidemiologic cohorts. JAMA 1997; 277:1219-23. [PMID: 9103346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine the association between silica exposure and end-stage renal disease (ESRD). DESIGN Retrospective cohort study. PARTICIPANTS A cohort of 2412 white male gold miners was studied. Eligible gold miners worked underground for at least 1 year between 1940 and 1965 in a South Dakota gold mine and were alive on January 1,1977. Of primary interest was exposure to silica. METHODS The ESRD Program Management and Medical Information System (PMMIS) was used to identify members of the gold mine cohort who had treated ESRD and to create a US rate file for treated ESRD. The ESRD incidence among the gold miners was compared with that in the US population. RESULTS Based on the 11 cohort members identified with treated ESRD, the risk for ESRD in the cohort was elevated (standardized incidence ratio [SIR], 1.37; 95% confidence interval [CI], 0.68-2.46). The risk was greatest for nonsystemic ESRD (ESRD caused by glomerulonephritis or interstitial nephritis) for which the SIR was 4.22 (95% CI, 1.54-9.19), increasing to 7.70 (95% CI, 1.59-22.48) among workers with 10 or more years of employment underground. CONCLUSIONS To our knowledge this is the first epidemiologic study to examine ESRD incidence in an occupational cohort. This study provides evidence that silica exposure is associated with an increased risk for ESRD, especially ESRD caused by glomerulonephritis. This study also demonstrates the usefulness of the ESRD PMMIS to assess ESRD risk among cohorts exposed to potential nephrotoxins.
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Affiliation(s)
- G M Calvert
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio 45226, USA.
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Calvert GM, Willie KK, Sweeney MH, Fingerhut MA, Halperin WE. Evaluation of serum lipid concentrations among U.S. workers exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin. Arch Environ Health 1996; 51:100-7. [PMID: 8638959 DOI: 10.1080/00039896.1996.9936001] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
2,3,7,8-Tetrachlorodibenzo-p-dioxin alters lipid metabolism in animals; however, evidence for such an effect in humans is conflicting. This conflict was addressed using data from a cross-sectional medical study conducted between 1987 and 1988. The exposed participants had been employed at least 15 y earlier in the manufacture of 2,4,5-trichlorophenol or one of its derivatives at two chemical plants in the United States. A total of 281 workers and 260 unexposed referents participated. Workers had substantial exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin, evidenced by a median serum 2,3,7,8-tetrachlorodibenzo-p-dioxin concentration of 406.6 femtograms/gram of serum (fg/g serum), compared with 36.9 fg/g serum among the referents. A slight association between triglyceride concentration and serum 2,3,7,8-tetrachlorodibenzo-p-dioxin concentration was found (p = .05). Over the range of observed 2,3,7,8-tetrachlorodibenzo-p-dioxin values (i.e., 37-19000 fg/g serum), triglyceride concentration increased only about 0.4 mmol/I. No association was found between an abnormally elevated triglyceride (i.e., > 2.82 mmol/I) concentration and serum 2,3,7,8-tetrachlorodibenzo-p-dioxin concentration. An association was also found between serum 2,3,7,8-tetrachlorodibenzo-p-dioxin concentration and an abnormal high-density lipoprotein concentration (p = .09). in summary, there was evidence of an effect on lipid metabolism in a group of workers with high serum 2,3,7,8-tetrachlorodibenzo-p-dioxin concentrations. The influence of serum 2,3,7,8-tetrachlorodibenzo-p-dioxin on lipid concentrations, however, was small, compared with the influence of other factors.
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Affiliation(s)
- G M Calvert
- Division of Surveillance, Hazard Evaluations and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
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Calvert GM, Sweeney MH, Fingerhut MA, Hornung RW, Halperin WE. Evaluation of porphyria cutanea tarda in U.S. workers exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin. Am J Ind Med 1994; 25:559-71. [PMID: 7912041 DOI: 10.1002/ajim.4700250410] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A cross-sectional medical study was performed to evaluate whether occupational exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)-contaminated substances is associated with porphyria cutanea tarda or porphyrinuria. The exposed participants were employed more than 15 years earlier in the manufacture of sodium trichlorophenol and its derivatives. The referent group consisted of individuals with no occupational exposure to phenoxy herbicides. A total of 281 workers and 260 referents participated. The pattern of urinary porphyrin excretion for each participant was assessed to determine if symptomatic or subclinical porphyria cutanea tarda was present. None of the participants were found to have symptomatic porphyria cutanea tarda. No difference was found between workers and referents in the prevalence of subclinical porphyria cutanea tarda (odds ratio [OR] = 0.93, 95% confidence interval [CI] 0.19, 4.54). There were also no differences in the risk between workers and referents for an out-of-range urinary uroporphyrin or coproporphyrin concentration. In conclusion, this study did not find an elevated risk for porphyria cutanea tarda or porphyrinuria among workers with high serum TCDD levels. Our review of the literature indicates that there is insufficient evidence available to convincingly support or refute an association in humans between TCDD exposure and porphyria cutanea tarda or porphyrinuria.
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Affiliation(s)
- G M Calvert
- Industrywide Studies Branch, National Institute for Occupational Safety and Health, Cincinnati, Ohio 45226
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Calvert GM, Hornung RW, Sweeney MH, Fingerhut MA, Halperin WE. Hepatic and gastrointestinal effects in an occupational cohort exposed to 2,3,7,8-tetrachlorodibenzo-para-dioxin. JAMA 1992; 267:2209-14. [PMID: 1348289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
OBJECTIVE To examine the effect of occupational exposure to substances contaminated with 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD) on the liver and gastrointestinal system. DESIGN A medical survey. PARTICIPANTS The exposed participants were employed at two chemical plants more than 15 years earlier in the manufacture of sodium trichlorophenol and its derivatives. The reference group consisted of individuals with no occupational exposure to phenoxy herbicides and who lived within the communities of the workers. A total of 281 workers and 260 unexposed referents participated in the medical study. MEASUREMENTS AND MAIN RESULTS The workers had substantial exposure to substances contaminated with TCDD, as evidenced by a mean serum TCDD level, lipid adjusted, of 220 pg per gram of lipid compared with a mean of 7 pg per gram of lipid in the referents. Compared with the unexposed reference group, workers had a statistically significantly elevated risk for an out-of-range gamma-glutamyltransferase (GGT) level (odds ratio, 2.27; 95% confidence interval, 1.17 to 4.39 [unadjusted for confounders]). In multivariate analyses run with logistic regression, a statistically significant interaction was found between TCDD exposure and lifetime alcohol consumption, indicating that the elevated risk for an out-of-range GGT was confined to those workers with a history of alcohol consumption and that the risk among the alcohol-consuming workers for an out-of-range GGT increased with increasing TCDD level. No difference was found between workers and referents for any of the other liver and gastrointestinal outcomes of interest. CONCLUSIONS This study found no evidence of an elevated risk for clinical hepatic or gastrointestinal disease in a group of workers with high exposure to TCDD. However, TCDD-exposed workers with a history of sufficient alcohol consumption were found to have a statistically significantly elevated risk for an out-of-range GGT compared with referents.
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Affiliation(s)
- G M Calvert
- Division of Surveillance, Hazard Evaluations, and Field Studies, NIOSH, Cincinnati, OH 45226
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Calvert GM, Sweeney MH, Morris JA, Fingerhut MA, Hornung RW, Halperin WE. Evaluation of chronic bronchitis, chronic obstructive pulmonary disease, and ventilatory function among workers exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin. Am Rev Respir Dis 1991; 144:1302-6. [PMID: 1741543 DOI: 10.1164/ajrccm/144.6.1302] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) is produced as an undesirable contaminant in the manufacture of 2,4,5-trichlorophenol (TCP) and its derivatives. There is considerable concern about the health effects that may be associated with exposure to TCDD-contaminated substances. A cross-sectional medical study that included a comprehensive medical history, medical examination, and measurement of pulmonary function was conducted on workers employed more than 15 yr earlier in the manufacture of NaTCP and its derivatives at two chemical plants. The workers had substantial exposure to substances contaminated with TCDD, as evidenced by a mean serum TCDD level, lipid adjusted, of 200 ppt compared with a mean of 7 ppt in the unexposed reference group. The comparison group consisted of individuals with no occupational exposure to phenoxy herbicides who lived in the same communities as the workers. A total of 281 workers and 260 unexposed referents participated in the medical examination. Logistic and linear regression analyses, which contained categorical and continuous measures of TCDD exposure, were performed to control for important confounders, including cigarette and alcohol consumption. No difference was found between workers and referents in the risk for chronic bronchitis or COPD. Analysis of the ventilatory function data revealed no association between history of exposure to substances contaminated with TCDD and the forced expiratory volume at one second (FEV1), forced vital capacity (FVC), or the ratio of FEV1 to FVC (FEV1/FVC%).
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Affiliation(s)
- G M Calvert
- Division of Surveillance, Hazard Evaluations and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio 45226
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Abstract
Ciguatera fish poisoning is the most common fish poisoning in the United States. Symptoms involve the gastrointestinal, cardiovascular and neurological systems. No known treatment exists. We explore the therapeutic effect of amitriptyline in two patients and nifedipine in one patient. Amitriptyline demonstrated resolution of most symptoms except for heat/cold reversal in one patient and heat/cold reversal, pruritus and headache in the second patient. We then used nifedipine in the second patient and noted only the resolution of his headaches. We recommend further study of these agents for the treatment of ciguatera fish poisoning.
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Affiliation(s)
- G M Calvert
- Department of Medicine, Cook County Hospital, University of Illinois at Chicago
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