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Carnide N, Feng G, Song C, Demers PA, MacLeod JS, Sritharan J. Occupational patterns of opioid-related harms comparing a cohort of formerly injured workers to the general population in Ontario, Canada. Can J Public Health 2024:10.17269/s41997-024-00882-w. [PMID: 38658439 DOI: 10.17269/s41997-024-00882-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 03/19/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES The role of work-related injuries as a risk factor for opioid-related harms has been hypothesized, but little data exist to support this relationship. The objective was to compare the incidence of opioid-related harms among a cohort of formerly injured workers to the general population in Ontario, Canada. METHODS Workers' compensation claimants (1983-2019) were linked to emergency department (ED) and hospitalization records (2006-2020). Incident rates of opioid-related poisonings and mental and behavioural disorders were estimated among 1.7 million workers and in the general population. Standardized incidence ratios (SIRs) and 95% confidence intervals (CI) were calculated, adjusting for age, sex, year, and region. RESULTS Compared to the general population, opioid-related poisonings among this group of formerly injured workers were elevated in both ED (SIR = 2.41, 95% CI = 2.37-2.45) and hospitalization records (SIR = 1.54, 95% CI = 1.50-1.59). Opioid-related mental and behavioural disorders were also elevated compared to the general population (ED visits: SIR = 1.86, 95% CI = 1.83-1.89; hospitalizations: SIR = 1.42, 95% CI = 1.38-1.47). Most occupations and industries had higher risks of harm compared to the general population, particularly construction, materials handling, processing (mineral, metal, chemical), and machining and related occupations. Teaching occupations displayed decreased risks of harm. CONCLUSION Findings support the hypothesis that work-related injuries have a role as a preventable risk factor for opioid-related harms. Strategies aimed at primary prevention of occupational injuries and secondary prevention of work disability and long-term opioid use are warranted.
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Affiliation(s)
- Nancy Carnide
- Institute for Work & Health, Toronto, Ontario, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Gregory Feng
- Institute for Work & Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Chaojie Song
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
| | - Paul A Demers
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
| | - Jill S MacLeod
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
| | - Jeavana Sritharan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
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Sritharan J, Arrandale VH, Kirkham TL, Dakouo M, MacLeod JS, Demers PA. Risk of chronic obstructive pulmonary disease in a large cohort of Ontario, Canada workers. Sci Rep 2024; 14:8756. [PMID: 38627517 PMCID: PMC11021393 DOI: 10.1038/s41598-024-59429-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/10/2024] [Indexed: 04/19/2024] Open
Abstract
Although several occupational exposures have been linked to the risk of COPD; limited data exists on sex-specific differences. This study aimed to identify at-risk occupations and sex differences for COPD risk. Cases were identified in a large surveillance system established through the linkage of former compensation claimants' data (non-COPD claims) to physician visits, ambulatory care data, and hospital inpatient data (1983-2020). Cox proportional hazard models were used to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CI) for occupation groups (occupation at time of claim), stratified by sex. HRs were indirectly adjusted for cigarette smoking using another population dataset. A total of 29,445 male and 14,693 female incident cases of COPD were identified. Increased risks were observed in both sexes for construction (HRmale 1.15, 95% CI 1.12-1.19; HRfemale 1.54, 95% CI 1.29-1.83) transport/equipment operating (HRmale 1.32, 95% CI 1.28-1.37; HRfemale 1.53, 95% CI 1.40-1.68) farming (HRmale 1.23, 95% CI 1.15-1.32; HRfemale 1.19, 95% CI 1.04-1.37) and janitors/cleaners (HRmale 1.31, 95% CI 1.24-1.37; HRfemale 1.40, 95% CI 1.31-1.49). Increased risks were observed for females employed as chefs and cooks (HR 1.44, 95% CI 1.31-1.58), bartenders (HR 1.38, 95% CI 1.05-1.81), and those working in food/beverage preparation (HR 1.34, 95% CI 1.24-1.45) among other occupations. This study demonstrates elevated risk of COPD among both male and female workers potentially exposed to vapours, gases, dusts, and fumes, highlighting the need for occupational surveillance of COPD.
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Affiliation(s)
- Jeavana Sritharan
- Occupational Cancer Research Centre, Ontario Health, 525 University Avenue, 3rd Floor, Toronto, ON, M5G 1X3, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Victoria H Arrandale
- Occupational Cancer Research Centre, Ontario Health, 525 University Avenue, 3rd Floor, Toronto, ON, M5G 1X3, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Tracy L Kirkham
- Occupational Cancer Research Centre, Ontario Health, 525 University Avenue, 3rd Floor, Toronto, ON, M5G 1X3, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Mamadou Dakouo
- Occupational Cancer Research Centre, Ontario Health, 525 University Avenue, 3rd Floor, Toronto, ON, M5G 1X3, Canada
| | - Jill S MacLeod
- Occupational Cancer Research Centre, Ontario Health, 525 University Avenue, 3rd Floor, Toronto, ON, M5G 1X3, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre, Ontario Health, 525 University Avenue, 3rd Floor, Toronto, ON, M5G 1X3, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Asamoah-Boaheng M, Grunau B, Karim ME, Kirkham TL, Demers PA, MacDonald C, Goldfarb DM. The Association of Post-COVID-19-Related Symptoms and Preceding Severe Acute Respiratory Syndrome Coronavirus 2 Infection Among Fully Vaccinated Paramedics in Canada. J Infect Dis 2024; 229:1019-1025. [PMID: 37930308 DOI: 10.1093/infdis/jiad475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 10/18/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023] Open
Abstract
This study investigated the association between previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and risk of symptoms associated with post-COVID conditions among fully vaccinated paramedics in Canada. We included vaccinated paramedics who provided blood sample and questionnaire data on the same date during the study period. We examined the presence of symptoms associated with post-COVID conditions and depression severity against prior SARS-CoV-2 infection categories. Compared to the "no previous SARS-CoV-2 infection" group, there was no detected association between known prior SARS-CoV-2 infection (odds ratio [OR], 1.42 [95% confidence interval {CI}, 0.96-2.09]), nor unknown prior SARS-CoV-2 infection (OR, 0.54 [95% CI, 0.29-1.00]), and the presence of symptoms associated with post-COVID conditions.
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Affiliation(s)
| | - Brian Grunau
- Department of Emergency Medicine, University of British Columbia, Vancouver
| | | | - Tracy L Kirkham
- Dalla Lana School of Public Health, University of Toronto, Ontario
| | - Paul A Demers
- Dalla Lana School of Public Health, University of Toronto, Ontario
| | - Chris MacDonald
- Dalla Lana School of Public Health, University of Toronto, Ontario
| | - David M Goldfarb
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
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Ohlander J, Kromhout H, Vermeulen R, Portengen L, Kendzia B, Savary B, Cavallo D, Cattaneo A, Migliori E, Richiardi L, Plato N, Wichmann HE, Karrasch S, Consonni D, Landi MT, Caporaso NE, Siemiatycki J, Gustavsson P, Jöckel KH, Ahrens W, Pohlabeln H, Fernández-Tardón G, Zaridze D, Jolanta Lissowska JL, Beata Swiatkowska BS, John K Field JKF, McLaughlin JR, Demers PA, Pandics T, Forastiere F, Fabianova E, Schejbalova M, Foretova L, Janout V, Mates D, Barul C, Brüning T, Behrens T, Straif K, Schüz J, Olsson A, Peters S. Respirable crystalline silica and lung cancer in community-based studies: impact of job-exposure matrix specifications on exposure-response relationships. Scand J Work Environ Health 2024; 50:178-186. [PMID: 38264956 PMCID: PMC11064806 DOI: 10.5271/sjweh.4140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVES The quantitative job-exposure matrix SYN-JEM consists of various dimensions: job-specific estimates, region-specific estimates, and prior expert ratings of jobs by the semi-quantitative DOM-JEM. We analyzed the effect of different JEM dimensions on the exposure-response relationships between occupational silica exposure and lung cancer risk to investigate how these variations influence estimates of exposure by a quantitative JEM and associated health endpoints. METHODS Using SYN-JEM, and alternative SYN-JEM specifications with varying dimensions included, cumulative silica exposure estimates were assigned to 16 901 lung cancer cases and 20 965 controls pooled from 14 international community-based case-control studies. Exposure-response relationships based on SYN-JEM and alternative SYN-JEM specifications were analyzed using regression analyses (by quartiles and log-transformed continuous silica exposure) and generalized additive models (GAM), adjusted for age, sex, study, cigarette pack-years, time since quitting smoking, and ever employment in occupations with established lung cancer risk. RESULTS SYN-JEM and alternative specifications generated overall elevated and similar lung cancer odds ratios ranging from 1.13 (1st quartile) to 1.50 (4th quartile). In the categorical and log-linear analyses SYN-JEM with all dimensions included yielded the best model fit, and exclusion of job-specific estimates from SYN-JEM yielded the poorest model fit. Additionally, GAM showed the poorest model fit when excluding job-specific estimates. CONCLUSION The established exposure-response relationship between occupational silica exposure and lung cancer was marginally influenced by varying the dimensions of SYN-JEM. Optimized modelling of exposure-response relationships will be obtained when incorporating all relevant dimensions, namely prior rating, job, time, and region. Quantitative job-specific estimates appeared to be the most prominent dimension for this general population JEM.
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Affiliation(s)
- Johan Ohlander
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
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5
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Xu M, Ho V, Lavoué J, Olsson A, Schüz J, Richardson L, Parent ME, McLaughlin JR, Demers PA, Guénel P, Radoi L, Wichmann HE, Ahrens W, Jöckel KH, Consonni D, Landi MT, Richiardi L, Simonato L, 't' Mannetje A, Świątkowska B, Field JK, Pearce N, Siemiatycki J. Prevalent occupational exposures and risk of lung cancer among women: Results from the application of the Canadian Job-Exposure Matrix (CANJEM) to a combined set of ten case-control studies. Am J Ind Med 2024; 67:200-213. [PMID: 38192156 DOI: 10.1002/ajim.23562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/19/2023] [Accepted: 12/22/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Worldwide, lung cancer is the second leading cause of cancer death in women. The present study explored associations between occupational exposures that are prevalent among women, and lung cancer. METHODS Data from 10 case-control studies of lung cancer from Europe, Canada, and New Zealand conducted between 1988 and 2008 were combined. Lifetime occupational history and information on nonoccupational factors including smoking were available for 3040 incident lung cancer cases and 4187 controls. We linked each reported job to the Canadian Job-Exposure Matrix (CANJEM), which provided estimates of probability, intensity, and frequency of exposure to each selected agent in each job. For this analysis, we selected 15 agents (cleaning agents, biocides, cotton dust, synthetic fibers, formaldehyde, cooking fumes, organic solvents, cellulose, polycyclic aromatic hydrocarbons from petroleum, ammonia, metallic dust, alkanes C18+, iron compounds, isopropanol, and calcium carbonate) that had lifetime exposure prevalence of at least 5% in the combined study population. For each agent, we estimated lung cancer risk in each study center for ever-exposure, by duration of exposure, and by cumulative exposure, using separate logistic regression models adjusted for smoking and other covariates. We then estimated the meta-odds ratios using random-effects meta-analysis. RESULTS AND CONCLUSIONS None of the agents assessed showed consistent and compelling associations with lung cancer among women. The following agents showed elevated odds ratio in some analyses: metallic dust, iron compounds, isopropanol, and organic solvents. Future research into occupational lung cancer risk factors among women should prioritize these agents.
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Affiliation(s)
- Mengting Xu
- University of Montreal Hospital Research Center (CRCHUM), Montreal, Canada
| | - Vikki Ho
- University of Montreal Hospital Research Center (CRCHUM), Montreal, Canada
| | - Jérôme Lavoué
- University of Montreal Hospital Research Center (CRCHUM), Montreal, Canada
| | - Ann Olsson
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Joachim Schüz
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Lesley Richardson
- University of Montreal Hospital Research Center (CRCHUM), Montreal, Canada
| | - Marie-Elise Parent
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique, Laval, Quebec, Canada
| | - John R McLaughlin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre, Ontario Health, Toronto, Canada
| | - Pascal Guénel
- Center for Research in Epidemiology and Population Health (CESP), Team Exposome and Heredity, U1018 Inserm, Institut Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Loredana Radoi
- Center for Research in Epidemiology and Population Health (CESP), Team Exposome and Heredity, U1018 Inserm, Institut Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Heinz-Erich Wichmann
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Lorenzo Richiardi
- Department of Medical Sciences, Cancer Epidemiology Unit, University of Turin, Turin, Italy
| | - Lorenzo Simonato
- Department of Cardiovascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Andrea 't' Mannetje
- Research Centre for Hauora and Health, Massey University, Wellington, New Zealand
| | | | - John K Field
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, The University of Liverpool, Liverpool, UK
| | - Neil Pearce
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Jack Siemiatycki
- University of Montreal Hospital Research Center (CRCHUM), Montreal, Canada
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6
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Kreuzer M, Sommer M, Deffner V, Bertke S, Demers PA, Kelly-Reif K, Laurier D, Rage E, Richardson DB, Samet JM, Schubauer-Berigan MK, Tomasek L, Wiggins C, Zablotska LB, Fenske N. Lifetime excess absolute risk for lung cancer due to exposure to radon: results of the pooled uranium miners cohort study PUMA. Radiat Environ Biophys 2024; 63:7-16. [PMID: 38172372 PMCID: PMC10920468 DOI: 10.1007/s00411-023-01049-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/09/2023] [Indexed: 01/05/2024]
Abstract
The Pooled Uranium Miners Analysis (PUMA) study is the largest uranium miners cohort with 119,709 miners, 4.3 million person-years at risk and 7754 lung cancer deaths. Excess relative rate (ERR) estimates for lung cancer mortality per unit of cumulative exposure to radon progeny in working level months (WLM) based on the PUMA study have been reported. The ERR/WLM was modified by attained age, time since exposure or age at exposure, and exposure rate. This pattern was found for the full PUMA cohort and the 1960 + sub-cohort, i.e., miners hired in 1960 or later with chronic low radon exposures and exposure rates. The aim of the present paper is to calculate the lifetime excess absolute risk (LEAR) of lung cancer mortality per WLM using the PUMA risk models, as well as risk models derived in previously published smaller uranium miner studies, some of which are included in PUMA. The same methods were applied for all risk models, i.e., relative risk projection up to <95 years of age, an exposure scenario of 2 WLM per year from age 18-64 years, and baseline mortality rates representing a mixed Euro-American-Asian population. Depending upon the choice of model, the estimated LEAR per WLM are 5.38 × 10-4 or 5.57 × 10-4 in the full PUMA cohort and 7.50 × 10-4 or 7.66 × 10-4 in the PUMA 1960 + sub-cohort, respectively. The LEAR per WLM estimates derived from risk models reported for previously published uranium miners studies range from 2.5 × 10-4 to 9.2 × 10-4. PUMA strengthens knowledge on the radon-related lung cancer LEAR, a useful way to translate models for policy purposes.
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Affiliation(s)
- M Kreuzer
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany.
| | - M Sommer
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
| | - V Deffner
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
| | - S Bertke
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - P A Demers
- Occupational Cancer Research Centre, Toronto, Canada
| | - K Kelly-Reif
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - D Laurier
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - E Rage
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | | | - J M Samet
- Colorado School of Public Health, Aurora, CO, USA
| | | | - L Tomasek
- National Radiation Protection Institute, Prague, Czech Republic
| | - C Wiggins
- University of New Mexico, Albuquerque, NM, USA
- New Mexico Tumor Registry, Albuquerque, NM, USA
| | | | - N Fenske
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
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7
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Kraut A, Rydz E, Walld R, Demers PA, Peters CE. Carpal tunnel syndrome among Manitoba workers: Results from the Manitoba Occupational Disease Surveillance System. Am J Ind Med 2024; 67:243-260. [PMID: 38265110 DOI: 10.1002/ajim.23566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is associated with occupational high-force repetitive tasks and vibration. This project examines the relationship between CTS and work to: (1) identify jobs and industries with increased CTS risk; (2) explore whether there is a sex difference in the risk of CTS after controlling for occupation; and (3) determine whether any observed relationships persist after excluding Workers Compensation Board (WCB) accepted time-loss CTS claims. METHODS We linked 95.5% of time-loss WCB claims from 2006 to 2019 to provincial administrative health data. The cohort included 143,001 unique person-occupation combinations. CTS cases were defined as at least two medical claims for (ICD-9 354) within a 12-month period or a surgical claim for CTS from 2 years before the WCB claim to 3 years after. WCB accepted CTS time-loss claims not identified by the medical claims were also included. RESULTS A total of 4302 individuals (3.0%) met the CTS definition. Analysis revealed that the hazard ratios (HRs) of CTS vary considerably with occupation. Sex-based differences in CTS risks were observed, both in low- and high-risk occupations. In many occupations with increased HR, the HR remained elevated after excluding accepted time-loss WCB cases. CONCLUSIONS The risk of developing CTS varied with occupation. Job titles with ergonomic risk factors had higher risks than those with lower exposures. This finding remained after eliminating time-loss compensated WCB cases, suggesting that all cases of CTS in high risk jobs are not identified in WCB statistics. Female workers in some job titles had excess CTS cases compared to male workers within the same job title.
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Affiliation(s)
- Allen Kraut
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth Rydz
- CAREX Canada, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Randy Walld
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Cheryl E Peters
- CAREX Canada, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- BC Cancer, Vancouver, British Columbia, Canada
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8
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Wan W, Peters S, Portengen L, Olsson A, Schüz J, Ahrens W, Schejbalova M, Boffetta P, Behrens T, Brüning T, Kendzia B, Consonni D, Demers PA, Fabiánová E, Fernández-Tardón G, Field JK, Forastiere F, Foretova L, Guénel P, Gustavsson P, Jöckel KH, Karrasch S, Landi MT, Lissowska J, Barul C, Mates D, McLaughlin JR, Merletti F, Migliore E, Richiardi L, Pándics T, Pohlabeln H, Siemiatycki J, Świątkowska B, Wichmann HE, Zaridze D, Ge C, Straif K, Kromhout H, Vermeulen R. Occupational Benzene Exposure and Lung Cancer Risk: A Pooled Analysis of 14 Case-Control Studies. Am J Respir Crit Care Med 2024; 209:185-196. [PMID: 37812782 PMCID: PMC10806413 DOI: 10.1164/rccm.202306-0942oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/06/2023] [Indexed: 10/11/2023] Open
Abstract
Rationale: Benzene has been classified as carcinogenic to humans, but there is limited evidence linking benzene exposure to lung cancer. Objectives: We aimed to examine the relationship between occupational benzene exposure and lung cancer. Methods: Subjects from 14 case-control studies across Europe and Canada were pooled. We used a quantitative job-exposure matrix to estimate benzene exposure. Logistic regression models assessed lung cancer risk across different exposure indices. We adjusted for smoking and five main occupational lung carcinogens and stratified analyses by smoking status and lung cancer subtypes. Measurements and Main Results: Analyses included 28,048 subjects (12,329 cases, 15,719 control subjects). Lung cancer odds ratios ranged from 1.12 (95% confidence interval, 1.03-1.22) to 1.32 (95% confidence interval, 1.18-1.48) (Ptrend = 0.002) for groups with the lowest and highest cumulative occupational exposures, respectively, compared with unexposed subjects. We observed an increasing trend of lung cancer with longer duration of exposure (Ptrend < 0.001) and a decreasing trend with longer time since last exposure (Ptrend = 0.02). These effects were seen for all lung cancer subtypes, regardless of smoking status, and were not influenced by specific occupational groups, exposures, or studies. Conclusions: We found consistent and robust associations between different dimensions of occupational benzene exposure and lung cancer after adjusting for smoking and main occupational lung carcinogens. These associations were observed across different subgroups, including nonsmokers. Our findings support the hypothesis that occupational benzene exposure increases the risk of developing lung cancer. Consequently, there is a need to revisit published epidemiological and molecular data on the pulmonary carcinogenicity of benzene.
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Affiliation(s)
- Wenxin Wan
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Susan Peters
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Lützen Portengen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Ann Olsson
- International Agency for Research on Cancer/World Health Organization, Lyon, France
| | - Joachim Schüz
- International Agency for Research on Cancer/World Health Organization, Lyon, France
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
- Faculty of Mathematics and Computer Science, Institute of Statistics, University of Bremen, Bremen, Germany
| | - Miriam Schejbalova
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University, Prague, Czechia
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Thomas Behrens
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University, Bochum, Germany
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University, Bochum, Germany
| | - Benjamin Kendzia
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University, Bochum, Germany
| | - Dario Consonni
- Epidemiology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paul A. Demers
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
| | - Eleonóra Fabiánová
- Regional Authority of Public Health, Banská Bystrica, Slovakia
- Faculty of Health, Catholic University, Ružomberok, Slovakia
| | - Guillermo Fernández-Tardón
- Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain
- Health Research Institute of Asturias, University Institute of Oncology of Asturias – Cajastur Social Program, University of Oviedo, Oviedo, Spain
| | - John K. Field
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
| | | | | | - Pascal Guénel
- Center for Research in Epidemiology and Population Health, Team Exposome and Heredity, U1018 Institut national de la santé et de la recherche médicale, University of Paris-Saclay, Villejuif, France
| | - Per Gustavsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany
| | - Stefan Karrasch
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, and
- Comprehensive Pneumology Center Munich, Member of the German Center for Lung Research, Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München – German Research Center for Environmental Health, Neuherberg, Germany
| | - Maria Teresa Landi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Jolanta Lissowska
- Epidemiology Unit, Department of Cancer Epidemiology and Prevention, M. Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Christine Barul
- Université Rennes, Institut national de la santé et de la recherche médicale, École des hautes études en santé publique, Institut de recherche en santé, environnement et travail, UMR_S 1085, Pointe-à-Pitre, France
| | - Dana Mates
- National Institute of Public Health, Bucharest, Romania
| | - John R. McLaughlin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Franco Merletti
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Enrica Migliore
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Hermann Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Jack Siemiatycki
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Beata Świątkowska
- Department of Environmental Epidemiology, The Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Heinz-Erich Wichmann
- Institut für Medizinische Informatik Biometrie Epidemiologie, Ludwig-Maximilians-Universität München, Munich, Germany
- Comprehensive Pneumology Center Munich, Member of the German Center for Lung Research, Munich, Germany
| | - David Zaridze
- Department of Cancer Epidemiology and Prevention, N.N. Blokhin National Research Center of Oncology, Moscow, Russia
| | - Calvin Ge
- Nederlandse Organisatie voor Toegepast Natuurwetenschappelijk Onderzoek, Utrecht, the Netherlands
| | - Kurt Straif
- ISGlobal, Barcelona, Spain; and
- Boston College, Boston, Massachusetts
| | - Hans Kromhout
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
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9
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Olsson A, Bouaoun L, Schüz J, Vermeulen R, Behrens T, Ge C, Kromhout H, Siemiatycki J, Gustavsson P, Boffetta P, Kendzia B, Radoi L, Barul C, Karrasch S, Wichmann HE, Consonni D, Landi MT, Caporaso NE, Merletti F, Migliore E, Richiardi L, Jöckel KH, Ahrens W, Pohlabeln H, Fernández-Tardón G, Zaridze D, Field JK, Lissowska J, Świątkowska B, McLaughlin JR, Demers PA, Schejbalova M, Foretova L, Janout V, Pándics T, Fabianova E, Mates D, Forastiere F, Straif K, Brüning T, Vlaanderen J, Peters S. Lung Cancer Risks Associated with Occupational Exposure to Pairs of Five Lung Carcinogens: Results from a Pooled Analysis of Case-Control Studies (SYNERGY). Environ Health Perspect 2024; 132:17005. [PMID: 38236172 PMCID: PMC10795675 DOI: 10.1289/ehp13380] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND While much research has been done to identify individual workplace lung carcinogens, little is known about joint effects on risk when workers are exposed to multiple agents. OBJECTIVES We investigated the pairwise joint effects of occupational exposures to asbestos, respirable crystalline silica, metals (i.e., nickel, chromium-VI), and polycyclic aromatic hydrocarbons (PAH) on lung cancer risk, overall and by major histologic subtype, while accounting for cigarette smoking. METHODS In the international 14-center SYNERGY project, occupational exposures were assigned to 16,901 lung cancer cases and 20,965 control subjects using a quantitative job-exposure matrix (SYN-JEM). Odds ratios (ORs) and 95% confidence intervals (CIs) were computed for ever vs. never exposure using logistic regression models stratified by sex and adjusted for study center, age, and smoking habits. Joint effects among pairs of agents were assessed on multiplicative and additive scales, the latter by calculating the relative excess risk due to interaction (RERI). RESULTS All pairwise joint effects of lung carcinogens in men were associated with an increased risk of lung cancer. However, asbestos/metals and metals/PAH resulted in less than additive effects; while the chromium-VI/silica pair showed marginally synergistic effect in relation to adenocarcinoma (RERI: 0.24; CI: 0.02, 0.46; p = 0.05). In women, several pairwise joint effects were observed for small cell lung cancer including exposure to PAH/silica (OR = 5.12; CI: 1.77, 8.48), and to asbestos/silica (OR = 4.32; CI: 1.35, 7.29), where exposure to PAH/silica resulted in a synergistic effect (RERI: 3.45; CI: 0.10, 6.8). DISCUSSION Small or no deviation from additive or multiplicative effects was observed, but co-exposure to the selected lung carcinogens resulted generally in higher risk than exposure to individual agents, highlighting the importance to reduce and control exposure to carcinogens in workplaces and the general environment. https://doi.org/10.1289/EHP13380.
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Affiliation(s)
- Ann Olsson
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Liacine Bouaoun
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Joachim Schüz
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Thomas Behrens
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University (IPA), Bochum, Germany
| | - Calvin Ge
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Hans Kromhout
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jack Siemiatycki
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Canada
| | - Per Gustavsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Benjamin Kendzia
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University (IPA), Bochum, Germany
| | - Loredana Radoi
- Center for Research in Epidemiology and Population Health (CESP), Team Exposome and Heredity, U1018 Inserm, University Paris-Saclay, University Paris Cité, Villejuif, France
| | - Christine Barul
- University Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) -UMR_S 1085, Pointe-à-Pitre, France
| | - Stefan Karrasch
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health, Neuherberg, Germany
| | - Heinz-Erich Wichmann
- Institute of Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health, Neuherberg, Germany
- Institut für Medizinische Informatik Biometrie Epidemiologie, Ludwig Maximilians University, Munich, Germany
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Teresa Landi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Neil E. Caporaso
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Franco Merletti
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Enrica Migliore
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Essen, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Faculty of Mathematics and Computer Science, Institute of Statistics, University of Bremen, Bremen, Germany
| | - Hermann Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | | | - David Zaridze
- Department of Cancer Epidemiology and Prevention, N.N. Blokhin National Research Centre of Oncology, Moscow, Russia
| | - John K. Field
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Jolanta Lissowska
- Epidemiology Unit, Department of Cancer Epidemiology and Prevention, M. Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Beata Świątkowska
- Department of Environmental Epidemiology, The Nofer Institute of Occupational Medicine, Lodz, Poland
| | - John R. McLaughlin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Paul A. Demers
- Occupational Cancer Research Centre, Ontario Health, Toronto, Canada
| | - Miriam Schejbalova
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Vladimir Janout
- Faculty of Health Sciences, Palacky University, Olomouc, Czech Republic
| | | | - Eleonora Fabianova
- Regional Authority of Public Health, Banská Bystrica, Slovakia
- Faculty of Health, Catholic University, Ružomberok, Slovakia
| | - Dana Mates
- National Institute of Public Health, Bucharest, Romania
| | | | - Kurt Straif
- ISGlobal, Barcelona, Spain
- Boston College, Chestnut Hill, Massachusetts, USA
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University (IPA), Bochum, Germany
| | - Jelle Vlaanderen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Susan Peters
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
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10
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Sritharan J, Demers PA, Eros FR, Berriault C, Dakouo M, Kirkham TL. Cancer Risks among Emergency Medical Services Workers in Ontario, Canada. PREHOSP EMERG CARE 2023; 28:620-625. [PMID: 37967276 DOI: 10.1080/10903127.2023.2283079] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVES Emergency medical services workers, such as paramedics, provide important emergency care and may be exposed to potential carcinogens while working. Few studies have examined the risk of cancer among paramedics demonstrating an important knowledge gap in existing literature. This study aimed to investigate cancer risks among paramedics in a large cohort of Ontario workers. METHODS Paramedics were identified in the Occupational Disease Surveillance System (ODSS) from 1996 to 2019. The ODSS was established by linking lost-time worker's compensation claims to administrative health data, including the Ontario Cancer Registry to identify incident cases of cancer. Cox-proportional hazard models were used to calculate age and sex-adjusted hazard ratios and 95% confidence intervals to estimate the risk of cancer among paramedics compared to all other workers in the ODSS. RESULTS A total of 7240 paramedics were identified, with just over half of the paramedics identifying as male similar to the overall ODSS cohort. Paramedics had a statistically significant elevated risk of any cancer (HR 1.19, 95% CI 1.06-1.34), and elevated risks for melanoma (HR 2.18, 95% CI 1.46-3.26) and prostate cancer (HR 1.73, 95% CI 1.34-2.22). Paramedics had a statistically significant reduced risk for lung cancer (HR 0.48, 95% CI 0.28-0.83). Findings were similar to cancer risks identified in firefighters and police in the same cohort. CONCLUSIONS This study contributes valuable findings to understanding cancer risks among paramedics and further supports the existing evidence on the increased risk of cancer among emergency medical services workers. We have observed some similar results for firefighters and police, which may be explained by similar exposures, including vehicle exhaust, shiftwork, and intermittent solar radiation. This can lead to a better understanding of carcinogens and other exposures among paramedics and inform cancer prevention strategies.
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Affiliation(s)
- Jeavana Sritharan
- Occupational Cancer Research Centre, Ontario Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre, Ontario Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Fanni R Eros
- Occupational Cancer Research Centre, Ontario Health, Toronto, Canada
| | - Colin Berriault
- Occupational Cancer Research Centre, Ontario Health, Toronto, Canada
| | - Mamadou Dakouo
- Occupational Cancer Research Centre, Ontario Health, Toronto, Canada
| | - Tracy L Kirkham
- Occupational Cancer Research Centre, Ontario Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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11
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Kelly-Reif K, Bertke SJ, Rage E, Demers PA, Fenske N, Deffner V, Kreuzer M, Samet J, Schubauer-Berigan MK, Tomasek L, Zablotska LB, Wiggins C, Laurier D, Richardson DB. Radon and lung cancer in the pooled uranium miners analysis (PUMA): highly exposed early miners and all miners. Occup Environ Med 2023; 80:385-391. [PMID: 37164624 PMCID: PMC10369304 DOI: 10.1136/oemed-2022-108532] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 04/20/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Radon is a ubiquitous occupational and environmental lung carcinogen. We aim to quantify the association between radon progeny and lung cancer mortality in the largest and most up-to-date pooled study of uranium miners. METHODS The pooled uranium miners analysis combines 7 cohorts of male uranium miners with 7754 lung cancer deaths and 4.3 million person-years of follow-up. Vital status and lung cancer deaths were ascertained between 1946 and 2014. The association between cumulative radon exposure in working level months (WLM) and lung cancer was modelled as the excess relative rate (ERR) per 100 WLM using Poisson regression; variation in the association by temporal and exposure factors was examined. We also examined analyses restricted to miners first hired before 1960 and with <100 WLM cumulative exposure. RESULTS In a model that allows for variation by attained age, time since exposure and annual exposure rate, the ERR/100 WLM was 4.68 (95% CI 2.88 to 6.96) among miners who were less than 55 years of age and were exposed in the prior 5 to <15 years at annual exposure rates of <0.5 WL. This association decreased with older attained age, longer time since exposure and higher annual exposure rate. In analyses restricted to men first hired before 1960, we observed similar patterns of association but a slightly lower estimate of the ERR/100 WLM. CONCLUSIONS This new large, pooled study confirms and supports a linear exposure-response relationship between cumulative radon exposure and lung cancer mortality which is jointly modified by temporal and exposure factors.
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Affiliation(s)
- Kaitlin Kelly-Reif
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Stephen J Bertke
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Estelle Rage
- Institute for Radiological Protection and Nuclear Safety, Fontenay-aux-Roses, France
| | - Paul A Demers
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nora Fenske
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
| | - Veronika Deffner
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
| | - Michaela Kreuzer
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
| | | | - Mary K Schubauer-Berigan
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Lydia B Zablotska
- Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Charles Wiggins
- University of New Mexico, Albuquerque, New Mexico, USA
- New Mexico Tumor Registry, Albuquerque, Mexico, USA
| | - Dominique Laurier
- Institute for Radiological Protection and Nuclear Safety, Fontenay-aux-Roses, France
| | - David B Richardson
- Department of Environmental and Occupational Health, University of California, Irvine, Program in Public Health, Irvine, California, USA
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12
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DeBono NL, Daniels RD, Beane Freeman LE, Graber JM, Hansen J, Teras LR, Driscoll T, Kjaerheim K, Demers PA, Glass DC, Kriebel D, Kirkham TL, Wedekind R, Filho AM, Stayner L, Schubauer-Berigan MK. Firefighting and Cancer: A Meta-analysis of Cohort Studies in the Context of Cancer Hazard Identification. Saf Health Work 2023; 14:141-152. [PMID: 37389311 PMCID: PMC10300491 DOI: 10.1016/j.shaw.2023.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/22/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
Objective We performed a meta-analysis of epidemiological results for the association between occupational exposure as a firefighter and cancer as part of the broader evidence synthesis work of the IARCMonographs program. Methods A systematic literature search was conducted to identify cohort studies of firefighters followed for cancer incidence and mortality. Studies were evaluated for the influence of key biases on results. Random-effects meta-analysis models were used to estimate the association between ever-employment and duration of employment as a firefighter and risk of 12 selected cancers. The impact of bias was explored in sensitivity analyses. Results Among the 16 included cancer incidence studies, the estimated meta-rate ratio, 95% confidence interval (CI), and heterogeneity statistic (I2) for ever-employment as a career firefighter compared mostly to general populations were 1.58 (1.14-2.20, 8%) for mesothelioma, 1.16 (1.08-1.26, 0%) for bladder cancer, 1.21 (1.12-1.32, 81%) for prostate cancer, 1.37 (1.03-1.82, 56%) for testicular cancer, 1.19 (1.07-1.32, 37%) for colon cancer, 1.36 (1.15-1.62, 83%) for melanoma, 1.12 (1.01-1.25, 0%) for non-Hodgkin lymphoma, 1.28 (1.02-1.61, 40%) for thyroid cancer, and 1.09 (0.92-1.29, 55%) for kidney cancer. Ever-employment as a firefighter was not positively associated with lung, nervous system, or stomach cancer. Results for mesothelioma and bladder cancer exhibited low heterogeneity and were largely robust across sensitivity analyses. Conclusions There is epidemiological evidence to support a causal relationship between occupational exposure as a firefighter and certain cancers. Challenges persist in the body of evidence related to the quality of exposure assessment, confounding, and medical surveillance bias.
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Affiliation(s)
- Nathan L. DeBono
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, Lyon, France
| | - Robert D. Daniels
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, USA
| | - Laura E. Beane Freeman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, USA
| | - Judith M. Graber
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, USA
| | - Johnni Hansen
- Danish Cancer Society Research Centre, Copenhagen, Denmark
| | | | - Tim Driscoll
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | | | - Paul A. Demers
- Occupational Cancer Research Centre, Ontario Health, Toronto, Canada
| | - Deborah C. Glass
- School of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - David Kriebel
- Lowell Center for Sustainable Production, University of Massachusetts Lowell, Lowell, USA
| | - Tracy L. Kirkham
- Occupational Cancer Research Centre, Ontario Health, Toronto, Canada
| | - Roland Wedekind
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, Lyon, France
| | - Adalberto M. Filho
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, Lyon, France
| | - Leslie Stayner
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, Lyon, France
- University of Illinois at Chicago, School of Public Health, Division of Epidemiology and Biostatistics
| | - Mary K. Schubauer-Berigan
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, Lyon, France
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13
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Heikkinen S, Demers PA, Hansen J, Jakobsen J, Kjaerheim K, Lynge E, Martinsen JI, Mehlum IS, Pitkäniemi J, Selander J, Torfadóttir J, Weiderpass E, Pukkala E. Incidence of cancer among Nordic police officers. Int J Cancer 2023; 152:1124-1136. [PMID: 36196485 DOI: 10.1002/ijc.34311] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/25/2022] [Accepted: 09/02/2022] [Indexed: 01/21/2023]
Abstract
Police work may expose officers to various circumstances that have potential for increasing their risk of cancer, including traffic-related air pollution, night shift work and radiation from radars. In this study, we examined the incidence of cancer among Nordic male and female police officers. We utilize data from the Nordic Occupational Cancer (NOCCA) project, which linked census data on occupations from Finland, Iceland, Norway and Sweden to national cancer registries for the period 1961 to 2005. We report standardized incidence ratios (SIR) and 95% confidence intervals (CI) of selected cancers for each country by sex, age and calendar period. The cohort included 38 523 male and 1998 female police officers. As compared with the general population, male police officers had a 7% (95% CI: 4-9%) excess cancer risk, with elevated SIRs for various cancer sites, including prostate (SIR 1.19, 1.14-1.25), breast (SIR 1.77, 1.05-2.80), colon (SIR 1.22, 1.12-1.32) and skin melanoma (SIR 1.44, 1.28-1.60). Conversely, male police officers had a lower risk of lung cancer than the general population (SIR 0.72, 0.66-0.77). In female police officers, the SIR for cancer overall was 1.15 (0.98-1.34), and there was a slight excess of cancers of the breast (SIR 1.25, 0.97-1.59) and colon (SIR 1.21, 0.55-2.30). In conclusion, cancer incidence among the police officers was slightly higher than in the general population. Notably, SIRs were elevated for cancer sites potentially related to night shift work, namely colon, breast and prostate cancer.
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Affiliation(s)
- Sanna Heikkinen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Paul A Demers
- Occupational Cancer Research Center, Ontario Health, Ontario, Canada
| | - Johnni Hansen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Jarle Jakobsen
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | | | | | | | | | - Janne Pitkäniemi
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
- Tampere University, Tampere, Finland
| | | | - Jóhanna Torfadóttir
- Icelandic Cancer Registry, Reykjavik, Iceland
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Eero Pukkala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
- Tampere University, Tampere, Finland
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14
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Behrens T, Ge C, Vermeulen R, Kendzia B, Olsson A, Schüz J, Kromhout H, Pesch B, Peters S, Portengen L, Gustavsson P, Mirabelli D, Guénel P, Luce D, Consonni D, Caporaso NE, Landi MT, Field JK, Karrasch S, Wichmann HE, Siemiatycki J, Parent ME, Richiardi L, Simonato L, Jöckel KH, Ahrens W, Pohlabeln H, Fernández-Tardón G, Zaridze D, McLaughlin JR, Demers PA, Świątkowska B, Lissowska J, Pándics T, Fabianova E, Mates D, Bencko V, Foretova L, Janout V, Boffetta P, Bueno-de-Mesquita B, Forastiere F, Straif K, Brüning T. Occupational exposure to nickel and hexavalent chromium and the risk of lung cancer in a pooled analysis of case-control studies (SYNERGY). Int J Cancer 2023; 152:645-660. [PMID: 36054442 DOI: 10.1002/ijc.34272] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 02/01/2023]
Abstract
There is limited evidence regarding the exposure-effect relationship between lung-cancer risk and hexavalent chromium (Cr(VI)) or nickel. We estimated lung-cancer risks in relation to quantitative indices of occupational exposure to Cr(VI) and nickel and their interaction with smoking habits. We pooled 14 case-control studies from Europe and Canada, including 16 901 lung-cancer cases and 20 965 control subjects. A measurement-based job-exposure-matrix estimated job-year-region specific exposure levels to Cr(VI) and nickel, which were linked to the subjects' occupational histories. Odds ratios (OR) and associated 95% confidence intervals (CI) were calculated by unconditional logistic regression, adjusting for study, age group, smoking habits and exposure to other occupational lung carcinogens. Due to their high correlation, we refrained from mutually adjusting for Cr(VI) and nickel independently. In men, ORs for the highest quartile of cumulative exposure to CR(VI) were 1.32 (95% CI 1.19-1.47) and 1.29 (95% CI 1.15-1.45) in relation to nickel. Analogous results among women were: 1.04 (95% CI 0.48-2.24) and 1.29 (95% CI 0.60-2.86), respectively. In men, excess lung-cancer risks due to occupational Cr(VI) and nickel exposure were also observed in each stratum of never, former and current smokers. Joint effects of Cr(VI) and nickel with smoking were in general greater than additive, but not different from multiplicative. In summary, relatively low cumulative levels of occupational exposure to Cr(VI) and nickel were associated with increased ORs for lung cancer, particularly in men. However, we cannot rule out a combined classical measurement and Berkson-type of error structure, which may cause differential bias of risk estimates.
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Affiliation(s)
- Thomas Behrens
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance-Institute of the Ruhr-University Bochum (IPA), Germany
| | - Calvin Ge
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Benjamin Kendzia
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance-Institute of the Ruhr-University Bochum (IPA), Germany
| | - Ann Olsson
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Joachim Schüz
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Hans Kromhout
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Beate Pesch
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance-Institute of the Ruhr-University Bochum (IPA), Germany
| | - Susan Peters
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Lützen Portengen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Per Gustavsson
- The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Dario Mirabelli
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Pascal Guénel
- Center for Research in Epidemiology and Population Health (CESP), Team Exposome and Heredity, U1018 Inserm, University Paris-Saclay, Institut Gustave Roussy, Villejuif, France
| | - Danièle Luce
- Univ. Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, Pointe-à-Pitre, France
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - John K Field
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, The University of Liverpool, Liverpool, UK
| | - Stefan Karrasch
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital LMU Munich; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Heinz-Erich Wichmann
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | - Jack Siemiatycki
- University of Montreal Hospital Research Center (CRCHUM), Montreal, Canada
| | - Marie-Elise Parent
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique, Laval, Quebec, Canada
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Lorenzo Simonato
- Department of Cardiovascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Hermann Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | | | - David Zaridze
- Department of Epidemiology and Prevention, N.N. Blokhin National Medical Research Centre of Oncology, Moscow, Russia
| | - John R McLaughlin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre, Ontario Health, Toronto, Canada
| | | | - Jolanta Lissowska
- Department of Cancer Epidemiology and Prevention, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | | | - Dana Mates
- National Institute of Public Health, Bucharest, Romania
| | - Vladimir Bencko
- Institute of Hygiene and Epidemiology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Vladimír Janout
- Faculty of Health Sciences, Palacky University, Olomouc, Czech Republic
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Bas Bueno-de-Mesquita
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Francesco Forastiere
- Environmental Research Group, School of Public Health, Imperial College, London, UK, and National Research Council (CNR-Irib), Palermo, Italy
| | - Kurt Straif
- ISGlobal, Barcelona, Spain
- Boston College, Chestnut Hill, Massachusetts, USA
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance-Institute of the Ruhr-University Bochum (IPA), Germany
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15
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Zeng X, Berriault C, Arrandale VH, DeBono NL, Harris MA, Demers PA. Radon exposure and risk of neurodegenerative diseases among male miners in Ontario, Canada: A cohort study. Am J Ind Med 2023; 66:132-141. [PMID: 36495187 DOI: 10.1002/ajim.23449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/08/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Environmental radon has been examined as a risk factor for neurodegenerative diseases in a small number of previous studies, but the findings have been inconsistent. This study aims to investigate the association between occupational radon exposure and neurodegenerative disease in a cohort of male miners with work experience in multiple ore types in Ontario, Canada. METHODS Radon exposure (1915-1988) was assessed using two job-exposure matrices (JEM) constructed from using historical records for 34,536 Ontario male miners. Neurodegenerative outcomes were ascertained between 1992 and 2018. Poisson regression models were used to estimate incidence rate ratios (RR) and 95% confidence intervals (CI) between cumulative radon exposure in working level months (WLM) and each neurodegenerative outcome. RESULTS Levels of cumulative radon exposure showed variability among cohort members with a mean of 7.5 WLM (standard deviation 24.4). Miners in uranium mines or underground jobs had higher levels and more variability in exposure than workers in non-uranium work or surface jobs. Compared to the reference group (radon < 1 WLM), increased rates of Alzheimer's (RR 1.23, 95% CI 1.05-1.45) and Parkinson's disease (RR 1.43, 95% CI 1.08-1.89) were observed among workers with >1-5 WLM and >5-10 WLM, respectively, but not among higher exposed workers (>10 WLM). CONCLUSION This study did not observe a positive monotonic dose-response relationship between cumulative radon exposure and Alzheimer's or Parkinson's disease in Ontario mining workers. There was no association observed with motor neuron disease.
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Affiliation(s)
- Xiaoke Zeng
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada.,Occupational and Environmental Health Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Colin Berriault
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
| | - Victoria H Arrandale
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada.,Occupational and Environmental Health Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nathan L DeBono
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada.,Occupational and Environmental Health Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - M Anne Harris
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada.,Occupational and Environmental Health Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,School of Occupational and Public Health, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada.,Occupational and Environmental Health Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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16
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Slavik CE, Demers PA, Tamburic L, Warden H, McLeod C. Do patterns of past asbestos use and production reflect current geographic variations of cancer risk?: mesothelioma in Ontario and British Columbia, Canada. Cancer Causes Control 2023; 34:349-360. [PMID: 36729166 PMCID: PMC9971118 DOI: 10.1007/s10552-023-01672-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/20/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE Canada was a major global asbestos producer and consumer. Geographic patterns of Canadian asbestos use and mesothelioma, a highly fatal cancer linked to asbestos exposure, have not been previously reported. This study summarized key trends in mesothelioma incidence by geography and time in two Canadian provinces, Ontario and British Columbia (BC), and explored how past workforce characteristics and geographic trends in asbestos production and use may shape variations in regional rates of mesothelioma. METHODS We report trends in mesothelioma incidence (1993-2016) for Ontario and British Columbia using population-based incidence data that were age-standardized to the 2011 Canadian population. Historical records of asbestos production and use were analyzed to geo-locate industrial point sources of asbestos in Ontario and BC. The prevalence of occupations in regions with the highest and lowest rates of mesothelioma in Ontario and BC were calculated using labor force statistics from the 1981 Canadian Census. RESULTS Regional mesothelioma rates varied in both provinces over time; more census divisions in both Ontario and BC registered mesothelioma rates in the highest quintile of incidences during the period 2009 to 2016 than in any prior period examined. Certain occupations such as construction trades workers were more likely to be overrepresented in regions with high mesothelioma rates. CONCLUSION This work explored how studying asbestos exposure and mesothelioma incidence at small-scale geographies could direct cancer surveillance and research to more targeted areas. Findings indicated that regional variations in mesothelioma could signal important differences in past occupational and potentially environmental exposures.
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Affiliation(s)
- Catherine E. Slavik
- grid.419887.b0000 0001 0747 0732Occupational Cancer Research Centre, Ontario Health (Cancer Care Ontario), Toronto, ON M5G 1X3 Canada
| | - Paul A. Demers
- grid.419887.b0000 0001 0747 0732Occupational Cancer Research Centre, Ontario Health (Cancer Care Ontario), Toronto, ON M5G 1X3 Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7 Canada
| | - Lillian Tamburic
- grid.17091.3e0000 0001 2288 9830Partnership for Work, Health and Safety, School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3 Canada
| | - Hunter Warden
- grid.419887.b0000 0001 0747 0732Occupational Cancer Research Centre, Ontario Health (Cancer Care Ontario), Toronto, ON M5G 1X3 Canada ,grid.17063.330000 0001 2157 2938Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8 Canada
| | - Christopher McLeod
- grid.17091.3e0000 0001 2288 9830Partnership for Work, Health and Safety, School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3 Canada
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17
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Fenton S, Rydz E, Demers PA, Peters CE. Prevalence and Level of Occupational Exposure to Asbestos in Canada in 2016. Ann Work Expo Health 2022; 67:536-545. [PMID: 36383235 DOI: 10.1093/annweh/wxac077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/20/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Objective
Asbestos use has decreased over time but occupational exposure still exists today due to the presence of asbestos in older buildings. The objective of this study was to update CAREX Canada’s prevalence of exposure estimate from 2006 to 2016, and to assess the level of occupational exposure by industry, occupation, province/territory, and sex.
Methods
Estimates by occupation, industry, province/territory, and sex were calculated using labor force data from the 2016 Census of Population and proportions of workers exposed by occupation and industry, which were previously developed for the 2006 estimates and updated here to reflect new knowledge and changes in exposures. Statistics Canada concordance tables were used to account for changes between the 2006 and 2016 job and industry coding systems. Expert assessment was used to qualitatively assign levels of exposure (low, moderate, or high) for each occupation and industry, with consideration of workers’ proximity and access to asbestos-containing material, and the condition and content of asbestos.
Results
Approximately 235 000 workers are exposed to asbestos on the job in Canada. The majority of Canadian workers exposed to asbestos are male (89%). Only 5% of all exposed workers are in the high-exposure category, while most workers are in the low (49%) or moderate (46%) exposure categories. The construction sector and associated jobs (e.g. carpenters, trades helpers and laborers, electricians) accounted for the majority of exposed workers.
Conclusions
Occupational exposure to asbestos continues to occur in Canada. Updating the prevalence of exposure estimate and adding exposure levels highlights the shift from high to lower-lever exposures associated with asbestos-containing materials remaining in the built environment.
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Affiliation(s)
- Shelby Fenton
- CAREX Canada, School of Population and Public Health, University of British Columbia , Vancouver, British Columbia V6T 1Z3 , Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, 2500 University Dr NW , Calgary, Alberta T2N 1N4 , Canada
| | - Ela Rydz
- CAREX Canada, School of Population and Public Health, University of British Columbia , Vancouver, British Columbia V6T 1Z3 , Canada
| | - Paul A Demers
- Occupational Cancer Research Centre (OCRC), Ontario Health , Toronto, Ontario M5G 1X3 , Canada
- Dalla Lana School of Public Health, University of Toronto , Toronto, Ontario M5T 3M7 , Canada
| | - Cheryl E Peters
- CAREX Canada, School of Population and Public Health, University of British Columbia , Vancouver, British Columbia V6T 1Z3 , Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, 2500 University Dr NW , Calgary, Alberta T2N 1N4 , Canada
- Population and Public Health, British Columbia Centre for Disease Control , Vancouver, British Columbia V5Z 4R4 , Canada
- Prevention, Screening and Hereditary Cancer Program, BC Cancer , Vancouver, British Columbia V5Z 1G1 , Canada
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18
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Grunau B, Asamoah-Boaheng M, Lavoie PM, Karim ME, Kirkham TL, Demers PA, Barakauskas V, Marquez AC, Jassem AN, O’Brien SF, Drews SJ, Haig S, Cheskes S, Goldfarb DM. A Higher Antibody Response Is Generated With a 6- to 7-Week (vs Standard) Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Vaccine Dosing Interval. Clin Infect Dis 2022; 75:e888-e891. [PMID: 34849655 PMCID: PMC8690265 DOI: 10.1093/cid/ciab938] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Indexed: 01/19/2023] Open
Abstract
The optimal dosing interval for severe acute respiratory syndrome coronavirus 2 vaccines remains controversial. In this prospective study, we compared serology results of paramedics vaccinated with mRNA vaccines at the recommended short (17-28 days) vs long (42-49 days) interval. We found that a long dosing interval resulted in higher spike, receptor binding domain, and spike N terminal domain antibody concentrations.
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Affiliation(s)
- Brian Grunau
- Centre for Health Evaluation & Outcome Sciences, University of British Columbia, Canada
- Department of Emergency Medicine, University of British Columbia, Canada
- British Columbia Emergency Health Services, British Columbia, Canada
| | - Michael Asamoah-Boaheng
- Department of Emergency Medicine, University of British Columbia, Canada
- Faculty of Medicine, Clinical Epidemiology, Memorial University of Newfoundland, Canada
| | - Pascal M Lavoie
- Department of Pediatrics, University of British Columbia, Canada
| | - Mohammad Ehsanul Karim
- Centre for Health Evaluation & Outcome Sciences, University of British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Canada
| | - Tracy L Kirkham
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Ontario Occupational Cancer Research Centre, Ontario, Canada
| | - Paul A Demers
- School of Population and Public Health, University of British Columbia, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Ontario Occupational Cancer Research Centre, Ontario, Canada
| | - Vilte Barakauskas
- Department of Pathology and Laboratory Medicine, University of British Columbia, Canada
| | - Ana Citlali Marquez
- Department of Pathology and Laboratory Medicine, University of British Columbia, Canada
- Public Health Laboratory, British Columbia Centre for Disease Control, British Columbia, Canada
| | - Agatha N Jassem
- Department of Pathology and Laboratory Medicine, University of British Columbia, Canada
- Public Health Laboratory, British Columbia Centre for Disease Control, British Columbia, Canada
| | | | - Steven J Drews
- Canadian, Blood Services Canada
- Laboratory Medicine and Pathology, University of Alberta, Alberta, Canadaand
| | - Scott Haig
- British Columbia Emergency Health Services, British Columbia, Canada
| | - Sheldon Cheskes
- Li Ka Shing Knowledge Institute and Division of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, Ontario, Canada
| | - David M Goldfarb
- Department of Pathology and Laboratory Medicine, University of British Columbia, Canada
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19
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Zablotska LB, Richardson DB, Golden A, Pasqual E, Smith B, Rage E, Demers PA, Do M, Fenske N, Deffner V, Kreuzer M, Samet J, Bertke S, Kelly-Reif K, Schubauer-Berigan MK, Tomasek L, Wiggins C, Laurier D, Apostoaei I, Thomas BA, Simon SL, Hoffman FO, Boice JD, Dauer LT, Howard SC, Cohen SS, Mumma MT, Ellis ED, Eckerman KF, Leggett RW, Pawel DJ. The epidemiology of lung cancer following radiation exposure. Int J Radiat Biol 2022; 99:569-580. [PMID: 35947399 PMCID: PMC9943789 DOI: 10.1080/09553002.2022.2110321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/28/2022] [Accepted: 07/07/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Lydia B Zablotska
- Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, CA, USA
| | - David B. Richardson
- Environmental and Occupational Health, Program in Public Health, Susan and Henry Samueli College of Health Sciences University of California, Irvine, Irvine, CA, USA
| | - Ashley Golden
- Oak Ridge Associated Universities, Oak Ridge, Tennessee, USA
| | - Elisa Pasqual
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20892, USA
| | | | - Estelle. Rage
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | | | - Minh Do
- Occupational Cancer Research Centre, Toronto, Canada
| | - Nora Fenske
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
| | - Veronika Deffner
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
| | - Michaela Kreuzer
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
| | | | - Stephen Bertke
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Kaitlin Kelly-Reif
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | | | | | - Charles Wiggins
- University of New Mexico, Albuquerque, NM, USA
- New Mexico Tumor Registry, Albuquerque, NM, USA
| | - Dominque Laurier
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | | | - Brian A. Thomas
- Oak Ridge Center for Risk Analysis, Inc., Oak Ridge, TN, USA
| | - Steven L. Simon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20892, USA
| | - F. Owen Hoffman
- Oak Ridge Center for Risk Analysis, Inc., Oak Ridge, TN, USA
| | - John D. Boice
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
- National Council on Radiation Protection and Measurements (NCRP), Bethesda, MD, USA
| | | | - Sara C. Howard
- Oak Ridge Associated Universities, Oak Ridge, Tennessee, USA
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20
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Demers PA, DeMarini DM, Fent KW, Glass DC, Hansen J, Adetona O, Andersen MH, Freeman LEB, Caban-Martinez AJ, Daniels RD, Driscoll TR, Goodrich JM, Graber JM, Kirkham TL, Kjaerheim K, Kriebel D, Long AS, Main LC, Oliveira M, Peters S, Teras LR, Watkins ER, Burgess JL, Stec AA, White PA, DeBono NL, Benbrahim-Tallaa L, de Conti A, El Ghissassi F, Grosse Y, Stayner LT, Suonio E, Viegas S, Wedekind R, Boucheron P, Hosseini B, Kim J, Zahed H, Mattock H, Madia F, Schubauer-Berigan MK. Carcinogenicity of occupational exposure as a firefighter. Lancet Oncol 2022; 23:985-986. [PMID: 35780778 DOI: 10.1016/s1470-2045(22)00390-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Paul A Demers
- International Agency for Research on Cancer, Lyon, France
| | | | - Kenneth W Fent
- International Agency for Research on Cancer, Lyon, France
| | | | - Johnni Hansen
- International Agency for Research on Cancer, Lyon, France
| | | | | | | | | | | | | | | | | | | | | | - David Kriebel
- International Agency for Research on Cancer, Lyon, France
| | | | - Luana C Main
- International Agency for Research on Cancer, Lyon, France
| | - Marta Oliveira
- International Agency for Research on Cancer, Lyon, France
| | - Susan Peters
- International Agency for Research on Cancer, Lyon, France
| | - Lauren R Teras
- International Agency for Research on Cancer, Lyon, France
| | | | | | - Anna A Stec
- International Agency for Research on Cancer, Lyon, France
| | - Paul A White
- International Agency for Research on Cancer, Lyon, France
| | | | | | - Aline de Conti
- International Agency for Research on Cancer, Lyon, France
| | | | - Yann Grosse
- International Agency for Research on Cancer, Lyon, France
| | | | - Eero Suonio
- International Agency for Research on Cancer, Lyon, France
| | - Susana Viegas
- International Agency for Research on Cancer, Lyon, France
| | | | | | - Bayan Hosseini
- International Agency for Research on Cancer, Lyon, France
| | - Joanne Kim
- International Agency for Research on Cancer, Lyon, France
| | - Hana Zahed
- International Agency for Research on Cancer, Lyon, France
| | - Heidi Mattock
- International Agency for Research on Cancer, Lyon, France
| | - Federica Madia
- International Agency for Research on Cancer, Lyon, France
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21
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Olsson A, Guha N, Bouaoun L, Kromhout H, Peters S, Siemiatycki J, Ho V, Gustavsson P, Boffetta P, Vermeulen R, Behrens T, Brüning T, Kendzia B, Guénel P, Luce D, Karrasch S, Wichmann HE, Consonni D, Landi MT, Caporaso NE, Merletti F, Mirabelli D, Richiardi L, Jöckel KH, Ahrens W, Pohlabeln H, Tardón A, Zaridze D, Field JK, Lissowska J, Świątkowska B, McLaughlin JR, Demers PA, Bencko V, Foretova L, Janout V, Pándics T, Fabianova E, Mates D, Forastiere F, Bueno-de-Mesquita B, Schüz J, Straif K. Occupational Exposure to Polycyclic Aromatic Hydrocarbons and Lung Cancer Risk: Results from a Pooled Analysis of Case-Control Studies (SYNERGY). Cancer Epidemiol Biomarkers Prev 2022; 31:1433-1441. [PMID: 35437574 PMCID: PMC9377765 DOI: 10.1158/1055-9965.epi-21-1428] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/22/2022] [Accepted: 04/11/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Exposure to polycyclic aromatic hydrocarbons (PAH) occurs widely in occupational settings. We investigated the association between occupational exposure to PAH and lung cancer risk and joint effects with smoking within the SYNERGY project. METHODS We pooled 14 case-control studies with information on lifetime occupational and smoking histories conducted between 1985 and 2010 in Europe and Canada. Exposure to benzo[a]pyrene (BaP) was used as a proxy of PAH and estimated from a quantitative general population job-exposure matrix. Multivariable unconditional logistic regression models, adjusted for smoking and exposure to other occupational lung carcinogens, estimated ORs, and 95% confidence intervals (CI). RESULTS We included 16,901 lung cancer cases and 20,965 frequency-matched controls. Adjusted OR for PAH exposure (ever) was 1.08 (CI, 1.02-1.15) in men and 1.20 (CI, 1.04-1.38) in women. When stratified by smoking status and histologic subtype, the OR for cumulative exposure ≥0.24 BaP μg/m3-years in men was higher in never smokers overall [1.31 (CI, 0.98-1.75)], for small cell [2.53 (CI, 1.28-4.99)] and squamous cell cancers [1.33 (CI, 0.80-2.21)]. Joint effects between PAH and smoking were observed. Restricting analysis to the most recent studies showed no increased risk. CONCLUSIONS Elevated lung cancer risk associated with PAH exposure was observed in both sexes, particularly for small cell and squamous cell cancers, after accounting for cigarette smoking and exposure to other occupational lung carcinogens. IMPACT The lack of association between PAH and lung cancer in more recent studies merits further research under today's exposure conditions and worker protection measures.
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Affiliation(s)
- Ann Olsson
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Neela Guha
- Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, California
| | - Liacine Bouaoun
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Hans Kromhout
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Susan Peters
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Jack Siemiatycki
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Canada
| | - Vikki Ho
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Canada
| | - Per Gustavsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Thomas Behrens
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University (IPA), Bochum, Germany
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University (IPA), Bochum, Germany
| | - Benjamin Kendzia
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University (IPA), Bochum, Germany
| | - Pascal Guénel
- Center for research in Epidemiology and Population Health (CESP), Exposome and Heredity team, Inserm U1018, University Paris-Saclay, Villejuif, France
| | - Danièle Luce
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Pointe-à-Pitre, France
| | - Stefan Karrasch
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Heinz-Erich Wichmann
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Institut für Medizinische Informatik Biometrie Epidemiologie, Ludwig Maximilians University, Munich, Germany
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Teresa Landi
- Division of Cancer Epidemiology and Genetics, NCI, NIH, Bethesda, Maryland
| | - Neil E Caporaso
- Division of Cancer Epidemiology and Genetics, NCI, NIH, Bethesda, Maryland
| | - Franco Merletti
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Dario Mirabelli
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Essen, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Faculty of Mathematics and Computer Science, Institute of Statistics, University of Bremen, Bremen, Germany
| | - Hermann Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Adonina Tardón
- Department of Public Health, University of Oviedo. ISPA and CIBERESP, Oviedo, Spain
| | - David Zaridze
- Department of cancer epidemiology and Prevention, N.N. Blokhin National Research Centre of oncology, Moscow, Russia
| | - John K Field
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Jolanta Lissowska
- Epidemiology Unit, Department of Cancer Epidemiology and Prevention, M. Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Beata Świątkowska
- Department of Environmental Epidemiology, The Nofer Institute of Occupational Medicine, Lodz, Poland
| | - John R McLaughlin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre, Ontario Health, Toronto, Canada
| | - Vladimir Bencko
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University, Prague, Czechia
| | | | - Vladimir Janout
- Faculty of Health Sciences, Palacky University, Olomouc, Czechia
| | | | - Eleonora Fabianova
- Regional Authority of Public Health, Banská Bystrica, Slovakia
- Faculty of Health, Catholic University, Ružomberok, Slovakia
| | - Dana Mates
- National Institute of Public Health, Bucharest, Romania
| | | | - Bas Bueno-de-Mesquita
- Former senior scientist, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Joachim Schüz
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Kurt Straif
- ISGlobal, Barcelona, Spain
- Boston College, Massachusetts
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22
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Hall AL, Demers PA, VanTil L, MacLean MB, Dalton ME, Batchelor T, Rushton L, Driscoll TR. Lessons Learned From Presumptive Condition Lists in Veteran Compensation Systems. Front Public Health 2022; 10:739746. [PMID: 35619818 PMCID: PMC9127463 DOI: 10.3389/fpubh.2022.739746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 04/04/2022] [Indexed: 12/01/2022] Open
Abstract
Presumptive condition lists formally accept connections between military factors and veteran health conditions. An environmental scan of such lists and their evidentiary basis was conducted across four veterans' administrations to inform other administrations considering the development of such lists. Information on included conditions, qualifying military factors, and scientific processes was obtained through targeted internet searches and correspondence with veterans' administrations. The content of presumptive condition lists across jurisdictions varied by conditions included, as well as military eligibility requirements (e.g., service in particular conflict, context, or time period). Scientific review processes to develop lists also varied across jurisdictions. Findings indicate that evidence and experience may be leveraged across compensation systems (veteran and civilian). Ongoing research to understand links between military exposures and veteran health is recommended.
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Affiliation(s)
- Amy L Hall
- Research Directorate, Veterans Affairs Canada, Charlottetown, Prince Edward Island, PE, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, ON, Canada
| | - Linda VanTil
- Research Directorate, Veterans Affairs Canada, Charlottetown, Prince Edward Island, PE, Canada
| | - Mary Beth MacLean
- Faculty of Health Sciences School of Rehabilitation Therapy, Queens University, Kingston, ON, Canada
| | - Maria E Dalton
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Lesley Rushton
- School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Tim R Driscoll
- Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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23
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Marjerrison N, Jakobsen J, Demers PA, Grimsrud TK, Hansen J, Martinsen JI, Nordby KC, Veierød MB, Kjærheim K. Comparison of cancer incidence and mortality in the Norwegian Fire Departments Cohort, 1960-2018. Occup Environ Med 2022; 79:oemed-2022-108331. [PMID: 35589382 PMCID: PMC9606497 DOI: 10.1136/oemed-2022-108331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/05/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Elevated risk of cancer at several sites has been reported among firefighters, although with mixed findings. The purpose of this study was to calculate standardised incidence ratios (SIRs) and standardised mortality ratios (SMRs) for cancer and compare them to assess whether use of the different measures could be a source of inconsistencies in findings. METHODS The Norwegian Fire Departments Cohort, comprising 4295 male employees who worked at 15 fire departments across Norway, was linked to health outcome registries for the period 1960-2018. SIRs and SMRs were derived using national reference rates. RESULTS Overall, we observed elevated incidence of colon cancer (SIR, 95% CI 1.27, 1.01 to 1.58), mesothelioma (2.59, 1.12 to 5.11), prostate cancer (1.18, 1.03 to 1.34) and all sites combined (1.15, 1.08 to 1.23). Smaller, non-significant elevations were found for mortality of colon cancer (SMR, 95% CI 1.20, 0.84 to 1.67) and mesothelioma (1.66, 0.34 to 4.86), while SMR for prostate cancer was at unity. Potential errors were observed in some of the mortality data, notably for mesothelioma cases. Among those who died of cancer, 3.7% (n=14) did not have a prior diagnosis of malignancy at the same site group. CONCLUSIONS Assessment of incidence or mortality did not greatly influence the interpretation of results. The most prominent differences in SIR and SMR appeared to be due to inconsistencies between sites of cancer diagnosis and cause of death. The difference in SIR and SMR for prostate cancer suggested a detection bias from differential screening practices.
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Affiliation(s)
- Niki Marjerrison
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Department of Biostatistics, Institute of Basic Medical Sciences, Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway
| | - Jarle Jakobsen
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Department of Biostatistics, Institute of Basic Medical Sciences, Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway
| | - Paul A Demers
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
| | - Tom K Grimsrud
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Johnni Hansen
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | | | - Karl-Christian Nordby
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
| | - Marit B Veierød
- Department of Biostatistics, Institute of Basic Medical Sciences, Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway
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24
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Richardson DB, Rage E, Demers PA, Do MT, Fenske N, Deffner V, Kreuzer M, Samet J, Bertke SJ, Kelly-Reif K, Schubauer-Berigan MK, Tomasek L, Zablotska LB, Wiggins C, Laurier D. Lung Cancer and Radon: Pooled Analysis of Uranium Miners Hired in 1960 or Later. Environ Health Perspect 2022; 130:57010. [PMID: 35604341 PMCID: PMC9126132 DOI: 10.1289/ehp10669] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/28/2022] [Accepted: 05/03/2022] [Indexed: 05/21/2023]
Abstract
BACKGROUND Despite reductions in exposure for workers and the general public, radon remains a leading cause of lung cancer. Prior studies of underground miners depended heavily upon information on deaths among miners employed in the early years of mine operations when exposures were high and tended to be poorly estimated. OBJECTIVES To strengthen the basis for radiation protection, we report on the follow-up of workers employed in the later periods of mine operations for whom we have more accurate exposure information and for whom exposures tended to be accrued at intensities that are more comparable to contemporary settings. METHODS We conducted a pooled analysis of cohort studies of lung cancer mortality among 57,873 male uranium miners in Canada, Czech Republic, France, Germany, and the United States, who were first employed in 1960 or later (thereby excluding miners employed during the periods of highest exposure and focusing on miners who tend to have higher quality assessments of radon progeny exposures). We derived estimates of excess relative rate per 100 working level months (ERR/100 WLM) for mortality from lung cancer. RESULTS The analysis included 1.9 million person-years of observation and 1,217 deaths due to lung cancer. The relative rate of lung cancer increased in a linear fashion with cumulative exposure to radon progeny (ERR/100 WLM = 1.33 ; 95% CI: 0.89, 1.88). The association was modified by attained age, age at exposure, and annual exposure rate; for attained ages < 55 y , the ERR/100 WLM was 8.38 (95% CI: 3.30, 18.99) among miners who were exposed at ≥ 35 years of age and at annual exposure rates of < 0.5 working levels. This association decreased with older attained ages, younger ages at exposure, and higher exposure rates. DISCUSSION Estimates of association between radon progeny exposure and lung cancer mortality among relatively contemporary miners are coherent with estimates used to inform current protection guidelines. https://doi.org/10.1289/EHP10669.
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Affiliation(s)
| | - Estelle Rage
- Institute for Radiological Protection and Nuclear Safety, Fontenay-aux-Roses, France
| | | | - Minh T. Do
- Occupational Cancer Research Centre, Toronto, Canada
| | - Nora Fenske
- Federal Office for Radiation Protection, Munich (Neuherberg), Germany
| | - Veronika Deffner
- Federal Office for Radiation Protection, Munich (Neuherberg), Germany
| | - Michaela Kreuzer
- Federal Office for Radiation Protection, Munich (Neuherberg), Germany
| | | | - Stephen J. Bertke
- National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Kaitlin Kelly-Reif
- National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Mary K. Schubauer-Berigan
- National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
- International Agency for Research on Cancer, Lyon, France
| | | | | | - Charles Wiggins
- University of New Mexico, Albuquerque, New Mexico, USA
- New Mexico Tumor Registry, Albuquerque, New Mexico, USA
| | - Dominique Laurier
- Institute for Radiological Protection and Nuclear Safety, Fontenay-aux-Roses, France
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25
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Sritharan J, Kirkham TL, MacLeod J, Marjerrison N, Lau A, Dakouo M, Logar-Henderson C, Norzin T, DeBono NL, Demers PA. Cancer risk among firefighters and police in the Ontario workforce. Occup Environ Med 2022; 79:533-539. [PMID: 35354650 PMCID: PMC9304109 DOI: 10.1136/oemed-2021-108146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/05/2022] [Indexed: 11/23/2022]
Abstract
Objective Firefighters and police often work in high-stress, complex environments with known and suspected carcinogenic exposures. We aimed to characterise cancer incidence among firefighters and police. Methods The Occupational Disease Surveillance System (ODSS) was used to identify workers employed as firefighters or police in Ontario. A cohort of workers were identified using lost-time workers’ compensation claims data and followed for cancer in the Ontario Cancer Registry (1983–2020). Cox proportional hazard models were used to estimate HRs and 95% CIs for primary site-specific cancer diagnoses adjusted for age at start of follow-up, birth year and sex. Results A total of 13 642 firefighters and 22 595 police were identified in the cohort. Compared with all other workers in the ODSS, firefighters and police had increased risk of prostate cancer (firefighters: HR=1.43, 95% CI 1.31 to 1.57; police: HR=1.47, 95% CI 1.35 to 1.59), colon cancer (firefighters: HR=1.39, 95% CI 1.19 to 1.63; police: HR=1.39, 95% CI 1.21 to 1.60) and skin melanoma (firefighters: HR=2.38, 95% CI 1.99 to 2.84; police: HR=2.27, 95% CI 1.96 to 2.62). Firefighters also had increased risk of cancer of the pancreas, testis and kidney, as well as non-Hodgkin’s lymphoma and leukaemia. Police had increased risk of thyroid, bladder and female breast cancer. When compared directly with the police, firefighters had an elevated risk of mesothelioma and testicular cancer. Conclusions Firefighters and police demonstrated some similar as well as some unique cancer risks. Findings from this larger worker population may have important implications for workplace and policy-level changes to improve preventative measures and reduce potential exposures to known carcinogenic hazards.
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Affiliation(s)
- Jeavana Sritharan
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
| | - Tracy L Kirkham
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jill MacLeod
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
| | - Niki Marjerrison
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada.,Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Ashley Lau
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
| | - Mamadou Dakouo
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
| | | | - Tenzin Norzin
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
| | - Nathan L DeBono
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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26
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Mofidi A, Tompa E, Kalcevich C, McLeod C, Lebeau M, Song C, Kim J, Demers PA. Occupational Exposure to Wood Dust and the Burden of Nasopharynx and Sinonasal Cancer in Canada. Int J Environ Res Public Health 2022; 19:ijerph19031144. [PMID: 35162168 PMCID: PMC8834578 DOI: 10.3390/ijerph19031144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/09/2022] [Accepted: 01/13/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Millions of workers around the world are exposed to wood dust, as a by-product of woodworking. Nasopharynx cancers (NPCs) and sinonasal cancers (SNCs) are two cancers that can be caused by occupational exposure to wood dust, but there is little evidence regarding their burden in Canada. OBJECTIVE the aim of this study was to estimate the incidence and economic burden of newly diagnosed cases of NPC and SNC in 2011 in Canada, attributable to occupational exposures to wood dust. METHODS calculating the incidence of cancer attributable to occupational exposure involved three steps of defining relative risk, assessing the prevalence of exposure and population modelling. We estimated the lifetime costs of newly diagnosed NPC and SNC from the societal perspective. The three major cost categories that we considered were direct costs (healthcare costs, out-of-pocket costs, and informal caregiving costs), indirect costs (labour productivity/output costs, employer adjustment costs, and home production losses), and intangible costs (health-related quality of life losses). To generate an estimate of economic burden, we used secondary data from multiple sources and applied them to our computational model developed from an extensive literature review. RESULTS From approximately 1.3 million workers exposed to wood dust, we expected 28%, 43% and 29% were exposed to low, medium, and high levels, respectively. We estimated from 235 newly diagnosed cases of NPC and 245 newly diagnosed cases of SNC, 4.6% (11 cases) and 4.4% (11 cases) were attributed to occupational exposure to wood dust, respectively. Our estimates of the economic burden of occupational NPC and SNC were about CAD 5.4 million (CAD 496,311 per-case) and CAD 6.7 million (CAD 627,437 per-case), respectively. For NPC direct costs constituted approximately 20% of all costs, and indirect and intangible costs accounted for 55% and 25%, while for SNC the breakdown distribution were 16%, 42% and 42%, respectively. CONCLUSIONS Our estimates highlighted the importance of occupational NPC and SNC amongst other occupational cancers, especially in countries with large wood-related industries. This paper also serves the information needs of policymakers who are seeking to make evidence-based decisions about occupational cancer prevention efforts.
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Affiliation(s)
- Amirabbas Mofidi
- Institute for Work & Health, Toronto, ON M5G 1S5, Canada; (E.T.); (C.K.); (C.M.)
- Correspondence: ; Tel.: +1-416-927-2027 (ext. 2176)
| | - Emile Tompa
- Institute for Work & Health, Toronto, ON M5G 1S5, Canada; (E.T.); (C.K.); (C.M.)
- Department of Economics, McMaster University, Hamilton, ON L8S 4L8, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Christina Kalcevich
- Institute for Work & Health, Toronto, ON M5G 1S5, Canada; (E.T.); (C.K.); (C.M.)
| | - Christopher McLeod
- Institute for Work & Health, Toronto, ON M5G 1S5, Canada; (E.T.); (C.K.); (C.M.)
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Martin Lebeau
- Institut de Recherche Robert-Sauvé en Santé et en Sécurité du Travail (IRSST), Montreal, QC H3A 3C2, Canada;
| | - Chaojie Song
- Occupational Cancer Research Centre (OCRC), Toronto, ON M5G 1X3, Canada; (C.S.); (J.K.); (P.A.D.)
| | - Joanne Kim
- Occupational Cancer Research Centre (OCRC), Toronto, ON M5G 1X3, Canada; (C.S.); (J.K.); (P.A.D.)
| | - Paul A. Demers
- Occupational Cancer Research Centre (OCRC), Toronto, ON M5G 1X3, Canada; (C.S.); (J.K.); (P.A.D.)
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27
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Abstract
This study investigates the immunogenicity of extended mRNA vaccine dosing intervals.
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Affiliation(s)
- Brian Grunau
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - David M. Goldfarb
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | | | - Liam Golding
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
| | - Tracy L. Kirkham
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Paul A. Demers
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Pascal M. Lavoie
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
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28
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Tompa E, Mofidi A, Song C, Arrandale V, Jardine KJ, Davies H, Tenkate T, Demers PA. Break-even Analysis of Respirable Crystalline Silica (RCS) Exposure Interventions in the Construction Sector. J Occup Environ Med 2021; 63:e792-e800. [PMID: 34739444 DOI: 10.1097/jom.0000000000002375] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We investigated long-term economic impacts of respirable crystalline silica (RCS) removal interventions in the construction at the societal level. METHODS We estimated costs and benefits of two RCS exposure interventions, use of "respirators" and "wet method," over a 30-year time period. We identified economic impacts of the interventions under four different scenarios. RESULTS Under current practices, we estimated that approximately 125 lung cancer cases attributable to RCS exposure would arise in 2060. Under the full exposure removal scenario, we estimated there would be 53 new cases. Over the 30-year time period, the estimated cumulative averted cases are 787 and 482 for respirators and wet method, respectively, which amount to net benefits of $422.13 and $394.92 million. CONCLUSIONS Findings provide important information for policymakers seeking to reduce the economic burden of occupational lung cancer in society.
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Affiliation(s)
- Emile Tompa
- Institute for Work & Health, Toronto, Ontario, Canada (Dr Tompa and Dr Mofidi); Department of Economics, McMaster University, Hamilton, Ontario, Canada (Dr Tompa); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (Dr Tompa, Dr Arrandale, and Dr Demers); Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada (Dr Arrandale, Dr Demers, Ms Jardine, and Mr Song); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (Dr Davies); School of Occupational and Public Health, Ryerson University, Toronto, Ontario, Canada (Dr Tenkate)
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29
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Zeng X, Macleod J, Berriault C, DeBono NL, Arrandale VH, Harris AM, Demers PA. Aluminum dust exposure and risk of neurodegenerative diseases in a cohort of male miners in Ontario, Canada. Scand J Work Environ Health 2021; 47:531-539. [PMID: 34591975 PMCID: PMC8504163 DOI: 10.5271/sjweh.3974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES We estimated associations between respirable aluminum exposure through McIntyre Powder (MP), a fine-sized aluminum and aluminum compound powder, and neurological disease in a retrospective cohort of mining workers from Ontario, Canada. Outcomes included Alzheimer's disease, Alzheimer's with other dementias, Parkinson's disease, parkinsonism, and motor neuron disease. METHODS The cohort was created by linking a database of mining workers' work history to healthcare records. This analysis included 36 826 male miners potentially exposed to MP between 1943 and 1979, followed up for disease diagnosis between 1992 and 2018. Exposure was assessed using two approaches, self-reported and historical records. Neurological diseases were ascertained using physician billing and hospital discharge records. Poisson regression models were used to estimate associations between MP exposure and neurological outcomes using incidence rate ratios (RR) and 95% confidence intervals (95% CI). RESULTS Exposure to self-reported MP was associated with an elevated incidence rate of Parkinson's disease (RR 1.34, 95% CI 1.14-1.57). The rate of Parkinson's disease appeared to increase with the duration of exposure assessed by historical records. Having ever been exposed to MP was positively associated with an elevated rate of Alzheimer's with other dementias (RR 1.12, 95% CI 1.06-1.19) but not Alzheimer's disease alone. CONCLUSION This study found that miners who were exposed to MP (respirable aluminum) had elevated rates of Parkinson's disease. The rate of Parkinson's disease appeared to increase with the duration of exposure assessed by historical records.
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Affiliation(s)
- Xiaoke Zeng
- Occupational Cancer Research Centre, Ontario Health (Cancer Care Ontario), Toronto, M5G 2L3, Canada.
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30
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Ziembicki S, Kirkham TL, Demers PA, Peters CE, Gorman Ng M, Davies HW, Tenkate T, Kalenge S, Blagrove-Hall N, Jardine KJ, Arrandale VH. Diesel Engine Exhaust Exposure in the Ontario Civil Infrastructure Construction Industry. Ann Work Expo Health 2021; 66:150-162. [PMID: 34585719 DOI: 10.1093/annweh/wxab068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/26/2021] [Accepted: 08/06/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Diesel engine exhaust (DEE) is a known lung carcinogen and a common occupational exposure in Canada. The use of diesel-powered equipment in the construction industry is particularly widespread, but little is known about DEE exposures in this work setting. The objective of this study was to determine exposure levels and identify and characterize key determinants of DEE exposure at construction sites in Ontario. METHODS Elemental carbon (EC, a surrogate of DEE exposure) measurements were collected at seven civil infrastructure construction worksites and one trades training facility in Ontario using NIOSH method 5040. Full-shift personal air samples were collected using a constant-flow pump and SKC aluminium cyclone with quartz fibre filters in a 37-mm cassette. Exposures were compared with published health-based limits, including the Dutch Expert Committee on Occupational Safety (DECOS) limit (1.03 µg m-3 respirable EC) and the Finnish Institute of Occupational Health (FIOH) recommendation (5 µg m-3 respirable EC). Mixed-effects linear regression was used to identify determinants of EC exposure. RESULTS In total, 149 EC samples were collected, ranging from <0.25 to 52.58 µg m-3 with a geometric mean (GM) of 3.71 µg m-3 [geometric standard deviation (GSD) = 3.32]. Overall, 41.6% of samples exceeded the FIOH limit, mostly within underground worksites (93.5%), and 90.6% exceeded the DECOS limit. Underground workers (GM = 13.20 µg m-3, GSD = 1.83) had exposures approximately four times higher than below grade workers (GM = 3.56 µg m-3, GSD = 1.94) and nine times higher than above ground workers (GM = 1.49 µg m-3, GSD = 1.75). Training facility exposures were similar to above ground workers (GM = 1.86 µg m-3, GSD = 4.12); however, exposures were highly variable. Work setting and enclosed cabins were identified as the key determinants of exposure in the final model (adjusted R2 = 0.72, P < 0.001). The highest DEE exposures were observed in underground workplaces and when using unenclosed cabins. CONCLUSIONS This study provides data on current DEE exposure in Canadian construction workers. Most exposures were above recommended health-based limits, albeit in other jurisdictions, signifying a need to further reduce DEE levels in construction. These results can inform a hazard reduction strategy including targeted intervention/control measures to reduce DEE exposure and the burden of occupational lung cancer.
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Affiliation(s)
- Stephanie Ziembicki
- Occupational Cancer Research Centre, Ontario Health, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Tracy L Kirkham
- Occupational Cancer Research Centre, Ontario Health, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre, Ontario Health, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Cheryl E Peters
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Holy Cross Centre, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,CAREX Canada, Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Melanie Gorman Ng
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,BC Construction Safety Alliance, New Westminster, BC, Canada
| | - Hugh W Davies
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Thomas Tenkate
- School of Occupational and Public Health, Ryerson University, Toronto, ON, Canada
| | - Sheila Kalenge
- Occupational Cancer Research Centre, Ontario Health, Toronto, ON, Canada
| | | | | | - Victoria H Arrandale
- Occupational Cancer Research Centre, Ontario Health, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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31
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Blagrove-Hall N, Berriault C, Jardine KJ, Demers PA, Arrandale VH. Estimating Historical Exposure to Respirable Crystalline Silica in the Mining Industry in Ontario, Canada Using a Newly Developed Exposure Database. Ann Work Expo Health 2021; 65:1040-1049. [PMID: 34170289 DOI: 10.1093/annweh/wxab033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 03/31/2021] [Accepted: 04/21/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To use the recently developed Ontario Mining Exposure Database (OMED) to describe historical silica exposure in the Ontario metal mining industry and identify predictors of historical silica exposure. METHODS Personal respirable crystalline silica (RCS) data for metal mines were extracted from OMED and included both individual and summary measures, where multiple exposure measurements (n > 1) were aggregated and entered as a single exposure value (n = 1). Data were stratified by sample location (underground/surface) for analysis. Monte Carlo simulation was used to simulate individual measures from the summary measures. A fixed effects multiple linear regression model was used to assess the effects of commodity (ore mined), sample year, source of exposure data, and occupational group on RCS concentration. Parameter estimates (β), standard errors, and 95% upper and lower confidence intervals were reported. RESULTS The OMED contained 12 995 silica measurements. After limiting to RCS measurements in metal mines, and measures with sufficient information for analysis, 2883 RCS measurements collected from 1974 to 1991 remained, including 2816 individual and 67 summary measurements. In total, 321 individual RCS measurements were simulated from the 67 summary measures. The analysis database contained 2771 (12% simulated) underground measurements and 366 surface measurements (0% simulated). In the underground group, an overall geometric mean (GM) of 0.05 [geometric standard deviation (GSD) 3.09] mg m-3 was estimated with a 6% annual decrease over time. In this group, the commodity with the highest average RCS level was zinc mines (GM = 0.07 mg m-3) and the lowest was iron mines (GM = 0.01 mg m-3). In the surface group, an overall GM of 0.05 (GSD 3.70) mg m-3 was estimated with an 8% decreased over time. In this group, the commodity with the highest average RCS level was gold mines (GM = 0.07 mg m-3) and the lowest was zinc mines (GM = 0.03 mg m-3). In both groups, company collected data had lower estimated RCS compared with regulator collected data. CONCLUSIONS Historical RCS levels decreased over time. Mean measurements exceeded the American Conference of Governmental Industrial Hygienists current health-based threshold limit value (0.025 mg m-3). The main predictors of exposure were commodity, source of exposure data, and sample year. However, low R2 and high GSD values suggest additional predictors of RCS exposures in Ontario's metal mines exist that were unavailable in OMED.
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Affiliation(s)
| | - Colin Berriault
- Occupational Cancer Research Centre, Ontario Health, Toronto, ON, Canada
| | | | - Paul A Demers
- Occupational Cancer Research Centre, Ontario Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Victoria H Arrandale
- Occupational Cancer Research Centre, Ontario Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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DeBono NL, Warden H, Logar‐Henderson C, Shakik S, Dakouo M, MacLeod J, Demers PA. Incidence of mesothelioma and asbestosis by occupation in a diverse workforce. Am J Ind Med 2021; 64:476-487. [PMID: 33834530 DOI: 10.1002/ajim.23245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/09/2021] [Accepted: 03/02/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We sought to characterize detailed patterns of mesothelioma and asbestosis incidence in the workforce as part of an occupational disease surveillance program in Ontario, Canada. METHODS The Occupational Disease Surveillance System (ODSS) cohort was established using workers' compensation claims data and includes 2.18 million workers employed from 1983 to 2014. Workers were followed for mesothelioma and asbestosis diagnoses in Ontario Cancer Registry, physician, hospital, and ambulatory care records through 2016. Trends in incidence rates were estimated over the study period. Cox proportional hazard models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS A total of 854 mesothelioma and 737 asbestosis cases were diagnosed during follow-up. Compared with all other workers in the ODSS, those employed in construction trades occupations had the greatest adjusted incidence rate of both mesothelioma (223 cases; HR, 2.38; 95% CI: 2.03-2.78) and asbestosis (261 cases; HR, 3.64; 95% CI: 3.11-4.25). Rates were particularly elevated for insulators, pipefitters and plumbers, and carpenters. Workers in welding and flame cutting, boiler making, and mechanic and machinery repair occupations, as well as those in industrial chemical and primary metal manufacturing industries, had strongly elevated rates of both diseases. Rates were greater than anticipated for workers in electrical utility occupations and education and related services. CONCLUSIONS Results substantiate the risk of mesothelioma and asbestosis in occupation and industry groups in the Ontario workforce with known or suspected asbestos exposure. Sustained efforts to prevent the occurrence of additional cases of disease in high-risk groups are warranted.
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Affiliation(s)
- Nathan L. DeBono
- Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada
- Occupational Cancer Research Centre Ontario Health Toronto Ontario Canada
| | - Hunter Warden
- Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada
- Faculty of Medicine University of Toronto Toronto Ontario Canada
| | | | - Sharara Shakik
- Occupational Cancer Research Centre Ontario Health Toronto Ontario Canada
| | - Mamadou Dakouo
- Occupational Cancer Research Centre Ontario Health Toronto Ontario Canada
| | - Jill MacLeod
- Occupational Cancer Research Centre Ontario Health Toronto Ontario Canada
| | - Paul A. Demers
- Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada
- Occupational Cancer Research Centre Ontario Health Toronto Ontario Canada
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Mofidi A, Tompa E, Song C, Tenkate T, Arrandale V, J Jardine K, Davies H, Demers PA. Economic evaluation of interventions to reduce solar ultraviolet radiation (UVR) exposure among construction workers. J Occup Environ Hyg 2021; 18:250-264. [PMID: 33989124 DOI: 10.1080/15459624.2021.1910278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Solar ultraviolet radiation is one of the most common occupational carcinogens in Canada and is responsible for approximately 5,556 non-melanoma skin cancers per year. A large part of these cases are preventable by reducing solar ultraviolet radiation exposure. In this study, investigators estimated the potential economic impacts of different solar ultraviolet radiation reduction interventions among construction workers, as they are one of the largest at-risk occupational groups. Investigators performed an economic evaluation from a societal perspective, by comparing incremental costs in relation to incremental benefits achieved by two interventions-use of personal protective equipment by all exposed individuals and use of shade structure wherever and whenever feasible. Interventions costs were estimated for 2020-2050, and benefits with a 10-year delay, i.e., for the period 2030-2060. Economic evaluation estimates were reported by intervention costs, total costs of non-melanoma skin cancers cases averted, incremental cost per avert case, return on investment, and the break-even point. Various sensitivity analyses were undertaken with key parameters. Our findings indicate that if the rising trend of incidence continues, cases will be double in 2060, whereas by using personal protective equipment or shade structure, with the best-case scenario of full ultraviolet radiation removal, would result in 6,034 and 2,945 cases averted over 30 years, respectively. This translates into a total of $38.0 and $20.5 million of averted costs (all monetary values represented in 2017 Canadian dollars). Under this scenario investigators expect that by 2060, for every dollar invested in personal protective equipment and shade structures, $0.49 and $0.35 will be returned, respectively. Findings also suggested that under a conservative scenario, prevention of non-melanoma skin cancer cases by personal protective equipment and shade structures resulted in $5,812 and $7,355 incremental costs, respectively, over the 30-year period. This study provides important insights for decision makers about the potential impacts of solar ultraviolet radiation reduction interventions in the construction sector and other sectors with substantial outdoor work. Our estimates also can raise awareness of the importance of solar ultraviolet radiation reduction interventions.
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Affiliation(s)
| | - Emile Tompa
- Institute for Work & Health, Toronto, Ontario, Canada
- Department of Economics, McMaster University, Hamilton, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Chaojie Song
- Occupation Cancer Research Centre, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Thomas Tenkate
- School of Occupational and Public Health, Ryerson University, Toronto, Ontario, Canada
| | - Victoria Arrandale
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Occupation Cancer Research Centre, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Katherine J Jardine
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hugh Davies
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul A Demers
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Occupation Cancer Research Centre, Cancer Care Ontario, Toronto, Ontario, Canada
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Richardson DB, Rage E, Demers PA, Do MT, DeBono N, Fenske N, Deffner V, Kreuzer M, Samet J, Wiggins C, Schubauer-Berigan MK, Kelly-Reif K, Tomasek L, Zablotska LB, Laurier D. Mortality among uranium miners in North America and Europe: the Pooled Uranium Miners Analysis (PUMA). Int J Epidemiol 2021; 50:633-643. [PMID: 33232447 DOI: 10.1093/ije/dyaa195] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Pooled Uranium Miners Analysis (PUMA) study draws together information from cohorts of uranium miners from Canada, the Czech Republic, France, Germany and the USA. METHODS Vital status and cause of death were ascertained and compared with expectations based upon national mortality rates by computing standardized mortality ratios (SMRs) overall and by categories of time since first hire, calendar period of first employment and duration of employment as a miner. RESULTS There were 51 787 deaths observed among 118 329 male miners [SMR = 1.05; 95% confidence interval (CI): 1.04, 1.06]. The SMR was elevated for all cancers (n = 16 633, SMR = 1.23; 95% CI: 1.21, 1.25), due primarily to excess mortality from cancers of the lung (n = 7756, SMR = 1.90; 95% CI: 1.86, 1.94), liver and gallbladder (n = 549, SMR = 1.15; 95% CI: 1.06, 1.25), larynx (n = 229, SMR = 1.10; 95% CI: 0.97, 1.26), stomach (n = 1058, SMR = 1.08; 95% CI: 1.02, 1.15) and pleura (n = 39, SMR = 1.06; 95% CI: 0.75, 1.44). Lung-cancer SMRs increased with duration of employment, decreased with calendar period and persisted with time since first hire. Among non-malignant causes, the SMR was elevated for external causes (n = 3362, SMR = 1.41; 95% CI: 1.36, 1.46) and respiratory diseases (n = 4508, SMR = 1.32; 95% CI: 1.28, 1.36), most notably silicosis (n = 814, SMR = 13.56; 95% CI: 12.64, 14.52), but not chronic obstructive pulmonary disease (n = 1729, SMR = 0.98; 95% CI: 0.93, 1.02). CONCLUSIONS Whereas there are important obstacles to the ability to detect adverse effects of occupational exposures via SMR analyses, PUMA provides evidence of excess mortality among uranium miners due to a range of categories of cause of death. The persistent elevation of SMRs with time since first hire as a uranium miner underscores the importance of long-term follow-up of these workers.
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Affiliation(s)
| | - E Rage
- Institute for Radiological Protection and Nuclear Safety (IRSN), PSE-SANTE, SESANE, Fontenay-aux-Roses, France
| | - P A Demers
- Occupational Cancer Research Centre, Toronto, Canada
| | - M T Do
- Occupational Cancer Research Centre, Toronto, Canada
| | - N DeBono
- Occupational Cancer Research Centre, Toronto, Canada
| | - N Fenske
- Federal Office for Radiation Protection, Neuherberg, Germany
| | - V Deffner
- Federal Office for Radiation Protection, Neuherberg, Germany
| | - M Kreuzer
- Federal Office for Radiation Protection, Neuherberg, Germany
| | - J Samet
- Colorado School of Public Health, Aurora, CO, USA
| | - C Wiggins
- University of New Mexico, Albuquerque, NM, USA
- New Mexico Tumor Registry, Albuquerque, NM, USA
| | - M K Schubauer-Berigan
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
- International Agency for Research on Cancer, Lyon, France
| | - K Kelly-Reif
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - L Tomasek
- Radiation Protection Institute, Prague, Czech Republic
| | - L B Zablotska
- University of California, San Francisco, San Francisco, CA, USA
| | - D Laurier
- Institute for Radiological Protection and Nuclear Safety (IRSN), PSE-SANTE, SESANE, Fontenay-aux-Roses, France
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Troke N, Logar‐Henderson C, DeBono N, Dakouo M, Hussain S, MacLeod JS, Demers PA. Incidence of acute myocardial infarction in the workforce: Findings from the Occupational Disease Surveillance System. Am J Ind Med 2021; 64:338-357. [PMID: 33682182 DOI: 10.1002/ajim.23241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/30/2021] [Accepted: 02/15/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Increased risks of acute myocardial infarction (AMI) may be attributable to the workplace, however, associations are not well-established. Using the Occupational Disease Surveillance System (ODSS), we sought to estimate associations between occupation and industry of employment and AMI risk among workers in Ontario, Canada. METHODS The study population was derived by linking provincial accepted lost-time workers' compensation claims data, to inpatient hospitalization records. Workers aged 15-65 years with an accepted non-AMI compensation claim were followed for an AMI event between 2007 and 2016. Adjusted Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for each industry and occupation group, compared to all other workers in the cohort. Sex-stratified analyses were also performed. RESULTS In all, 24,514 incident cases of AMI were identified among 1,502,072 Ontario workers. Increased incidence rates of AMI were found across forestry (HR 1.37, 95% CI 1.19-1.58) and wood processing (HR 1.50, 1.27-1.77) job-titles. Elevated rates were also detected within industries and occupations both broadly related to mining and quarrying (HR 1.52, 1.17-1.97), trucking (HR 1.32, 1.27-1.38), construction (HR 1.32, 1.14-1.54), and the manufacturing and processing of metal (HR 1.41, 1.19-1.68), textile (HR 1.41, 1.07-1.88), non-metallic mineral (HR 1.30, 0.82-2.07), and rubber and plastic (HR 1.42, 1.27-1.60) products. Female food service workers also had elevated AMI rates (HR 1.36, 1.23-1.51). CONCLUSION This study found occupational variation in AMI incidence. Future studies should examine work-related hazards possibly contributing to such excess risks, like noise, vibration, occupational physical activity, shift work, and chemical and particulate exposures.
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Affiliation(s)
- Natalie Troke
- Occupational Cancer Research Centre Ontario Health (Cancer Care Ontario Division) Toronto Ontario Canada
- Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada
| | - Chloë Logar‐Henderson
- Occupational Cancer Research Centre Ontario Health (Cancer Care Ontario Division) Toronto Ontario Canada
| | - Nathan DeBono
- Occupational Cancer Research Centre Ontario Health (Cancer Care Ontario Division) Toronto Ontario Canada
- Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada
| | - Mamadou Dakouo
- Occupational Cancer Research Centre Ontario Health (Cancer Care Ontario Division) Toronto Ontario Canada
| | - Selena Hussain
- Occupational Cancer Research Centre Ontario Health (Cancer Care Ontario Division) Toronto Ontario Canada
- Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada
| | - Jill S. MacLeod
- Occupational Cancer Research Centre Ontario Health (Cancer Care Ontario Division) Toronto Ontario Canada
| | - Paul A. Demers
- Occupational Cancer Research Centre Ontario Health (Cancer Care Ontario Division) Toronto Ontario Canada
- Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada
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Guha N, Bouaoun L, Kromhout H, Vermeulen R, Brüning T, Behrens T, Peters S, Luzon V, Siemiatycki J, Xu M, Kendzia B, Guenel P, Luce D, Karrasch S, Wichmann HE, Consonni D, Landi MT, Caporaso NE, Gustavsson P, Plato N, Merletti F, Mirabelli D, Richiardi L, Jöckel KH, Ahrens W, Pohlabeln H, Tse LA, Yu ITS, Tardón A, Boffetta P, Zaridze D, 't Mannetje A, Pearce N, Davies MPA, Lissowska J, Świątkowska B, McLaughlin J, Demers PA, Bencko V, Foretova L, Janout V, Pándics T, Fabianova E, Mates D, Forastiere F, Bueno-de-Mesquita B, Schüz J, Straif K, Olsson A. Lung cancer risk in painters: results from the SYNERGY pooled case-control study consortium. Occup Environ Med 2021; 78:269-278. [PMID: 33115922 PMCID: PMC7958079 DOI: 10.1136/oemed-2020-106770] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/02/2020] [Accepted: 09/29/2020] [Indexed: 12/03/2022]
Abstract
OBJECTIVES We evaluated the risk of lung cancer associated with ever working as a painter, duration of employment and type of painter by histological subtype as well as joint effects with smoking, within the SYNERGY project. METHODS Data were pooled from 16 participating case-control studies conducted internationally. Detailed individual occupational and smoking histories were available for 19 369 lung cancer cases (684 ever employed as painters) and 23 674 age-matched and sex-matched controls (532 painters). Multivariable unconditional logistic regression models were adjusted for age, sex, centre, cigarette pack-years, time-since-smoking cessation and lifetime work in other jobs that entailed exposure to lung carcinogens. RESULTS Ever having worked as a painter was associated with an increased risk of lung cancer in men (OR 1.30; 95% CI 1.13 to 1.50). The association was strongest for construction and repair painters and the risk was elevated for all histological subtypes, although more evident for small cell and squamous cell lung cancer than for adenocarcinoma and large cell carcinoma. There was evidence of interaction on the additive scale between smoking and employment as a painter (relative excess risk due to interaction >0). CONCLUSIONS Our results by type/industry of painter may aid future identification of causative agents or exposure scenarios to develop evidence-based practices for reducing harmful exposures in painters.
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Affiliation(s)
- Neela Guha
- International Agency for Research on Cancer, Lyon, France
- California Environmental Protection Agency, Oakland, California, USA
| | | | - Hans Kromhout
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University (IPA), Bochum, Germany
| | - Thomas Behrens
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University (IPA), Bochum, Germany
| | - Susan Peters
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | | | - Jack Siemiatycki
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Mengting Xu
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Benjamin Kendzia
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University (IPA), Bochum, Germany
| | - Pascal Guenel
- Center for Research in Epidemiology and Population Health (CESP), Exposome and Heredity team, Inserm U1018, University Paris-Saclay, Villejuif, France
| | - Danièle Luce
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Pointe-à-Pitre, France
| | - Stefan Karrasch
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Inner City Clinic, University Hospital of Munich, Ludwig-Maximilians-Universität; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munchen, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Heinz-Erich Wichmann
- Institut für Medizinische Informatik Biometrie Epidemiologie, Ludwig Maximilians University, Munich, Germany
- Institut für Epidemiologie, Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Germany
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Teresa Landi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Neil E Caporaso
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Per Gustavsson
- Institute of Environmental Medicine, Unit of Occupational Medicine, Karolinska Institute, Stockholm, Sweden
| | - Nils Plato
- Institute of Environmental Medicine, Unit of Occupational Medicine, Karolinska Institute, Stockholm, Sweden
| | - Franco Merletti
- Department of Medical Sciences, Cancer Epidemiology Unit, University of Turin, Turin, Italy
| | - Dario Mirabelli
- Department of Medical Sciences, Cancer Epidemiology Unit, University of Turin, Turin, Italy
| | - Lorenzo Richiardi
- Department of Medical Sciences, Cancer Epidemiology Unit, University of Turin, Turin, Italy
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Essen, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Faculty of Mathematics and Computer Science, Institute of Statistics, University of Bremen, Bremen, Germany
| | - Hermann Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Lap Ah Tse
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Ignatius Tak-Sun Yu
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Adonina Tardón
- Department of Public Health, University of Oviedo, ISPA and CIBERESP, Oviedo, Spain
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - David Zaridze
- Department of Cancer Epidemiology and Prevention, N.N. Blokhin National Research Centre of Oncology, Moscow, Russian Federation
| | - Andrea 't Mannetje
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Neil Pearce
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Michael P A Davies
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool. Roy Castle Lung Cancer Foundation, Liverpool, UK
| | - Jolanta Lissowska
- Epidemiology Unit, Department of Cancer Epidemiology and Prevention, M. Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Beata Świątkowska
- Health Capital School; Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - John McLaughlin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Paul A Demers
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
| | - Vladimir Bencko
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lenka Foretova
- Masaryk Memorial Cancer Institute, Brno, Jihomoravský, Czech Republic
| | - Vladimir Janout
- Faculty of Health Sciences, Palacky University, Olomouc, Czech Republic
| | | | - Eleonora Fabianova
- Occupational Health and Toxicology, Regional Authority of Public Health, Banska Bystrica, Slovakia
- Faculty of Health, Catholic University, Ružomberok, Slovakia
| | - Dana Mates
- National Institute of Public Health, Bucharest, Romania
| | | | - Bas Bueno-de-Mesquita
- Former senior scientist, Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Joachim Schüz
- International Agency for Research on Cancer, Lyon, France
| | - Kurt Straif
- International Agency for Research on Cancer, Lyon, France
| | - Ann Olsson
- International Agency for Research on Cancer, Lyon, France
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Giles Murphy T, Bornstein S, Oudyk J, Demers PA. A Quantitative Retrospective Exposure Assessment for Former Chrysotile Asbestos Miners and Millers from Baie Verte, NL, Canada. Ann Work Expo Health 2021; 65:113-126. [PMID: 32959879 DOI: 10.1093/annweh/wxaa092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 01/27/2020] [Accepted: 08/24/2020] [Indexed: 11/14/2022] Open
Abstract
Despite numerous studies of asbestos workers in the epidemiologic literature, there are very few cohort studies of chrysotile asbestos miners/millers that include high-quality retrospective exposure assessments. As part of the creation of the Baie Verte Miners' Registry in 2008, a two-dimensional job exposure matrix (JEM) was developed for estimating asbestos exposures for former chrysotile asbestos miners/millers. Industrial hygiene data collected between 1963 and 1994 were analysed to assess validity for use in a retrospective exposure assessment and epidemiologic study. Registered former employees were divided into 52 exposure groups (EGs) based on job title and department and mean asbestos concentrations were calculated for each EG. The resulting exposure estimates were linked to individual registrants' work histories allowing for the calculation of cumulative asbestos exposure for each registrant. The distribution of exposure for most EGs (82.6%) could be described as fitting a log-normal distribution, although variability within some EGs (55%) exceeded a geometric standard deviation (GSD) of 2.5. Overall, the data used to create EGs in the development of the JEM were deemed to be of adequate quality for estimating cumulative asbestos exposures for the former employees of the Baie Verte asbestos mine/mill. The variability between workers in the same job was often high and is an important factor to be considered when using estimates of cumulative asbestos exposure to adjudicate compensation claims. The exposures experienced in this cohort were comparable to those of other chrysotile asbestos miners/millers cohorts, specifically Italian and Québec cohorts.
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Affiliation(s)
- Tina Giles Murphy
- Memorial University of Newfoundland, SafetyNet Centre for Occupational Health & Safety Research, Bruneau Centre, St. John's, NL, Canada
| | - Stephen Bornstein
- Memorial University of Newfoundland, SafetyNet Centre for Occupational Health & Safety Research, Bruneau Centre, St. John's, NL, Canada
| | - John Oudyk
- Occupational Health Clinics for Ontario Workers, Hamilton, ON, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, ON, Canada
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Zeng X, DeBono NL, Harris AM, Arrandale VH, Demers PA. Neurodegenerative diseases among miners in Ontario, Canada, using a linked cohort. Occup Environ Med 2020; 78:oemed-2020-106958. [PMID: 33234693 DOI: 10.1136/oemed-2020-106958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/21/2020] [Accepted: 11/03/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined employment in mining occupations and industries and its association with neurological disease incidence in a linkage cohort from Ontario, Canada. Outcomes included Alzheimer's disease (alone and with other dementias), Parkinson's disease, parkinsonism, motor neuron disease and amyotrophic lateral sclerosis (ALS). METHODS The Occupational Disease Surveillance System cohort was created by linking workers' compensation data and healthcare usage records. This analysis included over 1.1 million male workers, followed between 1999 and 2016. Neurological diseases were ascertained using physician billing and hospital discharge records. Adjusted Poisson regression models were used to estimate incidence rate ratios (RR) comparing mining to non-mining workers overall and by ore (industry) and occupation group. RESULTS Suggested elevations in incidence rates were observed for ALS among workers of metal mines (RR 2.21, 95% CI 1.04 to 4.69) and for motor neuron disease among those employed in mining occupations within metal mining industries (RR 1.96, 95% CI 1.01 to 3.79), though these were based on relatively few cases. In miscellaneous metal mines, workers who held mining occupations had an elevated rate of Alzheimer's disease (RR 1.27, 95% CI 0.92 to 1.77). Parkinson's disease rate was elevated among workers with rock and soil drilling occupations (RR 1.60, 95% CI 1.04 to 2.45). CONCLUSIONS Mining hazards may be associated with elevated rates of neurodegenerative diseases among workers in mining occupations and industries. More work is needed to better understand mining exposures and their associations with neurodegenerative diseases.
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Affiliation(s)
- Xiaoke Zeng
- Occupational and Environmental Health Division, University of Toronto, Toronto, Ontario, Canada
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
| | - Nathan L DeBono
- Occupational and Environmental Health Division, University of Toronto, Toronto, Ontario, Canada
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
| | - Anne M Harris
- Occupational and Environmental Health Division, University of Toronto, Toronto, Ontario, Canada
- School of Occupational and Public Health, Ryerson University, Toronto, Ontario, Canada
| | - Victoria H Arrandale
- Occupational and Environmental Health Division, University of Toronto, Toronto, Ontario, Canada
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
| | - Paul A Demers
- Occupational and Environmental Health Division, University of Toronto, Toronto, Ontario, Canada
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
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Astrakianakis G, Jeronimo M, Griffiths A, Colombo M, Kramer D, Demers PA, Hon CY. The application of novel field measurement and field evaluation protocols for assessing health care workers' exposure risk to antineoplastic drugs. J Occup Environ Hyg 2020; 17:373-382. [PMID: 32615872 DOI: 10.1080/15459624.2020.1777296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Contamination of multiple antineoplastic drugs (ADs) on work surfaces presents an exposure concern for health care workers. Surface wipe sampling is a recognized method to evaluate the degree of contamination present. Our research team has previously reported on wipe sampling and analytical methods to simultaneously detect 10 commonly used ADs from a single wipe. Our objectives here were: to field test a protocol consisting of the wipe sampling method and an accompanying wipe sample collection tool kit and confirm this protocol can be effectively used by health care workers to assess drug contamination levels in their facilities; and, to confirm the potential for simultaneous exposure to multiple antineoplastic drugs. Three facilities within one health authority in British Columbia, Canada participated in this field study. In collaboration with the site health and safety advisors, up to 25 surfaces within each facility were considered for sampling. Collected wipe samples were analyzed using HPLC-MS/MS to quantify the 10 analyte, resulting in 750 potential analyses. Following the sampling, each of the three facilities' safety advisors provided feedback regarding the usability of the protocols. Among the 72 wipe samples actually collected (or 720 analyses conducted), detectable levels and simultaneous contamination of work surfaces of five of the 10 analytes were found at all three participating sites: 5-fluorouracil, cyclophosphamide, vincristine, paclitaxel, and methotrexate; (range < LoD to 33.0 ng/cm2) with 5-fluorouracil having the highest concentration in every instance. Drug contamination was found on a variety of different work surfaces in pharmacies and patient care areas among all three sites. Users of the sampling protocols were generally satisfied with the wipe sample collection toolkit with some minor suggestions for improvement. Our findings support the hypothesis that health care workers may be simultaneously at risk of exposure to several ADs. Our toolkit was found to be user-friendly and manageable by those who were not experienced in collecting wipe samples to monitor contamination of ADs on the work surfaces in their facilities.
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Affiliation(s)
- George Astrakianakis
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Matthew Jeronimo
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Andrea Griffiths
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Manuel Colombo
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Desré Kramer
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Paul A Demers
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Chun-Yip Hon
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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DeBono NL, Logar-Henderson C, Warden H, Shakik S, Dakouo M, MacLeod J, Demers PA. Cancer surveillance among workers in plastics and rubber manufacturing in Ontario, Canada. Occup Environ Med 2020; 77:847-856. [PMID: 32847990 DOI: 10.1136/oemed-2020-106581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/08/2020] [Accepted: 07/24/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Occupational exposure to agents in plastics and rubber manufacturing has been associated with elevated risk of certain cancers. We sought to evaluate cancer risk among workers employed in occupations and industries with these exposures as part of an ongoing surveillance programme in Ontario, Canada. METHODS The Occupational Disease Surveillance System (ODSS) cohort was established using workers' compensation claims data and includes 2.18 million workers employed from 1983 to 2014. Workers were followed for site-specific cancer diagnoses in the Ontario Cancer Registry through 2016. Cox proportional hazard models were used to estimate adjusted HR and 95% CI. RESULTS We identified 81 127 workers employed in plastics and rubber manufacturing industries or materials processing and product fabricating occupations. Compared with all other women in the ODSS, those in materials processing occupations had an elevated rate of lung cancer (HR 1.38, 95% CI 1.20 to 1.58) that was not observed among men. An elevated rate of breast cancer was observed among female labourers (HR 1.36, 95% CI 1.01 to 1.82) and moulders (HR 1.47, 95% CI 0.91 to 2.37) in plastics and rubber product fabricating occupations. Overall, elevated rates were observed for oesophageal, liver, stomach, prostate and kidney cancer in job-specific subgroups, including mixing and blending, bonding and cementing, and labouring. There was little evidence of association for lymphatic or haematopoietic cancers. CONCLUSIONS Findings for lung and breast cancer in women are consistent with other studies and warrant further attention in Ontario. Given the relatively young age at end of follow-up, surveillance in these workers should continue as the cohort ages.
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Affiliation(s)
- Nathan L DeBono
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada .,Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
| | | | - Hunter Warden
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sharara Shakik
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
| | - Mamadou Dakouo
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
| | - Jill MacLeod
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
| | - Paul A Demers
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
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Kachuri L, Beane Freeman LE, Spinelli JJ, Blair A, Pahwa M, Koutros S, Hoar Zahm S, Cantor KP, Weisenburger DD, Pahwa P, Dosman JA, McLaughlin JR, Demers PA, Harris SA. Insecticide use and risk of non-Hodgkin lymphoma subtypes: A subset meta-analysis of the North American Pooled Project. Int J Cancer 2020; 147:3370-3383. [PMID: 32574374 PMCID: PMC7689728 DOI: 10.1002/ijc.33164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 05/12/2020] [Accepted: 06/09/2020] [Indexed: 12/11/2022]
Abstract
Insecticide use has been linked to increased risk of non-Hodgkin lymphoma (NHL), however, findings of epidemiologic studies have been inconsistent, particularly for NHL subtypes. We analyzed 1690 NHL cases and 5131 controls in the North American Pooled Project (NAPP) to investigate self-reported insecticide use and risk of NHL overall and by subtypes: follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL) and small lymphocytic lymphoma (SLL). Odds ratios (OR) and 95% confidence intervals for each insecticide were estimated using logistic regression. Subtype-specific associations were evaluated using ASSET (Association analysis for SubSETs). Increased risks of multiple NHL subtypes were observed for lindane (OR = 1.60, 1.20-2.10: FL, DLCBL, SLL), chlordane (OR = 1.59, 1.17-2.16: FL, SLL) and DDT (OR = 1.36, 1.06-1.73: DLBCL, SLL). Positive trends were observed, within the subsets with identified associations, for increasing categories of exposure duration for lindane (Ptrend = 1.7 × 10-4 ), chlordane (Ptrend = 1.0 × 10-3 ) and DDT (Ptrend = 4.2 × 10-3 ), however, the exposure-response relationship was nonlinear. Ever use of pyrethrum was associated with an increased risk of FL (OR = 3.65, 1.45-9.15), and the relationship with duration of use appeared monotonic (OR for >10 years: OR = 5.38, 1.75-16.53; Ptrend = 3.6 × 10-3 ). Our analysis identified several novel associations between insecticide use and specific NHL subtypes, suggesting possible etiologic heterogeneity in the context of pesticide exposure.
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Affiliation(s)
- Linda Kachuri
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Laura E Beane Freeman
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Bethesda, Maryland, USA
| | - John J Spinelli
- Population Oncology, BC Cancer, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aaron Blair
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Bethesda, Maryland, USA
| | - Manisha Pahwa
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Stella Koutros
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Bethesda, Maryland, USA
| | - Shelia Hoar Zahm
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Bethesda, Maryland, USA
| | - Kenneth P Cantor
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Bethesda, Maryland, USA
| | | | - Punam Pahwa
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - James A Dosman
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - John R McLaughlin
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Ontario, Canada.,Division of Occupational & Environmental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Population Health and Prevention, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Shelley A Harris
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Ontario, Canada.,Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Division of Occupational & Environmental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Population Health and Prevention, Cancer Care Ontario, Toronto, Ontario, Canada
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Demers PA. Abstract IA22: Impact of workplace exposures on cancer disparities. Cancer Prev Res (Phila) 2020. [DOI: 10.1158/1940-6215.envcaprev19-ia22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Workplace exposures can have a big impact on cancer disparities. Perhaps the earliest lens through which disparities were examined was through the UK “Registrar-General’s Social Classes,” which were introduced in 1913. These six classes were based on occupation ranging from “professional occupations” to “unskilled occupations” and were predictive of mortality. One can think of these occupational groups representing both education and income, but they also represent power, control, social prestige/status, and mobility, as well as differential exposure to a wide range of workplace carcinogens. While nonoccupational behavioral risk factors could potentially confound the relationship between social class based on occupation and cancer, adjustment for these factors often does not remove associations. For example, in IARC’s Synergy project, a pooled analysis of lung cancer case-control studies, strong associations between Treiman’s Standard International Occupational Prestige Scale and International Socio-Economic Index of Occupational Status remained after adjustment for smoking. In studies of occupational cancer, our focus has most often been on “skilled manual” and “semi-skilled” occupations, because it has been easier to document exposure and their employment by either large companies or unionization facilitates recruitment. Although potentially carcinogenic exposures can occur among a wide range of occupations, the risk is not spread evenly. For example, exposure to common workplace lung carcinogens such as asbestos, diesel exhaust, crystalline silica, nickel, and chromium remains prevalent among workers in construction, transportation, mining, and certain manufacturing and service industries, and very rare among managerial, professional, and sales workers. Although the first occupational chemical carcinogen identified was soot, to which chimney sweeps were exposed as child workers, few studies have focused on the lowest, most vulnerable social class because of difficulties recruiting and other practical challenges. For example, studies of pesticides and cancer have most often recruited farmers and pesticide applicators, and not the more vulnerable farm workers, particularly migrant workers. Other examples of vulnerable groups with potentially carcinogenic exposures are electronic waste, nail salon, and cleaning workers. Further studies of cancer among these vulnerable groups are needed.
Citation Format: Paul A. Demers. Impact of workplace exposures on cancer disparities [abstract]. In: Proceedings of the AACR Special Conference on Environmental Carcinogenesis: Potential Pathway to Cancer Prevention; 2019 Jun 22-24; Charlotte, NC. Philadelphia (PA): AACR; Can Prev Res 2020;13(7 Suppl): Abstract nr IA22.
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Affiliation(s)
- Paul A. Demers
- Occupational Cancer Research Centre, Toronto, ON, Canada
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Keefe AR, Demers PA, Neis B, Arrandale VH, Davies HW, Gao Z, Hedges K, Holness DL, Koehoorn M, Stock SR, Bornstein S. A scoping review to identify strategies that work to prevent four important occupational diseases. Am J Ind Med 2020; 63:490-516. [PMID: 32227359 DOI: 10.1002/ajim.23107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Despite being largely preventable, many occupational diseases continue to be highly prevalent and extremely costly. Effective strategies are required to reduce their human, economic, and social impacts. METHODS To better understand which approaches are most likely to lead to progress in preventing noise-related hearing loss, occupational contact dermatitis, occupational cancers, and occupational asthma, we undertook a scoping review and consulted with a number of key informants. RESULTS We examined a total of 404 articles and found that various types of interventions are reported to contribute to occupational disease prevention but each has its limitations and each is often insufficient on its own. Our principal findings included: legislation and regulations can be an effective means of primary prevention, but their impact depends on both the nature of the regulations and the degree of enforcement; measures across the hierarchy of controls can reduce the risk of some of these diseases and reduce exposures; monitoring, surveillance, and screening are effective prevention tools and for evaluating the impact of legislative/policy change; the effect of education and training is context-dependent and influenced by the manner of delivery; and, multifaceted interventions are often more effective than ones consisting of a single activity. CONCLUSIONS This scoping review identifies occupational disease prevention strategies worthy of further exploration by decisionmakers and stakeholders and of future systematic evaluation by researchers. It also identified important gaps, including a lack of studies of precarious workers and the need for more studies that rigorously evaluate the effectiveness of interventions.
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Affiliation(s)
- Anya R. Keefe
- SafetyNet Centre for Occupational Health and Safety Research, Memorial University St. John's Newfoundland Canada
| | - Paul A. Demers
- Occupational Cancer Research Centre, Cancer Care Ontario Toronto Ontario Canada
| | - Barbara Neis
- SafetyNet Centre for Occupational Health and Safety Research, Memorial University St. John's Newfoundland Canada
| | | | - Hugh W. Davies
- Occupational and Environmental Health, School of Population and Public HealthUniversity of British Columbia Vancouver British Columbia Canada
| | - Zhiwei Gao
- Department of Clinical Epidemiology, Faculty of MedicineMemorial University St. John's Newfoundland Canada
| | - Kevin Hedges
- Occupational Health Clinics for Ontario Workers Ottawa Ontario Canada
| | - D. Linn Holness
- Department of Medicine and Public Health SciencesSt. Michael's Hospital/University of Toronto, Toronto, Ontario, Canada
| | - Mieke Koehoorn
- Occupational and Environmental Health, School of Population and Public HealthUniversity of British Columbia Vancouver British Columbia Canada
| | - Susan R. Stock
- Division of Biological Risks and Occupational HealthInstitut national de santé publique du Québec (Quebec Institute of Public Health) Montreal Quebec Canada
- Department of Social and Preventive MedicineSchool of Public Health, Université de Montreal Montreal Quebec Canada
| | - Stephen Bornstein
- SafetyNet Centre for Occupational Health and Safety Research, Memorial University St. John's Newfoundland Canada
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Richardson DB, DeBono NL, Berriault C, Demers PA. Innovations in applied decision theory for health and safety. Occup Environ Med 2020; 77:520-526. [PMID: 32398293 DOI: 10.1136/oemed-2019-106303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 03/24/2020] [Accepted: 04/18/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES There are established methods for occupational epidemiological cohort analysis, such as proportional hazards regression, that are well suited to aetiological research and yield parameter estimates that allow for succinct communication among academics. However, these methods are not necessarily well suited for evaluation of health impacts of policy choices and communication to decision makers. An informed decision about a policy that impacts health and safety requires a valid estimate of the policy's potential impact. METHODS We propose methods for data summarisation that may facilitate communication with managers, workers and their advocates. We calculate measures of effect in a framework for competing events, graphically display potential impacts on cause-specific mortality under policy alternatives and contrast these results to estimates obtained using standard Poisson regression methods. Methods are illustrated using a cohort mortality study of 28 546 Ontario uranium miners hired between 1950 and 1996 and followed through 2007. RESULTS A standard regression analysis yields a positive association between cumulative radon progeny exposure and all-cause mortality (log(RR per 100 WLM)=0.09; SE=0.02). The proposed method yields an estimate of the expected gain in life expectancy (approximately 6 months per worker) and reduction of 261 lung cancer deaths under a policy that eliminated occupational radon progeny exposure. CONCLUSIONS The proposed method shifts attention from covariate-adjusted risk ratios or rate ratios to estimates of deaths that are avoided or delayed under a potential policy. The approach may help inform decision-making and strengthen the connection of epidemiological approaches to data analysis with developments in decision theory and systems engineering to improve health and safety.
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Affiliation(s)
- David B Richardson
- Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nathan L DeBono
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
| | - Colin Berriault
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
| | - Paul A Demers
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
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Harris MA, MacLeod J, Kim J, Pahwa M, Tjepkema M, Peters P, Demers PA. Use of a Canadian Population-Based Surveillance Cohort to Test Relationships Between Shift Work and Breast, Ovarian, and Prostate Cancer. Ann Work Expo Health 2020; 64:387-401. [PMID: 32144413 DOI: 10.1093/annweh/wxaa017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 12/20/2019] [Accepted: 02/05/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Shift work with circadian disruption is a suspected human carcinogen. Additional population-representative human studies are needed and large population-based linkage cohorts have been explored as an option for surveillance shift work and cancer risk. This study uses a surveillance linkage cohort and job-exposure matrix to test relationships. METHODS We estimated associations between shift work and breast, ovarian, and prostate cancer using the population-based Canadian Census Health and Environment Cohort (CanCHEC), linking the 1991 Canadian census to national cancer registry and mortality databases. Prevalence estimates from population labour survey data were used to estimate and assign probability of night, rotating, or evening shifts by occupation and industry. Cohort members were assigned to high (>50%), medium (>25 to 50%), low (>5 to 25%), or no (<5%) probability of exposure categories. Cox proportional hazards modelling was used to estimate associations between shift work exposure and incidence of prostate cancer in men and ovarian and breast cancer in women. RESULTS The cohort included 1 098 935 men and 939 520 women. Hazard ratios (HRs) indicated null or inverse relationships comparing high probability to no exposure for prostate cancer: HR = 0.96, 95% confidence interval (CI) = 0.91-1.02; breast cancer: HR = 0.94, 95% CI = 0.90-0.99; and ovarian cancer: HR = 0.99, 95% CI = 0.87-1.13. CONCLUSIONS This study showed inverse and null associations between shift work exposure and incidence of prostate, breast, or ovarian cancer. However, we explore limitations of a surveillance cohort, including a possible healthy worker survivor effect and the possibility that this relationship may require the nuanced exposure detail in primary collection studies to be measurable.
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Affiliation(s)
- M Anne Harris
- School of Occupational and Public Health, Ryerson University, Toronto ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, ON, Canada
| | - Jill MacLeod
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, ON, Canada
| | - Joanne Kim
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, ON, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Manisha Pahwa
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, ON, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | | | - Paul Peters
- Department of Health Sciences, Carleton University, Ottawa, ON, Canada
| | - Paul A Demers
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, ON, Canada
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Ge CB, Kim J, Labrèche F, Heer E, Song C, Arrandale VH, Pahwa M, Peters CE, Demers PA. Estimating the burden of lung cancer in Canada attributed to occupational radon exposure using a novel exposure assessment method. Int Arch Occup Environ Health 2020; 93:871-876. [PMID: 32232555 PMCID: PMC7452915 DOI: 10.1007/s00420-020-01537-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/16/2020] [Indexed: 11/30/2022]
Abstract
Objective Exposure to radon causes lung cancer. The scope and impact of exposure among Canadian workers have not been assessed. Our study estimated occupational radon exposure in Canada and its associated lung cancer burden. Methods Exposed workers were identified among the working population during the risk exposure period (1961–2001) using data from the Canadian Census and Labour Force Survey. Exposure levels were assigned based on 12,865 workplace radon measurements for indoor workers and assumed to be 1800 mg/m3 for underground workers. Lung cancer risks were calculated using the Biological Effects of Ionizing Radiation (BEIR) VI exposure-age-concentration model. Population attributable fractions were calculated with Levin’s equation and applied to 2011 Canadian lung cancer statistics. Results Approximately 15.5 million Canadian workers were exposed to radon during the risk exposure period. 79% of exposed workers were exposed to radon levels < 50 Bq/m3 and 4.8% were exposed to levels > 150 Bq/m3. We estimated that 0.8% of lung cancers in Canada were attributable to occupational radon exposure, corresponding to approximately 188 incident lung cancers in 2011. Conclusions The lung cancer burden associated with occupational radon exposure in Canada is small, with the greatest burden occurring among those exposed to low levels of radon.
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Affiliation(s)
- C B Ge
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Yalelaan 2, 3584 CM, Utrecht, Netherlands. .,CAREX Canada, Simon Fraser University, Burnaby, Canada.
| | - J Kim
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
| | - F Labrèche
- Institut de Recherche Robert-Sauvé en santé Et en sécurité du Travail, Montréal, Canada.,Department of Environmental and Occupational Health, School of Public Health, Université de Montréal, Montréal, Canada
| | - E Heer
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada
| | - C Song
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Canada
| | - V H Arrandale
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - M Pahwa
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Canada
| | - C E Peters
- CAREX Canada, Simon Fraser University, Burnaby, Canada.,Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - P A Demers
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Rage E, Richardson DB, Demers PA, Do M, Fenske N, Kreuzer M, Samet J, Wiggins C, Schubauer-Berigan MK, Kelly-Reif K, Tomasek L, Zablotska LB, Laurier D. PUMA - pooled uranium miners analysis: cohort profile. Occup Environ Med 2020; 77:194-200. [PMID: 32005674 PMCID: PMC8663280 DOI: 10.1136/oemed-2019-105981] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 12/02/2019] [Accepted: 12/21/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Epidemiological studies of underground miners have provided clear evidence that inhalation of radon decay products causes lung cancer. Moreover, these studies have served as a quantitative basis for estimation of radon-associated excess lung cancer risk. However, questions remain regarding the effects of exposure to the low levels of radon decay products typically encountered in contemporary occupational and environmental settings on the risk of lung cancer and other diseases, and on the modifiers of these associations. These issues are of central importance for estimation of risks associated with residential and occupational radon exposures. METHODS The Pooled Uranium Miner Analysis (PUMA) assembles information on cohorts of uranium miners in North America and Europe. Data available include individual annual estimates of exposure to radon decay products, demographic and employment history information on each worker and information on vital status, date of death and cause of death. Some, but not all, cohorts also have individual information on cigarette smoking, external gamma radiation exposure and non-radiological occupational exposures. RESULTS The PUMA study represents the largest study of uranium miners conducted to date, encompassing 124 507 miners, 4.51 million person-years at risk and 54 462 deaths, including 7825 deaths due to lung cancer. Planned research topics include analyses of associations between radon exposure and mortality due to lung cancer, cancers other than lung, non-malignant disease, modifiers of these associations and characterisation of overall relative mortality excesses and lifetime risks. CONCLUSION PUMA provides opportunities to evaluate new research questions and to conduct analyses to assess potential health risks associated with uranium mining that have greater statistical power than can be achieved with any single cohort.
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Affiliation(s)
- Estelle Rage
- Institute for Radiological Protection and Nuclear Safety (IRSN), PSE-SANTE, SESANE, Fontenay-aux-Roses, France
| | | | | | - Minh Do
- Cancer Care Ontario, Toronto, Ontario, Canada
| | - Nora Fenske
- Federal Office for Radiation Protection, Department of Radiation Protection and Health, Neuherberg, Germany
| | - Michaela Kreuzer
- Federal Office for Radiation Protection, Department of Radiation Protection and Health, Neuherberg, Germany
| | | | - Charles Wiggins
- University of New Mexico, Albuquerque, New Mexico, USA
- New Mexico Tumor Registry, Albuquerque, New Mexico, USA
| | - Mary K Schubauer-Berigan
- International Agency for Research on Cancer, Lyon, France
- National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Kaitlin Kelly-Reif
- National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | | | - Lydia B Zablotska
- University of California, San Francisco, San Francisco, California, USA
| | - Dominique Laurier
- Institute for Radiological Protection and Nuclear Safety (IRSN), PSE-SANTE, SESANE, Fontenay-aux-Roses, France
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48
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Mofidi A, Tompa E, Mortazavi SB, Esfahanipour A, Demers PA. A probabilistic approach for economic evaluation of occupational health and safety interventions: a case study of silica exposure reduction interventions in the construction sector. BMC Public Health 2020; 20:210. [PMID: 32046683 PMCID: PMC7014628 DOI: 10.1186/s12889-020-8307-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 01/31/2020] [Indexed: 11/10/2022] Open
Abstract
Background Construction workers are at a high risk of exposure to various types of hazardous substances such as crystalline silica. Though multiple studies indicate the evidence regarding the effectiveness of different silica exposure reduction interventions in the construction sector, the decisions for selecting a specific silica exposure reduction intervention are best informed by an economic evaluation. Economic evaluation of interventions is subjected to uncertainties in practice, mostly due to the lack of precise data on important variables. In this study, we aim to identify the most cost-beneficial silica exposure reduction intervention for the construction sector under uncertain situations. Methods We apply a probabilistic modeling approach that covers a large number of variables relevant to the cost of lung cancer, as well as the costs of silica exposure reduction interventions. To estimate the societal lifetime cost of lung cancer, we use an incidence cost approach. To estimate the net benefit of each intervention, we compare the expected cost of lung cancer cases averted, with expected cost of implementation of the intervention in one calendar year. Sensitivity analysis is used to quantify how different variables affect interventions net benefit. Results A positive net benefit is expected for all considered interventions. The highest number of lung cancer cases are averted by combined use of wet method, local exhaust ventilation and personal protective equipment, about 107 cases, with expected net benefit of $45.9 million. Results also suggest that the level of exposure is an important determinant for the selection of the most cost-beneficial intervention. Conclusions This study provides important insights for decision makers about silica exposure reduction interventions in the construction sector. It also provides an overview of the potential advantages of using probabilistic modeling approach to undertake economic evaluations, particularly when researchers are confronted with a large number of uncertain variables.
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Affiliation(s)
- Amirabbas Mofidi
- Institute for Work & Health, 481 University Ave Suite 800, Toronto, ON, M5G 2E9, Canada.,School of Medical Science, Tarbiat Modares University, PO: 14115-111, Tehran, Iran
| | - Emile Tompa
- Institute for Work & Health, 481 University Ave Suite 800, Toronto, ON, M5G 2E9, Canada.,Department of Economics, McMaster University, Hamilton, Ontario, Canada
| | - Seyed Bagher Mortazavi
- Institute for Work & Health, 481 University Ave Suite 800, Toronto, ON, M5G 2E9, Canada. .,School of Medical Science, Tarbiat Modares University, PO: 14115-111, Tehran, Iran.
| | - Akbar Esfahanipour
- Department of Industrial Engineering and Management Systems, Amirkabir University of Technology, Tehran, Iran
| | - Paul A Demers
- Occupational Cancer Research Centre, Toronto, Ontario, Canada
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Abstract
Firefighters are potentially exposed to many carcinogens while at fires. There is also concern that firefighters may be at risk of exposure to carcinogens at other times, such as exposure to diesel engine exhaust (DEE) within fire halls. The study objective was to evaluate DEE levels in career fire halls in Ontario, Canada. Twelve career fire halls from six cities across the province of Ontario, Canada were recruited. In each hall, 24-hr DEE area samples were collected using NIOSH method 5040 (modified) for respirable elemental carbon in three locations (vehicle bay, dormitory, living quarters). Sampling was conducted in both the summer and winter to assess seasonal differences. Factors that may influence DEE exposures were also collected including presence of local exhaust ventilation (LEV), emergency run data, vehicle bay design, and age of fire apparatus. LEV was assessed using a thermo-anemometer during both campaigns. Of the 69 samples collected, 16% had detectable elemental carbon concentrations, where all but one was taken within the vehicle bay (range: <0.5 µg/m3-2.7 µg/m3). The data indicates vehicle bay exposures may be higher in halls with LEV units, those that respond to more emergencies, have a back-in vehicle bay design compared to drive-through design, and during the summer season. Three samples (4.3%) exceeded the 1.03 µg/m3 proposed Dutch occupational exposure limit; however, the estimated exceedance fraction of the underlying vehicle bay exposure distribution was 17%. Eight halls had LEV units, where performance ranged from 3.6% to 85.3% (median = 54%) when compared to manufacturer recommendations. The results show that firefighters may be at an increased risk of exposure to DEE when in fire halls and that LEV units should be assessed regularly for efficiency. Although no occupational exposure limit for DEE is currently available for industrial/non-industrial workplaces in Ontario, fire departments should continue to implement DEE control strategies to reduce exposures to mitigate potential health risks. Additional exposure studies are recommended to better understand DEE exposure in fire halls.
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Affiliation(s)
- JuWon Chung
- Occupational and Environmental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
| | - Paul A Demers
- Occupational and Environmental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
| | - Sheila Kalenge
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
| | - Tracy L Kirkham
- Occupational and Environmental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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50
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Sritharan J, MacLeod JS, McLeod CB, Peter A, Demers PA. Prostate cancer risk by occupation in the Occupational Disease Surveillance System (ODSS) in Ontario, Canada. Health Promot Chronic Dis Prev Can 2019; 39:178-186. [PMID: 31091061 DOI: 10.24095/hpcdp.39.5.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Previous Canadian epidemiologic studies have identified associations between occupations and prostate cancer risk, though evidence is limited. However, there are no well-established preventable risk factors for prostate cancer, which warrants the need for further investigation into occupational factors to strengthen existing evidence. This study uses occupation and prostate cancer information from a large surveillance cohort in Ontario that linked workers' compensation claim data to administrative health databases. METHODS Occupations were examined using the Occupational Disease Surveillance System (ODSS). ODSS included 1 231 177 male workers for the 1983 to 2015 period, whose records were linked to the Ontario Cancer Registry (OCR) in order to identify and follow up on prostate cancer diagnoses. Cox proportional hazard models were used to calculate age-adjusted hazard ratios and 95% CI to estimate the risk of prostate cancer by occupation group. RESULTS A total of 34 997 prostate cancer cases were diagnosed among workers in ODSS. Overall, elevated prostate cancer risk was observed for men employed in management/ administration (HR 2.17, 95% CI = 1.98-2.38), teaching (HR 1.99, 95% CI = 1.79-2.21), transportation (HR 1.20, 95% CI = 1.16-1.24), construction (HR 1.09, 95% CI = 1.06-1.12), firefighting (HR 1.62, 95% CI = 1.47-1.78), and police work (HR 1.20, 95% CI = 1.10-1.32). Inconsistent findings were observed for clerical and farming occupations. CONCLUSION Associations observed in white collar, construction, transportation, and protective services occupations were consistent with previous Canadian studies. Findings emphasize the need to assess job-specific exposures, sedentary behaviour, psychological stress, and shift work. Understanding specific occupational risk factors can lead to better understanding of prostate cancer etiology and improve prevention strategies.
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Affiliation(s)
- Jeavana Sritharan
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Jill S MacLeod
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Christopher B McLeod
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Institute for Work & Health, Toronto, Ontario, Canada
| | - Alice Peter
- Population Health and Prevention, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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