Mortality among British asbestos workers undergoing regular medical examinations (1971-2005).
ABSTRACT The Great Britain Asbestos Survey was established to monitor mortality among workers covered by regulations to control occupational exposure to asbestos. This study updates the estimated burden of asbestos-related mortality in the cohort, and identifies risk factors associated with mortality.
From 1971, workers were recruited during initially voluntary and later statutory medical examinations. A brief questionnaire was completed during the medical, and participants were flagged for death registrations. Standardised mortality ratios (SMRs) and proportional mortality ratios (PMRs) were calculated for deaths occurring before 2006. Poisson regression analyses were undertaken for diseases with significant excess mortality.
There were 15 496 deaths among 98 117 workers followed-up for 1 779 580 person-years. The SMR for all cause mortality was 141 (95% CI 139 to 143) and for all malignant neoplasms 163 (95% CI 159 to 167). The SMRs for cancers of the stomach (166), lung (187), peritoneum (3730) and pleura (968), mesothelioma (513), cerebrovascular disease (164) and asbestosis (5594) were statistically significantly elevated, as were the corresponding PMRs. In age and sex adjusted analysis, birth cohort, age at first exposure, year of first exposure, duration of exposure, latency and job type were associated with the relative risk of lung, pleural and peritoneal cancers, asbestosis and mesothelioma mortality.
Known associations between asbestos exposure and mortality from lung, peritoneal and pleural cancers, mesothelioma and asbestosis were confirmed, and evidence of associations with stroke and stomach cancer mortality was observed. Limited evidence suggested that asbestos-related disease risk may be lower among those first exposed in more recent times.
- SourceAvailable from: PubMed CentralBritish Journal of Cancer 06/2012; 107 Suppl 1:S33-40. · 5.08 Impact Factor
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ABSTRACT: SUMMARY Lungs exposed to occupational dust may be especially vulnerable to fatal infections. We followed up asbestos-exposed workers (n=590) originally screened for lung cancer with computed tomography and scored for pleuropulmonary fibrosis. We checked these workers' influenza and pneumonia mortality data (ICD-10 codes J10-J18) in the national register. In total, 191 deaths, including 43 deaths from infectious pneumonia, occurred in 6158 person-years of follow-up (mean follow-up time 10·44 years). 'Some interstitial fibrosis' [hazard ratio (HR) 2·26, 95% confidence interval (CI) 0·98-5·19, P=0·06] and 'definite interstitial fibrosis' (HR 3·70, 95% CI 1·22-11·23, P=0·02) were associated with an increased risk of death from pneumonia compared to no fibrosis. Asbestosis patients, i.e. those with both asbestos exposure and lung fibrosis, therefore appear to be particularly at risk for death from pneumonia. These patients should be vaccinated against influenza and Pneumococcus.Epidemiology and Infection 01/2012; 140(11):1987-92. · 2.87 Impact Factor
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ABSTRACT: Interstitial lung diseases (ILDs) represent a heterogeneous group of more than two hundred diseases of either known or unknown etiology with different pathogenesis and prognosis. Lung cancer, which is the major cause of cancer death in the developed countries, is mainly attributed to cigarette smoking and exposure to inhaled carcinogens. Different studies suggest a link between ILDs and lung cancer, through different pathogenetic mechanisms, such as inflammation, coagulation, dysregulated apoptosis, focal hypoxia, activation, and accumulation of myofibroblasts as well as extracellular matrix accumulation. This paper reviews current evidence on the association between lung cancer and interstitial lung diseases such as idiopathic pulmonary fibrosis, sarcoidosis, systemic sclerosis, dermatomyositis/polymyositis, rheumatoid arthritis, systemic lupus erythematosus, and pneumoconiosis.Pulmonary medicine. 01/2012; 2012:315918.