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Occupational radon exposure and lung cancer mortality: estimating intervention effects using the parametric g-formula.

ABSTRACT: Traditional regression analysis techniques used to estimate associations between occupational radon exposure and lung cancer focus on estimating the effect of cumulative radon exposure on lung cancer. In contrast, public health interventions are typically based on regulating radon concentration rather than workers' cumulative exposure. Estimating the effect of cumulative occupational exposure on lung cancer may be difficult in situations vulnerable to the healthy worker survivor bias.Workers in the Colorado Plateau Uranium Miners cohort (n = 4,134) entered the study between 1950 and 1964 and were followed for lung cancer mortality through 2005. We use the parametric g-formula to compare the observed lung cancer mortality to the potential lung cancer mortality had each of 3 policies to limit monthly radon exposure been in place throughout follow-up.There were 617 lung cancer deaths over 135,275 person-years of follow-up. With no intervention on radon exposure, estimated lung cancer mortality by age 90 was 16%. Lung cancer mortality was reduced for all interventions considered, and larger reductions in lung cancer mortality were seen for interventions with lower monthly radon exposure limits. The most stringent guideline, the Mine Safety and Health Administration standard of 0.33 working-level months, reduced lung cancer mortality from 16% to 10% (risk ratio = 0.67 [95% confidence interval = 0.61 to 0.73]).This work illustrates the utility of the parametric g-formula for estimating the effects of policies regarding occupational exposures, particularly in situations vulnerable to the healthy worker survivor bias.

SUBMITTER: Edwards JK

PROVIDER: S-EPMC4524349 | biostudies-literature | 2014 Nov

REPOSITORIES: biostudies-literature

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Occupational radon exposure and lung cancer mortality: estimating intervention effects using the parametric g-formula.

Edwards Jessie K JK McGrath Leah J LJ Buckley Jessie P JP Schubauer-Berigan Mary K MK Cole Stephen R SR Richardson David B DB

Epidemiology (Cambridge, Mass.) 20141101 6

<h4>Background</h4>Traditional regression analysis techniques used to estimate associations between occupational radon exposure and lung cancer focus on estimating the effect of cumulative radon exposure on lung cancer. In contrast, public health interventions are typically based on regulating radon concentration rather than workers' cumulative exposure. Estimating the effect of cumulative occupational exposure on lung cancer may be difficult in situations vulnerable to the healthy worker surviv ...[more]

PMID: 25192403

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Project description:ObjectiveThe aim of this study was to estimate the fraction of lung cancer incidence in Iran attributed to occupational exposures to the well-established lung cancer carcinogens, including silica, cadmium, nickel, arsenic, chromium, diesel fumes, beryllium, and asbestos.MethodsNationwide exposure to each of the mentioned carcinogens was estimated using workforce data from the Iranian population census of 1995, available from the International Labor Organization (ILO) website. The prevalence of exposure to carcinogens in each industry was estimated using exposure data from the CAREX (CARcinogen EXposure) database, an international occupational carcinogen information system kept and maintained by the European Union. The magnitude of the relative risk of lung cancer for each carcinogen was estimated from local and international literature. Using the Levin modified population attributable risk (incidence) fraction, lung cancer incidence (as estimated by the Tehran Population-Based Cancer Registry) attributable to workplace exposure to carcinogens was estimated.ResultsThe total workforce in Iran according to the 1995 census identified 12,488,020 men and 677,469 women. Agriculture is the largest sector with 25% of the male and 0.27% of female workforce. After applying the CAREX exposure estimate to each sector, the proportion exposed to lung carcinogens was 0.08% for male workers and 0.02% for female workers. Estimating a relative risk of 1.9 (95% CI of 1.7-2.1) for high exposure and 1.3 (95% CI 1.2-1.4) for low exposure, and employing the Levin modified formula, the fraction of lung cancer attributed to carcinogens in the workplace was 1.5% (95% CI of 1.2-1.9) for females and 12% (95% CI of 10-15) for males. These fractions correspond to an estimated incidence of 1.3 and 0.08 cases of lung cancer per 100,000 population for males and females, respectively.ConclusionThe incidence of lung cancer due to occupational exposure is low in Iran and, as in other countries, more lung cancer is due to occupational exposure among males than females.

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Occupational radon exposure and lung cancer mortality: estimating intervention effects using the parametric g-formula.

Publications

Occupational radon exposure and lung cancer mortality: estimating intervention effects using the parametric g-formula.

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