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Occupational silica exposure and mortality from lung cancer and nonmalignant respiratory disease: G-estimation of structural nested accelerated failure time models

BACKGROUND: Occupational exposure to crystalline silica is known to increase risks of both lung cancer and noninfectious nonmalignant respiratory diseases (NMRD). However, associations between silica exposure and survival times have not been described. METHODS: In a longitudinal cohort of diatomaceo...

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Autores principales: Picciotto, Sally, Neophytou, Andreas M., Brown, Daniel M., Checkoway, Harvey, Eisen, Ellen A., Costello, Sadie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7660981/
https://www.ncbi.nlm.nih.gov/pubmed/33210072
http://dx.doi.org/10.1097/EE9.0000000000000029
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author Picciotto, Sally
Neophytou, Andreas M.
Brown, Daniel M.
Checkoway, Harvey
Eisen, Ellen A.
Costello, Sadie
author_facet Picciotto, Sally
Neophytou, Andreas M.
Brown, Daniel M.
Checkoway, Harvey
Eisen, Ellen A.
Costello, Sadie
author_sort Picciotto, Sally
collection PubMed
description BACKGROUND: Occupational exposure to crystalline silica is known to increase risks of both lung cancer and noninfectious nonmalignant respiratory diseases (NMRD). However, associations between silica exposure and survival times have not been described. METHODS: In a longitudinal cohort of diatomaceous earth workers exposed to crystalline silica (primarily cristobalite) and followed from 1942 to 2011, we applied g-estimation of structural nested accelerated failure time models to adjust for time-varying confounding that could result in healthy worker survivor bias. A continuous measure of exposure was used in analyses estimating the hypothetical effect of banning exposure to silica on survival time. Since a ban is infeasible, sensitivity analyses examined the hypothetical effects of enforcing various Occupational Exposure Limits. RESULTS: The estimated median number of years of life lost per worker (for all natural causes) due to silica exposure was 0.48 (95% confidence interval = 0.02, 1.01). For NMRD deaths, the corresponding estimate was 3.22 (0.82, 7.75) and for lung cancer deaths, 2.21 (0.97, 3.56). Cause-specific estimates were sensitive to the use of weights to adjust for competing events. Lung cancer mortality, which tended to occur at younger ages, was an important competing event for NMRD mortality. Sensitivity analyses supported the main results, but with larger estimates, and suggested that a strict limit would be nearly as effective as a complete ban on silica exposure. CONCLUSIONS: Workplace exposure to crystalline silica in this industry appears to shorten survival times significantly, particularly for those who die of lung cancer or NMRD. More stringent exposure limits are probably warranted.
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spelling pubmed-76609812020-11-16 Occupational silica exposure and mortality from lung cancer and nonmalignant respiratory disease: G-estimation of structural nested accelerated failure time models Picciotto, Sally Neophytou, Andreas M. Brown, Daniel M. Checkoway, Harvey Eisen, Ellen A. Costello, Sadie Environ Epidemiol Original Research BACKGROUND: Occupational exposure to crystalline silica is known to increase risks of both lung cancer and noninfectious nonmalignant respiratory diseases (NMRD). However, associations between silica exposure and survival times have not been described. METHODS: In a longitudinal cohort of diatomaceous earth workers exposed to crystalline silica (primarily cristobalite) and followed from 1942 to 2011, we applied g-estimation of structural nested accelerated failure time models to adjust for time-varying confounding that could result in healthy worker survivor bias. A continuous measure of exposure was used in analyses estimating the hypothetical effect of banning exposure to silica on survival time. Since a ban is infeasible, sensitivity analyses examined the hypothetical effects of enforcing various Occupational Exposure Limits. RESULTS: The estimated median number of years of life lost per worker (for all natural causes) due to silica exposure was 0.48 (95% confidence interval = 0.02, 1.01). For NMRD deaths, the corresponding estimate was 3.22 (0.82, 7.75) and for lung cancer deaths, 2.21 (0.97, 3.56). Cause-specific estimates were sensitive to the use of weights to adjust for competing events. Lung cancer mortality, which tended to occur at younger ages, was an important competing event for NMRD mortality. Sensitivity analyses supported the main results, but with larger estimates, and suggested that a strict limit would be nearly as effective as a complete ban on silica exposure. CONCLUSIONS: Workplace exposure to crystalline silica in this industry appears to shorten survival times significantly, particularly for those who die of lung cancer or NMRD. More stringent exposure limits are probably warranted. Wolters Kluwer 2018-09 2018-09-12 /pmc/articles/PMC7660981/ /pubmed/33210072 http://dx.doi.org/10.1097/EE9.0000000000000029 Text en Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of Environmental Epidemiology. All rights reserved. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.
spellingShingle Original Research
Picciotto, Sally
Neophytou, Andreas M.
Brown, Daniel M.
Checkoway, Harvey
Eisen, Ellen A.
Costello, Sadie
Occupational silica exposure and mortality from lung cancer and nonmalignant respiratory disease: G-estimation of structural nested accelerated failure time models
title Occupational silica exposure and mortality from lung cancer and nonmalignant respiratory disease: G-estimation of structural nested accelerated failure time models
title_full Occupational silica exposure and mortality from lung cancer and nonmalignant respiratory disease: G-estimation of structural nested accelerated failure time models
title_fullStr Occupational silica exposure and mortality from lung cancer and nonmalignant respiratory disease: G-estimation of structural nested accelerated failure time models
title_full_unstemmed Occupational silica exposure and mortality from lung cancer and nonmalignant respiratory disease: G-estimation of structural nested accelerated failure time models
title_short Occupational silica exposure and mortality from lung cancer and nonmalignant respiratory disease: G-estimation of structural nested accelerated failure time models
title_sort occupational silica exposure and mortality from lung cancer and nonmalignant respiratory disease: g-estimation of structural nested accelerated failure time models
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7660981/
https://www.ncbi.nlm.nih.gov/pubmed/33210072
http://dx.doi.org/10.1097/EE9.0000000000000029
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