Case studies in occupational epidemiology. Steenland K, ed. New York: Oxford University Press, 1993 Jan; :51-65
The hypothesis that occupational exposures to metals, solvents, and silica (14808607) are associated with end stage renal disease (ESRD) was investigated. This study was described as part of a text book and took the reader through the same steps that taken by the investigator when conducting the actual study to allow the student to solve the same problems solved by the investigator in the course of the study. The Michigan Kidney Registry identified 612 eligible cases who had been diagnosed as end stage from 1976 through 1984, but who were known to be alive in 1984. Questions were asked regarding prolonged and regular use of pain pills prior to renal disease, prolonged and regular drinking of moonshine whiskey, education, smoking, and family history of kidney disease. Occupational questions were asked regarding all jobs held for more than 6 months past the age of 18 years. Of the 471 selected for interview, 325 (69%) actually were interviewed. The odds ratios, for a number of variables, were lower than the crude or unadjusted univariate ones. The crude odds ratios for phenacetin (62442) acetaminophen (103902), moonshine, solvents, and silica were 3.14, 3.33, 1.74, and 1.89, respectively, all of which were statistically significant. The lower adjusted odds ratios reflect control of positive confounding by other variables such as years of education as well as mutual confounding among several of the variables listed. Increasing trends were noted for duration and frequency of phenacetin/acetaminophen and moonshine exposure, even though these trends were short of statistical significance. For occupational variables there was little or no evidence of increasing risk with increasing exposure duration, although the trend for sandblasting was highly positive and approached statistical significance.