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Hypothetical interventions to limit metalworking fluid exposures and their effects on COPD mortality: G-estimation within a public health framework.

Authors
Picciotto-S; Chevrier-J; Balmes-J; Eisen-EA
Source
Epidemiology 2014 May; 25(3):436-443
NIOSHTIC No.
20045310
Abstract
BACKGROUND: Current recommendations for limits on metalworking fluids may provide insufficient protection from workplace-related illness. Chronic obstructive pulmonary disease (COPD) is a challenging outcome in occupational cohorts because its long period of worsening pulmonary function allows sicker workers to reduce exposure, causing a healthy worker survivor bias. G-estimation is a statistical method that reduces this bias. We introduce a public health approach using g-estimation to compare a series of potential exposure-reducing interventions. METHODS: Autoworkers at three General Motors plants in Michigan were followed for COPD mortality from 1 January 1941 to 31 December 1994. For each of the three fluid types (straight, soluble, synthetic), a series of binary variables indicated whether exposure exceeded a series of potential limits. Separate g-estimation analyses for each limit yielded results expressed as the total number of years of life that could have been saved among those who died from COPD had that exposure limit been enforced. RESULTS: Lower limits would have had greater effect than higher limits. A ban on soluble fluids (the most common type) would have had the greatest effect, saving an estimated 1550 years of life. Corresponding estimates were 737 and 260 years for straight and synthetic fluids, respectively. Few workers were exposed to synthetic fluids, limiting analytic power. CONCLUSIONS: This application of g-estimation suggests that limiting exposure to metalworking fluids could have saved many years of life lost to COPD in this cohort. The approach permits comparison of different interventions. Separate limits should be considered for different types of fluids.
Keywords
Metalworking-fluids; Exposure-levels; Risk-factors; Workers; Work-areas; Work-environment; Pulmonary-function; Pulmonary-disorders; Pulmonary-system; Pulmonary-system-disorders; Automotive-industry; Morbidity-rates; Mortality-rates; Aerosol-particles; Aerosols; Particulates; Gases; Respiratory-system-disorders
Contact
Sally Picciotto, University of California, Berkeley, School of Public Health, EHS, 50 University Hall, Berkeley, CA 94720
CODEN
EPIDEY
Publication Date
20140501
Document Type
Journal Article
Email Address
sallypicciotto@berkeley.edu
Funding Type
Grant
Fiscal Year
2014
NTIS Accession No.
NTIS Price
Identifying No.
Grant-Number-R01-OH-010028; M112014
Issue of Publication
3
ISSN
1044-3983
Source Name
Epidemiology
State
CA
Performing Organization
University of California Berkeley
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