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Social disparities in heart disease risk and survivor bias among autoworkers: an examination based on survival models and g-estimation.

Authors
Costello-S; Picciotto-S; Rehkopf-DH; Eisen-EA
Source
Occup Environ Med 2015 Feb; 72(2):138-144
NIOSHTIC No.
20045359
Abstract
Objectives: To examine gender and racial disparities in ischaemic heart disease (IHD) mortality related to metalworking fluid exposures and in the healthy worker survivor effect. Methods: A cohort of white and black men and women autoworkers in the USA was followed from 1941 to 1995 with quantitative exposure to respirable particulate matter from water-based metalworking fluids. Separate analyses used proportional hazards models and g-estimation. Results: The HR for IHD among black men was 3.29 (95% CI 1.49 to 7.31) in the highest category of cumulative synthetic fluid exposure. The HR for IHD among white women exposed to soluble fluid reached 2.44 (95% CI 0.96 to 6.22). However, no increased risk was observed among white men until we corrected for the healthy worker survivor effect. Results from g-estimation indicate that if white male cases exposed to soluble or synthetic fluid had been unexposed to that fluid type, then 1.59 and 1.20 years of life would have been saved on average, respectively. Conclusions: We leveraged the strengths of two different analytic approaches to examine the IHD risks of metalworking fluids. All workers may have the same aetiological risk; however, black and female workers may experience more IHD from water-based metalworking fluid exposure because of a steeper exposure-response or weaker healthy worker survivor effect.
Keywords
Humans; Men; Women; Racial-factors; Heart; Cardiovascular-disease; Cardiovascular-system-disease; Cardiovascular-system-disorders; Cardiopulmonary-function; Cardiopulmonary-system; Cardiopulmonary-system-disorders; Cardiovascular-function; Cardiovascular-system; Morbidity-rates; Mortality-rates; Metalworking-fluids; Exposure-levels; Workers; Work-environment; Automotive-industry; Respirable-dust; Respiratory-system-disorders; Particulate-dust; Particulates; Hazards; Statistical-analysis
Contact
Dr. Sadie Costello, School of Public Health, University of California, 50 University Hall, #7360, Berkeley, CA 94720-7360
CODEN
OEMEEM
Publication Date
20150201
Document Type
Journal Article
Email Address
sadie@berkeley.edu
Funding Type
Grant
Fiscal Year
2015
NTIS Accession No.
NTIS Price
Identifying No.
Grant-Number-R01-OH-008927; M112014
Issue of Publication
2
ISSN
1351-0711
Source Name
Occupational and Environmental Medicine
State
CA
Performing Organization
University of California, Berkeley
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