Mortality from lung cancer in workers exposed to sulfur dioxide in the pulp and paper industry

Won Jin Lee, Kay Teschke, Timo Kauppinen, Aage Andersen, Paavo Jäppinen, Irena Szadkowska-Stanczyk, Neil Pearce, Bodil Persson, Alain Bergeret, Luiz Augusto Facchini, Reiko Kishi, Danuta Kielkowski, Bo Andreassen Rix, Paul Henneberger, Jordi Sunyer, Didier Colin, Manolis Kogevinas, Paolo Boffetta

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76 Citations (Scopus)


Our objective in this study was to evaluate the mortality of workers exposed to sulfur dioxide in the pulp and paper industry. The cohort included 57,613 workers employed for at least 1 year in the pulp and paper industry in 12 countries. We assessed exposure to SO2 at the level of mill and department, using industrial hygiene measurement data and information from company questionnaires; 40,704 workers were classified as exposed to SO2. We conducted a standardized mortality ratio (SMR) analysis based on age-specific and calendar period-specific national mortality rates. We also conducted a Poisson regression analysis to determine the dose-response relations between SO2 exposure and cancer mortality risks and to explore the effect of potential confounding factors. The SMR analysis showed a moderate deficit of all causes of death [SMR = 0.89; 95% confidence interval (CI), 0.87-0.96] among exposed workers. Lung cancer mortality was marginally increased among exposed workers (SMR = 1.08; 95% CI, 0.98-1.18). After adjustment for occupational coexposures, the lung cancer risk was increased compared with unexposed workers (rate ratio = 1.49; 95% CI, 1.14-1.96). There was a suggestion of a positive relationship between weighted cumulative SO2 exposure and lung cancer mortality (p-value of test for linear trend = 0.009 among all exposed workers; p = 0.3 among workers with high exposure). Neither duration of exposure nor time since first exposure was associated with lung cancer mortality. Mortality from non-Hodgkin lymphoma and from leukemia was increased among workers with high SO2 exposure; a dose-response relationship with cumulative SO2 exposure was suggested for non-Hodgkin lymphoma. For the other causes of death, there was no evidence of increased mortality associated with exposure to SO2. Although residual confounding may have occurred, our results suggest that occupational exposure to SO2 in the pulp and paper industry may be associated with an increased risk of lung cancer.

Original languageEnglish
Pages (from-to)991-995
Number of pages5
JournalEnvironmental Health Perspectives
Issue number10
Publication statusPublished - 2002 Oct 1
Externally publishedYes


  • Epidemiology
  • Lung neoplasms
  • Mortality
  • Pulp and paper industry
  • Sulfur dioxide

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis


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