TY - JOUR
T1 - Mortality from lung cancer in workers exposed to sulfur dioxide in the pulp and paper industry
AU - Lee, Won Jin
AU - Teschke, Kay
AU - Kauppinen, Timo
AU - Andersen, Aage
AU - Jäppinen, Paavo
AU - Szadkowska-Stanczyk, Irena
AU - Pearce, Neil
AU - Persson, Bodil
AU - Bergeret, Alain
AU - Facchini, Luiz Augusto
AU - Kishi, Reiko
AU - Kielkowski, Danuta
AU - Rix, Bo Andreassen
AU - Henneberger, Paul
AU - Sunyer, Jordi
AU - Colin, Didier
AU - Kogevinas, Manolis
AU - Boffetta, Paolo
PY - 2002/10/1
Y1 - 2002/10/1
N2 - 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.
AB - 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.
KW - Epidemiology
KW - Lung neoplasms
KW - Mortality
KW - Pulp and paper industry
KW - Sulfur dioxide
UR - http://www.scopus.com/inward/record.url?scp=18644374073&partnerID=8YFLogxK
U2 - 10.1289/ehp.02110991
DO - 10.1289/ehp.02110991
M3 - Article
C2 - 12361923
AN - SCOPUS:18644374073
SN - 0091-6765
VL - 110
SP - 991
EP - 995
JO - Environmental Health Perspectives
JF - Environmental Health Perspectives
IS - 10
ER -
