A case-control study of lung cancer at a dye and resin manufacturing plant

Our plain-English summary of A case-control study of lung cancer at a dye and resin manufacturing plant, by F. Barbone, E. Delzell, H. Austin, et al (American Journal of Industrial Medicine, 1992).

The study

• Authors: F. Barbone, E. Delzell, H. Austin, P. Cole
• Journal: American Journal of Industrial Medicine
• Published: 1992;22(6):835-49
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

This case-control study evaluated the relationship between lung cancer and occupational factors among employees at a dye and resin manufacturing plant. The study included 51 lung cancer cases and 102 controls who were members of a cohort of workers investigated in a previous retrospective follow-up study. Information on area of employment and on potential exposure to certain chemicals was obtained from plant personnel and medical records and from interviews with long-term employees. Information on potential confounders, including cigarette smoking, was obtained by interviewing study subjects or their next-of-kin. The odds ratio (OR) for heavy smokers compared with light or nonsmokers was 5.9 (95% confidence interval (CI) = 2.4-15). An elevated OR for lung cancer was observed for subjects who worked in the anthraquinone dye and epichlorohydrin manufacturing area of the plant (OR = 2.4; 95% CI = 1.1-5.2) and for employees who were seen at the plant infirmary for acute exposure to chlorine (OR, adjusted for smoking = 27; 95% CI = 3.5-205). Pipefitters employed at the plant for five or more years also had an elevated OR (3.3; 95% CI = 0.8-14).

In plain English

This case-control study examined lung cancer at a dye and resin manufacturing plant. It compared 51 white men with lung cancer before October 1, 1988, and 102 controls born in the same year, all from an earlier study of plant workers. Long-term employees helped rank each worker's potential contact with asbestos and epichlorohydrin. Smoking information came from interviews and plant medical records. Heavy smokers had an odds ratio of 5.9 (95% CI 2.4-15) compared with light or nonsmokers. Workers in the anthraquinone dye and epichlorohydrin area had an odds ratio of 2.4 (95% CI 1.1-5.2). Workers with potential asbestos contact had a smoking-adjusted odds ratio of 1.5 (95% CI 0.6-3.5). Men who held the pipefitter job title for 5 or more years, compared with men never employed as pipefitters, had an odds ratio of 3.3 (95% CI 0.8-14), based on 5 cases and 3 controls. Acute chlorine exposure recorded at the plant infirmary (6 cases, 3 controls) had a smoking-adjusted odds ratio of 27 (95% CI 3.5-205). The authors concluded that smoking appeared to be the major cause of lung cancer at the plant. They called the pipefitter and maintenance finding imprecise and possibly due to chance.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case-control study nested within a previously studied cohort of plant workers; controls matched to cases on year of birth
• Who was studied: 51 white men with lung cancer (47 identified from death certificates, 4 living) and 102 controls, all members of a cohort of 2,642 white men employed at a dye and resin manufacturing facility in New Jersey that began operating in 1952; the lung cancers occurred from 1964 to 1987
• Exposure: Work area and building at the plant (anthraquinone dye and epichlorohydrin production, azo dye production, plastics and additives, laboratories, maintenance, services); potential contact with asbestos (fiber type not specified) and epichlorohydrin, ranked by interviewed long-term employees on a scale from 0 to 10 and combined with years worked into a cumulative score; acute chemical exposures, including chlorine, recorded in plant infirmary records; cigarette smoking
• Main results:
  • Heavy smokers, compared with light or nonsmokers: odds ratio 5.9 (95% CI 2.4-15)
  • Workers in the anthraquinone (AQ) dye and epichlorohydrin (ECH) production area (21 cases, 24 controls): odds ratio 2.4 (95% CI 1.1-5.2). This was the only work area with a statistically significantly elevated odds ratio.
  • Subjects with potential contact with asbestos (20 cases and 29 controls): smoking-adjusted odds ratio 1.5 (95% CI 0.6-3.5). The trend with cumulative potential exposure was not statistically significant (p = 0.2).
  • Maintenance workers overall: odds ratio 1.4 (95% CI 0.7-2.8). Subjects who held the pipefitter job title for 5 or more years (5 cases, 3 controls), compared with those never employed as pipefitters: odds ratio 3.3 (95% CI 0.8-14)
  • Subjects with potential contact with epichlorohydrin (12 cases, 18 controls): odds ratio 1.7 (95% CI 0.7-4.1), not statistically significant, and restricted to subjects with short duration and low cumulative potential exposure
  • Acute chlorine exposure reported in plant infirmary records (6 cases, 3 controls): odds ratio unadjusted for smoking 5.7 (95% CI 1.1-30); smoking-adjusted 27 (95% CI 3.5-205). The association reflected mainly light smokers, among whom 3 of 6 cases and 3 of 40 controls were exposed.
  • Subjects routinely exposed to chlorine (8 cases, 6 controls), compared with those who never worked in areas with chlorine use: unadjusted odds ratio 4.3 (95% CI 1.3-15); smoking-adjusted 8.9 (95% CI 2.0-40)
  • Employment in high-risk jobs or industries outside the plant: odds ratio 0.9 (95% CI 0.4-2.1)
• The authors' conclusion: The authors concluded that cigarette smoking appears to be the major cause of lung cancer at this plant. They found that chlorine exposure and employment in AQ dyes production were also associated with lung cancer after adjustment for smoking, and said further studies were needed to clarify whether these associations are causal. They considered their results consistent with the hypothesis that pipefitter and perhaps other maintenance tasks in the late 1960s, when asbestos was not treated as a health hazard, might have carried increased lung cancer risk. They added that this association was moderate, statistically imprecise and may be due to chance.
• Limitations the authors state:
  • Not all subjects or next-of-kin could be interviewed, so smoking information was missing for about 20% of cases and controls. This may have left confounding by smoking incompletely controlled.
  • Interviews were with next-of-kin for about 90% of cases but about 30% of controls
  • The study was small, and precision was lower in analyses controlling for smoking and missing data
  • Exposure estimates for asbestos and epichlorohydrin were not based on actual measurements and are probably inaccurate. Industrial hygiene data were too sparse to estimate or validate exposure.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Case-Control Study, Lung Cancer, Odds Ratio, confidence interval, Pipefitter.

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