Industry, occupation, and exposure history of mesothelioma patients in the U.S. National Mesothelioma Virtual Bank, 2006-2022

Our plain-English summary of Industry, occupation, and exposure history of mesothelioma patients in the U.S. National Mesothelioma Virtual Bank, 2006-2022, by Y. Gao, J.M. Mazurek, Y. Li, et al (Environmental Research, 2023).

The study

• Authors: Y. Gao, J.M. Mazurek, Y. Li, D. Blackley, D.N. Weissman, S.V. Burton, W. Amin, D. Landsittel, M.J. Becich, Y. Ye
• Journal: Environmental Research
• Published: 2023;230:115085
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant mesothelioma is associated with environmental and occupational exposure to certain mineral fibers, especially asbestos. This study aims to examine work histories of mesothelioma patients and their survival time.

Method: Using the NIOSH Industry and Occupation Computerized Coding System, we mapped occupations and industries recorded for 748 of 1444 patients in the U.S. National Mesothelioma Virtual Bank (NMVB) during the period 2006-2022. Descriptive and survival analyses were conducted.

Results: Among the 1023 industries recorded for those having mesothelioma, the most frequent cases were found for those in manufacturing (n = 225, 22.0%), construction (138, 13.5%), and education services (66, 6.5%); among the 924 occupation records, the most frequent cases were found for those in construction and extraction (174, 18.8%), production (145, 15.7%), and management (84, 9.1%). Males (583) or persons aged >40 years (658) at the time of diagnosis tended to have worked in industries traditionally associated with mesothelioma (e.g., construction), while females (163) or persons aged 20-40 years (27) tended to have worked in industries not traditionally associated with mesothelioma (e.g., health care). Asbestos, unknown substances, and chemical solvents were the most frequently reported exposure, with females most often reporting an unknown substance. A multi-variable Cox Hazard Regression analysis showed that significant prognostic factors associated with decreased survival in mesothelioma cases are sex (male) and work experience in utility-related industry, while factor associated with increased survival are epithelial or epithelioid histological type, prior history of surgery and immunotherapy, and industry experience in accommodation and food services.

Conclusion: The NMVB has the potential of serving as a sentinel surveillance mechanism for identifying industries and occupations not traditionally associated with mesothelioma. Results indicate the importance of considering all potential sources of asbestos exposures including occupational, environmental, and extra-occupational exposures when evaluating mesothelioma patients and advising family members.

Copyright © 2022 Elsevier Inc. All rights reserved.

In plain English

This study examined self-reported work histories in the U.S. National Mesothelioma Virtual Bank (NMVB), which held 1444 mesothelioma patients from 6 institutions as of January 2022. Of these, 748 patients reported 1091 jobs. Using a NIOSH coding system, the authors assigned industry codes to 1023 of these job records and occupation codes to 924. Among the industry records, manufacturing (225), construction (138) and education services (66) were most frequent. Of the 748 patients, 583 were male and 464 (62.0%) reported asbestos exposure. Women most often reported educational services, health care and social assistance, and manufacturing, and most often reported exposure to an unknown substance. Survival analysis covered 693 patients with survival information. In an adjusted analysis, male sex and work in utilities were associated with shorter survival. Epithelial or epithelioid tumor type, prior surgery and immunotherapy, and work in accommodation and food services or wholesale trade were associated with longer survival. The wholesale result rested on 7 patients. The authors concluded the NMVB could help flag industries and occupations not previously associated with mesothelioma. They noted the patients were not a random sample and that exposures were self-reported.

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: Descriptive and survival analysis (Kaplan Meier and Cox proportional-hazard regression) of a patient registry's self-reported work and exposure histories
• Who was studied: 1444 mesothelioma patients from 6 institutions in the U.S. National Mesothelioma Virtual Bank (2006 to January 25, 2022). Of these, 748 patients reported 1091 work history records. 693 of the 748 had survival time and vital status information and were used for survival analysis. The article does not state how many entered the multi-variable model.
• Exposure: Self-reported industries and occupations, coded to NAICS 2012 codes (1023 records) and SOC 2010 codes (924 records), with 826 records receiving both. Also self-reported exposure for more than 6 months to substances including asbestos, chemical solvents, metal work, paint and others. Asbestos fiber types were not distinguished, and the questionnaire did not separate work-related from non-work exposure.
• Main results:
  • Among 1023 industry records, the most frequent were manufacturing (225 records, 22.0%), construction (138, 13.5%) and education services (66, 6.5%).
  • Among the 748 patients, the most frequently reported exposures were asbestos (62.0%), chemical solvents (8.0%) and metal particles (5.1%).
  • Among female patients, the top industries were educational services (32), health care and social assistance (30) and manufacturing (24). Females reported exposure to unknown substances most often.
  • Patients aged 21 to 40 were more likely to have worked in industries not traditionally associated with mesothelioma risk.
  • Patients who had worked in construction had a prevalence ratio of asbestos exposure of 1.46 (95% CI 1.32 to 1.61) compared with patients not in that industry. The ratio was 1.47 (1.32 to 1.65) for military work. Educational services (0.64) and health care and social assistance (0.60) showed lower prevalence of asbestos exposure.
  • In the univariable survival analysis, male patients (n = 543) had a hazard ratio of 1.94 (95% CI 1.555 to 2.426) compared with female patients.
  • In the univariable survival analysis, patients reporting asbestos exposure (426 patients) had a hazard ratio of 1.50 (95% CI 1.236 to 1.76) compared with those who did not (267 patients).
  • In the multi-variable analysis, male sex and work in utilities were associated with decreased survival.
  • In the multi-variable analysis, epithelial or epithelioid type, prior surgery and immunotherapy, and work in accommodation and food services or wholesale trade were associated with increased survival. The authors noted that the wholesale trade finding had only 7 instances and may not be stable.
• The authors' conclusion: The authors concluded that the NMVB could serve as a sentinel surveillance mechanism for identifying industries and occupations not previously associated with mesothelioma. They suggested adding spouse or partner work history and living environment to the questionnaire.
• Limitations the authors state:
  • The patients were not randomly sampled, so there may be selection bias.
  • Work duration was not considered, so short exposure histories were included.
  • Exposure was self-reported, and the authors assumed all reported exposure was work-related, which may sometimes be incorrect.
  • Including industry-only or occupation-only records may have caused associations to wash out.
  • The analysis did not consider mesothelioma latency or how latency affects young patients.
  • Univariable p-values were not adjusted for multiple comparisons, so type I error may increase.

Topics

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

Medical terms in this study, explained in our Lexicon: Exposure History, Mesothelioma, Occupational Exposure, Mineral Fiber, NIOSH, Epithelioid, Immunotherapy, Asbestos Exposure.

Related studies

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• Relationship of mortality, occupation, and pulmonary diffusing capacity to pleural thickening in the First National Health and Nutrition Examination Survey — D.P. Loomis, G.W. Collman, et al. (1989)
• Pleural mesothelioma risk by industry and occupation: results from the Multicentre Italian Study on the Etiology of Mesothelioma (MISEM) — E. Migliore, D. Consonni, et al. (2022)
• Pleural malignant mesothelioma epidemic: incidence, modalities of asbestos exposure and occupations involved from the Italian National Register — A. Marinaccio, A. Binazzi, et al. (2012)
• Developing Asbestos Job Exposure Matrix Using Occupation and Industry Specific Exposure Data (1984-2008) in Republic of Korea — S. Choi, D. Kang, et al. (2017)
• Compensation for Asbestos-Related Diseases in Japan: Utilization of Standard Classifications of Industry and Occupations — K. Sawanyawisuth, S. Furuya, et al. (2017)

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