Occupational lung cancer risk for men in Germany: results from a pooled case-control study

Our plain-English summary of Occupational lung cancer risk for men in Germany: results from a pooled case-control study, by I. Brüske-Hohlfeld, M. Möhner, H. Pohlabeln, et al (American Journal of Epidemiology, 2000).

The study

• Authors: I. Brüske-Hohlfeld, M. Möhner, H. Pohlabeln, W. Ahrens, U. Bolm-Audorff, L. Kreienbrock, M. Kreuzer, I. Jahn, H.E. Wichmann, K.H. Jöckel
• Journal: American Journal of Epidemiology
• Published: 2000;151(4):384-95
• Cited by: 111 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Occupational exposures such as crystalline silica, diesel engine exhaust, polycyclic aromatic hydrocarbons, and man-made mineral fibers are strongly suspected to increase lung cancer risk. Two case-control studies in Germany conducted between 1988 and 1996 were pooled for a joint analysis. A total of 3,498 male cases and 3,541 male population controls, frequency matched for age and region, were included in the study. The lifelong history of all jobs and industries was coded and occupational exposures were evaluated by expert rating. Odds ratios, crude and adjusted for smoking and asbestos exposure, were calculated by conditional logistic regression. Job-related evaluation showed a statistically significant increased odds ratio adjusted for smoking among farmers; forestry workers, fishermen, and livestock workers; miners and quarrymen; chemical processors; cabinet makers and related wood workers; metal producers and processors; bricklayers and carpenters; road construction workers, pipelayers and well diggers; plasterers, insulators, and upholsterers; painters and lacquerers; stationary engine and heavy equipment operators; transport workers and freight handlers; and service workers. With regard to specific occupational exposures, elevated odds ratios (OR) (95% confidence intervals (CI)) for lung cancer risk adjusted for smoking and asbestos exposure were observed for man-made mineral fibers (OR = 1.48, 95% CI 1.17, 1.88); crystalline silica (OR = 1.41, 95% CI 1.22, 1.62); diesel engine exhaust (OR = 1.43, 95% CI 1.23, 1.67); and polycyclic aromatic hydrocarbons (OR = 1.53, 95% CI 1.14, 2.04). The risk of asbestos exposure, adjusted for smoking was also increased (OR = 1.41, 95% CI 1.24, 1.60).

In plain English

This study pooled two German case-control studies (1988 to 1996): 3,498 men with lung cancer and 3,541 men from the general population. Lifelong job and smoking histories were collected; experts rated workplace exposures. Asbestos exposure was estimated from 17 job-specific questionnaires; no fiber types are named. After adjustment for smoking, men ever exposed to asbestos had an odds ratio of 1.41 (95 percent confidence interval 1.24 to 1.60). For more than 2,500 exposed workdays it was 1.79 (1.39 to 2.30). Adjusted for smoking and asbestos, odds ratios were 1.48 (1.17 to 1.88) for man-made mineral fibers, 1.41 (1.22 to 1.62) for silica, 1.43 (1.23 to 1.67) for diesel exhaust and 1.53 (1.14 to 2.04) for polycyclic aromatic hydrocarbons. A subgroup of 51 cases and 28 controls insulated only with glass or mineral wool and never reported asbestos. Their smoking-adjusted odds ratio was 1.56 (0.92 to 2.65), an interval that included 1. The authors concluded that particular industries and occupations carried increased lung cancer risk. They noted limited exposure assessment and under-represented lower social classes among one study's controls.

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: Pooled analysis of two population-based case-control studies (the BIPS Study and the GSF Study), analysed by conditional logistic regression
• Who was studied: 3,498 men with lung cancer (cases) and 3,541 men from the general population (controls), frequency matched for age and region, from several regions of West and East Germany, studied 1988 to 1996
• Exposure: Lifelong occupations and industries, plus expert-rated exposure to crystalline silica, diesel engine exhaust, man-made mineral fibers, polycyclic aromatic hydrocarbons and asbestos. Asbestos was assessed semi-automatically from 17 job-specific supplementary questionnaires, measured as calendar years and workdays of exposure. No asbestos fiber types are named.
• Main results:
  • Men ever exposed to asbestos: smoking-adjusted odds ratio 1.41 (95% CI 1.24, 1.60)
  • Asbestos risk showed a gradient with calendar years and days of exposure. Men with more than 2,500 exposed workdays had a smoking-adjusted odds ratio of 1.79 (95% CI 1.39, 2.30).
  • Men ever exposed to man-made mineral fibers: odds ratio adjusted for smoking and asbestos 1.48 (95% CI 1.17, 1.88)
  • The authors identified a subgroup who insulated only with glass wool or mineral wool and never reported asbestos exposure: 51 cases and 28 controls.
  • In that glass wool or mineral wool only subgroup, the smoking-adjusted odds ratio was 1.56 (95% CI 0.92, 2.65). The interval includes 1.
  • Men who ever worked at least 6 months in a job with a silicosis risk (miners, foundry and quarry workers): odds ratio adjusted for smoking and asbestos 1.41 (95% CI 1.22, 1.62)
  • All jobs with diesel engine exhaust exposure: odds ratio adjusted for smoking and asbestos 1.43 (95% CI 1.23, 1.67)
  • Men exposed to polycyclic aromatic hydrocarbons: odds ratio adjusted for smoking and asbestos 1.53 (95% CI 1.14, 2.04)
  • In engine and vehicle building, lung cancer risk fell markedly after adjusting for asbestos exposure but remained of borderline statistical significance.
• The authors' conclusion: The authors concluded that the study showed evidence of increased lung cancer risk associated with particular industries and occupations.
• Limitations the authors state:
  • Exposure assessment was limited; many exposures could only be defined as work in an occupation. The authors judged this likely to cause misclassification biasing odds ratios toward one, underestimating risk.
  • Response among controls in the GSF Study was low (41 percent), and lower social classes were under-represented among those controls. Adjusting for social status moved the odds ratios for silica, diesel exhaust and polycyclic aromatic hydrocarbons 5 to 15 percent toward one.
  • Residual bias from smoking could not be excluded, although the authors stated it was minimized.

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: Lung Cancer, Case-Control Study, Occupational Exposure, Crystalline, Mineral Fiber, Odds Ratio, Asbestos Exposure, Insulator.

Related studies

• Lung cancer and exposure to man-made vitreous fibers: results from a pooled case-control study in Germany — H. Pohlabeln, K.H. Jöckel, et al. (2000)
• Occupational risk factors for lung cancer in women: results of a case-control study in Germany — I. Jahn, W. Ahrens, et al. (1999)
• Parental occupational exposure and risk of childhood central nervous system tumors: a pooled analysis of case-control studies from Germany, France, and the UK — C. Huoi, A. Olsson, et al. (2014)
• Lung cancer risk in male workers occupationally exposed to diesel motor emissions in Germany — I. Brüske-Hohlfeld, M. Möhner, et al. (1999)
• Occupational risk factors for lung cancer: a case-control study in West Germany — K.H. Jöckel, W. Ahrens, et al. (1998)
• Occupational asbestos exposure as a risk factor for laryngeal carcinoma in a population-based case-control study from Germany — H. Ramroth, W. Ahrens, et al. (2011)

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