Relationships of Lower Lung Fibrosis, Pleural Disease, and Lung Mass with Occupational, Household, Neighborhood, and Slate Roof-Dense Area Residential Asbestos Exposure

Our plain-English summary of Relationships of Lower Lung Fibrosis, Pleural Disease, and Lung Mass with Occupational, Household, Neighborhood, and Slate Roof-Dense Area Residential Asbestos Exposure, by D. Kang, Y.Y. Kim, M. Shin, et al (International Journal of Environmental Research and Public Health, 2018).

The study

• Authors: D. Kang, Y.Y. Kim, M. Shin, M.S. Lee, H.J. Bae, S.Y. Kim, Y.K. Kim
• Journal: International Journal of Environmental Research and Public Health
• Published: 2018;15(8)
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

This study aimed to evaluate the relationship between various asbestos exposure routes and asbestos-related disorders (ARDs). The study population comprised 11,186 residents of a metropolitan city who lived near asbestos factories, shipyards, or in slate roof-dense areas. ARDs were determined from chest X-rays indicating lower lung fibrosis (LFF), pleural disease (PD), and lung masses (LMs). Of the subjects, 11.2%, 10.4%, 67.2% and 8.3% were exposed to asbestos via occupational, household, neighborhood, and slate roof routes, respectively. The odds ratio (OR) of PD from household exposure (i.e., living with asbestos-producing workers) was 1.9 (95% confidence interval: 0.9⁻4.2), and those of LLF and PD from neighborhood exposure, or residing near asbestos factories) for <19 or >20 years, or near a mine, were 4.1 (2.8⁻5.8) and 4.8 (3.4⁻6.7), 8.3 (5.5⁻12.3) and 8.0 (5.5⁻11.6), and 4.8 (2.7⁻8.5) and 9.0 (5.6⁻14.4), respectively. The ORs of LLF, PD, and LM among those residing in slate-dense areas were 5.5 (3.3⁻9.0), 8.8 (5.6⁻13.8), and 20.5 (10.4⁻40.4), respectively. Substantial proportions of citizens residing in industrialized cities have potentially been exposed to asbestos, and various exposure routes are associated with the development of ARDs. Given the limitations of this study, including potential confounders such as socioeconomic status, further research is needed.

In plain English

Researchers examined chest X-rays of 11,186 adults in Busan, South Korea, from asbestos health surveys conducted 2009 to 2016. Participants reported work, household and slate roof exposure. Residential histories were checked against official records. X-rays were read for lower lung fibrosis (an asbestosis stand-in), pleural disease and lung masses (suspected malignancy, not confirmed cancer). Exposure was 11.2% occupational, 10.4% household and 8.3% slate roof; neighborhood exposure was given as 67.2% overall, but also as 67.2% near factories plus 2.0% near mines. After adjusting for sex, age, smoking and other routes, living near asbestos factories or a mine, or under a slate roof in a slate roof-dense area, was linked to higher odds of fibrosis and pleural disease. For slate roof exposure in such areas, the lung mass odds ratio was 20.5 (10.4 to 40.4), which the authors said might reflect lower socioeconomic status. Among household members of asbestos-production workers, the pleural disease odds ratio was 1.9 (0.9 to 4.2). The authors noted that X-rays are only screening tests, that some exposure data relied on memory, and that socioeconomic status was uncontrolled.

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: Cross-sectional analysis of health impact survey data (questionnaire plus screening chest X-ray), using logistic regression adjusted for sex, age, smoking and other exposure routes
• Who was studied: 11,186 current residents of Busan, Korea, aged 20 or older, who took part in a health impact survey run by Pusan National University Yangsan Hospital's Environmental Health Center for Asbestos between 2009 and 2016 (from 13,433 participants)
• Exposure: Four exposure routes were studied. Occupational exposure meant asbestos production or use jobs. Household exposure meant living with asbestos-exposed workers. Neighborhood exposure meant living near asbestos factories or mines. Slate roof exposure meant living under a slate roof, with a separate category for a slate roof in a slate roof-dense area. Exposure was assessed qualitatively by questionnaire, with no fiber measurements. The authors state that Korea used mostly chrysotile asbestos.
• Main results:
  • The Results section gives these proportions of the 11,186 subjects for each exposure route: neighborhood 67.2%, slate roof 8.3%, occupational 11.2%, household 10.4%
  • Elsewhere the article assigns 67.2% (7515 subjects) to neighborhood exposure from factories and a further 2.0% (220) to exposure from mines, so the 67.2% overall neighborhood figure is internally inconsistent
  • Of the 1,257 occupationally exposed subjects, 104 (8.3%) had lower lung fibrosis, 95 (7.6%) pleural disease and 13 (1.0%) a lung mass on X-ray
  • For occupational exposure, odds ratios of lower lung fibrosis were increased for asbestos use for more than 20 years and for asbestos production
  • The fully adjusted model gave odds ratios for lower lung fibrosis and pleural disease by neighborhood exposure. Living near asbestos factories for 19 years or less gave 4.1 (2.8 to 5.8) and 4.8 (3.4 to 6.7). Living near factories for 20 years or more gave 8.3 (5.5 to 12.3) and 8.0 (5.5 to 11.6). Living near a mine gave 4.8 (2.7 to 8.5) and 9.0 (5.6 to 14.4).
  • In the fully adjusted model, the category 'roof in dense area' (slate roof exposure in a slate roof-dense area) had odds ratios of 5.5 (3.3 to 9.0) for lower lung fibrosis, 8.8 (5.6 to 13.8) for pleural disease and 20.5 (10.4 to 40.4) for lung mass
  • Odds ratios of all three findings were increased in all models for neighborhood factory exposure for more than 20 years and for slate roof exposure in a slate roof-dense area
  • For household exposure from living with asbestos-production workers, the odds ratio of pleural disease was 1.9, with a 95% confidence interval of 0.9 to 4.2
• The authors' conclusion: The authors concluded that, after adjustment for sex, age, smoking and other routes, each exposure route was associated with particular findings. Occupational exposure was associated with lower lung fibrosis and pleural disease. Household exposure was associated with pleural disease. Neighborhood exposure and slate roof exposure were each associated with lower lung fibrosis, pleural disease and lung mass.
• Limitations the authors state:
  • Occupational, household and slate roof exposure relied on participants' memories
  • Disease findings came from screening chest X-rays, not CT or clinical diagnosis, which may have over- or under-estimated prevalence
  • People with respiratory symptoms may have been more likely to recall exposure sources
  • Socioeconomic status was not investigated even though it is a potential confounder; the link between lung mass and slate-dense areas may be due to lower socioeconomic status
  • Participants were volunteers, which reduces how far the results can be generalized; exposure proportions may be over-estimated
  • No fiber measurements were made, so the authors called the study speculative and only indicative
  • Korea used mostly chrysotile, so the results cannot be generalized to settings where amphiboles were mainly used

Topics

Medical terms in this study, explained in our Lexicon: Fibrosis, Asbestos Exposure, Chest X-Ray, Odds Ratio, confidence interval, Environmental Exposure.

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