The potential impact of epidemiology on the prevention of occupational disease

Our plain-English summary of The potential impact of epidemiology on the prevention of occupational disease, by D.H. Wegman (American Journal of Public Health, 1992).

The study

• Author: D.H. Wegman
• Journal: American Journal of Public Health
• Published: 1992;82(7):944-54
• Type of article: Review
• Cited by: 23 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

This presentation reviews occupational epidemiology as a foundation for workplace disease prevention activities. By examining descriptive, etiologic and intervention occupational epidemiology studies, a range of opportunities are illustrated where epidemiology has played, or could play a principal role in guiding preventive efforts. Descriptive studies presented include ones based on vital records, on epidemic investigations, cross-sectional surveys, and surveillance. Etiologic studies review the largely successful development of knowledge for lung cancer and asbestos exposure for pulmonary effects of isocyanate exposures. However, attention is also directed to the need for etiologic studies of work environment risks for both cardiovascular and musculoskeletal disease. Finally importance is placed on the too infrequent epidemiologic studies of intervention. Historical examples of control of large risks from nickel cancers and silicosis are balanced with more recent examples of successes at reducing smaller risks of cardiovascular disease and oil acne. Throughout, emphasis is placed on the importance of reintegrating the academic discipline of epidemiology into the application of study findings to prevention of workplace risks.

In plain English

This article was a commentary by one author, based on an invited lecture. It reviewed uses of occupational epidemiology in preventing work-related disease and reported no new data. Examples were grouped as descriptive, etiologic or intervention studies and covered lead, benzene, isocyanates, silica, nickel and asbestos, among others. On asbestos, the author described a cohort study of textile workers by Doll, listed in the references as a study of lung cancer mortality, that documented an 11-fold excess risk. A case-control study by Breslow suggested that asbestos-related lung cancer mortality was not due to cigarette smoking alone. Citing a 1987 summary that counted 50 cohort studies, the author reported that other studies found high risk with chrysotile in textile work and much lower risk among chrysotile miners. Other studies found that duration and intensity of exposure contributed independently to risk; in at least one cohort, the joint risk with smoking was more than additive. The author proposed that tracking asbestos exposures could show future disease trends without waiting to count cases. The author concluded that academic epidemiology had become increasingly divorced from workplace prevention.

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: Commentary reviewing published occupational epidemiology studies (no original data)
• Who was studied: No study population of its own. The article reviewed descriptive, etiologic and intervention studies of occupational disease by other researchers.
• Exposure: Several workplace exposures discussed through examples, including asbestos (chrysotile in textile work and mining) in relation to lung cancer and mesothelioma, as well as lead, benzene, isocyanates, silica, nickel, carbon disulfide and mineral oils
• Main results:
  • As described by the author, Doll's earlier cohort study of asbestos textile workers, listed in the references under the title 'Mortality from lung cancer in asbestos workers', documented an 11-fold excess risk in textile workers. Breslow's case-control study of lung cancer provided evidence that asbestos-related lung cancer mortality was not due to cigarette smoking alone.
  • The author cited a 1987 summary by McDonald, which reported that 50 cohort studies of asbestos-exposed men and women had been carried out.
  • According to studies the author cited, chrysotile exposure in textile work was associated with high lung cancer risk (Dement), while workers exposed during mining of chrysotile were at much lower risk (McDonald).
  • Other cited studies found that duration and intensity of asbestos exposure contributed independently to risk.
  • In several asbestos cohorts, effects of asbestos were documented independent of cigarette smoking, and in at least one cohort the risk was shown to be more than additive.
  • The author proposed that hazard surveillance of asbestos exposures could show trends predictive of future disease, such as mesothelioma, without waiting to count actual cases.
• The authors' conclusion: The author concluded that the academic discipline of epidemiology appeared to have become increasingly divorced from applications to workplace prevention, and that epidemiology and public health should be rejoined.

Topics

Medical terms in this study, explained in our Lexicon: Epidemiology, Occupational Disease, Lung Cancer, Asbestos Exposure, Silicosis.

Related studies

• Design and conduct of occupational epidemiology studies: IV. The analysis of case-control data — N. Pearce, H. Checkoway, et al. (1989)
• Applying quality criteria to exposure in asbestos epidemiology increases the estimated risk — A. Burdorf, D. Heederik (2011)
• Lagging exposure information in cumulative exposure-response analyses — D.B. Richardson, S.R. Cole, et al. (2011)
• Programmed health surveillance and detection of emerging diseases in occupational health: contribution of the French national occupational disease surveillance and prevention network (RNV3P) — V. Bonneterre, L. Faisandier, et al. (2010)
• Extrapolation from occupational studies: a substitute for environmental epidemiology — P.E. Enterline (1981)
• How conflicted authors undermine the World Health Organization (WHO) campaign to stop all use of asbestos: spotlight on studies showing that chrysotile is carcinogenic and facilitates other non-cancer asbestos-related diseases — X. Baur, C.L. Soskolne, et al. (2015)

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