Cancer mortality in workers exposed to dieldrin and aldrin: an update

This study was conducted to investigate the possible long-term health effects, in particular carcinogenic effects, of occupational exposure to the organochlorine insecticides dieldrin and aldrin. We updated an earlier cohort mortality study of 570 employees involved in the production of these insecticides. All of the employees had worked in the production plants between 1 January 1954 and 1 January 1970 and were followed for cause-specific mortality until 1 January 2001. Based on dieldrin levels in blood samples taken during the exposure period, available for 343 workers, individual estimates of the total intake of dieldrin were estimated for all individual subjects in the cohort. The estimated total intake ranged from 11 to 7755 mg of dieldrin, with an average of 737 mg. One hundred and seventy-one workers had died before 1 January 2001, compared with an expected number of 226.6, giving a standardized mortality ratio (SM R) of 75.6 [95% confidence interval (CI): 64.6-87.7]. This deficit in total mortality was mainly attributable to a deficit in cardiovascular disease mortality, but cancer mortality was also lower than expected. The observed number of deaths from rectal cancer was significantly higher than expected (SM R 3/4-300.0; 95% CI: 109.5-649.3), but was most pronounced in the low-intake subgroup and appears to be unrelated to exposure to dieldrin and aldrin. This study reinforces the earlier findings that occupational exposure of workers to significant amounts of dieldrin and aldrin has not led to a higher cancer mortality than would be found in an unexposed population.

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Estimation of the cumulated exposure to polychlorinated dibenzo-p-dioxins/furans and standardized mortality ratio analysis of cancer mortality by dose in an occupationally exposed cohort.

Environmental Health Perspectives ◽

10.1289/ehp.98106655 ◽

1998 ◽

Vol 106 (suppl 2) ◽

pp. 655-662 ◽

Cited By ~ 48

Author(s):

D Flesch-Janys ◽

K Steindorf ◽

P Gurn ◽

H Becher

Keyword(s):

Cancer Mortality ◽

Standardized Mortality Ratio ◽

Ratio Analysis ◽

Occupationally Exposed ◽

Mortality Ratio

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Application of Standardized Proportional Mortality Ratio to the Assessment of Health Risk in Relatively Healthy Populations: Using a Study of Cancer Risk in Telecommunication Workers with Excess Exposure to Acid Mists as an Example

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18189870 ◽

2021 ◽

Vol 18 (18) ◽

pp. 9870

Author(s):

Ying-Fong Ker ◽

Perng-Jy Tsai ◽

How-Ran Guo

Keyword(s):

Cancer Risk ◽

Geometric Mean ◽

Epidemiological Studies ◽

Standardized Mortality Ratio ◽

Acid Mist ◽

Proportional Mortality ◽

Mortality Ratio ◽

Carcinogenic Effects ◽

Study Population

When a study population is relatively healthy, such as an occupational population, epidemiological studies are likely to underestimate risk. We used a case study on the cancer risk of workers with exposure to acid mists, a well-documented carcinogen, to demonstrate that using proportional mortality ratios (PMRs) is more appropriate than mortality ratios in assessing risk in terms of mortality. The study included 10,229 employees of a telecommunication company who worked in buildings with battery rooms. In these buildings, the battery rooms had the highest levels of sulfuric acid in the air (geometric mean = 10.7 μg/m3). With the general population in Taiwan as a reference, a decreased standardized mortality ratio (0.42, p < 0.01) from all causes combined, between 1 January 1985 and 31 December 1996, was observed, indicating a healthy worker effect. When we reanalyzed the data using standardized PMR, elevated risks were observed for all cancers combined (1.46, p = 0.01) and cancers of the digestive organs and peritoneum (1.61, p = 0.02), especially stomach cancer (2.94, p = 0.01). The results showed that PMR can detect increases in mortality when a study population is generally healthier than the comparison population and call for further studies on the possible carcinogenic effects of low-level acid mist exposures on the stomach.

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USE OF CODED MORTALITY DATA TO ASSESS AREA CANCER RATES: IMPACT OF RESIDENCE REPORTING AND CODING ERRORS

American Journal of Epidemiology ◽

10.1093/oxfordjournals.aje.a115780 ◽

1990 ◽

Vol 132 (supp1) ◽

pp. 178-182 ◽

Cited By ~ 8

Author(s):

ALLAN N. WILLIAMS ◽

REBECCA A. JOHNSON ◽

ALAN P. BENDER

Keyword(s):

Rural Areas ◽

Cancer Mortality ◽

Mortality Rates ◽

Mortality Data ◽

Standardized Mortality Ratio ◽

Death Certificates ◽

Total Cancer ◽

Mortality Ratio ◽

Cancer Rates ◽

Standardized Mortality Ratios

Abstract In spite of their limitations, mortality data are used in many epidemiologic and public health settings. In this investigation, the authors examined the extent to which community cancer mortality rates were affected by incorrect reporting or coding of residence on death certificates. Observed and expected cancer mortality for two adjacent communities in northern rural Minnesota for the periods 1970–1974 and 1980–1984 were obtained from computerized state mortality data. Using statewide rates to obtain expected values, standardized mortality ratios for total cancers for both periods combined were 138 for men (101 observed deaths) and 148 for women (86 observed deaths). These excesses were statistically significant (p < 0.05). However, after review of data from the actual death certificates, city maps, and information from city officials, 44 of the 187 total cancer deaths (24%) were found to have had an incorrectly reported or coded residence status. After removal of these cases, the standardized mortality ratio for total cancers for males went from 138 to 107, and for females the standardized mortality ratio went from 148 to 111. No standardized mortality ratios remained statistically significant These findings may have implications for those who use mortality data for assessing cancer rates in communities in rural areas.

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Standardized Incidence Ratio and Standardized Mortality Ratio of Malignant Mesothelioma in a Worker Cohort Using Employment Insurance Database in Korea

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182010682 ◽

2021 ◽

Vol 18 (20) ◽

pp. 10682

Author(s):

Eun-A Kim

Keyword(s):

Malignant Mesothelioma ◽

Food Service ◽

Standardized Mortality Ratio ◽

Standardized Incidence Ratio ◽

Employment Insurance ◽

Long Latency ◽

Long Term Follow Up ◽

Mortality Ratio ◽

Carcinogenic Effects ◽

Indirect Standardization

Malignant mesothelioma is one of the appropriate indicators for assessing the carcinogenic effects of asbestos. This study compared the risk ratio of mesothelioma according to the industry in the worker cohort. A cohort was constructed using the Korean employment insurance system during 1995–2017, enrolling 13,285,895 men and 10,452,705 women. The standardized mortality ratio (SMR) and standardized incidence ratio (SIR) were calculated using the indirect standardization method. There were 641 malignant mesotheliomas that occurred; the SIR was significantly higher than the general population (men 1.36, 95% confidence interval(CI) 1.24–1.48, women 1.44, 95% CI: 1.23–1.7). More than half (52.8%) of malignant mesothelioma cases occurred in the manufacturing (n = 240, 38.6%, SIR: men, 1.72, 95% CI: 1.37–2.15, women, 3.31, 95% CI: 1.71–5.79) and construction industries (n = 88, 14.2%, SIR: men, 1.54 95% CI: 1.33–1.78, women, 1.62 95% CI: 1.25–2.11). The accommodation and food service (men, 2.56 95% CI: 1.28–4.58, women 1.35, 95% CI: 0.65–2.48) and real estate (men 1.34, 95% CI: 0.98–1.83, women 1.95, 95% CI: 0.78–4.02) also showed a high SIR, indicating the risk of asbestos-containing materials in old buildings. The incidence of malignant mesothelioma is likely to increase in the future, given the long latency of this disease. Moreover, long-term follow-up studies will be needed.

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Abstract P358: Do Cardiac Interventions Affect Noncardiac Mortality?

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_1.ap358 ◽

2011 ◽

Vol 4 (suppl_1) ◽

Author(s):

Robert Bryg ◽

Tae Yang ◽

David Bryg

Keyword(s):

Clinical Trials ◽

Cardiovascular Mortality ◽

General Medicine ◽

Total Mortality ◽

Major Adverse Cardiovascular Events ◽

Standardized Mortality Ratio ◽

Multiple Endpoints ◽

Significant Difference ◽

Mortality Ratio ◽

Relative Change

Clinical trials of cardiovascular drugs and devices primarily assess benefit and risk in terms of cardiovascular mortality and other major adverse cardiovascular events. There is little data on how noncardiac mortality is impacted in clinical trials. In this study, we sought to determine how noncardiac mortality was affected in clinical trials that were published in the past 12 years in major general medicine journals. We calculated the standardized mortality ratio and its confidence intervals for cardiac, noncardiac and total mortality in all arms of 93 large clinical trials. Relative change and power to detect significant changes in all three components was calculated. Twenty two studies had a decrease in cardiovascular mortality of at least 20%, while only 4 studies had an increase in cardiovascular mortality more than 20%. Only 7 studies had a statistically significant decrease in cardiovascular mortality. Noncardiac mortality was at least 5% higher in the treatment arm in 31 (33%) of all studies. In 4 of these studies, noncardiac mortality was at least 20% higher in the treatment arm. Noncardiac mortality was at least 5% lower in the treatment arm in 24 studies, with 3 of then having at least a 20% lower mortality rate. In only 1 study was there a significant difference in noncardiac mortality. Only 3 studies were adequately powered to detect a 20% difference in noncardiac mortality. None were powered to detect a 10% difference in noncardiac mortality. Overall, there was no difference in noncardiac mortality in these studies. There is wide variation in differences in noncardiac mortality determined in clinical trials, with most studies showing at least a 5% difference in noncardiac mortality rates and over 1/3 of the studies demonstrating at least a 10% difference in noncardiac mortality. In primary prevention and hypertension studies, one would only need a 6-10% increase in noncardiac mortality to negate a 20% decrease in cardiac mortality. No studies were adequately powered to evaluate for this effect. With the strong push to evidence based medicine, studies need to be adequately powered to demonstrate a lack of harm as well as benefit. The increased use of multiple endpoints will exacerbate the problem of assessment of risk in cardiovascular clinical trials.

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MANAGEMENT OF ENDOCRINE DISEASE: Mortality remains increased in Cushing's disease despite biochemical remission: a systematic review and meta-analysis

Acta Endocrinologica ◽

10.1530/eje-14-0556 ◽

2015 ◽

Vol 172 (4) ◽

pp. R143-R149 ◽

Cited By ~ 36

Author(s):

Femke M van Haalen ◽

Leonie H A Broersen ◽

Jens O Jorgensen ◽

Alberto M Pereira ◽

Olaf M Dekkers

Keyword(s):

Systematic Review ◽

Cushing’S Disease ◽

Initial Treatment ◽

Meta Analysis ◽

Cushing's Disease ◽

Standardized Mortality Ratio ◽

Disease Mortality ◽

Statistical Heterogeneity ◽

Mortality Ratio ◽

Biochemical Cure

The aim of this systematic review and meta-analysis was to investigate whether mortality is increased in patients biochemically cured after initial treatment for Cushing's disease. This is a systematic review and meta-analysis of follow-up studies in patients cured from Cushing's disease after initial treatment was performed. Eight electronic databases were searched from 1975 to March 2014 to identify potentially relevant articles. Original articles reporting the standardized mortality ratio (SMR) for patients cured of Cushing's disease were eligible for inclusion. SMRs were pooled in a random effects model.I2statistics was used for quantification of heterogeneity. Eight cohort studies with a total of 766 patients were included. Out of eight studies, seven showed an SMR above 1.0 for cured patients. The pooled SMR was 2.5 (95% CI 1.4–4.2). TheI2statistics showed evidence for statistical heterogeneity (78%,Q-statisticsP<0.001), which was largely explained by two outliers. This meta-analysis reveals that mortality remains increased in patients with Cushing's disease even after initial biochemical cure remission, suggesting that cure does not directly reverse the metabolic consequences of long-term overexposure to cortisol. Other conditions such as hypopituitarism, including persistent adrenocortical insufficiency after surgery, may also contribute to the increased mortality risk.

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Abstract P510: Association of Animal and Plant Protein Intake With Mortality Among US Adults: A Prospective Cohort Study

Circulation ◽

10.1161/circ.141.suppl_1.p510 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Zhilei Shan ◽

Danielle E Haslam ◽

Colin D Rehm ◽

Mingyang Song ◽

Frank B Hu ◽

...

Keyword(s):

Heart Disease ◽

Cancer Mortality ◽

Protein Intake ◽

Total Mortality ◽

Cox Proportional Hazards ◽

Animal Protein ◽

Plant Protein ◽

Food Sources ◽

Processed Meat ◽

Disease Mortality

Introduction: Animal protein sources, especially red and processed meat, have been associated with adverse health outcomes. Epidemiological evidence on the isocaloric substitution of plant for animal protein on mortality risk remains limited. Hypothesis: We hypothesized that substituting plant protein for carbohydrates and animal protein would be associated with lower mortality. Method: We included a nationally representative sample of 37 233 US adults ≥20 years with 24-h dietary recall data from eight National Health and Nutrition Examination Survey (NHANES) cycles (1999-2014). Mortality from all causes, heart disease, and cancer were identified through National Death Index linkage (until December 31, 2015). We used Cox proportional hazards regression to estimate the association between plant and animal protein intake and mortality after adjustment for potential confounding factors. Results: During 297 768 person-years of follow-up, 4 866 total deaths occurred, including 849 deaths from heart disease and 1 068 deaths from cancer. After multivariable adjustment, higher intake of total animal protein was not associated with total mortality. Plant protein was associated with lower total mortality; when comparing the lowest with highest quintiles of plant protein intake, the multivariable adjusted HR (95% CIs) of total mortality was 0.73 (0.61, 0.88); P for trend <0.001. The HRs (95% CIs) comparing extreme quintiles were 0.71 (0.48, 1.05) for heart disease mortality, and 0.74 (0.53, 1.04) for cancer mortality. When isocalorically replacing 5% of energy from total animal protein with plant protein, the multivariable HRs were 0.49 (0.32, 0.74) for total mortality, 0.51 (0.28, 0.95) for heart disease mortality, and 0.53 (0.28, 1.00) for cancer mortality. For different food sources of animal protein, isocaloric substitution of 2% of energy from plant protein for protein in unprocessed red meat (0.74, 95% CI: 0.63, 0.87), processed meat (0.68, 95% CI: 0.53, 0.89), total dairy (0.74, 95% CI: 0.58, 0.94), and 1% of energy from plant protein for seafood (0.86, 95% CI: 0.79, 0.93) was each associated with a lower risk of total mortality. Conclusions: Higher plant protein intake was associated with lower total mortality. Isocalorically replacing animal protein with plant protein was associated with lower total mortality.

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A Population-Based Study of Cardiovascular Disease Mortality in Italian Cancer Patients

Cancers ◽

10.3390/cancers13235903 ◽

2021 ◽

Vol 13 (23) ◽

pp. 5903

Author(s):

Lucia Mangone ◽

Pamela Mancuso ◽

Luigi Tarantini ◽

Mario Larocca ◽

Isabella Bisceglia ◽

...

Keyword(s):

Cardiovascular Disease ◽

General Population ◽

Cancer Patients ◽

Cardiovascular Mortality ◽

Interdisciplinary Approach ◽

Population Based ◽

Standardized Mortality Ratio ◽

Disease Mortality ◽

Mortality Ratio ◽

Melanoma Patients

The present research describes 25 years of cardiovascular mortality in a cohort of patients in Northern Italy. The study included patients with malignant cancer enrolled in the period of 1996–2019, and describes cardiovascular and cancer mortality in relation to sex, age, year of diagnosis, months of survivorship, tumor site, and standardized mortality ratio (SMR). Out of 67,173 patients, 38,272 deaths (57.7%) were recorded: 4466 from cardiovascular disease (CVD) (6.6%), and 28,579 (42.6%) from cancer. The proportion of CVD death increased from 4.5% in the first two years after diagnosis, to 7.3% after more than 10 years, while the proportion of deaths from cancer decreased from 70.5% to 9.4%. The CVD SMR comparing cancer patients with the general population was 0.87 (95% CI: 0.82–0.92) in 1996–1999, rising to 0.95 (95% CI: 0.84–1.08) in 2015–2019, without differences in terms of sex or age. The risk of dying from CVD was higher compared with the general population (SMR 1.31; 95% CI: 1.24–1.39) only in the first two years after diagnosis. The trend over time underscored that CVD deaths increased in patients with breast, bladder, prostate, and colorectal cancers, and, in the more recent period, for kidney cancer and melanoma patients. Our data confirmed that cardiovascular mortality is an important issue in the modern management of cancer patients, suggesting the need for an extensive interdisciplinary approach.

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