Assessing the possible extent of confounding in occupational case-referent studies.

Checkoway, Harvey; Waldman, Gretchen

doi:10.5271/sjweh.2243

Cited by 11 publications

(4 citation statements)

References 4 publications

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“…Several investigators have argued convincingly that, in internal analyses of occupational groups, the potential for bias in the estimated relative risk due to confounding by nonoccupational factors is low [Axelson, 1978;Checkoway and Waldman, 1985;Siemiatycki, 1988;Steenland et al, 19841. Nevertheless, the possibility of confounding by smoking or alcohol in this study can be addressed by observing mortality patterns in the full cohort for causes of deaths known to be related to alcohol and smoking. Relative risks for lung cancer and cirrhosis estimated in Poisson regression models were available [Monson, 19921. Patterns in relative risks over increasing categories of exposure were examined for evidence of correlations between either cigarette smoking or alcohol and degree of MF exposure.…”

Section: Accounting For Unmeasured Risk Factorsmentioning

confidence: 99%

Mortality studies of machining fluid exposure in the automobile industry III: A case‐control study of larynx cancer

Eisen

Tolbert

Hallock

et al. 1994

American J Industrial Med

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A case-control study of larynx cancer was conducted within a cohort of automobile workers exposed to metal working fluids, commonly referred to as machining fluids (MF). Results are based on 108 cases of larynx cancer and 5:1 matched controls. Risks associated with specific types of MF, as well as specific components of the fluids were evaluated. Based on a retrospective exposure assessment, lifetime exposures to straight and soluble fluids, grinding particulate, biocides, selected metals, sulfur, and chlorine were examined. Exposure to asbestos and acid mists at two of the three study sites was also characterized. Results suggest that straight mineral oils are associated with almost a two-fold excess in larynx cancer risk. There was also evidence of an association with elemental sulfur, commonly added to straight MF to improve the integrity of the materials under extreme pressure and heat. It is not clear whether sulfur is causally related to an excess relative risk of larynx cancer or whether the observed association is the result of unmeasured confounding by another contaminant or process feature. For example, the high stress operations that require MF enriched with sulfur are also more likely to produce polycyclic aromatic hydrocarbons (PAHs) during the process. Thus, the observed association with sulfur may be due to an association with PAH. The finding of excess risk of laryngeal cancer associated with MF is consistent with several previous reports in the literature. This is the first study, however, to distinguish straight mineral oils from other types of MF. Based on these findings, a general reduction in concentrations of straight mineral oil particulate in occupational environments would be prudent.

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Section: Accounting For Unmeasured Risk Factorsmentioning

confidence: 99%

Mortality studies of machining fluid exposure in the automobile industry III: A case‐control study of larynx cancer

Eisen

Tolbert

Hallock

et al. 1994

American J Industrial Med

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“…The studies pooled in the NAPP relied on self-reported information on the personal use of pesticides, often years prior to the interview and in some instances information on use was reported by proxy respondents. Non-differential exposure misclassification would undoubtedly occur and has been demonstrated in methodological investigations of the NAPP and other farm populations [72][73][74][75]. Non-differential misclassification would tend to bias estimates of relative risk toward the null [75].…”

Section: Discussionmentioning

confidence: 99%

“…Non-differential exposure misclassification would undoubtedly occur and has been demonstrated in methodological investigations of the NAPP and other farm populations [72][73][74][75]. Non-differential misclassification would tend to bias estimates of relative risk toward the null [75]. However, the effects of measurement error, particularly in combination with unmeasured confounding can be unpredictable.…”

Section: Discussionmentioning

confidence: 99%

Pesticide use and risk of Hodgkin lymphoma: results from the North American Pooled Project (NAPP)

Latifovic

Freeman

Spinelli

et al. 2020

Cancer Causes Control

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Purpose The purpose of this study was to investigate associations between pesticide exposures and risk of Hodgkin lymphoma (HL) using data from the North American Pooled Project (NAPP). Methods Three population-based studies conducted in Kansas, Nebraska, and six Canadian provinces (HL = 507, Controls = 3886) were pooled to estimate odds ratios and 95% confidence intervals for single (never/ever) and multiple (0, 1, 2-4, ≥ 5) pesticides used, duration (years) and, for select pesticides, frequency (days/year) using adjusted logistic regression models. An age-stratified analysis (≤ 40/ > 40 years) was conducted when numbers were sufficient. Results In an analysis of 26 individual pesticides, ever use of terbufos was significantly associated with HL (OR: 2.53, 95% CI 1.04-6.17). In age-stratified analyses, associations were stronger among those ≤ 40 years of age. No significant associations were noted among those > 40 years old; however, HL cases ≤ 40 were three times more likely to report ever using dimethoate (OR: 3.76 95% CI 1.02-33.84) and almost twice as likely to have ever used malathion (OR: 1.86 95% CI 1.00-3.47). Those ≤ 40 years of age reporting use of 5 + organophosphate insecticides had triple the odds of HL (OR: 3.00 95% CI 1.28-7.03). Longer duration of use of 2,4-D, ≥ 6 vs. 0 years, was associated with elevated odds of HL (OR: 2.59 95% CI 1.34-4.97). Conclusion In the NAPP, insecticide use may increase the risk of HL, but results are based on small numbers.

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“…The proposed approach to adjust SMRs for competing causes of death can be compared to a certain degree to the so-called Axelson method, which is an indirect method for assessing the effects of tobacco use in occupational studies (Axelson 1978 ; Axelson and Steenland 1988 ; Checkoway and Waldman 1985 ).…”

Section: Discussionmentioning

confidence: 99%

An approach to adjust standardized mortality ratios for competing cause of death in cohort studies

Möhner

2015

Int Arch Occup Environ Health

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Results and conclusionsThe usual approach for calculating SMRs leads to an underestimation of the real lung cancer risk in subgroups of miners suffering from CWP. The same effect can be observed in workers exposed to respirable silica already suffering from silicosis. The presented approach results in more realistic risk estimation in mortality cohort studies of employees suffering from an occupational disease. It is easily calculable on the basis of usually published values of observed cases and the corresponding cause-specific SMR.

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Assessing the possible extent of confounding in occupational case-referent studies.

Cited by 11 publications

References 4 publications

Mortality studies of machining fluid exposure in the automobile industry III: A case‐control study of larynx cancer

Mortality studies of machining fluid exposure in the automobile industry III: A case‐control study of larynx cancer

Pesticide use and risk of Hodgkin lymphoma: results from the North American Pooled Project (NAPP)

An approach to adjust standardized mortality ratios for competing cause of death in cohort studies

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