A cohort of 34 560 men and 6128 women employed in 660 European factories manufacturing reinforced plastic products, followed up originally to assess the risk of cancer, was used to assess the risk of non-malignant respiratory diseases associated with exposure to styrene. Mortality from pneumonia was associated with intensity of exposure to styrene, but this may have been due to chance. Mortality from bronchitis, emphysema, and asthma was not associated with styrene exposure.(Occup Environ Med 1996;53:499-501) Keywords: styrene; mortality; respiratory system Styrene (C5H5) is an aromatic hydrocarbon produced in substantial quantities. Worker exposure occurs during its production and polymerisation, and in the manufacture of glass reinforced plastics, resins, and synthetic rubber.' Styrene is taken up through the lung and the skin, and causes irritation of the respiratory tract, even at low levels of exposure (about 20 ppm). Pulmonary lesions due to styrene have been reported in humans and animals, but data on possible long term morbidity and mortality from non-neoplastic diseases associated with exposure to styrene are scanty. The effects of styrene on the respiratory tract of workers exposed to concentrations above 100 ppm (433 mg/M3) include chronic bronchitis and obstructive pulmonary changes.' Cases of asthma induced by styrene have also been reported.' In experiments with rats, morphological damage occurred after exposure to styrene in the upper, and to a less extent, in the lower respiratory tract.2 Respiratory effects of styrene in rats are thought to be associated with gluthatione depletion in the lungs accompanied by inhibition of cytochrome P450 dependent oxidative drug metabolism. We examined mortality from non-malignant respiratory diseases in relation to exposure to styrene in a large international cohort study of workers in the glass reinforced plastics industry, where high workroom concentrations of styrene were encountered. The cohort had been established initially to assess the risk of cancer associated with exposure to styrene.
Materials and methodsThe cohort consisted of 34 560 men and 6128 women ever employed in 660 European factories to manufacture reinforced plastic products. The subjects were identified through eight research centres in Denmark, Finland, Italy, Norway, Sweden, and the United Kingdom. Cohort recruitment has been described in detail elsewhere.4 We excluded subjects unexposed or with unknown exposure to styrene (n = 5245). A total of 35 443 exposed subjects remained for the external comparisons with national reference rates. They accumulated 446 784 person-years during an average of 12-6 years of follow up. For internal comparisons, we excluded 2641 additional subjects with incomplete job data, leaving 32 802 subjects (405 975 person-years). Follow up for mortality was initiated at first exposure to styrene , or on the first date for which complete payrolls were available, whichever was later. A styrene exposure database was constructed from personal, environmental,...