Long-Term Exposure to Silica Dust and Risk of Total and Cause-Specific Mortality in Chinese Workers: A Cohort Study
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{"title"=>"Long-term exposure to silica dust and risk of total and cause-specific mortality in Chinese workers: A cohort study", "type"=>"journal", "authors"=>[{"first_name"=>"Weihong", "last_name"=>"Chen", "scopus_author_id"=>"14031086700"}, {"first_name"=>"Yuewei", "last_name"=>"Liu", "scopus_author_id"=>"16424749900"}, {"first_name"=>"Haijiao", "last_name"=>"Wang", "scopus_author_id"=>"23974656900"}, {"first_name"=>"Eva", "last_name"=>"Hnizdo", "scopus_author_id"=>"7003557425"}, {"first_name"=>"Yi", "last_name"=>"Sun", "scopus_author_id"=>"55960820000"}, {"first_name"=>"Liangping", "last_name"=>"Su", "scopus_author_id"=>"55194428900"}, {"first_name"=>"Xiaokang", "last_name"=>"Zhang", "scopus_author_id"=>"55194481000"}, {"first_name"=>"Shaofan", "last_name"=>"Weng", "scopus_author_id"=>"36999597100"}, {"first_name"=>"Frank", "last_name"=>"Bochmann", "scopus_author_id"=>"56798077100"}, {"first_name"=>"Frank J.", "last_name"=>"Hearl", "scopus_author_id"=>"6602730782"}, {"first_name"=>"Jingqiong", "last_name"=>"Chen", "scopus_author_id"=>"8631546800"}, {"first_name"=>"Tangchun", "last_name"=>"Wu", "scopus_author_id"=>"7404815278"}], "year"=>2012, "source"=>"PLoS Medicine", "identifiers"=>{"isbn"=>"1549-1676", "scopus"=>"2-s2.0-84860141101", "pui"=>"364670713", "doi"=>"10.1371/journal.pmed.1001206", "sgr"=>"84860141101", "pmid"=>"22529751", "issn"=>"15491277"}, "id"=>"b7dd3b5a-5fbe-382e-9429-a6a282dfe0ba", "abstract"=>"BACKGROUND: Human exposure to silica dust is very common in both working and living environments. However, the potential long-term health effects have not been well established across different exposure situations.\\n\\nMETHODS AND FINDINGS: We studied 74,040 workers who worked at 29 metal mines and pottery factories in China for 1 y or more between January 1, 1960, and December 31, 1974, with follow-up until December 31, 2003 (median follow-up of 33 y). We estimated the cumulative silica dust exposure (CDE) for each worker by linking work history to a job-exposure matrix. We calculated standardized mortality ratios for underlying causes of death based on Chinese national mortality rates. Hazard ratios (HRs) for selected causes of death associated with CDE were estimated using the Cox proportional hazards model. The population attributable risks were estimated based on the prevalence of workers with silica dust exposure and HRs. The number of deaths attributable to silica dust exposure among Chinese workers was then calculated using the population attributable risk and the national mortality rate. We observed 19,516 deaths during 2,306,428 person-years of follow-up. Mortality from all causes was higher among workers exposed to silica dust than among non-exposed workers (993 versus 551 per 100,000 person-years). We observed significant positive exposure-response relationships between CDE (measured in milligrams/cubic meter-years, i.e., the sum of silica dust concentrations multiplied by the years of silica exposure) and mortality from all causes (HR 1.026, 95% confidence interval 1.023-1.029), respiratory diseases (1.069, 1.064-1.074), respiratory tuberculosis (1.065, 1.059-1.071), and cardiovascular disease (1.031, 1.025-1.036). Significantly elevated standardized mortality ratios were observed for all causes (1.06, 95% confidence interval 1.01-1.11), ischemic heart disease (1.65, 1.35-1.99), and pneumoconiosis (11.01, 7.67-14.95) among workers exposed to respirable silica concentrations equal to or lower than 0.1 mg/m(3). After adjustment for potential confounders, including smoking, silica dust exposure accounted for 15.2% of all deaths in this study. We estimated that 4.2% of deaths (231,104 cases) among Chinese workers were attributable to silica dust exposure. The limitations of this study included a lack of data on dietary patterns and leisure time physical activity, possible underestimation of silica dust exposure for individuals who worked at the mines/factories before 1950, and a small number of deaths (4.3%) where the cause of death was based on oral reports from relatives.\\n\\nCONCLUSIONS: Long-term silica dust exposure was associated with substantially increased mortality among Chinese workers. The increased risk was observed not only for deaths due to respiratory diseases and lung cancer, but also for deaths due to cardiovascular disease. Please see later in the article for the Editors' Summary.", "link"=>"http://www.mendeley.com/research/longterm-exposure-silica-dust-risk-total-causespecific-mortality-chinese-workers-cohort-study", "reader_count"=>89, "reader_count_by_academic_status"=>{"Unspecified"=>3, "Professor > Associate Professor"=>4, "Researcher"=>14, "Student > Doctoral Student"=>9, "Student > Ph. D. Student"=>6, "Student > Postgraduate"=>9, "Student > Master"=>20, "Other"=>10, "Student > Bachelor"=>9, "Lecturer"=>3, "Lecturer > Senior Lecturer"=>2}, "reader_count_by_user_role"=>{"Unspecified"=>3, "Professor > Associate Professor"=>4, "Researcher"=>14, "Student > Doctoral Student"=>9, "Student > Ph. D. Student"=>6, "Student > Postgraduate"=>9, "Student > Master"=>20, "Other"=>10, "Student > Bachelor"=>9, "Lecturer"=>3, "Lecturer > Senior Lecturer"=>2}, "reader_count_by_subject_area"=>{"Unspecified"=>4, "Agricultural and Biological Sciences"=>9, "Arts and Humanities"=>1, "Business, Management and Accounting"=>1, "Computer Science"=>2, "Earth and Planetary Sciences"=>2, "Economics, Econometrics and Finance"=>2, "Engineering"=>4, "Environmental Science"=>12, "Nursing and Health Professions"=>6, "Biochemistry, Genetics and Molecular Biology"=>2, "Mathematics"=>1, "Medicine and Dentistry"=>39, "Design"=>1, "Social Sciences"=>2, "Immunology and Microbiology"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>39}, "Social Sciences"=>{"Social Sciences"=>2}, "Mathematics"=>{"Mathematics"=>1}, "Unspecified"=>{"Unspecified"=>4}, "Environmental Science"=>{"Environmental Science"=>12}, "Arts and Humanities"=>{"Arts and Humanities"=>1}, "Design"=>{"Design"=>1}, "Engineering"=>{"Engineering"=>4}, "Earth and Planetary Sciences"=>{"Earth and Planetary Sciences"=>2}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>2}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>9}, "Computer Science"=>{"Computer Science"=>2}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>1}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>6}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>2}}, "reader_count_by_country"=>{"Colombia"=>1, "Morocco"=>1, "United States"=>1, "South Africa"=>1, "United Kingdom"=>1, "Malaysia"=>1, "Spain"=>2, "India"=>1}, "group_count"=>5}

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  • {"files"=>["https://ndownloader.figshare.com/files/651923"], "description"=>"<p>Annual silica dust concentrations, average of all job titles in different mines/factories in China, 1950–2003.</p>", "links"=>[], "tags"=>["silica", "titles"], "article_id"=>322401, "categories"=>["Biotechnology"], "users"=>["Weihong Chen", "Yuewei Liu", "Haijiao Wang", "Eva Hnizdo", "Yi Sun", "Liangping Su", "Xiaokang Zhang", "Shaofan Weng", "Frank Bochmann", "Frank J. Hearl", "Jingqiong Chen", "Tangchun Wu"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001206.g001", "stats"=>{"downloads"=>0, "page_views"=>13, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Annual_silica_dust_concentrations_average_of_all_job_titles_in_different_mines_factories_in_China_1950_8211_2003_/322401", "title"=>"Annual silica dust concentrations, average of all job titles in different mines/factories in China, 1950–2003.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-04-17 00:40:01"}
  • {"files"=>["https://ndownloader.figshare.com/files/652216"], "description"=>"<p>All Cox proportional hazards models included age as the time variable. Categorical analyses were based on levels of CDE, including unexposed, low, medium, and high; the unexposed level was used as the reference category (low level for pneumoconiosis). In all models, the HRs associated with CDE were adjusted for gender, year of hire (five categories: 1955 or earlier, 1956–1960, 1961–1965, 1966–1970, and 1970 or later), age at hire (continuous), and type of mine/factory (four categories: tungsten, iron/copper, tin, and pottery).</p>a<p>Levels were tertiles of CDE of all the workers with exposure to silica dust: low, 0.01–1.23 mg/m<sup>3</sup>-y; medium, 1.24–4.46 mg/m<sup>3</sup>-y; and high, >4.46 mg/m<sup>3</sup>-y.</p>b<p>Assessed by including the median values of exposure within each category as a continuous variable in the model, including the reference category.</p>", "links"=>[], "tags"=>["hrs", "cause-specific", "cde", "cohort"], "article_id"=>322693, "categories"=>["Biotechnology"], "users"=>["Weihong Chen", "Yuewei Liu", "Haijiao Wang", "Eva Hnizdo", "Yi Sun", "Liangping Su", "Xiaokang Zhang", "Shaofan Weng", "Frank Bochmann", "Frank J. Hearl", "Jingqiong Chen", "Tangchun Wu"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001206.t003", "stats"=>{"downloads"=>4, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Estimated_HRs_for_total_and_cause_specific_mortality_associated_with_CDE_in_the_cohort_n_74_040_1960_2003_/322693", "title"=>"Estimated HRs for total and cause-specific mortality associated with CDE in the cohort (<i>n</i> = 74,040), 1960–2003.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-04-17 00:44:53"}
  • {"files"=>["https://ndownloader.figshare.com/files/652172"], "description"=>"<p>Values expressed as mean ± standard deviation, unless otherwise indicated. Percentages may not total 100 due to rounding.</p>a<p>Levels are tertiles of CDE of all the workers with exposure to silica dust: low, 0.01–1.23 mg/m<sup>3</sup>-y; medium, 1.24–4.46 mg/m<sup>3</sup>-y; and high, >4.46 mg/m<sup>3</sup>-y.</p>b<p>Data were available for the sub-cohorts that had been followed through the end of 2003. Smokers were defined as those who had smoked regularly for over 1 y. Smokers who stopped smoking within 1 y before the end of follow-up were defined as current smokers.</p>c<p>These characteristics were calculated among workers exposed to silica dust. Mean silica dust concentration was calculated as CDE divided by duration of silica dust exposure.</p>d<p>These characteristics were calculated among workers diagnosed with pneumoconiosis. Latency of pneumoconiosis was defined as the period between the year of first exposure to dust and the year of first diagnosis of pneumoconiosis.</p><p>NA, not applicable.</p>", "links"=>[], "tags"=>["cohort"], "article_id"=>322657, "categories"=>["Biotechnology"], "users"=>["Weihong Chen", "Yuewei Liu", "Haijiao Wang", "Eva Hnizdo", "Yi Sun", "Liangping Su", "Xiaokang Zhang", "Shaofan Weng", "Frank Bochmann", "Frank J. Hearl", "Jingqiong Chen", "Tangchun Wu"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001206.t002", "stats"=>{"downloads"=>5, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Characteristics_of_the_cohort_n_74_040_based_on_CDE_1960_2003_/322657", "title"=>"Characteristics of the cohort (<i>n</i> = 74,040) based on CDE, 1960–2003.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-04-17 00:44:17"}
  • {"files"=>["https://ndownloader.figshare.com/files/335067", "https://ndownloader.figshare.com/files/335135"], "description"=>"<div><h3>Background</h3><p>Human exposure to silica dust is very common in both working and living environments. However, the potential long-term health effects have not been well established across different exposure situations.</p> <h3>Methods and Findings</h3><p>We studied 74,040 workers who worked at 29 metal mines and pottery factories in China for 1 y or more between January 1, 1960, and December 31, 1974, with follow-up until December 31, 2003 (median follow-up of 33 y). We estimated the cumulative silica dust exposure (CDE) for each worker by linking work history to a job–exposure matrix. We calculated standardized mortality ratios for underlying causes of death based on Chinese national mortality rates. Hazard ratios (HRs) for selected causes of death associated with CDE were estimated using the Cox proportional hazards model. The population attributable risks were estimated based on the prevalence of workers with silica dust exposure and HRs. The number of deaths attributable to silica dust exposure among Chinese workers was then calculated using the population attributable risk and the national mortality rate. We observed 19,516 deaths during 2,306,428 person-years of follow-up. Mortality from all causes was higher among workers exposed to silica dust than among non-exposed workers (993 versus 551 per 100,000 person-years). We observed significant positive exposure–response relationships between CDE (measured in milligrams/cubic meter–years, i.e., the sum of silica dust concentrations multiplied by the years of silica exposure) and mortality from all causes (HR 1.026, 95% confidence interval 1.023–1.029), respiratory diseases (1.069, 1.064–1.074), respiratory tuberculosis (1.065, 1.059–1.071), and cardiovascular disease (1.031, 1.025–1.036). Significantly elevated standardized mortality ratios were observed for all causes (1.06, 95% confidence interval 1.01–1.11), ischemic heart disease (1.65, 1.35–1.99), and pneumoconiosis (11.01, 7.67–14.95) among workers exposed to respirable silica concentrations equal to or lower than 0.1 mg/m<sup>3</sup>. After adjustment for potential confounders, including smoking, silica dust exposure accounted for 15.2% of all deaths in this study. We estimated that 4.2% of deaths (231,104 cases) among Chinese workers were attributable to silica dust exposure. The limitations of this study included a lack of data on dietary patterns and leisure time physical activity, possible underestimation of silica dust exposure for individuals who worked at the mines/factories before 1950, and a small number of deaths (4.3%) where the cause of death was based on oral reports from relatives.</p> <h3>Conclusions</h3><p>Long-term silica dust exposure was associated with substantially increased mortality among Chinese workers. The increased risk was observed not only for deaths due to respiratory diseases and lung cancer, but also for deaths due to cardiovascular disease.</p> <h3></h3><p> <em>Please see later in the article for the Editors' Summary</em></p> </div>", "links"=>[], "tags"=>["silica", "cause-specific", "chinese", "cohort"], "article_id"=>126184, "categories"=>["Biotechnology"], "users"=>["Weihong Chen", "Yuewei Liu", "Haijiao Wang", "Eva Hnizdo", "Yi Sun", "Liangping Su", "Xiaokang Zhang", "Shaofan Weng", "Frank Bochmann", "Frank J. Hearl", "Jingqiong Chen", "Tangchun Wu"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1001206.s001", "https://dx.doi.org/10.1371/journal.pmed.1001206.s002"], "stats"=>{"downloads"=>3, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Long_Term_Exposure_to_Silica_Dust_and_Risk_of_Total_and_Cause_Specific_Mortality_in_Chinese_Workers_A_Cohort_Study/126184", "title"=>"Long-Term Exposure to Silica Dust and Risk of Total and Cause-Specific Mortality in Chinese Workers: A Cohort Study", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2012-04-17 01:43:04"}
  • {"files"=>["https://ndownloader.figshare.com/files/652053"], "description"=>"<p>HRs and 95% CIs were derived from penalized spline regression models to examine the nonlinear relation of CDE to mortality. The vertical solid line in each panel represents the 95th percentile of CDE. Dashed lines represent the point estimate of the HR adjusted for duration of follow-up (time-dependent, continuous) and calendar time (time-dependent, continuous); solid lines represent HR further adjusted for smoking (never smoked/ever smoked), with dotted lines indicating the 95% CI; the rug plots along the horizontal axes give the distribution of CDE values. For simplicity of presentation, the reference value of CDE was set to 0 mg/m<sup>3</sup>-y (0.01 mg/m<sup>3</sup>-y for pneumoconiosis).</p>", "links"=>[], "tags"=>["hrs", "cause-specific", "cde", "nested", "samples", "workers", "silica"], "article_id"=>322527, "categories"=>["Biotechnology"], "users"=>["Weihong Chen", "Yuewei Liu", "Haijiao Wang", "Eva Hnizdo", "Yi Sun", "Liangping Su", "Xiaokang Zhang", "Shaofan Weng", "Frank Bochmann", "Frank J. Hearl", "Jingqiong Chen", "Tangchun Wu"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001206.g002", "stats"=>{"downloads"=>1, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Estimated_HRs_for_total_and_cause_specific_mortality_associated_with_a_continuous_CDE_variable_in_nested_case_8211_control_samples_from_workers_with_detailed_data_on_historical_silica_exposure_and_smoking_1960_8211_2003_/322527", "title"=>"Estimated HRs for total and cause-specific mortality associated with a continuous CDE variable in nested case–control samples from workers with detailed data on historical silica exposure and smoking, 1960–2003.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-04-17 00:42:07"}
  • {"files"=>["https://ndownloader.figshare.com/files/652261"], "description"=>"<p>SMRs were estimated based on Chinese national mortality rates (not available before 1970).</p>", "links"=>[], "tags"=>["smrs", "silica-dust-exposed", "workers", "cohort"], "article_id"=>322741, "categories"=>["Biotechnology"], "users"=>["Weihong Chen", "Yuewei Liu", "Haijiao Wang", "Eva Hnizdo", "Yi Sun", "Liangping Su", "Xiaokang Zhang", "Shaofan Weng", "Frank Bochmann", "Frank J. Hearl", "Jingqiong Chen", "Tangchun Wu"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001206.t004", "stats"=>{"downloads"=>3, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Estimated_SMRs_for_underlying_cause_of_death_of_silica_dust_exposed_workers_in_the_cohort_n_72_248_1970_2003_/322741", "title"=>"Estimated SMRs for underlying cause of death of silica-dust-exposed workers in the cohort (<i>n</i> = 72,248), 1970–2003.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-04-17 00:45:41"}
  • {"files"=>["https://ndownloader.figshare.com/files/652127"], "description"=>"<p>Description of the cohort (<i>n</i> = 74,040) based on different types of mine/factory, 1960–2003.</p>", "links"=>[], "tags"=>["cohort", "types"], "article_id"=>322613, "categories"=>["Biotechnology"], "users"=>["Weihong Chen", "Yuewei Liu", "Haijiao Wang", "Eva Hnizdo", "Yi Sun", "Liangping Su", "Xiaokang Zhang", "Shaofan Weng", "Frank Bochmann", "Frank J. Hearl", "Jingqiong Chen", "Tangchun Wu"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001206.t001", "stats"=>{"downloads"=>7, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Description_of_the_cohort_n_74_040_based_on_different_types_of_mine_factory_1960_2003_/322613", "title"=>"Description of the cohort (<i>n</i> = 74,040) based on different types of mine/factory, 1960–2003.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-04-17 00:43:33"}

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Relative Metric

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