The asbestos-asbestosis exposure-response relationship: a cohort study of the general working population

Inge Brosbøl Iversen; Jesper Medom Vestergaard; Johan Ohlander; Susan Peters; Elisabeth Bendstrup; Jens Peter E Bonde; Vivi Schlünssen; Jakob H Bønløkke; Finn Rasmussen; Zara A Stokholm; Michael B Andersen; Hans Kromhout; Henrik A Kolstad

doi:10.5271/sjweh.4153

The asbestos-asbestosis exposure-response relationship: a cohort study of the general working population

Inge Brosbøl Iversen
, Jesper Medom Vestergaard
, Johan Ohlander
, Susan Peters
, Elisabeth Bendstrup
, Jens Peter E Bonde
, Vivi Schlünssen
, Jakob H Bønløkke
, Finn Rasmussen
, Zara A Stokholm
, Michael B Andersen
, Hans Kromhout
, Henrik A Kolstad

Aarhus University Hospital

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

OBJECTIVES: The association between asbestos exposure and asbestosis in high-exposed industrial cohorts is well-known, but there is a lack of knowledge about the exposure-response relationship for asbestosis in a general working population setting. We examined the exposure-response relationship between occupational asbestos exposure and asbestosis in asbestos-exposed workers of the Danish general working population.

METHODS: We followed all asbestos-exposed workers from 1979 to 2015 and identified incident cases of asbestosis using the Danish National Patient Register. Individual asbestos exposure was estimated with a quantitative job exposure matrix (SYN-JEM) from 1976 onwards and back-extrapolated to age 16 for those exposed in 1976. Exposure-response relations for cumulative exposure and other exposure metrics were analyzed using a discrete time hazard model and adjusted for potential confounders.

RESULTS: The range of cumulative exposure in the population was 0.001 to 18 fibers per milliliter-year (f/ml-year). We found increasing incidence rate ratios (IRR) of asbestosis with increasing cumulative asbestos exposure with a fully adjusted IRR per 1 f/ml-years of 1.18 [95% confidence interval (CI) 1.15- -1.22]. The IRR was 1.94 (95% CI 1.53-2.47) in the highest compared to the lowest exposure tertile. We similarly observed increasing risk with increasing cumulative exposure in the inception population.

CONCLUSIONS: This study found exposure-response relations between cumulative asbestos exposure and incident asbestosis in the Danish general working population with mainly low-level exposed occupations, but there is some uncertainty regarding the exposure levels.

Original language	English
Pages (from-to)	372-379
Number of pages	8
Journal	Scandinavian Journal of Work, Environment & Health
Volume	50
Issue number	5
Early online date	5 Apr 2024
DOIs	https://doi.org/10.5271/sjweh.4153
Publication status	Published - Jul 2024

Bibliographical note

Publisher Copyright:
© 2024, Nordic Association of Occupational Safety and Health. All rights reserved.

Funding

This work was funded by grants from the Danish Working Environment Research Fund (grant no. 34-2019-09 and 47-2019-03) . The original ISCO-68 SYN-JEM was developed in the SYNERGY project funded by the German Social Accident Insurance (DGUV) (grant FP 271) , and was coordinated by the International Agency for Research on Cancer (IARC) , the Institute for Prevention and Occupational Medicine of the DGUV, Institute of the Ruhr-University Bochum (IPA) , and the Institute for Risk Assessment Sciences (IRAS) at Utrecht University. The development of the Danish Occupational Cohort (DOC*X) was coordinated by the Department of Occupational and Environmental Medicine, Copenhagen University Hospital-Bispebjerg and Frederiksberg and funded by the Danish Working Environment Research Fund (grant no. 43-2014-03/20140016763) .

Funders	Funder number
Gentofte Hospital
International Arctic Research Center, University of Alaska, Fairbanks
Bispebjerg Hospital
Institute of the Ruhr-University Bochum
Centre International de Recherche sur le Cancer
IMA-DUST
International Psychogeriatric Association
Danish Center for Lung Cancer Research, Innovation Fund Denmark
Industrial Minerals Association
Universiteit Utrecht
Institute for Risk Assessment Sciences
IRAS
Deutsche Gesetzliche Unfallversicherung	FP 271
Danish Working Environment Research Fund	43-2014-03/20140016763, 47-2019-03, 34-2019-09

Keywords

asbestos
asbestosis
cohort study
exposure
exposure–response
interstitial lung disease
job exposure matrix
occupational exposure
register study
working population

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10.5271/sjweh.4153Licence: CC BY

372_379_IversenFinal published version, 378 KBLicence: CC BY

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Iversen, I. B., Vestergaard, J. M., Ohlander, J., Peters, S., Bendstrup, E., Bonde, J. P. E., Schlünssen, V., Bønløkke, J. H., Rasmussen, F., Stokholm, Z. A., Andersen, M. B., Kromhout, H., & Kolstad, H. A. (2024). The asbestos-asbestosis exposure-response relationship: a cohort study of the general working population. Scandinavian Journal of Work, Environment & Health, 50(5), 372-379. https://doi.org/10.5271/sjweh.4153

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title = "The asbestos-asbestosis exposure-response relationship: a cohort study of the general working population",

abstract = "OBJECTIVES: The association between asbestos exposure and asbestosis in high-exposed industrial cohorts is well-known, but there is a lack of knowledge about the exposure-response relationship for asbestosis in a general working population setting. We examined the exposure-response relationship between occupational asbestos exposure and asbestosis in asbestos-exposed workers of the Danish general working population.METHODS: We followed all asbestos-exposed workers from 1979 to 2015 and identified incident cases of asbestosis using the Danish National Patient Register. Individual asbestos exposure was estimated with a quantitative job exposure matrix (SYN-JEM) from 1976 onwards and back-extrapolated to age 16 for those exposed in 1976. Exposure-response relations for cumulative exposure and other exposure metrics were analyzed using a discrete time hazard model and adjusted for potential confounders.RESULTS: The range of cumulative exposure in the population was 0.001 to 18 fibers per milliliter-year (f/ml-year). We found increasing incidence rate ratios (IRR) of asbestosis with increasing cumulative asbestos exposure with a fully adjusted IRR per 1 f/ml-years of 1.18 [95\% confidence interval (CI) 1.15- -1.22]. The IRR was 1.94 (95\% CI 1.53-2.47) in the highest compared to the lowest exposure tertile. We similarly observed increasing risk with increasing cumulative exposure in the inception population.CONCLUSIONS: This study found exposure-response relations between cumulative asbestos exposure and incident asbestosis in the Danish general working population with mainly low-level exposed occupations, but there is some uncertainty regarding the exposure levels.",

keywords = "asbestos, asbestosis, cohort study, exposure, exposure–response, interstitial lung disease, job exposure matrix, occupational exposure, register study, working population",

author = "Iversen, \{Inge Brosb{\o}l\} and Vestergaard, \{Jesper Medom\} and Johan Ohlander and Susan Peters and Elisabeth Bendstrup and Bonde, \{Jens Peter E\} and Vivi Schl{\"u}nssen and B{\o}nl{\o}kke, \{Jakob H\} and Finn Rasmussen and Stokholm, \{Zara A\} and Andersen, \{Michael B\} and Hans Kromhout and Kolstad, \{Henrik A\}",

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doi = "10.5271/sjweh.4153",

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volume = "50",

pages = "372--379",

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Iversen, IB, Vestergaard, JM, Ohlander, J , Peters, S, Bendstrup, E, Bonde, JPE, Schlünssen, V, Bønløkke, JH, Rasmussen, F, Stokholm, ZA, Andersen, MB, Kromhout, H & Kolstad, HA 2024, 'The asbestos-asbestosis exposure-response relationship: a cohort study of the general working population', Scandinavian Journal of Work, Environment & Health, vol. 50, no. 5, pp. 372-379. https://doi.org/10.5271/sjweh.4153

TY - JOUR

T1 - The asbestos-asbestosis exposure-response relationship

T2 - a cohort study of the general working population

AU - Iversen, Inge Brosbøl

AU - Vestergaard, Jesper Medom

AU - Ohlander, Johan

AU - Peters, Susan

AU - Bendstrup, Elisabeth

AU - Bonde, Jens Peter E

AU - Schlünssen, Vivi

AU - Bønløkke, Jakob H

AU - Rasmussen, Finn

AU - Stokholm, Zara A

AU - Andersen, Michael B

AU - Kromhout, Hans

AU - Kolstad, Henrik A

PY - 2024/7

Y1 - 2024/7

N2 - OBJECTIVES: The association between asbestos exposure and asbestosis in high-exposed industrial cohorts is well-known, but there is a lack of knowledge about the exposure-response relationship for asbestosis in a general working population setting. We examined the exposure-response relationship between occupational asbestos exposure and asbestosis in asbestos-exposed workers of the Danish general working population.METHODS: We followed all asbestos-exposed workers from 1979 to 2015 and identified incident cases of asbestosis using the Danish National Patient Register. Individual asbestos exposure was estimated with a quantitative job exposure matrix (SYN-JEM) from 1976 onwards and back-extrapolated to age 16 for those exposed in 1976. Exposure-response relations for cumulative exposure and other exposure metrics were analyzed using a discrete time hazard model and adjusted for potential confounders.RESULTS: The range of cumulative exposure in the population was 0.001 to 18 fibers per milliliter-year (f/ml-year). We found increasing incidence rate ratios (IRR) of asbestosis with increasing cumulative asbestos exposure with a fully adjusted IRR per 1 f/ml-years of 1.18 [95% confidence interval (CI) 1.15- -1.22]. The IRR was 1.94 (95% CI 1.53-2.47) in the highest compared to the lowest exposure tertile. We similarly observed increasing risk with increasing cumulative exposure in the inception population.CONCLUSIONS: This study found exposure-response relations between cumulative asbestos exposure and incident asbestosis in the Danish general working population with mainly low-level exposed occupations, but there is some uncertainty regarding the exposure levels.

AB - OBJECTIVES: The association between asbestos exposure and asbestosis in high-exposed industrial cohorts is well-known, but there is a lack of knowledge about the exposure-response relationship for asbestosis in a general working population setting. We examined the exposure-response relationship between occupational asbestos exposure and asbestosis in asbestos-exposed workers of the Danish general working population.METHODS: We followed all asbestos-exposed workers from 1979 to 2015 and identified incident cases of asbestosis using the Danish National Patient Register. Individual asbestos exposure was estimated with a quantitative job exposure matrix (SYN-JEM) from 1976 onwards and back-extrapolated to age 16 for those exposed in 1976. Exposure-response relations for cumulative exposure and other exposure metrics were analyzed using a discrete time hazard model and adjusted for potential confounders.RESULTS: The range of cumulative exposure in the population was 0.001 to 18 fibers per milliliter-year (f/ml-year). We found increasing incidence rate ratios (IRR) of asbestosis with increasing cumulative asbestos exposure with a fully adjusted IRR per 1 f/ml-years of 1.18 [95% confidence interval (CI) 1.15- -1.22]. The IRR was 1.94 (95% CI 1.53-2.47) in the highest compared to the lowest exposure tertile. We similarly observed increasing risk with increasing cumulative exposure in the inception population.CONCLUSIONS: This study found exposure-response relations between cumulative asbestos exposure and incident asbestosis in the Danish general working population with mainly low-level exposed occupations, but there is some uncertainty regarding the exposure levels.

KW - asbestos

KW - asbestosis

KW - cohort study

KW - exposure

KW - exposure–response

KW - interstitial lung disease

KW - job exposure matrix

KW - occupational exposure

KW - register study

KW - working population

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U2 - 10.5271/sjweh.4153

DO - 10.5271/sjweh.4153

M3 - Article

C2 - 38577971

SN - 0355-3140

VL - 50

SP - 372

EP - 379

JO - Scandinavian Journal of Work, Environment & Health

JF - Scandinavian Journal of Work, Environment & Health

IS - 5

ER -

The asbestos-asbestosis exposure-response relationship: a cohort study of the general working population

Abstract

Bibliographical note

Funding

Keywords

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