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© 1995 Oxford University Press

research-article

Healthy Worker Effect in a Longitudinal Study of One-Second Forced Expiratory Volume (FEV1) and Chronic Exposure to Granite Dust

ELLEN A EISEN*, DAVID H WEGMAN*, THOMAS A LOUIS**, THOMAS J SMITH{dagger} and JOHN M PETERS{ddagger}

*Department of Work Environment, University of Massachusetts Lowell MA 01854, USA
**Division of Biostatistics, University of Minnesota, School of Public Health Minneapolis MN, USA
{dagger}Environmental Health Science, Harvard School of Public Health Boston MA, USA
{ddagger}Department of Preventive Medicine, University of Southern California Los Angeles CA, USA

BACKGROUND: Low level effects of granite dust on one-second forced expiratory volume (FEV1) are estimated in 618 Vermont granite workers followed for 5 years with annual pulmonary function tests. Reduced pulmonary function has already been reported for the subset of subjects lost to follow-up (dropouts) suggesting possible bias in analyses based only on survivors.

METHOD: Healthy worker selection bias is directly assessed by comparing the dose-response associations between survivors who remained in the study for the full 5-year observation period and the dropouts.

RESULTS: The 353 survivors had an FEV1 of 96% of predicted at baseline and were losing FEV1 at an average rate of 44 ml/yr. No association was found in this group between the rate of FEV1 decline and lifetime dust exposure. However, the 265 workers with incomplete follow-up, ‘dropouts’, had a lower FEV1 at baseline (94%) and were losing FEV1 at an average rate of 69 ml/yr. The dose-response parameter in this group was estimated to be 4 ml/yr loss per mg/m3-year and was statistically significant.

CONCLUSIONS: These results provide an illustration of bias due to the healthy worker effect and an example of the failure to detect a true work-related health effect in a study based only on a ‘survivor’ population.

Keywords healthy worker effect, epidemiology, longitudinal study, occupational exposure

Accepted 1 June 1995


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