International Journal of Epidemiology, Vol 28, 1037-1043, Copyright © 1999 by International Epidemiological Association
K Straif, L Chambless, SK Weiland, A Wienke, M Bungers, D Taeger and U Keil
OBJECTIVES: To determine occupational risk factors for stomach and lung
cancer among workers in the German rubber industry. METHODS: A cohort of
all male German rubber workers (n = 11,633) who had been employed for at
least one year in one of five study plants and who were alive and actively
employed or retired on 1 January 1981 was followed for mortality from 1
January 1981 through December 1991. A subcohort of n = 8,933 workers who
were hired after 1 January 1950 was defined to focus on working conditions
in the more recent rubber industry. Work histories were reconstructed using
routinely documented 'cost centre codes' and classified into six work areas
as well as subgroups of some work areas. The work areas are: 1. preparation
of materials, 2. production of technical rubber goods, 3. production of
tyres, 4. storage and dispatch, 5. maintenance, 6. others. Standardized
mortality ratios (SMR) and Cox proportional hazards models were calculated
for each of the work areas (>1 year of employment in the respective work
area). Hazard rate ratios were adjusted for age (time marker) and
stratified for year of hire (1950-1959, > or =1960) and years of
employment in the respective work area (1-9 years, > or =10 years);
years of employment were lagged 10 years to account for latency. RESULTS:
Compared to the national reference population mortality from cancer of
stomach (observed 44, SMR = 117; 95% CI: 85-157) and lung (observed 154,
SMR = 123; 95% CI: 104-144) was slightly increased. Using internal controls
we observed excess deaths from stomach cancer in work area 1 (relative risk
[RR] = 2.3; 95% CI: 1.2-4.2) and from lung cancer in work areas 1 (RR =
1.7; 95% CI: 1.2-2.3), 2 (RR = 1.5; 95% CI: 1.1-2.1), and 3 (RR = 1.3; 95%
CI: 0.9-1.8). On the basis of cumulative years of employment an exposure
response relationship was observed for mortality from both cancer sites
among a subcategory of work area 1: weighing and mixing. Increased risks
were also seen for lung cancer among workers employed in production of
technical rubber goods. CONCLUSION: Our results support an association
between an excess mortality from stomach and lung cancer and employment in
early production stages of rubber manufacturing, especially weighing and
mixing. This may point to an aetiologic role of asbestos or carbon black.
For stomach cancer additional risk factors, e.g. exposure to dust and talc,
deserve further investigation. The results of the present study do not
support a causal role of nitrosamines for stomach or lung cancer.
Occupational risk factors for mortality from stomach and lung cancer among rubber workers: an analysis using internal controls and refined exposure assessment
Institute of Epidemiology and Social Medicine, University of Munster, Germany. straif@nwz.uni-muenster.de
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