Assessment of the Healthy Worker Survivor Effect in Cancer Studies of the United Autoworkers-General Motors Cohort

Details

• Alternative Title:
  Occup Environ Med
• Personal Author:
  Garcia, Erika ; Picciotto, Sally ; Costello, Sadie ; Bradshaw, Patrick T. ; Eisen, Ellen A.
• Description:
  Objective:
  
  The healthy worker survivor effect (HWSE) can affect the validity of occupational studies when data are analyzed incorrectly. HWSE depends on three underlying conditions: (1) leaving work predicts future exposure, (2) leaving work is associated with disease outcome, and (3) prior exposure increases probability of leaving work. If all these conditions are satisfied, then employment status is a time-varying confounder affected by prior exposure, and standard regression will produce bias. We assessed these conditions for cancer outcomes in a cohort of autoworkers exposed to metalworking fluids (MWF).
  
  Methods:
  
  The cohort includes 31,485 workers followed for cancer incidence from 1985–1994. Since occupational exposures to straight, soluble, and synthetic MWF are necessarily zero after leaving work, condition (1) is satisfied. Cox models for cancer incidence and for employment termination were used to assess conditions (2) and (3), respectively. Employment termination by select ages was examined to better gauge the presence of condition (2).
  
  Results:
  
  The hazard ratio for leaving work as a predictor of all cancers combined and prostate cancer was null, but elevated for lung and colorectal cancers among men. Condition (2) was more clearly satisfied for all cancer outcomes when leaving work occurred younger. Higher exposures to all three MWF types were associated with increased rates of leaving work [condition (3)], with the exception of straight MWF among women.
  
  Conclusions:
  
  We found evidence for the structural conditions underlying HWSE in a cohort of autoworkers. G-methods should be applied to reduce HWSE bias in studies of all cancers presently examined.
  
  
• Subjects:
  Adult Age Factors Automobiles Bias Cohort Studies Female Healthy Worker Effect Humans Male Medical Record Linkage Michigan Middle Aged Neoplasms Occupational Diseases Occupational Exposure Proportional Hazards Models Registries Sex Distribution

  More +
• Keywords:
  Cancer Healthy Worker Survivor Effect Occupational Health
• Source:
  Occup Environ Med. 74(4):294-300
• Pubmed ID:
  28069969
• Pubmed Central ID:
  PMC11484988
• Document Type:
  Journal Article
• Funding:
  R01 OH010028/OH/NIOSH CDC HHSUnited States/ ; T42 OH008429/OH/NIOSH CDC HHSUnited States/
• Volume:
  74
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:c0dfdb65822de184b68900cdac79830a28776a659a7a1ac852a0e489c66c533eae59be1e1ca177ae11cd9719fbf1e3688f282eebe192fb51b6447fae1228fad9
• Download URL:
  https://stacks.cdc.gov/view/cdc/166676/cdc_166676_DS1.pdf
• File Type:
  [PDF - 389.52 KB ]